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Blood Bank Test 4 > Transfusions > Flashcards

Transfusions Flashcards

1
Q

how can delayed hemolytic reaction be prevented

A

thorough medical history documenting any previous, transfusions, pregnancies, and transplants

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2
Q

what is cyanosis

A

bluish discoloration of the skin due to decreased oxygen saturation of the blood

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3
Q

what are the symptoms of Febrile reaction

A

1C rise in temperature associated with transfusion and having no medial explanation 

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4
Q

what is the cause of TRALI

A

transfusion of pre-formed donor HLA AB into a patient that cause respiratory compromise during or within 6 hours of transfusion

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5
Q

what is urticaria

A

hives

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6
Q

Describe the Immunoglobulin Class of HDN

A

IgG, crosses the placenta
Subclasses of IgG=IgG1 and IgG3 are most efficient at crossing the placenta
Subclasses in mother affect severity of HDN

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7
Q

what is the cause of immediate hemolytic reaction

A

transfusion of incompatible RBC/whole blood

also anti-A, Kell, Jka, and Fya

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8
Q

which hepatitis is fecal-oral transmission

A

Hepatitis A and E

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9
Q

how can Transfusion-Associated Graft vs. Host Disease be prevented

A

irradiation of blood products, especially of family members, neonates, and transplant patients, to inactivate leukocytes

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10
Q

Describe the Exposure factor of HDN

A

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

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11
Q

Describe the Host Factor of HDN

A

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

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12
Q

which hepatitis is bloodborne

A

Hepatitis B, C, and D

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13
Q

what is the cause of Alloimmunization to HLA Antigens

A

formation of HLA antibodies following exposure to antigens from transfusion, pregnancies, or transplants. Common in multiparous women.

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14
Q

describe the process of HDN

A

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

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15
Q

Which hepatitis has a vaccine

A

Hepatitis B

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16
Q

what is a diuretic

A

substances that increase urine output either by increasing the rate of glomerular filtration or by decreasing tubular reabsorption

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17
Q

what are the 2 types of testing done during a workup when HDN is suspected for diagnosis

A

Serologic testing and Aminocentesis

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18
Q

what is hemosiderosis

A

deposition of iron in the tissues and organs, which may result from the long-term administration of blood to patients with chronic anemia.

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19
Q

what are the symptoms of TACO

A

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

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20
Q

describe air embolism reactions

A

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.

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21
Q

what are the symptoms of air embolism reactions

A

cough, difficulty breathing, choking, and potentially death.

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22
Q

how can Anaphylactic or anaphylactoid reaction be prevented

A

total plasma removal

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23
Q

what is a vasopressors

A

substances that cuase the contration of the muscle fibers in capillaries and artheries, resulting diminished blood flow

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24
Q

what are the causes of TACO

A

infusion of fluid volume beyond capacity of an inidividual’s cardiovascular system

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25
Q

what is erythema

A

redness of the skin caused by capillary dilation

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26
Q

what is the cause of delayed hemolytic reaction

A

it is a secondary response to transfused RBC

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27
Q

what are the symptoms of Transfusion-Associated Graft vs. Host Disease

A

rash, fever, nausea, vomiting, or diarrhea days to weeks following transfusion, and CBC reveals pancytopenia, with liver enzymes abnormal

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28
Q

what is pancytopenia

A

decreased numbers of all blood cell lines

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29
Q

what are the symptoms of TRALI

A

respiratory distress, acute pulmonary edema, hypotension, and fever.
Typical “white-out” lung fields on chest x-rays classic signs

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30
Q

what are the symptoms of delayed hemolytic reactions

A

fever, chills, and mild jaundice

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31
Q

What is purpura

A

sudden onset of red to purple discoloration on the skin or mucus membrane the size of a pencil eraser

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32
Q

what is the cause of allergic reaction

A

allergen complexes

histamine release

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33
Q

what are the symptoms of Anaphylactic or anaphylactoid reaction

A

occurs after transfusionof only a few mL of plasma or plasma-containg components
coughing, breathing trouble, hives, chest pain, shock, and death

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34
Q

what is the cause of Bacterial contamination

A

endotoxins produced by bacteria capable of growing in cold; E. coli, Staphylococcus, and Yersinia enterocolitica

35
Q

Describe Antibody Specificity of HDN

A

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

36
Q

how can immediate hemolytic reactions be prevented

A

by following all procedures/policies to ensure safe transfusion

37
Q

what type of reaction will you see in bacterial contamination

A

“warm” reaction; dryness and flushing of the skin

38
Q

What are the 2 clinical symptoms of HDN

A

1) Hemolysis, anemia, and erythropoiesis

2) bilirubin

39
Q

how can allergic reactions be prevented

A

pre-medicate with Benadryl

40
Q

what is a storage lesion

A

changes to cells in the bag

41
Q

what is the Rh IG administration dose calculation

A 
# of fetal cells / # of adult cells X 5000/30 = # vials (only full vials)
(#fetal cells X mom's blood volume/30) / # adult cells = # vials
42
Q

Describe the Aminocentesis testing done for the diagnosis of HDN

A

monitors concentration of bilirubin pigment in the amniotic fluid = degree of fetal anemai

43
Q

describe hypothermia reactions

A

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.

44
Q

how can Posttransfusion Purpura be prevented

A

HLA negative platelets in future

45
Q

what are the symptoms of allergic reaction

A

redness, itching, and hives

46
Q

which hepatitis has a carrier state to it

A

Hepatitis B, C, and D

47
Q

What is TACO

A

circulatory overload

acute pulmonary edema, caused by inability of the circulatory system to handle an increased fluid voume

48
Q

Describe the clinical symptom of HDN; Bilirubin

A

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

49
Q

what can Alloimmunization to HLA Antigens be prevented

A

irradiated HLA matched platelets and ABO-matched leukorodeuced platelets

50
Q

what is epinephrine

A

hormone produced by the adrenal medulla that can be used as a vasoconstrictor and bronchiole dilator

51
Q

What are the ways that HDN is managed

A

Intrauterine transfusion- Photo-therapy with UV light,

Early delivery- Transfusion of Newborn

52
Q

describe transfusion-related Immunomodulation

A

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

53
Q

what are the symptoms of immediate hemolytic reaction

A

are intravascular

fever, oliguria, anuria, death, nausea, back or chest pain, and vomiting

54
Q

What are the 4 factors affecting the severity of HDN

A

Exposure, Host Factors, Immunoglobulin Class, and Antibody Specificity

55
Q

what is orthopnea

A

difficulty breathing in any but an erect position

56
Q

what fluids have HIV been isolated from

A

blood, semen, vaginal secretions, tears, sweat, breast milk

57
Q

how long can RBC be stored for

A

AABB standard allow packed RBC’s to be stored up to 42 days at 1-6C when using additive solutions

58
Q

Describe the procedure for a transfusion work up

A

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

59
Q

Name 2 reactions considered to be delayed non-hemolytic reactions

A

Post-transfusion purpura
transfusion associated graft vs. host disease
Iron overload

60
Q

what is TRALI

A

pulmonary edema, not associated with cardiac failure, that is usually due to the transfusion of preformed donor leukoagglutinins in the plasma of blood compenets

61
Q

what individuals are at risk for HIV infections

A

homosexuals, bisexuals, prostitutes, IV drug users, recipients of transfusion of blood products, sexual partners of above, health-care workers, infants born to infected mothers

62
Q

what is the cause of Febrile reaction

A

anti-leukocytic antibodies in patient’s plasma

63
Q

how can TACO be prevented

A

slow infusion rate transfusion to 100mL/hr and use aliquot blood

64
Q

describe potassium abnormalities reactions

A

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

65
Q

what is the first symptom of AHTR

A

Fever

66
Q

define transfusion reaction

A

physical reaction to the transfusion of blood.

67
Q

what is the cause of Anaphylactic or anaphylactoid reaction

A

anti-IgA in patient’s plasma

68
Q

what is hypoxemia

A

condition of having low oxygen in the the blood

69
Q

what does TRALI stand for

A

Transfusion-Related Acute Lung Injury

70
Q

name some of the disease transmitted by blood

A

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

71
Q

how can bacterial contamination be prevented

A

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.

72
Q

what is dyspnea

A

shortness of breath

73
Q

what are the symptoms of Alloimmunization to HLA Antigens

A

platelet refractoriness- no increase in counts following transfusion of platelets

74
Q

what is pulmonary edema

A

accumulation of fluid in the lungs

75
Q

what is the cause of Transfusion-Associated Graft vs. Host Disease

A

attack from donor T-cell lymphocytes against the patient, and recipient becomes foreigner

76
Q

Describe the serologic testing done for the diagnosis of HDN

A

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

77
Q

how can TRALI be prevented

A

possibility of deferring multiparous women from future donation of blood products, definitely stop TRALI donors from donating.

78
Q

which hepatitis has a long incubation period

A

Hepatitis B and C (40-150 and 20-90)

79
Q

what does TACO stand for

A

Transfusion Associated Circulatory Overload

80
Q

Describe the clinical symptoms of HDN: Hemolysis, anemia, and erythropoiesis

A

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

81
Q

describe the kernicterus of HDN

A

toxic levels of bilirubin in a newborn’s brain that causes permanent brain damage

82
Q

what is the cause of Posttransfusion Purpura

A

pre-fomred platelets-specific alloantibodies present in patient’s plasma that were induced from prior transfusion, pregnancy, or tissues exposure (often PLA-1)

83
Q

which hepatitis has a chronic state to it

A

Hepatitis B, C, and D

Blood Bank Test 4 (1 decks)

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