5. Transfusion Flashcards
antigen is found on
RBC
antibody is found
in plasma for the antigen that they do not have
A: antibody
anti-B
A: antigen
A antigen
B: antibody
anti-A
B: antigen
B antigen
AB: antibody
none
AB: antigen
A antigen
B antigen
O: antibody
anti-A
anti-B
O: antigen
none
immunogemic
most likely to cause reaction due to incompatibility
which blood system is most important
ABO
which blood system is 2nd important
Rh system
Rh antigens are
highly immunogenic
Rh+ can receive
Rh+
Rh-
Rh- can receive
Rh- only
when do Rh antibodies develop
after exposure
- transfusion
- pregnancy
main cause of hemolytic disease in newborn
Rh
which blood type is universal recipient
AB+
which blood type is universal donor
O-
AB+ can receive
ALL blood
AB- can receive
O-
A-
B-
AB-
A+ can receive
O+
O-
A+
A-
A- can receive
O-
A-
B+ can receive
O+
O-
B+
B-
B- can receive
O-
B-
O+ can receive
O+
O-
O- can receive
O-
universal FFP recipient
O
universal FFP donor
AB
O can receive FFP
O
A
B
AB
A can receive FFP
A
AB
B can receive FFP
B
AB
AB can receive FFP
AB
does the Rh matter for FFP
no
agglutination
occurs if antigen is mixed with its corresponding antibody
type and screen purpose
to detect antibodies commonly associated w/non-ABO hemolytic reactions
type and screen time
45-90 mins
incidence of reaction after T+S
<1%
type and cross purpose
- confirm ABO/Rh typing
- detects antibodies to other systems
- detects antibodies in low titers
type and cross time
15 - 60 mins
which blood test is mixing pt blood with donor blood
type and cross
incidence of reaction after T+C
~ 0%
what are donor bloods tested for
Hep B
Hep C
HIV
syphilis
blood donation preservative
CPDA-1
CPDA -1
Citrate
Phosphate
Dextrose
Adenosine
CPDA shelf life
35d
Citrate function
anti-coag
binds Ca2+
Phosphate function
buffer
Dextrose function
red cell energy source
adenosine function
precursor for ATP synthesis
best blood to give if you have it
whole blood
PRBC shelf life
35 days
PRBC effect
1 unit will raise :
Hg 1g/dL
Hct 3%
PRBC SE
citrate toxicity
hypothermia
hyperkalemia
decr 2,3-DPG
when is transfusion considered
Hg 6-10 g/dL
which pts need higher Hg
CAD
cardiopulm
cerebrovascular
elderly
how many donors are needed for 1 bag of plts
6-8
plt storage
20-24C
Plt effect
1 unit will raise plts by 5k-10k
plt indication
thrombocytopenia
plt dysfunction
is ABO compatibility req for plts
no
only prophyaltic indication for plts
TBI
FFP contains
plasma proteins
most clotting factors
difference between FFP and albumi
FFP contains clotting factors
FFP effect
1 unit will raise clotting factor by 2-3%
is ABO compatibility needed for FFP?
yes
is Rh compatibility needed for FFP?
no
FFP indications
Tx of isolated factor deficiencies
warfarin reversal
coagulopathy (liver dz)
massive transfusio n
FFP warfarin reversal dose
5-8 mL/kg
cryo
prepicipitate remaining after FFP is thawed slowly
cryo contains
F VIII
FXII
vWF
fibrinogen
cryo effect
1 unit incr fibrinogen by 5-7 mg/dL
cryo indications
F VIII deficiency
hemophilia A
fibrinogen deficiency (< 80-100 mg/dL)
min required filter size for blood admin
170 micron
fluids for blood admin
NS only
why cant you give LR with blood?
LR contains Ca2+ which binds the citrate causing clots
which blood products cannot be warmed
plts
cryo
min IV size for blood amin
20 ga
things you must check before blood admin (6)
Name
MRN
DOB
Unit #
Blood Type
Expiration Date
how many people must check before blood admin
2
what is the mandatory transfusion trigger
there is no mandatory transfusion trigger
ABL =
ABL = EBV x [ (Hct i - Hct f) / Hct i ]
can use Hct or Hgb
adult male Blood volume
75 mL/kg
adult female blood volume
65 mL/kg
infant blood volume
80 mL/kg
full term neonate blood volume
85 mL/kg
premie neonate blood volume
95 mL/kg
which blood do you give if you dont know blood type
O-
MTP
need to transfuse 1-2x the pt blood volume
MTP other definitions
loss of 50% BV in 3 hr
need >4 u PRBCs in 1 hr
blood loss > 150 mL/hr
Class 1 hemorrhage
loss of <15% BV
no change HR/BP
class 1 hemorrhage treatment
no fluids needed
class 2 hemorrhage
loss of 15-30% BV
sympathetic response
incr HR
incr DBP
class 2 hemorrhage treatment
need to give fluid
class 3 hemorrhage
loss of 30-40%
hypoperfusion
metabolic acidosis
class 3 treatment
crystalloids
not-long term solution
class 4 hemorrhage
loss of >40% BV
class 4 treatment
needs blood products ASAP
blood consumption score
+1 pt for:
- HR > 120bpm
- SBP < 90mmHg
- positive FAST
- penetrating injury
which blood consumption score indicates need for MTP
+2
belmont transfusion speed
1000 mL/min
belmont SE
citrate tox
hypothermia
hyperkalemia
acid-base disturbances
goal SBP
80-100 mmHg
goal Temp
> 35 C
goal Hb
> 7g/dL
goal pH
> 7.2
goal BE
> -6
goal lactate
< 4 mmols/L
goal Ca2+
> 1.1 mmol/L
goal Plts
> 50K
goal PT/PTT
< 1.5 x nL
goal INR
< 1.5
goal fibrinogen
> 1.0g/L
how long before surgery do you need autologous transfusion
4-5 wks
Hg for autologus
11
Hct for autologus
34%
how long between autologus donations
72 hrs
cell saver blood is mixed with
heparin
how much blood loss is needed for cell saver
> 1000 mL
cell saver Hct
50-60%
cell saver CI
cancer
sepsis
citrate tox S+S
paresthesia
hyptension
arrythmias
citrate tox treatment
CaCl
CaGlu
transfusion immune SE
hemolytic
febrile
anaphylaxis
TRALI
TACO
GvH disease
post transfusion purpura
transfusion infection SE
hepatitis
HIV
cytomegalovirus
epstein-barr
parasitic
bacterial
transfusion other SE
hypothermia
L shift Hg-O2 curve
hyperkalemia
human error
iron overload
hemolytic rxn
destruction of RBCs by recipients antibodies
acute hemolytic timeline
w/i 24 hrs of transfusion
sometimes immediate
acute hemolytic cause
ABO incompatibility
acute hemolytic S+S
incr temp
incr HR
decr BP
hemoglobinuria
oozing
acute hemolytic treatment
stop transfusion
labs
test urine for Hg
diuresis
delayed hemolytic rxn timeline
> 24 hrs post-transfusion
delayed hemolytic cause
Rh incompatibility
delayed hemolytic S+S
malaise
jaundice
fever
decr Hg
febrile rxn cause
pts develop antibodies to leukocytes
febrile reaction S+S
temp incr >1 deg within 4hrs
febrile rxn treatment
stop transfusion
labd
antipyretics
benadryl
allergic rxn is common with which blood product
FFP
anaphylacitc rxn is common is what pts
IgA-deficient pts with anti-IgA antibodies
anaphylactic S+S
decr BP
incr HR
bronchospasm
hives
anaphylactic treatment
100 mcg epi
fluids
steroid
leading cause of death fron transfusions
TRALI
TRALI timeline
w/i 6 hrs of transfusion
TRALI is more common with which products
plt
FFP
TRALI S+S
dyspnea
cyanosis
chills
fever
decr BP
TRALI treatment
supp O2 (not 100%)
vent support
PEEP 5-7
TACO cause
blood products given faster than CO can keep up
TACO S+S
3 or more:
- resp distress
- pulm edema
- incr BNP
- incr CVP
TACO treatment
stop infusion
supp O2
vent support
diuresis
GvH diseasee common in what pts
immunocompromised
GvH S+S
rash
fever
diarrhea
liver dysfunction
GvH treatment
give irradiated products to avoid lymphocyte reactiojn
post-transfusion purpura
plt alloantibodies destroy pts plts
PTP plt levels
< 10,000
PTP treatment
IV IgG
plasmapheresis (plasma exchange)
which hepatitis are we most concerned with
Hep C
how long after covid to donate blood
10d post + test
how long after covid vax to donate blood
14 days post vax
second leading cause of transfusion mortality
bacterial infection
most often cuse by bacteremia or contamination
bacterial infection S+S
fever
chills
tachycardia
emesis
hypotension
shock
bacterial infection treatment
stop transfusion
get cultures
give abx
