EXAM #2: TRANSFUSION REACTIONS Flashcards Preview

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Flashcards in EXAM #2: TRANSFUSION REACTIONS Deck (29)
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1
Q

What are acute hemolytic transfusion reactions?

A

INTRAVASCULAR hemolysis that occurs in response to blood antigen

2
Q

List the major clinical effects of acute hemolytic transfusion reactions. What is the difference between mild and severe acute hemolytic transfusion reaction?

A

Mild= fever, chills, rigors

Severe=

  • Abdominal, chest, flank, and back pain
  • Hypotension, dyspnea, shock
  • DIC

May see Hemoglobunira in unconscious or anesthetized patient

3
Q

What is the most effective method to prevent acute hemolytic transfusion reactions?

A

Minimize human clerical errors by:

  • Multiple checks
  • Technology e.g. hand-held scanners…etc.
4
Q

List the clinical symptoms of delayed transfusion reactions.

A
  • Occurs days to week after transfusion
  • EXTRAVASCULAR HEMOYLSIS causing:
    1) Anemia
    2) Jaundice
5
Q

What are the lab findings of delayed hemolytic transfusion reactions?

A

Anemia

6
Q

What are the three major clinical situations in which Rh immune globulin should be given to prevent HDN?

A

1) Mother is Rh- and Dad is Rh+
2) Mother is Rh- and Dad’s status is unknown
3) Infant is known to be Rh+

7
Q

What is the most common reaction to transfused blood? What causes it?

A

Fever

  • Leukocytes in product release cytokines that accumulate
  • Patient antibodies to leukocytes induce fever
8
Q

What are the adverse consequences of transfusion that may first manifest as fever?

A

1) TRALI
2) Acute hemolytic transfusion reaction
3) TA-GVHD
4) TTBI (transfusion transmitted bacterial infection)

Note that premedication with acetaminophen may mask fever/ initial presentation*

9
Q

Describe the presentation of Transfusion-Associated Acute Lung Injury (TRALI).

A
Fever 
Dyspnea 
Cyanosis 
Hypotension
Acute pulmonary edema 

All occurs WITHIN 6 HOURS of transfusion

10
Q

What causes TRALI?

A

Two-HIT mechanism that occurs with plasma or platelets

1) Neutrophil sequestration and priming
- Injury to the microvasculature in the lungs
- Neutrophils accumulate at the site of injury, called “sequestration”
- Neutrophils are shifted into a “primed state” and respond to previously INNOCUOUS stimuli
2) Neutrophil activation occurs

–> Neutrophil release of cytokines, ROS, oxidases, and proteases causing pulmonary edema

11
Q

What is Transfusion Associated Graft Versus Host Disease?

A
  • Blood donor has a different HLA-type from recipient

- T-cells in component see patient HLA antigens as foreign and attack

12
Q

Who is at risk for TA-GVHD?

A

Immunocompromised patients:

1) Leukemia
2) Lymphoma
3) Patient on immunosuppresive drugs
4) Neonates

13
Q

How is TA-GVHD prevented?

A

Irradiation of blood components

14
Q

What blood component is most likely to cause bacterial sepsis?

A

Platelets b/c they are stored at room temp. i.e. at a better temperature for bacterial growth

15
Q

Why do platelets cause bacterial sepsis?

A

Platelets are stored at room temp. i.e. at a better temperature for bacterial growth

16
Q

Why is directed donation not regarded as safer than volunteer donor blood?

A

The donor is more likely to be untruthful in screening b/c they want to help the patient

17
Q

What should you do if you suspect a transfusion reaction?

A

STOP the transfusion

1) Keep line open with saline
2) Do a “clerical recheck””
3) Contact physician

18
Q

How is Febrile TR prevented?

A

1) Leukoreduction*

2) Premedicate with acetaminophen

19
Q

What is the etiology of anaphylaxis seen in transfusion? What patient population is this relatively common in, in patients receiving transfusion?

A
  • Patient has an antibody to something in the component

E.g. IgA deficient patient with an antibody to the IgA can develop anaphylaxis to transfusion

20
Q

Is pretreatment a good management for anaphylaxis?

A

No–pre-treatment does NOT work i.e. giving Benadryl will not prevent the reaction

21
Q

What is TACO?

A

Transfusion Associated Circulatory Overload

Occurs in patients that are already at risk of circulatory overload.

22
Q

What are the most common signs of TACO?

A

Increased BP and HR

There is nothing specifically diagnostic*

23
Q

What are the diagnostic criteria for TRALI?

A

1) No evidence of lung injury prior to transfusion
2) Onset within 6 hours of transfusion
3) Hypoxemia i.e. SaO2 less than 90% on room air
4) X-ray with bilateral infiltrates
5) No circulatory overload

24
Q

How is TRALI treated?

A

1) Supplemental oxygen
2) Pressors
3) NO DIURETICS

25
Q

What are the key distinguishing features of TACO and TRALI?

A

TACO=

  • Patient at risk for volume overload
  • Increased BP

TRALI=

  • Fever and chills
  • HYPOtension
26
Q

What is the classical antigen/ antibody combination that causes delayed hemolytic anemia?

A
  • Kidd antigen and anti-kidd antibody

**vs. ABO in acute hemolysis*

27
Q

What percentage of TA-GVHD cases are fatal?

A

90%

28
Q

When are allergic transfusion reactions most common i.e. in response to what component therapy?

A

Plasma or platelets

29
Q

What are the two most common transfusion reactions?

A

Fever

TACO