Unit 9: Transfusion Reaction Investigation

What 5 antibodies cause intravascular hemolysis by activating complement de destroy RBC membranes?

• anti-Jk^a, Jk^b, Le^a, Le^b, and Vel

• anti-Jk^a, P+P₁+P^k (Tj^a), Le^a, Le^b, and Vel

• anti-Jk^a, Jk^b, P+P₁+P^k (Tj^a), Le^a, and Vel

• anti-Jk^a, Jk^b, P+P₁+P^k (Tj^a), Le^b, and Vel

• anti-Jk^a, Jk^b, P+P₁+P^k (Tj^a), Le^a, and Vel

Severe intravascular hemolysis will most likely occur with antibodies in:

• ABO system

• Rh system

• Kell system

• MNS system

ABO (the rest are clinically significant IgG antibodies that would cause extravascular hemolysis)

What type of antibodies cause extravascular hemolysis that is a slower and more controlled form of hemolysis that removes RBCs and destroys them in the liver or spleen?

• clinically significant IgM

• clinically significant IgG

• clinically insignificant IgM

• clinically insignificant IgG

clinically significant IgG

Hemolytic transfusion reactions (both acute and delayed) can occur with as little as _______ mL of blood.

• 2-4 mL

• 5-10 mL

• 10-15 mL

• 25-50 mL

10-15 mL

What are the 5 types of acute immunologic transfusion reactions?

1. acute hemolytic transfusion reactions

2. nonhemolytic febrile transfusion reactions

3. allergic transfusion reactions

4. anaphylactic transfusion reactions

5. noncardiogenic pulmonary reactions (TRALI)

What type of transfusion reaction is caused by the patient’s antibodies destroying donor RBCs, resulting in immediate symptoms?

• acute hemolytic transfusion reactions

• allergic transfusion reactions

• anaphylactic transfusion reactions

• noncardiogenic pulmonary reactions (TRALI)

acute hemolytic transfusion reaction

What type of transfusion reaction is caused by patient HLA antibodies reacting with donor WBCs?

• nonhemolytic febrile transfusion reaction

• allergic transfusion reactions

• anaphylactic transfusion reactions

• noncardiogenic pulmonary reactions (TRALI)

nonhemolytic febrile transfusion reaction

What acute immunologic transfusion reaction associated with at least a 1 degree Celsius increase?

• nonhemolytic febrile transfusion reaction

• allergic transfusion reactions

• anaphylactic transfusion reactions

• noncardiogenic pulmonary reactions (TRALI)

nonhemolytic febrile transfusion reaction

A 55 year old woman experienced shaking, chills, and a temperature of 103 F approximately 30

minutes following the transfusion of a unit of blood. The most likely explanation for the patient’s symptoms is:

• bacterial contamination of donor blood

• congestive heart failure due to fluid overload

• anaphylactic reaction

• febrile reaction

febrile reaction

How can you prevent a nonhemolytic febrile transfusion reactions?

• treat patient with antihistamines prior to transfusing

• transfuse leukocyte reduced units

• transfuse irradiated products (except FFP and cryo)

• transfuse IgA deficient or deglycerolized units

transfuse leukocyte reduced units (the HLA antibodies in patient are reacting against donor WBCs)

What type of transfusion reaction is caused by patient antibodies reacting with soluble proteins in donor blood?

• acute hemolytic transfusion reactions

• allergic transfusion reactions

• anaphylactic transfusion reactions

• noncardiogenic pulmonary reactions (TRALI)

allergic transfusion reaction

Which transfusion reaction can be resumed after symptoms are treated?

• acute hemolytic transfusion reactions

• allergic transfusion reactions

• anaphylactic transfusion reactions

• noncardiogenic pulmonary reactions (TRALI)

allergic transfusion reaction

Which of the following listed tranfusion reactions is the most common?

• ABO incompatibility due to clerical errors.

• Urticarial

• TRALI

• Delayed hemolytic

Urticarial (allergic reactions)

How would you prevent an allergic transfusion reaction?

• treat patient with antihistamines prior to transfusing

• transfuse leukocyte reduced units

• transfuse irradiated products (except FFP and cryo)

• transfuse IgA deficient or deglycerolized units

treat patient with antihistamines prior to transfusion

What type of transfusion reaction is caused by IgA antibodies in patient plasma reacting with IgA immunoglobulins in donor units?

• nonhemolytic febrile transfusion reaction

• allergic transfusion reactions

• anaphylactic transfusion reactions

• noncardiogenic pulmonary reactions (TRALI)

anaphylactic transfusion reactions

Which of the following transfusion reactions occurs after infusion of only a few milliliters of blood and gives no history of fever?

• febrile

• anaphylactic

• allergic

• hemolytic

anaphylactic

How would you prevent an anaphylactic transfusion reaction?

• treat patient with antihistamines prior to transfusing

• transfuse leukocyte reduced units

• transfuse irradiated products (except FFP and cryo)

• transfuse IgA deficient or deglycerolized units

transfuse IgA deficient or deglycerolized units (IgA antibodies in patient are reacting with donor’s IgA immunoglobulins)

What are the 2 types of transfusion reactions that can cause urticaria (hives), itching, rash, erythema (redness), and edema?

• Acute hemolytic transfusion reaction and TRALI

• Allergic transfusion reaction and anaphylactic transfusion reaction

• Febrile nonhemolytic transfusion reaction and bacterial contamination

• Delayed hemolytic transfusion reaction and transfusion-associated graft-versus-host disease (TA-GVHD)

Allergic transfusion reaction and anaphylactic transfusion reaction

What type of transfusion reaction is caused by patient WBCs reacting with donor HLA antibodies?

• nonhemolytic febrile transfusion reaction

• allergic transfusion reactions

• anaphylactic transfusion reactions

• noncardiogenic pulmonary reactions (TRALI)

noncardiogenic pulmonary reactions (TRALI)

What organ of the recipient's body is involved in a TRALI transfusion reaction?

• Kidney

• Heart

• Lung

• Spleen

Lung

What are the 6 types of acute nonimmunologic transfusion reactions?

1. bacterial contamination (spesis)

2. circularity overload

3. physical/chemical hemolysis

4. hypothermia

5. air embolus

6. hypotension

What types of bacteria can cause transfusion reactions due to production of endotoxins?

• Gram positive cocci

• Gram positive rods (spore producing)

• Gram negative bacteria (both rods and cocci)

• All of the above

Gram negative bacteria (E. coli, Citrobacter fruendii, Yersinia enterocolitica)

What transfusion reaction is associated with DIC and shock of the warm type?

• bacterial contamination

• circulatory overload

• hypothermia

• air embolus

bacterial contamination (sepsis)

What nonimmunologic acute transfusion reactions is caused by administering units too fast, causing hypervolemia?

• bacterial contamination

• circulatory overload

• hypothermia

• air embolus

circulatory overload

What type of transfusion reaction is associated with a patient not being able to breath when not in an upright position, known as orthopnea, and congestive heart failure?

• bacterial contamination

• circulatory overload

• hypothermia

• air embolus

circulatory overload

Coughing, cyanosis, and shortness of breath are symptoms of:

• febrile reaction

• allergic reaction

• delayed hemolytic

• circulatory overload

circulatory overload

Administration of Whole Blood to a patient with cardiac insufficiency could result in which of the following transfusion reactions?

• TRALI

• Febrile nonhemolytic

• Delayed hemolytic

• Circulatory Overload

Circulatory Overload

What type of transfusion reaction is associated with hemolysis or donor RBCs before they are transfused?

• circulatory overload

• physical/chemical hemolysis

• hypothermia

• air embolus

physical/chemical hemolysis

What type of transfusion reaction is associated with asymptomatic hemoglobinuria?

• circulatory overload

• physical/chemical hemolysis

• hypothermia

• air embolus

physical/chemical hemolysis

What transfusion reaction is caused by air in the infusion line?

• circulatory overload

• physical/chemical hemolysis

• hypothermia

• air embolus

air embolus

What transfusion reaction is caused by angiotensin converting enzyme (ACE) inhibition?

• circulatory overload

• hypothermia

• air embolus

• hypotension

hypotension

What are the 3 types of delayed immunologic transfusion reactions?

1. delayed hemolytic transfusion reactions

2. transfusion associated graft versus host disease

3. post-transfusion purpura

What transfusion reaction is caused by destruction of donor RBCs once patient antibody titers are at a sufficient level?

• delayed hemolytic transfusion reaction

• transfusion associated graft versus host disease

• post-transfusion purpura

• All of the above

delayed hemolytic transfusion reaction

What transfusion reaction is a result of transfusing cytotoxic lymphocytes into an immunologically incompetent patient?

• delayed hemolytic transfusion reaction

• transfusion associated graft versus host disease

• post-transfusion purpura

• All of the above

transfusion associated graft versus host disease

All of the following are clinical sequelae of a hemolytic transfusion reaction except:

• DIC

• Renal failure

• Shock

• Graft-vs-Host Disease

Graft-vs-Host Disease (not a hemolytic transfusion reaction)

How would you prevent transfusion associated graft versus host disease?

• treat patient with antihistamines prior to transfusing

• transfuse leukocyte reduced units

• transfuse irradiated products (except FFP and cryo)

• transfuse IgA deficient or deglycerolized units

transfuse irradiated products (except FFP and cryo)

What component is indicated for patients who receive directed donations from family members to prevent GVHD?

• Washed RBCs

• ABO/Rh compatible

• CMV-negative

• Irradiated

Irradiated

What transfusion reaction causes a destruction of the patient’s platelets and the donor platelets?

post-transfusion purpura

What platelet antibody is associated with post-transfusion purpura?

• Anti-HPA-5b

• Anti-HPA-3a

• Anti-HPA-1a

• Anti-HPA-2a

Anti-HPA-1a (anti-P1^A1)

What are the 3 types of delayed nonimmunogenic transfusion reactions?

1. transfusion transmitted infections (TTIs) - HIV, malaria, syphilis, hepatitis, cytomegalovirus

2. hypocalcemia

3. hemosiderosis (iron overload)

Which of the following is the most common transfusion transmitted complication?

• HIV

• Hepatitis

• CMV

• HTLV

Hepatitis

Hypotension, hemoglobinuria, generalized bleeding, nausea, flushing, fever and chills are symptoms of:

• hemolytic reaction

• hemosiderosis

• allergic reaction

• anaphylactic reaction

hemolytic reaction

Fever and chills are symptoms of:

• noncardiogenic pulmonary

• circulatory overload

• allergic

• febrile

febrile

What type of specimen is used for post-transfusion reaction testing?

• pre-transfusion sodium citrate

• post-transfusion sodium citrate

• pre-transfusion EDTA

• post-transfusion EDTA

post-transfusion EDTA

What are the steps of a post-transfusion reaction work-up?

• visual check for hemolysis, clerical check of paperwork, DAT, ABO/Rh typing, examine urine for free hemoglobin

• visual check for hemolysis, clerical check of paperwork, ABO/Rh typing, DAT, examine urine for free hemoglobin

• clerical check of paperwork, visual check for hemolysis, DAT, ABO/Rh typing, examine urine for free hemoglobin

• clerical check of paperwork, visual check for hemolysis, examine urine for free hemoglobin, ABO/Rh typing, DAT

clerical check of paperwork, visual check for hemolysis, DAT, ABO/Rh typing, examine urine for free hemoglobin

When performing an initial transfusion reaction investigation, it is noted that the post-

transfusion sample serum is yellow in color and the DAT is negative.  No clerical errors are noted.  What would you recommend as the next step in the testing?

• Repeat the crossmatch on the donor unit

• Perform plasma hemoglobin

• Repeat the antibody screen

• No further testing is necessary

No further testing is necessary

What initial results of post-hemolytic transfusion reaction testing would rule out a hemolytic transfusion reaction has occurred?

• positive post-transfusion DAT with hemolysis

• positive post-transfusion DAT with no hemolysis

• negative post-transfusion DAT with hemolysis

• negative post-transfusion DAT with no hemolysis

negative post-transfusion DAT with no hemolysis

What initial results of post-hemolytic transfusion reaction testing would indicate a hemolytic transfusion reaction has occurred?

• positive post-transfusion DAT with hemolysis

• positive post-transfusion DAT with no hemolysis

• negative post-transfusion DAT with hemolysis

• negative post-transfusion DAT with no hemolysis

positive post-transfusion DAT with hemolysis

What should you do it the post-transfusion DAT is positive?

• Discard the patient's sample and repeat the transfusion

• Perform a pre-transfusion DAT for comparison

• Perform an ABO/Rh typing

• Immediately issue more units for transfusion

Perform a pre-transfusion DAT for comparison

If both the pre-transfusion and post-transfusion DATs are of equal strength, what should be the next step in the transfusion reaction work-up?

• Repeat the DAT using fresh donor cells

• Perform an elution immediately

• Use monospecific antisera to determine if IgG or complement is present

• Rule out hemolytic transfusion reaction and end the investigation

Use monospecific antisera to determine if IgG or complement is present

If the DAT is positive due to IgG, what should be the next step in the transfusion reaction work-up?

• Transfuse additional units immediately

• Perform an elution to identify the antibody coating the red cells

• Ignore the result if no hemolysis is present

• Perform a cold agglutinin screen

Perform an elution to identify the antibody coating the red cells

If the post-transfusion DAT is stronger than the pre-transfusion DAT, what should be the next step in the transfusion reaction investigation?

• Repeat the transfusion with crossmatch-compatible units

• Perform a complete serologic work-up, including ABO/Rh typing, antibody panel, antigen typing, and elution

• Ignore the DAT result if no symptoms are present

• Only perform an antibody screen and issue antigen-negative units

Perform a complete serologic work-up, including ABO/Rh typing, antibody panel, antigen typing, and elution

10 days after transfusion of 2 units, a patient had a 2 gm/dL drop in Hgb and was slightly jaundiced. What tests would be helpful in determining whether there was a delayed hemolytic transfusion reaction?

• Culture the donor unit

• Compare preptransfusion and postransfusion ABO and Rh

• Repeat all of the pretransfusion tests

• Perform an antibody screen on the post transfusion sample.

Perform an antibody screen on the post transfusion sample.

A patient is observed to have a rise in temperature and chills during a transfusion. Which of the following tests should be performed immediately?

• ABO/Rh on pre-transfusion sample

• Antibody screen and identification of antibody

• Repeat the crossmatches

• DAT and look at color of plasma

DAT and look at color of plasma (faster test for detecting what kind of antibody may be attacking patient’s RBCs)

At what time should a bilirubin be collected after a suspected transfusion reaction?

• 6 hours

• 12 hours

• 24 hours

• 48 hours

6 hours

To which agency or center should fatalities caused by transfusion reactions be reported?

• Centers for Disease Control and Prevention (CDC)

• American Red Cross (ARC)

• Center for Biologics Evaluation and Research (CBER)

• Occupational Safety and Health Administration (OSHA)

Center for Biologics Evaluation and Research (CBER)