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umeed99
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09/23/08 - 11:19 AM       #1

a 42 yr old woman with severe uterine bleeding + iron def; anemia is receiving blood transfusion prior to hysterectomy ,blood product consist of washed ,leukocyte depleted packed rbc and also screen for bacteria.one hr after the transfusion she complain of fever chill and flank pain,,,infusion stop but she still complain of same symptoms and eventually begin bleeding around her i/v catheter site,wt is most likely cause of her transfusion reaction?

1)reaction to cytokines stored in transfuse blood product
2)ABO miss match
3)Ig A def;
4)blood product with bacteria
5)anamnestic antibody response a minor RBC antigen

plz expain u ans

nightflight1945
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09/23/08 - 11:30 AM       #2

2)ABO miss match


jehanzebali
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09/23/08 - 04:12 PM       #3

but y the bledding around the vene pencture sites ?

DrAlex_76
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09/23/08 - 07:08 PM       #4

how about IgA def ?


umeed99
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09/23/08 - 07:11 PM       #5

that y i bring this question......how will we diffrentiated b/w these choice

DrAlex_76
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09/23/08 - 07:21 PM       #6

i think this case is IgA def, because the wasded -rbc could not bring the transfusion reaction due to ABO mismatch.


DrAlex_76
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09/23/08 - 07:28 PM       #7

ops, got mistake ! IgA def causes anaphylacitc reaction : wheezing, dyspnea, ...due to Ab-ag reaction. meanwhile , ABO mismatch cause hemolytic reaction : fever, flusing, anxiety then bleeding tendency . so this case is ABO . thanks nightflight


umeed99
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09/23/08 - 08:39 PM       #8

yes u guys r absolutely right nod..but wt is the explanation of no 1 choice.

DrAlex_76
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09/23/08 - 08:41 PM       #9

i think there s no more cytokines in washed- RBC products !


Eagle_303
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09/23/08 - 09:38 PM       #10

jehanzebali wrote:
but y the bledding around the vene pencture sites ?
With intravascular hemolysis there is release of cystokines which leads to
  1. Activation of coagulation systems
  2. Shock
  3. DIC
  4. Renal vasoconstriction --------> Renal failure
  5. Pulmonary ARDS

DIC leads to
  1. Hypofibrogenemia
  2. Decrease in other coagulation factors like V, VIII and Prothrombin
  3. FDP production which prevent coagulation

Consequently there is bleeding tendency

Hope it helps




nightflight1945
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09/24/08 - 02:05 AM       #11

ur Welcome!


jehanzebali
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09/24/08 - 03:47 AM       #12

thanks eagle smiling face









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