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Immunohematology > Transfusion Therapy, Adverse, Apheresis, Cellular Therapy, HLA and Relationships > Flashcards

Transfusion Therapy, Adverse, Apheresis, Cellular Therapy, HLA and Relationships Flashcards

1
Q

The specific cell product used for treating sepsis is the:

A

granulocyte

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2
Q

Which cell type is densest in the white blood cell layer when anticoagulated blood is centrifuged?

A

Granulocyte

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3
Q

A child undergoing apheresis may require CFC to minimize:

A

extracorporeal volume.

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4
Q

A normal healthy donor undergoes a procedure to obtain platelets that will be transfused to a patient is representative of:

A

component apheresis collection.

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5
Q

Plateletpheresis components are
prepared from one donor and must contain
a minimum of

A

3x10^11 plts

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6
Q

In what circumstance is a plasmapheresis donor rejected from donation?

A

Serum protein = 5.0 g/dL

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7
Q

What other technique is available for neonates with sepsis when apheresis is unavailable?

A

A buffy coat prepared from a whole blood unit less than 12 hours old

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8
Q

Which of the following is an indication for therapeutic apheresis?

A

b. A pathogenic substance exists in the blood that contributes to a disease process. c. A substance can be more effectively removed by apheresis than by the body’s own homeostatic mechanisms. d. Options B and C

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9
Q

Which of the following factors influenced the need for apheresis technology?

A

The blood component needs of patients on chemotherapy

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10
Q

What is Photopheresis?

A

Utilizes leukapheresis to collect the buffy coat layer from whole blood.
-treated with 8 methoxypsoralen (8 MOP)
- exposed to UV light
- reinfused into pt
- FDA approved for treatment of cutaneous T-Cell lymphoma
- has been used to treat acute and chronic GVHD, organ transplant rejection, and selected immunologically mediated diseases.

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11
Q

Adverse effects of apheresis

A

-citrate toxicity
- vascular access difficulties
-vasovagal rxn
-hypovolemia
-allergic reactions
-hemolysis

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12
Q

All of the following statements are consistent with photopheresis except:

A

a. the patient is given an oral dose of psoralen, which binds to the DNA of all nucleated cells.
b. collected white blood cells are exposed to ultraviolet light, which activates psoralen, preventing replication.
c. the patient is given an oral dose of piroxicam, which binds to the RNA of all nucleated cells.
d. treated cells are returned to the patient, inducing an immune response against the abnormal lymphocyte clone.
answer C

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13
Q

Which of the following statements best describes the apheresis concept?

A

Blood is removed from an individual, anticoagulated, and separated, the desired component is retained, and the remaining portions are returned to the donor/patient.

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14
Q

Fresh frozen plasma (FFP) is not the optimal product for replacement fluids for a therapeutic plasma exchange procedure. For which patient is FFP the optimal product of choice?

A

a. Patient with liver disease
b. Patient with thrombotic thrombocytopenic purpura (TTP) c. Patient scheduled to undergo an invasive procedure
d. All of the above
Answer D

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15
Q

What is CFC

A

continuous flow centrifugation

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16
Q

All of the following statements are consistent with CFC except:

A

a. blood is drawn from one phlebotomy site and returned through another.
b. reinfusion to the patient completes one cycle.
c. the process of phlebotomy, separation, and reinfusion is uninterrupted.
d. separation of components is achieved through centrifugation.
answer is B

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17
Q

TTP

A

Thrombotic Thrombocytopenic Purpura, serious and rare blood disorder resulting in blood clots forming in small blood vessels throughout the body

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18
Q

What is a disadvantage of choosing fresh frozen plasma for fluid replacement in persons undergoing therapeutic plasmapheresis?

A

a. Citrate toxicity
c. ABO incompatibility
b. Disease transmission
d. All of the above
Answer: D

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19
Q

The platelet count of the plateletpheresis donor must be ________ prior to the procedure.

A

> 150  109 per L

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20
Q

In plateletpheresis, which blood component is returned to the donor?

A

RBC and WBC

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21
Q

Plasmapheresis is synonymous with what term?

A

Plasma exchange

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22
Q

The removal of red blood cells in a hemapheresis procedure is called:

A

erythrocytapheresis

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23
Q

What is the primary anticoagulant used in pheresis procedures?

A

Citrate

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24
Q

Fatalities that result from therapeutic apheresis have primarily been caused by:

A

cardiac arrest and arrhythmia.

25
Q

Leukopheresis may be indicated when the white blood cell count exceeds

A

100,000 per µL

26
Q

What is immunoadsorption

A

refers to a method in
which
- a specific ligand is bound to an
insoluble matrix in a column or filter
- selective removal of the pathogenic substance
- reinfused of the pts own plasma and cellular components

27
Q

What can be done to prevent the development of HLA alloimmunization and platelet refractoriness?

A

Reduce the number of leukocytes in the platelet product.

28
Q

Which of the following is not an indication for plasmapheresis?

A

To decrease iron deposition in tissues in chronically transfused patients

29
Q

Transplants can be

A

allo- auto-syngenic

30
Q

While undergoing plasmapheresis, the donor experienced numbness around his mouth, which is indicative of citrate toxicity. How can this be treated?

A

Administering exogenous calcium

31
Q

During a plasmapheresis procedure, the red blood cells must be returned within how many hours of phlebotomy?

A

2 hrs

32
Q

What effect do steroids have on leukapheresis?

A

Increase the vascular pool of granulocytes

33
Q

What does the hematocrit need to be (regardless of gender) for a double red blood cell collection?

A

40%

34
Q

A negative direct antiglobulin test (DAT) is found in all of the following transfusion reactions except:

A

Acute immune hemolytic transfusion rxn

35
Q

Alloimmunization is categorized as what type of transfusion reaction?

A

Delayed nonhemolytic

36
Q

HUS and TTP have similar simptoms

A

-Thrombocytopenia
-Microangiopathic hemolytic anemia
-Renal dysfunction
- Central nervous system involvement

37
Q

Sickle cell anemia

A

25% to 30% of pts with SCD will develop alloantibodies

38
Q

TRALI Symptoms

A

Transfusion-related Acute lung injury
-fever
-no circulatory overload
- EF:Normal
- BNP: <250 picograms/mL
-HTN
-Exudate edema fluid
- JVP (jugular venous pressure) unchanged
- Transient leukopenia
-inconsistent improvements

39
Q

TACO

A

Transfusion Associated Circulatory overload
- No fever
- circulatory overload +
- EF decreased
-BNP (Brain natriuretic peptide) >1200pg/mL
- HTN
-edema fluid: transudate
- JVP may be distended
- leukocytes may be unchanged
- improvement with diuretics

40
Q

Transfusion reaction

A
  • reactions with signs and symptoms present during or within 24 hrs of transfusion
    -can be grouped to common etiology
41
Q

Transfusion rxn types

A

-TRALI
-TACO
-Hemolytic
-Febrile
-Allergic
-Delayed hemolytic
-bacterial

42
Q

What causes TRALI

A

immune trali- implicated leukocyte Ab and components HLA
nonimmune- predisposition of the pt

43
Q

What are causes of TACO

A
  • overload onto pts cardiovascular system leading to manifesting CHF
44
Q

Immune hemolysis

A
  • alloimmunization
    -cold aggl dz
  • PCH
    -PNH
    -Rhogham administration
45
Q

Nonimmune hemolysis

A
  • osmotic: incompatible fluids, improper glycerides
  • thermal- malfxn blood warmer
  • mechanical: small needles
    -hemoglobinopathies: SCD, HbC disease
  • RBC membrane or enzyme disorders
  • microangiopathic
  • infections: clastridial sepsis, malaria, babesiosis
46
Q

What to do when immune AHTR suspected?

A
  • stop transfusion immediately
    -clerical verification
    -physician notified
47
Q

Febrile Non-hemolytic transfusion rxn

A
  • > 1°C (1.8°F)
  • asymptomatic rise in Temp in hypothermic pt not considered FNHTR
  • Etiology: related to two diff White cell related mechanisms: immune mediated mech. and plt storage changes and cytokines released from white cells present in the component
48
Q

Allergic transfusion rxn

A

-occurs as a response of recipient Ab to an allergen present in the blood component

49
Q

Delayed hemolytic transfusion rxn

A
  • detection of new Red cell Ab after 24 hrs
  • secondary to amnestic response
  • may delayed hemolytic or may not delayed serologic be associated with shortened survival of the transfused cells
50
Q

Transfusion-Transmitted Bacterial Infections

A

-evidence of pathogen
-evidence in at least one of the following: component, donor at collection, and donation from prepared components or recipient of component from same donation
-

51
Q

TAGVHD

A

A delayed immune transfusion reaction
due to an immunologic attack by viable
donor lymphocytes contained in the
transfused blood component against the
transfusion recipient
- gamma irradiation of cellular blood components

52
Q

PTP

A

-A delayed immune complication of
transfusion presenting with profound
thrombocytopenia 1–24 days post
transfusion

53
Q

Refractoriness

A
  • not responsive to therapy- plt given but not rising
    -some of these pts do not respond to plt transfusion because they have become alloimmunized to HLA Ag or plt specific antigens
54
Q

blood products

A

considered drugs, adverse effects may occur, also transplantation because it can cause rejection

55
Q

transfusion is primarily done to treat two conditions

A

-anemia
-hemostasis- insufficient coag proteins or plt to provide adequate hemostasis

56
Q

Freezing RBC

A

-allows long term storage rare blood
-must add glycerol before freezing and wash to declycerolize before transfusion

57
Q

cryoprecipitate

A

-primarily for fibrinogen replacement
-150mg of fibrinogen and 80 units of Factor VII

58
Q
A

Immunohematology (3 decks)

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