03 Blood Products

Question 1

when is CMV-negative blood used?

Answer 1

low birth weight infants, bone marrow transplant pts, other transplant patients

Question 2

can cold blood products or patients cause clotting?

Answer 2

no–cold will cause poor clotting. pt needs to be warm to clot correctly

Question 3

what is donated blood screened for?

Answer 3

HIV, HepB, HepC, HTLV, syphilis, west nile virus

Question 4

which blood products do not carry risk of HIV and hepatitis?

Answer 4

albumin and serum globulins (they are heat treated)

Question 5

what are symptoms of acute hemolysis?

Answer 5

back pain, chills, tachycardia, fever, hemoglobinuria

Question 6

what is the most common bacterial contaminate of blood products?

Answer 6

GNR (usually E. Coli)

Question 7

what are signs of anaphylaxis?

Answer 7

bronchospasm, hypotension, urticaria

Question 8

what causes transfusion-related acute lung injury (TRALI)?

Answer 8

caused by donor antibodies to recipient WBCs, clot in pulmonary capillaries

Question 9

what is the most common transfusion reaction?

Answer 9

febrile nonhemolytic transfusion reaction

Question 10

what happens to hemoglobin in stored blood?

Answer 10

left shift (increased affinity for oxygen) b/c low in 2,3-DPG

Question 11

what is treatment for urticaria after transfusion?

Answer 11

histamine blocker (benadryl), supportive therapy

Question 12

what causes urticaria after blood product donation?

Answer 12

recipient antibodies against donor plasma proteins or IgA in an IgA deficient patient

Question 13

what is treatment for febrile nonhemolytic transfusion reaction?

Answer 13

discontinue transfusion if pt had previous transfusions or if it occurs soon after transfusion has begun. use wbc filters for subsequent transfusions

Question 14

what is nonimmune hemolysis?

Answer 14

from squeezed blood

Question 15

how many units of pRBCs will cause dilutional thrombocytopenia?

Answer 15

occurs after 10U

Question 16

what is delayed hemolysis?

Answer 16

antibody mediated response against minor antigens

Question 17

what is the cause of febrile nonhemolytic transfuion reaction?

Answer 17

recipient antibody rxn against donor WBCs

Question 18

what is acute hemolysis caused by?

Answer 18

ABO incompatibility; antibody mediated

Question 19

what role does Ca play in clotting and what does it cause?

Answer 19

hypocalcemia can cause poor clotting. occurs with massive transfusion. Ca required for clotting cascade.

Question 20

what is treatment of delayed hemolysis?

Answer 20

observe if stable

Question 21

what causes anaphylaxis?

Answer 21

recipient antibodies against donor IgA in an IgA deficient recipient

Question 22

what are the types of hemolysis reactions?

Answer 22

acute, delayed, nonimmune

Question 23

how do transfusion reactions present in anesthetized patients?

Answer 23

diffuse bleeding

Question 24

what is the most common product source of contamination?

Answer 24

Platelets (not refrigerated)

Question 25

what is treatment for acute hemolysis?

Answer 25

fluids, diuretics, HCO3-, pressors, histamine blockers (benadryl)

Question 26

what are haptoglobin and free hemoglobin levels in acute hemolysis?what happens to bilirubin?

Answer 26

haptoglobin 5 g/dL

increase in unconjugated bilirubin

Question 27

what is treatment for anaphylaxis after transfusion?

Answer 27

fluids, lasix, pressors, steroids, epi, histamine blockers (benadryl)

Question 28

what are some other transfusion-related issues?

Answer 28

temperature of pt and product, dilutional thrombocytopenia, hypocalcemia, GNR contamination, Chagas’ dz

Question 29

what can acute hemolysis lead to?

Answer 29

ATN, DIC, shock