Transfusions Reactions

Question 1

What is a diverse group of unfavorable transfusion related events that occur during or after transfusion of blood and blood components

Answer 1

Transfusion Reactions

Question 2

What transfusion reactions occur with the transfusion of incompatible RBCs (most common) or plasma products that is immune mediated and results in intra or extravascular hemolysis

Answer 2

Hemolytic Transfusions reactions

Question 3

What transfusion reaction is where the immune system is a common pathway but intra and extravascular hemolysis does not occur

Answer 3

Non-Hemolytic Transfusion Reaction

Question 4

Immediate (acute) transfusion reaction occurs when?

Answer 4

during or within 24 hours of transfusion

Question 5

Delayed transfusion reaction occurs when?

Answer 5

several days to weeks after transfusion

Question 6

Name the 2 Hemolytic Reactions

Answer 6

1. Acute Intravascular (ABO)

2. Delayed Extravascular (IgG Abs)

Question 7

Name the 5 Immediate Non-Hemolytic Reactions

Answer 7

1. Febrile
2. Allergic/Anaphylactic
3. TRALI
4. TACO
5. Bacterial

Question 8

Name the 5 Delayed Non-Hemolytic Reactions

Answer 8

1. Alloimmunization
2. Post Transfusion Purpura
3. Transfusion related GVHD
4. Iron Overload
5. Disease Transmission

Question 9

Antibodies most associated with IHTRs and DHTRs

Answer 9

IHTRS: Intravascular-IgM (ABO)
DHTRS: Extravascular-IGG

Question 10

Bedside procedures in the event of a suspected transfusion reaction (8)

Answer 10

1. Stop transfusion
2. Clerical Check
3. Call MD
4. Call BB
5. Draw EDT
6. Send EDTA, donor bag, tubing paperwork and order to BB
7. Send 1st UA if AHTR suspected
8. Keep IV lines open

Question 11

Describe steps to follow in a lab investigation of a suspected transfusion reaction

Answer 11

• Clerical check and attached solution
• centrifuge post-transfusion sample to assess for visual hemoglobinemia (Compare to pre-transfusion sample)
• DAT perfomred on post tansfusion EDTA sample
• Additional workup based on results of the above 3 items AND clinical symptoms of patient
• Perform DAT
• If >2C temp rise, send bag to micro for culture

Question 12

Why will a DAT be either positive or negative in an acute HTR?

Answer 12

Negative if there is not an antibody antigen reaction and positive if there is!

Question 13

What is the characteristic appearance of the DAT when an acute or delayed HRT transfusion reaction has occurred

Answer 13

Positive/hemolyzed

Question 14

Explain why a IAT on a post-reaction serum sample may be negative following the infusion of antigen positive blood to an individual with corresponding antibody

Answer 14

*

Question 15

Most common transfusion-associated disease

Answer 15

Hepatitis

Question 16

If a patient should come down with Hepatitiis or HIV suspected to be due to blood transfusion, the hospital should follow a reporting process. Hospital > notifies Blood center > notifies donor > gets retested > and Blood center > notifies hospital of results > notifies other facilities that used products

Answer 16

Look-back process

Question 17

Most common cause of preventable hemolytic transfusion reaction

Answer 17

Clerical

Question 18

What two tests are diagnostic for a transfusion reaction?

Answer 18

1. DAT

2. Visual Hemoglobin

Question 19

Definition

- abnormally rapid heart rate

Answer 19

Tachycardia

Question 20

Definition

- Shortness of breath (SOB)

Answer 20

Dyspnea

Question 21

Define

- FNHTR

Answer 21

Febrile Non-Hemolytic Transfusion Reaction

Question 22

Define

- TRALI

Answer 22

Transfusion Related Acute Lung Injury

Question 23

Define

- TACO

Answer 23

Transfusion Associated Circulatory Overload

Question 24

Define

- PTP

Answer 24

Post-Transfusion (Thrombocytopenic) Purpura

Question 25

Define

- TA-GVHD

Answer 25

Transfusion Associated Graft Versus Host Disease

Question 26

Definition
- a rash of round, red welts on the skin that itch intensely, sometimes with dangerous swelling, caused by an allergic reaction, typically to specific foods.

Answer 26

Urticaria

Question 27

Definition
- unpleasant sensation of the skin that provokes the urge to scratch. It is a characteristic feature of many skin diseases and an unusual sign of some systemic diseases

Answer 27

Pruritis

Question 28

Definition
- superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilatation of the blood capillaries

Answer 28

Erythema

Question 29

Definition
- an immune response generated in an individual or strain of one species by an alloantigen from a different individual or strain of the same species

Answer 29

Alloimmunization

Question 30

Definition
- accumulation of iron in the liver and/or heart but also endocrine organs, in patients who receive frequent blood transfusions (such as those with thalassemia, sickle cell disease, aplastic anemia or myelodysplastic syndrome).

Answer 30

Transfusion Hemosiderosis

Question 31

Definition
- “White-out” caused by changes in permeability of the pulmonary capillary membrane as a result of either a direct or an indirect pathologic insult

Answer 31

Noncardiogenic Pulmonary Edema

Question 32

Definition

- condition that occurs due to a rapid transfusion of a large volume of blood

Answer 32

Circulatory Overload