255/256 - Blood Transfusions Flashcards
If a patient is acutely bleeding, what is “priority #1” to replace?
IV blood volume; use fluids
Goal is to avoid hypovolemia, hypoperfusion
Which of these infections is most frequently transmitted by blood transfusions?
- HCV
- HBV
- HIV
- Bacterial sepsis (platelets)
- West Nile virus
d. Bacterial sepsis (platelets)
A 72-year-old patient with metastatic breast cancer on chemotherapy is emergently transferred to your hospital with vertebral collapse and thoracic spinal cord compression. The neurosurgery service recommends immediate surgery. Her Hgb is 8.4 gm/dL, platelet count 55K/uL, PT 15.6 sec (normal 10-13) (INR 1.4), PTT 38.2 sec (normal 25-35), fibrinogen 160 mg/dL (normal 200-400).
Which blood component would be your highest priority for transfusion before surgery?
- None needed
- RBCs
- Platelets
- Plasma
- Cryoprecipitate
c. Platelets
* I think it’s this but not toally sure*
* Threshold to give RBCs: Hgb < 7 g/dL (<8 g/dL in cardiac issue)*
* Threshold to gibe plasma: INR > 1.7 (or PTT >1.5x normal)*
* Threshold to give cryoprecipitate: Fibrinogen <100 (<200 obstetric)*
What is the highset infectious-disease risk from transfusions?
(Result and type of transfusion)
Bacterial sepsis from platelets
What is the normal immediate response to platelet transfusion?
What constitutes a refractory response?
Normal = platelets rise by 25-30k
Refractory = platelets rise by <10k
1 dose of cryoprecipitate increases a patient’s fibrinogen level by how much…
on average?
Ideally?
Average: 40 mg/dL increase in fibrinogen
(if not consumed)
Ideally: 65 mg/dL
For which blood products (2) do we have pathogen inactivation methods?
Plasma
Platelets
Still in development for RBCs
What is the goal of giving cryoprecipitate to a patient?
Increase fibrinogen levels
List 4 key initial manifestations of transfusion reaction
Fever
Rash
Hypotension
Respiratory problems
What is the goal fibrinogen when you are giving cryoprecipitate?
(How do you know when you’re done?)
>100 mg/dL in pts with bleeding or surgery
>200 mg/dL in obstetric pts
Which element of RBC compatibility testing is most critical?
ABO
What causes graft vs. host disease?
What is the treatment?
Donor lymphocytes attack host tissues
Pts does not ahve a normal rejection response to the transfused RBCs
Most commoni in pts who are severely immunosupressed, or when there is very close HLA-matching
Recipient WBCs see donor RBCs as self and does not attack them, but the donor WBCs see recipient antigens and attack them
Treat with corticosteroids
1 unit of RBCs will increase a patient’s hemoglobin by how much?
1 g/dL
A 27-year-old motorcyclist suffers multiple injuries in a collision and is in trauma surgery. He has diffuse bleeding in the surgical fields and his plasma fibrinogen is 70 mg/dL despite numerous units of plasma. With an ideal response, how many doses of cryoprecipitate are needed to achieve the recommended fibrinogen level?
- None—no cryo needed
- One
- Two
- Five
b. One
* Ideal response = 40 mg/dL increase, target is >100 mg/dL*
The blood bank places a transfusion tag on each unit containing patient’s ID and unit number. Which one of the following pre-transfusion blood checks provides the most complete patient safety?
- Check the transfusion tag patient ID with the patient wristband ID
- Verify the transfusion tag unit # with the blood bag unit #.
- Compare the transfusion tag patient ID and unit # with the blood unit # and the patient wristband ID.
- Read the patient her name from the transfusion tag and her wristband
c. Compare the transfusion tag patient ID and unit # with the blood unit # and the patient wristband ID