22- Transfusion Medicine

Question 1

REVIEW!

What are the 4 Blood groups?

What RBCs can each recieve and what plasma?

Answer 1

Group O- Group O blood and Group O, A, B, AB plasma

Group A- Group A, O blood, and Group A, AB plasma

Group B- Group B, O blood, Group B, AB plasma

Group AB- Group A, B, AB, O blood, and group AB plasma

Question 2

When do we prophylactically give platelelet transfusions?

Answer 2

Marrow failure

before surgery

Question 3

What are the guidelines for giving platelets to marrow failure patients?

Answer 3

<10K transfusion indicated

<20K may be indicated (ie sepsis, mucosisitis, bleeding history)

Question 4

What are the guidelines for giving platelets before surgery?

Answer 4

<50K General surgery, IR procedures

<100K CNS, Eye, high-risk surgery

Any platelet count: platelet inhibitor drugs; platelet dysfunction

Question 5

When do we therapeutically give platelets transfusions?

Answer 5

active bleeding AND

• platelet count <50K
• platelet function defect- platelet inhibitor meds, congenital platelet disorder

Question 6

Which patients SHOULD get RBC transfusion?

Answer 6

• Symptomatic/perioperative anemia
  
  • ​single unit transfusions with H&H/symptom rechecks
  • decisions should be guided by combination of symptoms, vital signs, and lab values
• Patients who are actively bleeding
  
  • Hgb trigger to begin transfusion is based on rapidity of bleeding and ability to “stop the bleed”

Question 7

What is the safest bet for RBC transfusion Hgb cut off

Answer 7

RESTRICTIVE transfusionstrategy (Hgb 7-8 g/dL) is safe

the literature supports this

Question 8

When is it reccomended that you use restrictive RBC strategy?

Answer 8

• Restrictive
  
  • Hgb<7 for stable pts in hospital
  • Hgb<8 for pts undergoing ortho, cardiac surgery or pre-existing CVD

Question 9

In what pts is there no reccomendation for transfusion threshold?

Answer 9

ACS/MI, heme/onc w bleeding risk, chronic transfusion dependent anemia

**I guess this mean for these pts just use your best judgement

Question 10

What is the expected effect of 1 unit of RBC transfusion?

Answer 10

increase Hct by 3%

increase Hgb by 1 g/dL

rapid initial effect; Hbg recheck at 15 minutes post-transfusion should be similar to check 24 hrs (otherwise there may be a destructive process)

Question 11

What are the universal steps if you suspect a transfusion reaction?

Answer 11

STOP THE TRANSFUSION
Keep the IV patent (new tubing and .9NS)

Obtain vital signs, assess patient

provide supportive care

Question 12

What will the nurse do if a transfusion reaction is suspected?

Answer 12

verify all patient and product information

notify provider and transfusion services

follow provider orders (meds, labs, etc)

send blood bag and any paperwork to lab

document reaction in patient’s medical record

Question 13

What 4 conditions could be assciated w fever during a transfusion?

Answer 13

FNHTR

Hemolysis

Septic Reaction

Patient’s Underlying Disease

Question 14

What condition is associated with rash/itching during transfusion?

Answer 14

Allergic reaction

Question 15

What transfusion reactions are associated with dyspnea?

Answer 15

TRALI (most deadly)

TACO

Anaphylaxis

Question 16

What causes Acute Hemolytic Transfusion Reaction?

Answer 16

Accelerted clearance of transfused red cells due to red cell incompatibility between donor and recipient

Anti-A or Anti-B, Anti-Kell, Anti-Jk(a), Anti-Fy(a)

Question 17

What are the signs ans symptoms of Acute Hemolytic Transfusion Reaction?

Answer 17

Fever, chills, nausea and impending doom

hypotension

back pain, chest pain, or pain at infusion site

hemoglobinemia, hemoglobinuria

coagulopathy

renal failure

Question 18

How do you treat Acute Hemolytic Reaction?

Answer 18

• Stop transfusion
• IV fluids to maintain blood pressure and urine output
• supportive care
  
  • monitor vitals
  • monitor labs Hgb, renal function
  • administer platelets, FFP, and/or cryoprecipitate as needed for DIC

Question 19

What is the most common transfusion reaction that presents with a fever?

Answer 19

Febrile Non-Hemolytic Transfusion Reaction (1-3%)- honestly what a relief

Question 20

What does the frequency of Febrile non-hemolytic transfusion reaction vary with?

Answer 20

type of blood product and WBC content

age of blood product

recipient characteristics

Question 21

What signs and symptoms are associated with Febrile Non-hemolytic Transfusion Reaction and when do they occur?

Answer 21

during or up to 4 hrs post transfusion

Fever (at least 1C or 2 F elevation so >38C/100.4F)

usually associated with chills and/or rigors

no other cause is identifiable

Question 22

What is the etiology of FNHTR

Answer 22

interaction of leukocyte antibody (in recipient) with leukocytes/fragments in product

passive transfer of biologic response modifiers that accumulate in product during storage

activates cytokines (I-1B, IL-6, TNFa)

triggers fever and chills

Question 23

How do you manage suspected FNHTR?

Answer 23

antipyretic initially

if significant rigors 25-50mg Demerol IV

often see resolution of fever and chills within 30 minutes of dicontinuation of unit

Leukoreduction (LR) has reduced the incidence of FNHTR (reduced 50% in Red cells and 80% in platelets)