Transfusions Flashcards
how can delayed hemolytic reaction be prevented
thorough medical history documenting any previous, transfusions, pregnancies, and transplants
what is cyanosis
bluish discoloration of the skin due to decreased oxygen saturation of the blood
what are the symptoms of Febrile reaction
1C rise in temperature associated with transfusion and having no medial explanation
what is the cause of TRALI
transfusion of pre-formed donor HLA AB into a patient that cause respiratory compromise during or within 6 hours of transfusion
what is urticaria
hives
Describe the Immunoglobulin Class of HDN
IgG, crosses the placenta
Subclasses of IgG=IgG1 and IgG3 are most efficient at crossing the placenta
Subclasses in mother affect severity of HDN
what is the cause of immediate hemolytic reaction
transfusion of incompatible RBC/whole blood
also anti-A, Kell, Jka, and Fya
which hepatitis is fecal-oral transmission
Hepatitis A and E
how can Transfusion-Associated Graft vs. Host Disease be prevented
irradiation of blood products, especially of family members, neonates, and transplant patients, to inactivate leukocytes
Describe the Exposure factor of HDN
trans-placental hemorrhage of fetal RBC into the maternal circulation occurs in up to 7% of pregnancies
Amniocentesis, chorionic villus sampling, trauma to abdomen
A little as 0.1mL of fetal RBC can stimulate immune response inmother
Describe the Host Factor of HDN
depends on complex genetic factors
In Rh-neg individuals, transfused with one unit of Rh+ blood, about 80% will form anti-D
Rh-Negative mother after Rh+ pregnancy =10% will form anti-D
which hepatitis is bloodborne
Hepatitis B, C, and D
what is the cause of Alloimmunization to HLA Antigens
formation of HLA antibodies following exposure to antigens from transfusion, pregnancies, or transplants. Common in multiparous women.
describe the process of HDN
1) destruction of RBC of the fetus and neonate by antibodies produced by the mother
2) mother is stimulated to form the antibodies by previous pregnancy or transfusion
3) IgG antibodies cross the placenta, directed against antigens the baby has inherited from the father
4) during gestation, and particularity during delivery when the placenta separates from the uterus, variable numbers of fetal RBC enter the maternal circulation
5) these fetal cells carry antigens that stimulate antibody production in the mother
Which hepatitis has a vaccine
Hepatitis B
what is a diuretic
substances that increase urine output either by increasing the rate of glomerular filtration or by decreasing tubular reabsorption
what are the 2 types of testing done during a workup when HDN is suspected for diagnosis
Serologic testing and Aminocentesis
what is hemosiderosis
deposition of iron in the tissues and organs, which may result from the long-term administration of blood to patients with chronic anemia.
what are the symptoms of TACO
shortness of breath, coughing, decreased O2 saturation, wheezing, cyanosis, elevated BP, decreased pulse, and peripheral edema.
Chest x-rays shows bilateral lung infiltrates and sometimes heart enlargement
describe air embolism reactions
equipment malfunction or improper setup of infusion set or perioperative blood recovery. Infusion of as little as 100mL of air within intravascular space can be fatal.
what are the symptoms of air embolism reactions
cough, difficulty breathing, choking, and potentially death.
how can Anaphylactic or anaphylactoid reaction be prevented
total plasma removal
what is a vasopressors
substances that cuase the contration of the muscle fibers in capillaries and artheries, resulting diminished blood flow
what are the causes of TACO
infusion of fluid volume beyond capacity of an inidividual’s cardiovascular system
what is erythema
redness of the skin caused by capillary dilation
what is the cause of delayed hemolytic reaction
it is a secondary response to transfused RBC
what are the symptoms of Transfusion-Associated Graft vs. Host Disease
rash, fever, nausea, vomiting, or diarrhea days to weeks following transfusion, and CBC reveals pancytopenia, with liver enzymes abnormal
what is pancytopenia
decreased numbers of all blood cell lines
what are the symptoms of TRALI
respiratory distress, acute pulmonary edema, hypotension, and fever.
Typical “white-out” lung fields on chest x-rays classic signs
what are the symptoms of delayed hemolytic reactions
fever, chills, and mild jaundice
What is purpura
sudden onset of red to purple discoloration on the skin or mucus membrane the size of a pencil eraser
what is the cause of allergic reaction
allergen complexes
histamine release
what are the symptoms of Anaphylactic or anaphylactoid reaction
occurs after transfusionof only a few mL of plasma or plasma-containg components
coughing, breathing trouble, hives, chest pain, shock, and death
what is the cause of Bacterial contamination
endotoxins produced by bacteria capable of growing in cold; E. coli, Staphylococcus, and Yersinia enterocolitica
Describe Antibody Specificity of HDN
Rh [D] is the most immunogenic
C, E, and c are also potent immunogens; moderate to severe HDN
After Rh, anti-Kell is most clinically significant in HDN
how can immediate hemolytic reactions be prevented
by following all procedures/policies to ensure safe transfusion
what type of reaction will you see in bacterial contamination
“warm” reaction; dryness and flushing of the skin
What are the 2 clinical symptoms of HDN
1) Hemolysis, anemia, and erythropoiesis
2) bilirubin
how can allergic reactions be prevented
pre-medicate with Benadryl
what is a storage lesion
changes to cells in the bag
what is the Rh IG administration dose calculation
# of fetal cells / # of adult cells X 5000/30 = # vials (only full vials) (#fetal cells X mom's blood volume/30) / # adult cells = # vials
Describe the Aminocentesis testing done for the diagnosis of HDN
monitors concentration of bilirubin pigment in the amniotic fluid = degree of fetal anemai
describe hypothermia reactions
significant decrease in core body temperature due to low temperature of blood products (stored in cold 1-6C). Can lead to heart failure, respiratory distress, neurological disturbances. Use blood warmer to warm blood.
how can Posttransfusion Purpura be prevented
HLA negative platelets in future
what are the symptoms of allergic reaction
redness, itching, and hives
which hepatitis has a carrier state to it
Hepatitis B, C, and D
What is TACO
circulatory overload
acute pulmonary edema, caused by inability of the circulatory system to handle an increased fluid voume
Describe the clinical symptom of HDN; Bilirubin
RBC destruction releases Hgb= metabolized to bilirubin [indirect]
Newborn liver is unable to metabolize bilirubin
*Can reach toxic levesl in brain; >18mg/dL = brain damage = kernicterus
what can Alloimmunization to HLA Antigens be prevented
irradiated HLA matched platelets and ABO-matched leukorodeuced platelets
what is epinephrine
hormone produced by the adrenal medulla that can be used as a vasoconstrictor and bronchiole dilator
What are the ways that HDN is managed
Intrauterine transfusion- Photo-therapy with UV light,
Early delivery- Transfusion of Newborn
describe transfusion-related Immunomodulation
patients who have been transfused have been exposed to more HLA antigens- have better acceptance of transplants. Some research shows increase risk of infection, malignancy, short-term mortality
what are the symptoms of immediate hemolytic reaction
are intravascular
fever, oliguria, anuria, death, nausea, back or chest pain, and vomiting
What are the 4 factors affecting the severity of HDN
Exposure, Host Factors, Immunoglobulin Class, and Antibody Specificity
what is orthopnea
difficulty breathing in any but an erect position
what fluids have HIV been isolated from
blood, semen, vaginal secretions, tears, sweat, breast milk
how long can RBC be stored for
AABB standard allow packed RBC’s to be stored up to 42 days at 1-6C when using additive solutions
Describe the procedure for a transfusion work up
1) check for any discrepancies in patient/donor ID; label and record checks.
2) Observe patient’s pre- and post- transfurion samples for hemolysis
3) DAT on post-transfusion sample
4) ABO/Rh typing on patient’s pre- and post-transfusion samples and donor segments
5) Compatibility test on patient’s pre- and post- transfusion with donor segments.
6) Ab screen and Ab ID on patient’s pre- and post- transfusion samples and donor segments
7) Test urine for free Hgb
8) Bilirubin test
9) Hgb and Hct levels
Name 2 reactions considered to be delayed non-hemolytic reactions
Post-transfusion purpura
transfusion associated graft vs. host disease
Iron overload
what is TRALI
pulmonary edema, not associated with cardiac failure, that is usually due to the transfusion of preformed donor leukoagglutinins in the plasma of blood compenets
what individuals are at risk for HIV infections
homosexuals, bisexuals, prostitutes, IV drug users, recipients of transfusion of blood products, sexual partners of above, health-care workers, infants born to infected mothers
what is the cause of Febrile reaction
anti-leukocytic antibodies in patient’s plasma
how can TACO be prevented
slow infusion rate transfusion to 100mL/hr and use aliquot blood
describe potassium abnormalities reactions
extracellular K concentration narrow range of 3.5-5.5 mEq/L to prevent cardiac failure. During storage of RBC units, some of intra cellular K leaks into small extracellular volume. May send patient into hyperkalemia
what is the first symptom of AHTR
Fever
define transfusion reaction
physical reaction to the transfusion of blood.
what is the cause of Anaphylactic or anaphylactoid reaction
anti-IgA in patient’s plasma
what is hypoxemia
condition of having low oxygen in the the blood
what does TRALI stand for
Transfusion-Related Acute Lung Injury
name some of the disease transmitted by blood
Hepatitis (B,C,D), HIV, HTLB-I/II, West Nile Virus, CMV, Babesiosis, Chagas disease, Leishmaniasis, Dengue, Syphilis, Malaria, Toxoplasmosis, Parvovirus, EBV, Lyme Disease, Parvovirus B19, CHikungunya, CJD
how can bacterial contamination be prevented
strict adherence to component collection, storage, handling and preparation procedures, visual observation of units, transfusion within standard maximum allowable times lime = 4 hours. Now culture platelets after collection to ensure safer products.
what is dyspnea
shortness of breath
what are the symptoms of Alloimmunization to HLA Antigens
platelet refractoriness- no increase in counts following transfusion of platelets
what is pulmonary edema
accumulation of fluid in the lungs
what is the cause of Transfusion-Associated Graft vs. Host Disease
attack from donor T-cell lymphocytes against the patient, and recipient becomes foreigner
Describe the serologic testing done for the diagnosis of HDN
ABO/Rh typing and AB screen at first prenatal visit during first trimester; medical history
if Ab screen is positive, Ab ID must be performed
if mother has an Ab, a sample of father’s blood should be tested for corresponding antigen
aminocentesis can be done on fetus to test for antigen
*AB titer= testing for relative concentration of the Ab; patient serum is diluted and tested against appropriate RBC to determine the highest dilution at which RX occurs; in general a titer of 32 is considered significant; second titer should be done at 18 to 20 weeks gestation to look for increase of Ab produciton
how can TRALI be prevented
possibility of deferring multiparous women from future donation of blood products, definitely stop TRALI donors from donating.
which hepatitis has a long incubation period
Hepatitis B and C (40-150 and 20-90)
what does TACO stand for
Transfusion Associated Circulatory Overload
Describe the clinical symptoms of HDN: Hemolysis, anemia, and erythropoiesis
maternal IgG antibodies attach to specific antigens on fetal RBC
Antibody-coated cells are then removed from circulation by macrophages of spleen
destruction of fetal RBC and resulting anemia stimulate the fetal bone marrow to produce RBC at an accelerated rate= erythroblasts are released into the circulation (erythroblastosis fetalis)
the bone marrow fails to produce enough RBC to keep up with the rate of destruction; spleen and liver become enlarge =hypertension and damage
*Hydrops Fetalis= severe anemia, cardiac failure, edema, effusion and ascites= may develop at 18 to 20 weeks gestation= used to be fatal= may now be treated
describe the kernicterus of HDN
toxic levels of bilirubin in a newborn’s brain that causes permanent brain damage
what is the cause of Posttransfusion Purpura
pre-fomred platelets-specific alloantibodies present in patient’s plasma that were induced from prior transfusion, pregnancy, or tissues exposure (often PLA-1)
which hepatitis has a chronic state to it
Hepatitis B, C, and D
