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Y1 - Path - Exam 5 > 5. Transfusion > Flashcards

5. Transfusion Flashcards

1
Q

what is transfusion medicine?

A

branch of medicine concerned w/ transfuion of blood products and all related lab testing

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2
Q

epidemiology of blood transfusions in US?

A

blood product transfusion is among MOST COMMON INTERVENTIONS performed in healthcare;

21 M transfusions annually in US

across ass med/surg specialties, incl pod and dentistry

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3
Q

blood donates have tremendous impact on reducing morbidity and mortality;

how are blood donors compensated in the US?

A

In the US, blood donation is for purposes of producing blood components is an ALTRUISTIC, NON-COMPENSATED ACT (w/ no monetary payments or equivalents)

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4
Q

where are blood donations made?

A
  • designated donor centers (e.g. Red Cross)
  • mobile blood drives
  • hospital settings
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5
Q

what determines if a blood donor is “fit to donate”?

A
  • Donors have to be qualified (deemed fit to donate) at each donation; based on detailed hx questionnaire, interview, and brief physical exam
  • May be UNFIT - for reasons that pose risk to blood supply (infectious risk) or to themselves (inability to tolerate donation)
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6
Q

what is the most common blood donation method?

A

PHLEBOTOMY

  • sterile venipuncture by trained professionals
  • approx 450-500 mL of whole blood collected
  • into bag containing an anticoagulant/preservative solution (CPD, citrate phosphate dextrose)

Other, much less common would be Apheresis

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7
Q

how are blood components separated? into what components?

A

whole blood –>centrfuged to separate based on density

  1. packed red blood cells (pRBCs)
  2. platelet-rich plasma (PRP)
    • platelets (PLT)
    • fresh frozen plasma (FFP)
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8
Q

how is cryoprecipitate derived?

A

from fresh frozen plasma (which is a component of platelet-rich plasma

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9
Q

how are the blood components stored at the blood back until need for transfusion?

A
  • packed RBCs: refrigerated, up to 42 days
  • platelets: room temp for <5 days
  • plasma and cryoprecipitate
    • stored frozen up to 1 year
    • thawed prior to transfusion
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10
Q

what should be considered prior to transfusion?

A
  • certain unavoidable risks and potential adverse events that may accompany transfusions
  • should be treated like any other medical intervention
    • consider risks vs/ benefits
    • informed consent of recipient
  • ONLY TRANSFUSE WHEN ABSOLUTELY NECESSARY to avoid unnecessary risk to patient
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11
Q

Unless pt is in an active hemorrhage situation, how do you administer transfusions?

A

Transfuse 1 unit/bag of blood products at a time, THEN REASSESS the patient’s transfusion needs afterwards

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12
Q

indications for pRBC infusion?

A

ONLY for increasing oxygen carrying capacity, eg:

  • symptomatic anemia
  • acute blood loss

THERE ARE NO OTHER MEDICALLY JUSTIFIABLE INDICATIONS

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13
Q

what is the transfusion threshold for pRBCs?

A

Hemoglobin < 7-8 g/dL

*if labs are the only thing you’re looking at

**not applicable for all patient populations; must consider clinically relevant factors

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14
Q

what is the expected response to transfusion with 1 unit pRBCs?

A

1 unit pRBCs –> hemoglobin expected to increase by 1 g/dL

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15
Q

purpose and indications of using PLATELET TRANSFUSION?

A

To correct thrombocytopenia (decreased platelet levels)

  • active bleeding
  • risk of bleeding (e.g. prior to surgery)
  • dysfunctional platelets (less common)
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16
Q

what are the transfusion thresholds for platelets in the following situations?

  • stable, w/o active bleeding
  • active bleeding
  • surgery (non-neurosurgical)
  • neurosurgery
A

If pt is otherwise stable w/o active bleeding, platelets can get low to about 10,000 w/o risk of bleeding;

NO NEED TO TRANSFUSE IF ABOVE THE THRESHOLDS LISTED

17
Q

what are the 2 types of platelet products?

which is more commonly used today?

A
  • Whole blood-derived individual units - only inc 5,000-10,000 /mL
    • antiquated, have fallen out of favor
  • Apheresis units (*modern, special collection method)
    • 6x as potent as whole blood-derived units
18
Q

what is the expected resopnse to administering 1 apheresis Platelet unit?

A

1 apheresis Platelet unit →

Platelet increase by 30,000–60,000 /mL

19
Q

what are the indications to administer Plamsa?

A

to simultaneously correct the deficiency of multiple coagulation factors, as seen in;

  • ongoing massive bleeding
  • disseminated intravascular coagulation (DIC)
20
Q

could plasma be administered for Hemophilia?

why or why not?

A

Plasma transfusion should NOT be used for most isolated single coagulation factor deficiencies (i.e. hemophilia);

**there are better pharmacologic options

21
Q

how are PLASMA transfusion thresholds gauged?

what is the expected response to transfusion?

A
  • Plasma thresholds difficult to gauge
    • Based on clinical situation + coagulation labs (PT, aPTT)
  • Expected response to transfusion - UNPREDICTABLE
22
Q

Describe the dosing of plasma transfusion

A

Dosing of plasma is weight-based;

e. g. 10-20 mL per kilogram (patient weight)
* Rather than a 1 bag per transfusion model;*

23
Q

In general, how is pediatric dosing for transfusion calculated?

A

all transfusions are weight-based;

in adults, plasma transfusion is weight-based, as is chemotherapy

24
Q

what are the indications of cryoprecipitate?

A

Indicated to correct hypofibrinogenemia (LOW FIBRINOGEN)

(most relevant coagulation factor in cryoprecipitate is FIBRINOGEN)

25
Q

what is the difference b/w plasma and cryoprecipitate?

A

NOT interchangeable w/ plasma;

bc while cyroprecipitate is derived from plasma, it does NOT contain all of the coagulation factors present in plasma

26
Q

what amount of cryoprecipitate is transfused?

expected response?

A
  • transfused as pre-packaged dose: standard 10 unit dose
  • response
    • Standard 10 unit dose –> Fibrinogen inc by 50-70 mg/dL
27
Q

Purposes of pre-transfusion testing (performed by hospital blood banks)?

A
  1. ensures compatibility
    • b/w pt (recipient) and donor blood products
  2. decrease risk of hemolysis
  3. improve transfusion safety
28
Q

which tests are required prior to admin blood products?

A
  • ABO/Rh typing
  • Antibody screen
  • Cross match (for pRBCs)
29
Q

what does ABO typing convey?

A
  • Identifies which ABO antigens are present on a patient’s RBC’s to determine their blood group:
  • Identifies which naturally occurring ABO antibodies are present in a patient’s plasma
    • (you have naturally occuring antibodies against what you are not)
30
Q

which transfusion types are require compatiblity?

A
  • pRBCs - avoid transfusing RBCs against which pt has antibodies
  • Plasma - avoid transfusing plasma w/ antibodies against patient’s RBCs
31
Q

what is the universal pRBC donor?

A

Group O

32
Q

what is the universal plasma donor?

A

Group AB plasma

33
Q

What is Rh typing?

A

Identifies whether or not RhD-antigens are present on a patient’s RBC’s

  • Determines the “positive” or “negative” of blood types (i.e. “B positive”)
  • important to know if mom is at risk of developing antibodies
34
Q

what occurs if RhD negative individuals are exposed to foreign RhD-antigens?

A

RhD negative individuals may form an anti-D antibody if exposed to foreign RhD-antigens

  • Usually through prior transfusion or pregnancy
35
Q

Purpose and downside of ABO screen?

A
  • Purpose: Detects non-ABO antibodies that interact w/ transfused RBC’s
    • Antibodies are directed against other RBC antigen
  • May be time-consuming in pts w/ multiple concurrent antibodies
36
Q

what antibodies should be accounted for when selecting pRBCs for transfusion?

A

ALL ANTIBODIES DETECTED THROUGH AN ANTIBODY SCREEN SHOULD BE ACCOUNTED FOR;

  • pRBC’s should be negative for (not express) the corresponding antigen(s)
  • E.g. Antibody screen detects an anti-K antibody →
    Transfuse “K-antigen negative” pRBC’s
37
Q

which transfusions require CROSSMATCH?

what is the purpose of such testing?

A

pRBC transfusions only;

  • Final check to assure compatibility between:
    • Patient’s plasma (any antibodies that are present)
    • pRBC’s you intend to transfuse • ABO/Rh type and antibody screen must already be complete prior to a crossmatch
38
Q

How is a crossmatch performed?

A
  • Performed by combining a sample of the patient’s plasma and a sample from the intended pRBC unit
  • If a pRBC unit is compatible by crossmatch → OK to transfuse that unit
    • If incompatible → Do not transfuse that unit → Keep looking until a compatible unit is identified

Y1 - Path - Exam 5 (4 decks)

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