86 Questions
What is the main cause of acute hemolytic transfusion reactions?
Recipient antibody attacking transfused donor cells
Why are hemolytic transfusion reactions involving extravascular RBC destruction generally less serious?
Destruction primarily occurs in the reticuloendothelial system
What is the incidence of an acute hemolytic transfusion reaction resulting from ABO incompatibility in 2011?
1:1200 to 1:190,000.
What is crucial to prevent during hemolytic transfusion reactions?
Renal failure and DIC
How do fatal reactions occurring in blood recipients or donors need to be reported according to FDA requirements?
Within 24 hours by telephone or within 7 days in writing
What was the primary cause of deaths from acute hemolytic reactions between 1976 and 1985?
Errors involving ABO incompatibility
What is the classic presenting sign of a hemolytic transfusion reaction under general anesthesia?
Hemoglobinuria
At what level of plasma hemoglobin (Hb) concentration does hemoglobinuria occur?
150 mg/dL
What protein binds free hemoglobin in the plasma?
Haptoglobin
What laboratory test can confirm the presence of a hemolytic transfusion reaction?
Direct antiglobulin test
What may be the only clue of a hemolytic transfusion reaction under general anesthesia?
Hemoglobinuria
Which substance is released due to complement activation during a hemolytic transfusion reaction?
Vasoactive amines
what is the most common sign and Symptoms of Hemolytic Transfusion Reactions
Fever
What is the likely cause of acute renal failure from intravascular hemolysis?
Precipitation of hemoglobin in the form of acid hematin in the proximal tubule
What is one approach to therapy for intravascular hemolysis to prevent acute renal failure?
Use of diuretics to increase urine flow
Why is alkalization of urine recommended in the treatment for intravascular hemolysis?
To prevent precipitation of acid hematin in the distal tubules
Why does Disseminated Intravascular Coagulation (DIC) commonly occur with hemolytic transfusion reactions?
Activation of the intrinsic system of coagulation by released erythrocytin
What is the recommended approach if initial mannitol administration is ineffective in treating intravascular hemolysis?
Use more potent diuretics like furosemide
What is a possible consequence of intravascular hemolysis on the renal system?
Mechanical blockage due to precipitation of Hb in the distal tubule
What laboratory values should be obtained as soon as a hemolytic transfusion reaction is recognized?
Platelet count, PT, and PTT
What may cause hypotension during a hemolytic transfusion reaction?
Activation of the kallikrein system
What is the purpose of obtaining baseline platelet count, PT, and PTT values during a hemolytic transfusion reaction?
To monitor coagulation status
In a hemolytic transfusion reaction, why is it important to have baseline laboratory values for comparison?
To compare with subsequent test results
What is the main reason for the delayed hemolytic transfusion reactions in recipients sensitized to RBC antigens?
Presence of alloantibodies after a secondary stimulus
Which system commonly involves antibodies in delayed hemolytic transfusion reactions?
Rh system
What is the typical manifestation of delayed hemolytic transfusion reactions?
Jaundice and hemoglobinuria
Why are delayed hemolytic transfusion reactions more common in females with a known disposition for alloimmunization?
Previous blood transfusions or pregnancy
How do delayed hemolytic transfusion reactions differ from immediate reactions regarding antibody concentration?
Antibody concentration is not detectable at the time of transfusion
What is the primary cause of RBC destruction in delayed hemolytic transfusion reactions?
Elevated levels of alloantibodies after a secondary stimulus
What should the surgical team consider in a patient who experiences an unexplained decrease in Hb 2 to 21 days after a transfusion?
Delayed hemolytic transfusion reaction
Why are delayed hemolytic transfusion reactions harder to prevent compared to immediate reactions?
Pretransfusion testing cannot detect very low levels of antibodies
What is a critical differential diagnosis that the surgical team should include for patients with a decrease in Hb after a transfusion?
Delayed hemolytic transfusion reaction
Why might a decrease in Hb following a transfusion in a postoperative patient lead to a return to the operative room?
Attributed to postoperative bleeding
What is a significant challenge in preventing delayed hemolytic transfusion reactions according to the text?
Inability of pretransfusion testing to detect low levels of antibodies
What is the most common cause of transfusion-related mortality reported to the FDA from 2012 to 2016?
Transfusion-Related Acute Lung Injury (TRALI)
What symptom of TRALI usually appears within 6 hours after a blood transfusion?
Fluid in the endotracheal tube
Why is TRALI considered to occur in the absence of excessive intravascular volume and cardiac failure?
Manifestation as noncardiogenic pulmonary edema
What is the definitive therapy recommended for treating TRALI during a blood transfusion?
Stopping the transfusion and providing supportive measures
Which component of blood is particularly implicated as an inciting factor for TRALI?
Fresh Frozen Plasma (FFP)
the incidence of TRALI is
1.3% to 3%
despite TRALI remains the leading cause of transfusion-related death. most patients recover within
96 hours
Identified risk factors include all the following except?
Negative fluid-balance
what is the most common risk factor for TRALI?
plasma from female donors
What clinical finding can help differentiate between TRALI and TACO?
Elevated B-type natriuretic peptide/protein
What is a possible reason for the declining incidence rate of TACO according to the text?
More restrictive transfusion practice
Besides volume transfused, what other factor is mentioned as a risk factor for TACO?
Intraoperative fluid balance
How have leukoreduction techniques been suggested to impact the incidence rate of TACO?
Reduce the incidence rate
What supportive measure is recommended in both TRALI and TACO cases according to the text?
Lung protective ventilation measures
What treatment is recommended to relieve the symptoms of an allergic reaction during a blood transfusion?
Antihistamines
Which symptom characterizes the more severe allergic reaction involving anaphylaxis during a blood transfusion?
Dyspnea
What type of blood should be given to patients who have experienced anaphylactic reactions due to IgA deficiency?
Washed RBCs or IgA-deficient blood
What is the cause of anaphylactic reactions in patients during a blood transfusion?
Transfusion of IgA
How do anaphylactic reactions differ from other allergic reactions during a blood transfusion?
Involve rapid onset and severe symptoms
What is the primary cause of febrile nonhemolytic reactions to blood transfusions?
Release of pyrogenic cytokines and intracellular contents by donor leukocytes
How can a hemolytic reaction be differentiated from a febrile reaction?
Positive direct antiglobulin test
What is the role of leukoreduced blood in reducing adverse reactions to transfusions?
Lowers the incidence of febrile reactions
What symptom is not typically associated with a febrile nonhemolytic reaction to a blood transfusion?
Hematuria
What type of allergic reaction to a blood transfusion is not mediated by IgE?
Anaphylactoid
Which test can definitively confirm the presence of a hemolytic transfusion reaction?
Direct antiglobulin test
which type of allergic reaction to a blood transfusion is the most common ?
minor Allergic reactions
what is the main cause for Most allergic transfusion reactions
foreign protein
what is The most common symptom in allergic transfusion reactions ?
urticaria with itching
patient arriving to operation room, planned for liver resection, surgeon informing you that this patient has a high risk for bleeding intraoperative due to surgical factors, and also informing you that he had allergic reaction for blood transfusion few years ago. what s your next step?
order washed RBCs from blood bank
What is the primary mechanism by which transfusion-associated graft-versus-host disease (GVHD) is initiated?
Engraftment of donor lymphocytes
who is considered at risk for GVHD?
Severely immunocompromised patients
How can transfusion-associated GVHD be prevented?
By irradiating the blood products before transfusion
Which symptom is commonly associated with transfusion-associated GVHD?
Leukopenia
In what situation might transfusion-associated GVHD still occur despite leukocyte filtering?
When irradiation is not performed
why patients receiving directed donations from first or second-degree relatives are at risk for Transfusion-associated graft-versus-host disease (GVHD) ?
because transfused lymphocytes with shared HLA haplotypes cannot be recognized and eliminated
What is the main complication associated with iron overload resulting from chronic transfusion therapy?
Liver or heart dysfunction
What is the term for the condition in which recipient alloantibodies attack donor platelet antigens post-transfusion?
Posttransfusion purpura
Which complication may arise due to HLA alloimmunization resulting in antibodies directed against HLA class I antigens?
platelet counts become refractory
What is the outcome for patients with microchimerism where donor lymphocytes persist in the patient?
Unknown
Which type of transfusion reaction involves activation of the coagulation pathway leading to bradykinin production and allergic reactions?
Hypotensive transfusion reaction
What is the risk associated with HPA alloimmunization leading to platelet refractoriness from antibodies against platelet antigens?
platelet refractoriness
what is the percentage of recipients who are chronically transfused develop RBC alloantibodies ?
2% to 8%
How can universal leukoreduction help reduce the risk of platelet transfusion refractoriness?
By reducing the risk of HLA alloimmunization from blood transfusions
What is one of the benefits that universal leukoreduction might provide according to the text?
Decreasing postoperative mortality
In the debate on universal leukoreduction, which approach has been used to justify its implementation?
'May help, won't hurt' approach
How can leukoreduction potentially reduce the transmission of variant Creutzfeldt-Jakob disease?
By removing white blood cells from blood transfusions
Which type of blood products need to be irradiated to prevent transfusion-associated GVHD?
RBCs, platelets, and granulocytes
Who is particularly recommended to receive irradiated blood products to prevent GVHD?
Infants younger than 4 months
For which patients undergoing extracorporeal membrane oxygenation is irradiation of blood products recommended?
Children younger than 1 year old
What is a common indication for irradiation of blood products other than in infants and critically ill children?
Recipients of cellular components known to be from a blood relative
Which recipients are NOT required to have their blood products irradiated to prevent GVHD?
Patients receiving routine chemotherapy for solid tumors
When is irradiation of blood products not necessary according to the text?
For patients on immunosuppressive therapy post organ transplant
Learn about one of the most catastrophic transfusion reactions involving intravascular hemolysis, where there is a direct attack on transfused donor cells by recipient antibody and complement. Explore the causes, symptoms, treatment, and prevention of this serious condition.
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