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Hematology – ABIM

Transfusion reactions

QuestionAnswer
Name the two hemolytic transfusion reactions 1. Acute hemolytic transfusion reaction AHTR (ABO mismatch), 2. Delayed hemolytic transfusion reaction DHTR (recipient develops antibodies against the Rh antigen; donor red blood cell is Rh positive)
Name the five possible transfusion reactions that have fever 1. AHTR, 2. DHTR, 3. TRALI (donor antibodies attack recipient neutrophils), 4. febrile non-hemolytic reaction (patient antibody attacks the HLA antigen on donor leukocytes), 5. Bacterial infection (bacteria in the bag that holds the blood product)
What is the mechanism behind acute hemolytic transfusion reaction? What is the time course? How do you manage the next transfusion? ABO mismatch, usually due to a clerical error. Recipient's preformed Ab attacks the donor red blood cell. Pt experiences hypoTN, fever, acute renal failure, DIC within one hour. Next txfn, need to cross match to check for incompatibility and hemolysis.
What is the mechanism behind delayed hemolytic transfusion reaction? What is the time course? How do you manage the next transfusion? Recipient is Rh negative, but gets Rh positive blood.1st transfusion is uneventful, but pt develops anti-Rh Ab. 5 to 10 days after 2nd trxfn, anti-Rh Abs will attack the donor red blood cells. Next trxfn, crossmatch again to identify the new antibody.
What is the mechanism behind transfusion -related circulatory overload (TACO)? What is the time course? How do you manage the next transfusion? Patient starts out with a low cardiopulmonary reserve. Within 1 to 2 hours of starting the transfusion, patients will have cough, shortness of breath, lower extremity edema. Treat with oxygen and diuretics. Next transfusion needs to run slowly.
What is the mechanism behind transfusion -related acute lung injury (TRALI)? What is the time course? How do you manage the next transfusion? Donor Ab attacks patient neutrophils. WBCs get sequestered in the lung, causing capillary leakage into the alveoli. With in 6 hours, patient is feverish, hypotensive and hypoxic. For the next transfusion, the donor needs to be removed from the donor pool.
What is the mechanism behind febrile non-hemolytic transfusion reaction? What is the time course? How do you manage the next transfusion? On first trxfn, pt developed anti-HLA Ab. On 2nd trfxn, these Abs attack WBCs with those HLA antigens --> release of cytokines --> fever <24h. Treat with antipyretic. Next txnfn, give an antipyretic pretreatment as well as leukoreduced donor blood (WBCs
What is the mechanism behind transfusion anaphylaxis? What is the time course? How do you manage the next transfusion? Pt is IgA deficient & has anti-IgA Abs. These attack donor IgA. Within 45 min, pt will experience pruritus, urticaria, airway obstr, hypoTN, & shock. Tx w anti-histamine & epi. Future trfxn use washed RBCs wash away the plasma proteins and IgA.
What is the mechanism behind an allergic transfusion reaction? What is the time course? How do you manage the next transfusion? Recipient allergic to plasma proteins in donor blood – i.e. allergens the donor ate. In minutes, sxs of urticaria, local erythema. Tx with antihist & epi. Tsfxn can be restarted. Next tsfxn, pretx c antihist and use pRBCs washed of the plasma proteins.
What is the mechanism behind graft versus host disease? What is the time course? How do you manage the next transfusion? Patient is immunosuppressed. The donor white blood cells attack patients marrow --> 7-10 days --> pancytopenia and marrow aplasia, Inc LFTs, rash. Tx supportive. Next transfusion need irradiated blood – kill all donor leukocytes.
What is the mechanism behind CMV transmission transfusion reaction? What is the time course? How do you manage the next transfusion? Pt is immunosuppressed and CMV negative. Gets WBCs from donor that contain CMV. Treat with an antiviral. Next transfusion should use blood from a CMV negative donor or the blood should be leukoreduced – filter out the leukocytes that have CMV inside.
What is the mechanism behind bacterial transfusion reaction? What is the time course? How do you manage the next transfusion? Within hours of a transfusion, the patient develops a mild fever – usually from a platelet transfusion because platelets often sit outside at room temperature. Treat with antibiotics.
Created by: christinapham