17 Transfusion Med

Question 0

DAT

Answer 0

Dirrect antiglobin test

Donor blood + patient serum and anti IgG = Precipitation

Question 1

Additions to blood products and their function

Answer 1

Citrate- calcium chelator- anticoagulant
Phosphate- stabalizes 2,3 DPG
Dextrose- Cell food
Adenine- ATP/ADP production

Question 2

When do I transfuse

Answer 2

If patient is Hb <8 and symptomatic

Question 3

FFP

Answer 3

Can normalize clotting cascade, but will likely overload patient- need 10ccs per KG- 70kg adult needs 3 units at 200-250mls

ONLY CORRECTS INR IF > 1.5

Question 4

Cryo

Answer 4

Factor 8 and VW(there are drugs that deal with these)
FIBRINOGEN
factor 13
Fibronectin

USUALLY ONLY GIVVE IF ACTIVELY BLEEDING

Question 5

Platelet concentrates

Answer 5

5 day room temp preservation
Give if platelets <10K
want 50K platelets for gen surg and 100K for eye, CNS, or high risk

Question 6

Febrile non hemolytic transfusion Rxn

Answer 6

Anibodies in recipient to donor WBCs, 1:200 transfusions
usually occurs at 1-2 hours (end of transffusion)

FEVERS
chillls rigrs
HTN
tachycardia
SOB

Question 7

hemolytic transfusion reacton

Answer 7

RBC clearance due too antibodies
Acute: -ABO errors or intravascular hemolysis (1-2 hrs)
Delayed: Antibodies not detected at screen, Extravascular hemolysis (5-7 days)

Fevers, chills, rigors, anxiety/doomed feeling, chest and abd pain, dyspnea

Treatment- stop infusion
Dopamne for BP as necessary
Administer platelets,FFP, and or Cryo for DIC

Question 8

TRALI

Answer 8

1 CAUSE OF TRANSFUSION REACTION DEATH 2-6 hrs after transfusion

Pulmonary edema and ARDS
hypoxemia/cyanosis
tachycardia, hypotension
Fever
pO2 <90mm HG

Antibody mediated: HLA and neutrophil specific activating antibodies (preprimed from chronic disease)

Question 9

TRALI PREVENTION

Answer 9

FFP only from males and females with no history of prior pregnancy

Aphoresis platelets only males and females screened for HLA antibodies.

Question 10

Transfusion GVHD

Answer 10

FEVER and RASH 3 weeks after transfusion
Pancytopenia
90% mortality
Risk is highest in immunosuppressed

Question 11

Massive hemorrhage

Answer 11

5L in 150mL/min with hemodynamic instability

Question 12

Massive transfusion

Answer 12

> 10 units RBCS in 50 units components in 4 units RBCs in one hour

Transfuse in 1-2RBC:1FFP:1Platelet (or 1/6 aphoresis)