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QuestionAnswer
First step in a transfusion reaction work-up STOP THE TRANSFUSION
Main indicator of survival of an acute HTR amount of incompatible blood infused
This protein binds to free HGB molecules, cleared by monocytes and macrophages in the RE system; Levels decrease sharply in hemolysis; Long turnaround time and acute phase reaction make for limited usefulness in acute setting haptogobin
Most common cause of Acute hemolytic transfusion reactions (AHTRs) Clerical errors
Rate of fatal hemolytic transfusion reaction per transfusion 1 in 1.8 million transfusions
Most common presenting symptom in a hemolytic transfusion reaction Fever and chills > 80%
First indication of a hemolytic transfusion reaction in anesthetized patients Hemoglobinuria
RBC abnormality associated with Intravascular hemolysis Schistocytes
RBC abnormality associated with Extravascular hemolysis Spherocytes
Treatment of Acute hemolytic transfusion reactions (AHTRs) Hydration/diuresis critical early components; Low-dose dopamine use is controversial; Consider DIC; (+/-) heparin; Consider early exchange transfusion,for high volume incompatible transfusion
how can Acute hemolytic transfusion reactions be prevented? 1) Training and careful attention to phlebotomy, labeling, issue, and administration 2) Two separate ABO/Rh types before transfusion 3) Advanced methods (RFID, bar codes, etc.)
Pathophysiology of FNHTR Increased pyrogenic substances, mostly from WBCs 1) Cytokines produced before transfusion 2) cytokines made after transfusion • Recipient anti-HLA/HNA antibodies attack donor WBCs, or donor antibodies attack recipient WBCs
What can reduce risk of FNHTR? leukoreduction
Definition of FNHTR Transient fever/chills (+/- rigors?) during or up to 2 hours after transfusion
#1 infectious risk from transfusion Transfusion-related sepsis (septic transfusion reaction)
Most common bacterial infection from a RBC transfusion Yersinia enterocolitica (most common historically)
Most common bacterial infection from a platelet transfusion Vast majority are gram-positive cocci (skin)
#1 cause of transfusion-related fatality in the US Transfusion-related acute lung injury (TRALI)
Incidence of TRALI Incidence varies: 1:1200 to 1:190,000 transfusions
TRALI definition New acute lung injury < 6 hours post transfusion
Blood products implicated in TRALI cases PLTs/plasma transfusions, but also RBCs/WB
CBC finding in TRALI Transient neutropenia
List TRALI mitigation strategies 1. Male-only or female never pregnant plasma has been shown to decrease the risk of TRALI (females have more anti-HLA and anti-neutrophil antibodies); 2. Female plasma/PLT donors with h/o pregnancy tested for antibodies
Pathophysiology of allergic transfusion reactions a) Type I (IgE-mediated) hypersensitivity to transfused plasma proteins b) Mast cell secretion of histamine and other mediators of allergic reactions
Describe treatment and prevention optons for allergic transfusion reactions Diphenhydramine IV 25-50 mg as treatment, oral form as prophylaxis; Washed products work too (not usually done); May restart transfusion after hives clear.
What blood products are options in IgA deficient patients with h/o anaphylactic transfusion reaction? Washed cellular products (RBCs, PLTs), or products from IgA-deficient donors; If possible, bank autologous units
Drug classically associated with hypotensive transfusion reaction angiotensin-converting enzyme inhibitors
TRALI definition New acute lung injury < 6 hours post transfusion;; Lack of other risk factors for pulmonary edema; No pre-existing acute lung injury; Usually fever, chills, transient hypertension then hypotension; Should have no JVD, widened pulse pressure
In TRALI, an early CBC may show this finding Transient neutropenia
What strategies have been used for TRALI mitigation? Male-only or female never pregnant plasma has been shown to decrease the risk of TRALI;
Acute onset of congestive heart failure as a direct result of blood transfusion Transfusion-associated circulatory overload (TACO)
Outline differences between TACO and TRALI Clinical (response to diuretics/positional changes in TACO, fever in TRALI); CXR: Less cardiac silhouette widening in TRALI; Lab: Elevated BNP favors TACO; Finding HLA/HNA antibodies establishes TRALI
Results from an attack on recipient cells by viable T-lymphocytes in a transfused blood product Transfusion-associated graft-vs-host disease (TAGVHD)
Presentation of Transfusion-associated graft-vs-host disease Fever 7-10 days post-transfusion Face/trunk rash that spreads to extremities; Mucositis, nausea/vomiting, watery diarrhea; Hepatitis; Pancytopenia and subsequent marrow aplasia; Most patients die from infections
What can be done to prevent Transfusion-associated graft-vs-host disease? irradiate blood products
Radiation dose requirements for preventing Transfusion-associated graft-vs-host disease 2500 cGy (“rad”) dose required targeted to center of bag, with at least 1500 cGy in all parts of the bag
Condition with marked thrombocytopenia and increased risk of bleeding about ten days following transfusion (may be below 10,000/L) Post-transfusion Purpura (PTP)
Demographic group at risk for post-transfusion purpura Multiparous females at risk (5:1 female-male ratio)
Pathophysiology of post-transfusion purpura Anti-HPA-1A (PLA1; 98% frequency) 75%; HPA-1A neg pts exposed via pregnancy/trnsfzn; HPA-1A-+ trnsfsd PLTs and HPA1a-negative pt PLTs both destroyed; Ab has autoab activity; Passive adsorption of Ag/Ab complexes or soluble PLT Ags suggested
Created by: jfshikle