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Rosens > 108. Blood and Blood Products > Flashcards

108. Blood and Blood Products Flashcards

1
Q

Blood banking: RBC aims for viability of ?% of cells 24 hours after infusion

A

75

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2
Q

Blood banking: RBC contain anticoagulant that make half life ? days
vs additives contribute make half life ? days

A

35 vs 42

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3
Q

Blood banking: RBC changes secondary to storage (4):

A
  1. loss deformability
  2. leak K
  3. Irreversible membrane changes
  4. biochem alterations
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4
Q

Blood typing: what is this?

A

process of categorizing blood by antigens expressed on RBC and antibodies contained in serum

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5
Q

Blood typing: How many blood system types?

A

> 30

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6
Q

Blood typing: what blood system type main categories do we care about?

A
  1. abo
  2. rh
  3. Kell, duffy and Kidd
  4. type and screen/ type and cross match
  5. titer testing (whole blood donation)
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7
Q

Universal donor blood type for RBC

why?

A

O -

has no antigen A or B, so has anti A and anti B antibodies in the serum (so not whole blood universal donor!!)

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8
Q

Universal recipient blood type RBC ?

A

AB+

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9
Q

Rh: what is most immunogenic?

A

D antigen
+ means present

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10
Q

Rh+ what is needed for a significant reaction

A

person Rh- and prior exposure so body has. time to build antibodies (ie through pregnancy or blood transfusion)

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11
Q

What does a type and screen get you?

A

abo grouping
rh type
antibody screen for unexpected non abo or rh antibodies

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12
Q

Type and crossmatch - what has to be done first, and how is this accomplished? what does it get you?

A

type and screen first

mixes receipient serum with donor rbc to observe for agglutination

antibody screen and abbreviated crossmatch require 45-60 min to watch for this agglutination and if occurs, has to undergo complet crossmatch (can take several days)

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13
Q

Titer testing - whole blood donation - what is this?

A

O has anti A nad B which can cause destruction of A/B RBC

can mitigate this by giving type specific blood or low titer O universal blood (if titer <256 saline dilutions)

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14
Q

Low titer O blood does not cause hemolysis with up to ? units given

A

4

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15
Q

RBC volume

A

300ml

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16
Q

Storage temp RBC

A

1-6 deg

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17
Q

Prep type RBC in transfusion

A

10-45 mins

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18
Q

2 ways to get platelets?

A

Buffy coat from 4 units
apheresis

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19
Q

Vol buffy vs apheresis platelets

A

350ml vs 330

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20
Q

Vol buffy/ apheresis platelets - storage limit

A

5d

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21
Q

Vol buffy vs apheresis platelets storage temp

A

20-24 deg both

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22
Q

Vol buffy vs apheresis platelets - time to prep?

A

both 5 mins

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23
Q

Frozen vs apheresis plasma: vol?

A

290 ml vs 500ml

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24
Q

Frozen and apheresis plasma, cryoprecipitate: storage limit?

A

1 year

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25
Q

Frozen and apheresis plasma, cryo: storage temp?

A

-18 or colder

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26
Q

Frozen and apheresis plasma, cryo: time to prep?

A

30mins

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27
Q

Cryoprecipitate: approx vol?

A

10ml

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28
Q

How are RBC transfusions administered?

A

filter, IV and IO with NS

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29
Q

3 main preparations for PRBC:

A

washed
leukocyte reduced
irradiated

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30
Q

RBC preparation: Washed RBC: why done?

A

remove residual plasma and any remaining leukocytes, plt, microaggregates, plasma PRO and free hemoglobin
to reduce titer of anti a nad anti b antibodies
for recurrent allergic reaction to transfusion or IGA deficiency

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31
Q

RBC preparation: Washed RBC: which pt require this? (3)

A

recurrent allergic reaction to transfusion or IgA or paroxysmal nocturnal hemoglobinuria

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32
Q

RBC preparation: Washed RBC: how long does this take and what does it do to viability?

A

1hr
reduced to 24h

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33
Q

RBC preparation: Leukocyte reduced RBC: why is this done?

A

wbc can cause febrile reactions, immune sn and transmission of disease (viral, bacterial)

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34
Q

RBC preparation: Leukocyte reduced RBC: how is this done and for which 3 gr of pt?

A

through leukocyte filter, reduces wbc by 99.9%

chemo pt
multiparous females
pt receiving multiple transfusions

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35
Q

RBC preparation: Irradiated RBC: why is this done?

A

reduces GVHD by destorying donor lymphocytes

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36
Q

RBC preparation: Irradiated RBC: how often does GVHD occur and how high is mortality?

A

1/1 mill
90% mort

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37
Q

RBC preparation: Irradiated RBC: which 8 populations of patients may benefit from this?

A

Immunocomp
HLA match to donor
neonatal or IU transfusion
hematologic malignancy
stem cell transplant/harvest
hodgkin lymphoma
directed donation from family
congenital cellular immune deficiency
pt with antithymocyte globulin or chemo with purine analogs (fludarabine ex)

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38
Q

Whole blood: is this as good as components in hemorrhaging pt?

A

yes and actually lit recommends whole blood when available

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39
Q

What are the benefits of whole blood?

A
  1. stored whole blood less dilute than composite parts
  2. physioologic balance
  3. smaller vol of anticoagulant/preservative required
  4. higher levels of hemostatic factors
  5. fibrinogen delivery higher
  6. hemolytic transfusion rate is lower as less donor exposures
  7. Improved time to completion of transfusion
  8. Errors with transfusion or type sp blood minimized
  9. Cost effective
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40
Q

Drawbacks of using whole blood

A

shelf life shorter
concern for low titer O universal whole blood - isoimm causing hemolytic disease of newborn (but consider candidate for rhogam)

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41
Q

What is an autotransfusion?

A

giving pt back own blood

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42
Q

Advantages of an autotransfusion:

A

immediately available
blood compatible
elimination donor to pt disease transmission
lower risk circulatory overload
fewer direct complicartions related to transfusion (low ca, high k, hypothermia, metabolic acidosis)
acceptable to religious inds

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43
Q

Disadvantages of autotransfusion

A

impractical as low number of appropriate trauma pt
requires sp training
time to set up

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44
Q

Which 3 groups of pt need CMV testing on their RBC?

A

seronegative pt (pregnant)
fetal or IU transfusion
solid organ, stem cell or BM transplant recipients who are CMV negative

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45
Q

What is the goal of an RBC transfusion?

A

improve o2 delivery to tissue at microvascular level

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46
Q

What is the commonplace transfusion threshold?

A

70g/L

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47
Q

What specific patients may benefit from a transfusion threshold of 80g/L?

A

ortho surgery
cardiac surgery
pre-existing CV disease

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48
Q

Clinical judgement is still important when deciding to transfuse - what might you consider as key signs to continue/start transfusion?

A

ongoing sign inadequate perfusion - elevated lactate, ams, decreased u/o

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49
Q

1 unit of PRBC incr hbg by ?
adult vs ped

A

10 vs 10ml/kg

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50
Q

how fast should you give most transfusions?

A

60-90 mins
not more than 4 hours as bacteria can grow

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51
Q

Indications for RBC transfusion:

A
  1. active hemolysis with hemoglin <70 (to keep hemoglobin >70)
    - consider 80 of unstable or ACS, CAD, uncontrolled/unpredictable bleed
  2. anemia in CC: hemoglobin <70
  3. chronic anemia - probably consider IV iron or minimal to get no sx of anemia
    chelation therapy if pt iron overload, transfusion dependent or life expectancy more than 1 year
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52
Q

How many transfusions do you then typically see iron overload?

A

2 units

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53
Q

Fresh frozen plasma: what does this have?

A

all clotting factors

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54
Q

Fresh frozen plasma: vol?

A

200-250ml

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55
Q

Fresh frozen plasma: must be ? compatible

A

abo

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56
Q

Indications Fresh frozen plasma:

A
  1. INR >/= 1.8: active bleed or prior sign operation *liver disease pt often have preserved thrombin generation despite elevatred INR and often do not need abnormality correction)
  2. results not availbe for inr/ptt - microvascuular bleed orv massive transfusion and pt cannot wait 30-45 minsc for inr/ptt results
  3. any - TTP
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57
Q

Fresh frozen plasma: use for warfarin reversal, xa or IIa inhib anticoag reversal or heparin/LMWH reversal?

A

no!

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58
Q

Fresh frozen plasma: specific 4 rosen’s indications

A
  1. massive hemorrhage
  2. component for plasma exchange procedure
  3. emergency reversal of vitamin K if PCC unavailable
  4. tx of ACEI induced angioedema
59
Q

Fresh frozen plasma: what INR can you not decrease?

A

1.5 as innate

60
Q

Fresh frozen plasma: dose?

A

10-30ml/kg

61
Q

Platelets <10: when to transfuse (procedure):

A
  1. non immune thrombocytopenia
  2. ” and HLA alloimmunized
62
Q

Platelets <20: when to transfuse (procedure):

A

procedures not asssoc with sign blood loss - central line

63
Q

Platelets <20-50: when to transfuse (procedure):

A

procedures not assoc with sign blood loss

64
Q

Platelets <30: when to transfuse (procedure):

A

pt on antiocoag that should not be stopped

65
Q

Platelets <50: when to transfuse (procedure):

A

epi anesthesia and LP
procedures assoc with major blood loss (>500ml expected)
immune thrombocytopenia

66
Q

Platelets <100: when to transfuse (procedure):

A

pre neurosurg or head trauma

67
Q

Platelets any: when to transfuse (procedure):

A

plt dysfunction and marked bleeding like post CPB

except NOT for pt with ICH on antiplt agents not undergoing surgery as incr mortality

68
Q

PEDS: Platelets <20: when to transfuse (procedure):

A

term infant

69
Q

PEDS: Platelets <30: when to transfuse (procedure):

A

pre term >7d
neonatal alloimm thrombocytopenia

70
Q

PEDS: Platelets <50: when to transfuse (procedure):

A

pre term and <.=7d old
pre non neuraxial surgery
concurrent coagulopathy
previous sign hemorrhag (gr 3-4 IV or pulmonary hemorrhage)
active bleeding

71
Q

PEDS: Platelets <100: when to transfuse (procedure):

A

pre neuraxial surgery

72
Q

Plt count above 10 with no bleeding, ITP without major hemorrhage even if plt <10, pt undergoing procedures more than 6 hours later, minor procedures with plt >20 (para, thorac):

give plt?

73
Q

Do plt need to be cross matched?

74
Q

Rh premeno women need which type plt?

75
Q

platelets: dose adult vs ped

A

4 units of plt concentrate or single apheresis unit
vs
1 unit/1okg per bw

76
Q

platelets: how much should incr per 1x dose?

77
Q

Cryopreciptiate: what is this?

A

single donor plasma gradually thawing rapidly frozen plasma gives you a precipitate of fibrinogen, factor VIII, factor XIII, vWF, fibronectin

78
Q

Cryopreciptiate: how much is each unit in ml?
how much fibronigen and VIII?

A

15-20ml

150mg

80IU

79
Q

Cryopreciptiate: need abo compatibility?

80
Q

Cryopreciptiate: rosen’s indications:

A

fibrinogen deficiency: bleeding w <1g/L or massive hemorrhage <1.5-2
congenital afibrinogenemia
dysfibrogenemia
Hem A or vWF if recombinant factors not available

81
Q

Cryopreciptiate: adult dose

82
Q

Prothrombin concentrate complex: what 4 factors does this have?

83
Q

Prothrombin concentrate complex: indication?

A

reversal INR elevated >1.4 in pt with life thr bleeding of ICH

84
Q

Massive transfusion protocol: defn

A

administration of 10 units of PRBC in 24 hours

reality: 3 units over 1 hour or use of 4 components in >30 mins

85
Q

Massive transfusion protocol: 1:1:1 of ?

A

prbc
ffp
plt

86
Q

Massive transfusion protocol: 1:1:1 initiated when how many prbc exceeded?

87
Q

Massive transfusion protocol: complications

A
  1. hypothermia - warm fluids and active/passive warm
  2. low mag and ca
  3. low/high K level
  4. acidosis
  5. citrate metabolized to bicarb = metabolic acidosis
88
Q

Basics of major hemorrhage management: 4

A
  1. address source of bleed
  2. early resus w blood: peds rbc 10-12cc/kg, consider mtp
  3. reverse anticoag
  4. consider txa
89
Q

TACO: clinical findings

A

evidence of vol overload proportional to vol given - dyspnea, edema, rales, tachycardia, hypertension
6-12 hours post transfusion

90
Q

TRALI: clinical sx

A

hypotension, fever, hypoxia

91
Q

transfusion reaction, risk of event: red cell sensitization, incr risk hemolytic transfusion reaction, hemolytic disease of newborn

92
Q

transfusion reaction, risk of event: febrile non hemolytic transfusion reaction per pool of plt

93
Q

transfusion reaction, risk of event: TACO

94
Q

transfusion reaction, risk of event: minor allergic reaction/urticaria

95
Q

transfusion reaction, risk of event: febrile non hemolytic transfusion reaction per unit of RBC

96
Q

transfusion reaction, risk of event: delayed hemolytic tranfusion reaction per pt transfused

97
Q

transfusion reaction, risk of event: TRALI or sepsis

98
Q

transfusion reaction, risk of event: serious allergic reaction per unit of component

99
Q

transfusion reaction, risk of event: post transfusion purpura

100
Q

transfusion reaction, risk of event: abo incompatible transfusion per rbc transfusion

101
Q

Transfusion reaction: minor allergic: sx

A

urticaria > wheezing, angioedema

102
Q

Transfusion reaction: minor allergic: cause?

A

allergic
abody mediated reesponse to donor plasma pro

103
Q

Transfusion reaction: minor allergic: tx

A

antihistamine and resume transfusion if skin limited

104
Q

Transfusion reaction: Anaphylactic: cause?

A

idiopathic (anti IgA in host to IgA of donor - can occur in IgA deficient people)

105
Q

Transfusion reaction: Anaphylactic: treatment

A

Stop transfusion and tx anaphylaxis perv N

106
Q

Transfusion reaction: Anaphylactic: if have to keep going with transfusion once treat anaphylaxis, how to proceed?

A

steroids/antihis + washed cellular products

107
Q

Transfusion reaction: Febrile non hemolytic: defn

A

temp elevation of 1C or higher occurs with transfusion and for which no other explanation is available

108
Q

Transfusion reaction: Febrile non hemolytic: sx

A

fever
rigors and chills

109
Q

Transfusion reaction: Febrile non hemolytic: why?

A

recipient anti leukocyte antibodies thta react with donor wbc and from CK release during storage

110
Q

Transfusion reaction: Febrile non hemolytic: doing what to rbc reduces risk?

A

leukoreduction

111
Q

Transfusion reaction: Febrile non hemolytic: management

A
  1. first time - tx as acute hemolytic reaction until proven otherwise
  2. if temp >2 or hd instability - tx as Acute hemolytic reaction

Once r/o hemolysis - tx acetaminophen and transfuse new unit

Hx feb reaction and no incr temp by >2 then can tx antipyretics and cont original transfusion

112
Q

what is the most serious acute transfusion reaction?

A

Acute hemolytic transfusion reaction:

113
Q

Acute hemolytic transfusion reaction: what tends to happen for this to occur?

A

abo incompatibility through a clerical or lab error

114
Q

Acute hemolytic transfusion reaction: as little as _ml can be fatal

115
Q

Acute hemolytic transfusion reaction: pathophysiology

A

recipients serum has antibodies against donor rbc and get hemolysis or donor cells within seconds to minutes (donor clumps together then hemolyzed)

116
Q

Acute hemolytic transfusion reaction: timeline of occurence

A

immed but can be up to 24h

117
Q

Acute hemolytic transfusion reaction: sx

A

fever, chills, hypotension and shock
hemoglobinuria
burning site, impending doom, n/v, chest restriction

118
Q

Acute hemolytic transfusion reaction: labs to get and their results

A

Decreased:
- hemoglobin and or hematocrit
serum haptoglobin
fibrinogen level (DIC)

Incr:
hemogloinemia, hemoglobinuria, LDH, indirect bili, prolonged PT/PTT/d-dimer

Schistoyctoes or spherocytes on peripheral smear

119
Q

Acute hemolytic transfusion reaction: treatment

A

stop transfusion
replace all tubing, installation of vigorous crystalloid fluid therapy
vaso pressure/diuretic up to u/o 1-2ml/kg/hour
blood/urine specium, transfusion and tubing sent for testing

120
Q

Acute hemolytic transfusion reaction: diagnossi confirmed by?

A

free hemoglobin in blood and urine and + coombs post transfusion but no pre transfusion specimens

121
Q

TRALI defn

A

noncardiogenic pulmonary edema occurring during or shortly after transfusion of virtually any blood product

vs

National Healthcare safety network defn: no evidence lung injury prior and onset of lung injury within 6 hours of stopping transfusion and hypoexmia as pao2/fio2 </= 300mhg or o2 sat 90% or less on RA and
radiographic bilateral infilrates and no evidence of LA hypertension/circulatory overload

122
Q

What blood product typically causes TRALI?

A

plt more often

123
Q

TRALI: clinical features

A

noncardiogenic pulmonary edema
dyspnea
hypoxemia
bilateral infiltrates on cxr

fever, hypotensio and transient leukopenia may be seen

124
Q

TRALI treatment

A

stop transfusion, tell blood bank
NIPPV or intubation as required
safr to comlete transfusion of blood products from different donor
Complete resolution within 48-72 hours

125
Q

TACO: defn

A

vol overload proportional to vol transfused

126
Q

TACO: RF

A

pre existing heart condition
renal insufficiency
age extremes

127
Q

2 hit hypothesis TACO pathophysiology:

A
  1. vol incompliance
  2. composition of fluid given
128
Q

TACO: tx

A

stop transfusion
diuretics
nitro 50-100mcg/min IV
NIPPV
intubation/vent if RQ
Future transfusion: slow rate and prophylactic diuretics

129
Q

Infectious complications of blood transfusions: risk HIV, hep b/c

A

<1 in a million

130
Q

Infectious complications of blood transfusions:reduced risk of bacterial transfusion duration < ? hours and return blood if unrefridgerated for __ mins

131
Q

Bacterial culture positive transfusion reaction vs septic transfusion reaction defns

A

BCPTRs: + bact culture from transfused blood, recipient or both

STR: matched culture result from both donor unit and pt blood culture
- consider if temp >38 and >1c rise from pretransfusion temp + rigors/n/v/dyspnea/hypotension/shock

132
Q

Delayed hemolytic transfusion reaction: how many days post?

133
Q

Delayed hemolytic transfusion reaction: how does this occur?

A

previously sensitized to red cell minor. ag through transfusions, pregnancy, transplantation

134
Q

Delayed hemolytic transfusion reaction: clinical features

A

fever
anemia
jaundice

rare dic/oliguria

135
Q

Delayed hemolytic transfusion reaction: tx

A

supportive and notify blood bank

136
Q

Transfusion associated GVHD: defn

A

transfused lymphocytes proliferate and attach a recipient incapable of mounting a response

137
Q

Transfusion associated GVHD: RF

A

cell mediated ID
congenital ID
hematologic malignancy
stem cell transplant
treatment with purine analogue chemo
HLA type similar between donor and recipient (first degree relatives)

138
Q

Transfusion associated GVHD: timeline after transfusion?

139
Q

Transfusion associated GVHD: sx

A

fever
erythematous skin rash
diarrhea
elevated LE
pancytopenia

140
Q

Transfusion associated GVHD: preventation tactic

A

gamma irrad of cellular components so donor lymphocytes cannot proliferate

141
Q

Transfusion associated GVHD: tx?

A

palliative

142
Q

Post transfusion purpura: defn

A

profound thrombocytopenia can develop 1-3 weeks after transfusion due to antibody response to plt antigen (likely eliminated and resolves on own)

143
Q

Post transfusion purpura: if at risk for bleed or actively hemorrhage, supportive tx +:

A

high dose ivig
plasmapheresis
platelet transfusion

Rosens (67 decks)

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