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Heme/Lymph 2 CP > 21- An Introduction to Transfusion Medicine > Flashcards

21- An Introduction to Transfusion Medicine Flashcards

1
Q

What are the requirements to be able to donate blood? How much blood is taken and how frequently can you donate whole blood?

A

age>16 yrs

pass a limited history/physical (questionnaire, general appearance POC, BP, Hb)

donation for whole blood= 8 week intervals

apporx 500 ml of blood is taken

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2
Q

How do we manufacture a blood product?

A

Centrifugation! We separate Cells from plasma

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3
Q

What 9 diseases do we test blood products for?

A

Syphillis

Hepatitis B

Hepatitis C

HIV

HTLV-I/II

West Nile Virus

Trypanosoma cruzi

Zika Virus

Babesia microti

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4
Q

What antigen(s) and antibodies does group A blood have?

A

A antigen (on RBC)

Anti-B antibody (in plasma)

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5
Q

What antigen(s) and antibodies does group B blood have?

A

B antigen (on RBC)

Anti-A antibody (plasma)

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6
Q

What antigen(s) and antibodies does group AB blood have?

A

A and B antigen (on RBC)

No antibodies!

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7
Q

What antigen(s) and antibodies does group O blood have?

A

No antigens! (on RBC)

Anti-A antibody and Anti-B antibody , Anti-AB antibody

(I have never heard of anti-AB antibody but I put it on here bc it was on this picture, not sure if it is real. but what do I know I’m not a doctor)

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8
Q

How important is the ABO red cell blood group system?

When do people develop their antibodies?

A

Most important red cell blood group system!

Antibodies are naturally occuring, very potent, and can activate complement

(responsible for many acute/fatal hemolytic transfusion reactions)

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9
Q

What is the most important antigen for Rh blood typing? When do people develop antibody?

A

You either have the Rh antigen (D antigen) (+) or you don’t (-)

D is immunogneic-80% sensitization

antibodies develop thorugh pregnancy or trans fusion (aka exposure)

implicated in hemolytic disease of the newborn and hemolytic transfusion reactions

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10
Q

Pre-transfusion testing can be “type and screen” or “type and cross” what thing do we type and screen for?

A

ABO and Rh

Antibody screen

low likelyhood for transfusion ie pre-op for cholecystectomy

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11
Q

Pre-transfusion testing can be “type and screen” or “type and cross” what thing do we type and cross for?

A

ABO and Rh

Antibody Screen

Cross Match

Moderate to high likelyhood for transfusion likelihood (ie pre-op heart surgery)

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12
Q

What is done for pre-transfusion testing? Write out the path if the antibody screen was negative

A

Patient blood sample

perform ABO/D typing

perform antibody screen ***negative**

select ABO/D compatible product

perform cross-match

issue RBC product

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13
Q

What is done for pre-transfusion testing? Write out the path if the antibody screen was positive

A

Patient blood sample

perform ABO/D typiing

Perform antibody screen (unexpected antibodies) **positive**

perform antibody identification panel

Select ABO/D compatible, antigen-negative RBC product

perform cross-match

issue RBC product

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14
Q

How do we test for ABO?

A

Add in A, B and AB cells to the patients plasma/serum and see what clumps

clumping signals that the patient has antibody against whatever cell type was added

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15
Q

What is the IAT Antiglobulin Test (IAT)? Screen

A

The IAT detects red cell antibodies in the patient’s serum

(we are adding known cells to the patients serum and looking for response)

uses: antibody screen/panel, compatibility testing

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16
Q

What do you do if the IAT antibody screen is positive?

A

an antibody identification panel (another bigger IAT)

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17
Q

What is crossmatch?

A
  • Another IAT
  • Final test: is the blood that we selested for your patient?
  • units are screened for antigen if Abs identified (via the IAT)
  • confirmation/Ab specificity not ID’d on AB screen
  • crossmatch may be omitted under certain circumstances

so add in donor cells to the patient’s serum. these are not the same cells from the IAT, these are cells from a volunteer that we don’t know a lot about

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18
Q

What does the DAT detect? What are 4 causes?

A

antibody attached to patient red cells in vivo

Autoimmune Hemolytic Anemia

Drug Induced Hemolytic Anemia

Hemolytic Transfusion Reactions

Hemolytic DIsease of Newborn

(we add atibodies to patient whole blood)

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19
Q

Why is it important to plan ahead for pre-transfusion testing?

A

It can take an hour! and that is if nothing is found on the IAT!

You need to get one of these every 3 days while transfusions are needed

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20
Q

What does emergency release blood mean?

A

skips all the steps to get you blood fast!

uncrossmatched

red cells=O (mostly pos), plasma=ABA/A

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21
Q

What does Massive support mean?

A

Friends like Drs. Pook and Matter <3 but also…

helpful at times of severe, uncontrolled bleeding

uses emergency blood components in a ratio to prevent coagulopathy

10RBCs/6plasma/1plt, or 6 RBCs/6plasma/1plt

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22
Q

What blood products can you get?

A

Red blood cells (RBCs)

Plasma (FFP)

Platelets (Plts)

Cryoprecipitate (Cryo)

(aldo whole blood and granulocytes)

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23
Q

How do we prep and store RBCs? What do they contain? what is their outcome?

A

Prep: Cells separated by centrifugation, plasma removed, stored at 4C for 42 days

Contains: 300ml, HCT 55-60%, no viable platelets for WBCs

Outcome: transfuse over 3-4hrs, raise Hgb 1g/dl in average size adult

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24
Q

What blood type is the universal recipient and the universal donor?

A

Donor: O-

Recipient: AB+

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25
Q

When should patients be transfused with RBCs?

A
  • acute,rapid, blood loss
  • symptomatice perioperative anemia
26
Q

What are the suggestions for RBC transfusion during acute rapid blood loss?

A

to increase o2 delivery (>7)

anemic pts with hemodynamic instability

15-30% loss: not required

30-40% loss: probably required

>40% loss required

27
Q

What are the suggestions for RBC transfusion during symptomatic/perioperative anemia?

A

single unit transfusions with H&H/ symptom rechecks

decisions should be guided by symptoms, vitals, labs

Hgb<7 transfusion indicated

28
Q

What are 3 reasons you should NOT give RBC transfusion?

A

based only on Hemoglobn levels

as volume expander (use saline)

as a means of improving iron/B12/folate

29
Q

What is the prep/storage, contents, and outcomes of plasma transfusion?

A

prep: plasma separated from whole blood by centrifugation, red cells removed. store at -18C for 12 months, stored at 4C for 5 days
contains: 250ml plasmaproteins, no platelets, RBCs, or WBCs
outcome: 10-20ml/kg rasises all clotting factors by 20-30% in average size adults

30
Q

So what is in plasma?

A

all coagulation factors! (including fibrinogen, fibronectin, vWF)

all thrombolysis factors (Protein C, S, plasmin)

antibodies

cytokines

proteins (albumin)

31
Q

who is the universal PLASMA donor? recipient?

A

Donor: AB

Recipient: O

32
Q

When are plasma transfusion helpful for:

A

active/expected bleeding and documented coagulopathy (INR>1.7 or PT and/or PTT greater than 1.5 times upper limit of normal range)

  1. cases of massive hemorrhage
  2. pts with mulitple coagulation factor deficiencies (liver failure, DIC)
  3. isolated deficiency with no available concentrate (V, ADAMTS13-TTP)
  4. Angioedema (ACE or congenital)
33
Q

When are plasma transfusions NOT helpful?

A
  • as a volume expander (use saline/albumin)
  • to quickly reverse Heparine (use protamine), Warfarin (use PCC if urgent Vit K if not), other anticoagulants (ie dabigatran)
  • Mildly elevated INR or PT/PTT
  • Routine paracentesis or variceal band ligation
34
Q

how do INR and plasma transfusions relate?

A

Plasma ha a low INR so it won’t necessarily fix the pts INR

FFP never completely correct PT in pts with severe liver disease

PT/INR is not directly correlated with bleeding incidence and severity

35
Q

Cryoprecipitate

prep/storage

contains

outcome

A

prep: fluid separated thawing plasma slowly , stored at -18C for 12 months, room temp for 4 hours

contains: 15-20ml/unit, enriched for Fibrinogen, noviable platelets, RBCS, WBCs

Outcome: 1 unit/10 kg will raise fibrinogen by 50mg/dL in an average size adult

36
Q

So what is in cryoprecipitate

A

a big bag of fibrinogen!!

there is also this stuff…

37
Q

What are the 4 indications for cryoprecipitate?

A
  • Hypofibrinogenemia with bleeding (DIC, Severe liver disease, massive bleeding/obstetric bleeding)
  • Dysfibrinogenemia with bleeding (acquired-liver disease, congenital)
  • Factor XII deficiency
  • Not indicated for hempphilia A or VWD
38
Q

How do we store platelets? Outcome?

A

prep/storage: cells separated by centrifugation of whole blood or apheresis, stored at room temp for 5 days

outcome: raises plt count 30,000-60,000 in an average size adult

39
Q

what is contained in a unit of platelets?

A

random donor unit: 5.5* 10^10 platelets in 50-70ml plasma

single donor platelets: 3*10^11 platelets in 300 ml plasma

no viable RBCs, or WBCS

40
Q

When do we transfuse platelets?

A

active bleeding

marrow failure patients

prophylaxis before surgery

41
Q

what are the guidelines for transufusion of platelets during active bleeding?

A

platelet count< 50,000

platelet function defect (platelet inhibitor medication, cardiac bypass circuit, congenital platelet disorder)

42
Q

What are the guidelines for platelet transfusion in marrow failure patients?

A

<10K transfusion indicated

10-20K if bleeding history, fever, mucositis

43
Q

What are the guidelines for platelet transfusion prophylactically before surgery?

A

<50K: general surgery, procedures

<100K: Eye, CNS, high risk surgery

any count: platelet inhibitory drugs or congenital platelet dysfunction (aspirin, plavix)

44
Q

What are 4 contrandications to platelet transfusion

A

TTP

HIT

ITP

PTP (post transfusion purpura)

ina all these cases either the platelets are quickly consumed or there may be an increased risk of thrombosis (ie HIT)

45
Q

Define these words that are related to blood products (sorry didnt kno how else to do this slide)

Leukoreduced

CMV negative

CMV safe

irradiated

volume reduced

washed

fresh

A

Leukoreduced- less WBCs all products are leukoreduced

CMV negative- tested product is negative

CMV safe: donor or product is negatvie but product was not tested

irradiated: to prevent GVHD!

volume reduced: in fluid sensitive patients

washed: if your patient has a lot of allergies/ anaphylaxis
fresh: old products RBCs may lyse leading to increase K, so fresh blood is good for K sensitive people

46
Q

What things cause acute infectious transfusion reactions? Delayed (days-weeks)

A

acute: bacteria/sepsis

delayed (days-weeks): Hepatitis B, C, HIV

47
Q

What are 5 Acute (hours) non-infectious transfusion reactions

A

Simple fever (FNHTR)

Hemolysis (AHTR)-rejection

Cardiac overload (TACO)

Acute lung injury (TRALI)

Allergic/anaphylaxis

48
Q

What are 4 delayed non-infectious transfusion reactions?

A

GVHD

Iron overload

Hemolysis (DHTR)

Post transfusion purpura

49
Q

What adverse transfusion events are associated with fever?

A

FNHTR (benign)

Hemolysis (deadly)

Sepsis (deadly)

either way STOP THE TRANSFUSION if they have a fever

50
Q

What adverse transfusion events are associated with dyspnea?

A

TRALI

TACO
Anaphylaxis

51
Q

What adverse transfusion reactions are associated with prupritis?

A

allergy/anaphylaxis

52
Q

Which adverse reactions are the most deadly?

A

Dyspnea associated one! TACO and TRALI

TRALI IS NUMBER 1

53
Q

What is the most common adverse transfusion reaction?

A

allergies/hives

54
Q

Which infection is most common to get from an infusion?

A

Hep B

55
Q

What are the symptoms of TRALI?

A

acute respiratory distress and hypoxemia (wet crackles/rales, pink frothy sputum)

hypotension

fever/chills

56
Q

What is the pathogenesis of TRALI? idk if we need to know this……

A

nothing helps with the fluid overload so hopefully in 3-7 days it will pass

57
Q

What is the difference between acute hemolytic reaction and delayed hemolytic reaction?

A

Acute=rapid (1-2hrs), intravascular, ABO error

Delayed= late (5-7 days), extravascular, undetected antibody at XM

58
Q

How do we prevent Ta-GVHD?

A

Irraditation of blood products and pathogen inactivation

**he skipped this slide so I am attaching it but i dont htink we need to know it!

59
Q

Who is at risk for Ta-GVHD?

A

Seems to me like anyone who is receiving immunotherapy for any reason…again he skipped this slide. sorry

60
Q

what is the pathophysiology of Febrile non-hemolytic reactions?

A

IL1, 6, TNF from activated mono/macro. passive/induced donor cytokines from donor WBC

Heme/Lymph 2 CP (16 decks)

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