6/17 - Transfusion Medicine

Question 1

Interpret the following:

Answer 1

O pos

Apos

B neg

AB pos

Question 2

Treatment of ABO incompatible transfusion reaction:

Answer 2

STOP the transfusion immediately.

• Keep IV line open.
• IV fluids
• Aggressive diuresis, with Lasix or mannitol.
• Check labs for hemolysis: ind bilirubin, LDH, haptoglobin, hemoglobin and hematotcrit in blood, urine hb

Question 3

Compatible vs incompatible XM

Answer 3

Incompatible XM: clumping/agglutination is present. Example: B RBCs mixed with plasma from an A pos pt.

Compatible XM: no clumping. Example: O pos RBCs mixed with plasma from an A pos pt.

Question 4

This is how long we hold XM’d RBCs in the blood bank for your patient.

Answer 4

72 hours: this is how long we hold XM’d RBCs in the blood bank for your patient.

Question 5

All of the following are true EXCEPT:
•A. T+S screens the patient for compatible red cell units.
•B. T+C reserves RBCs for the pt for 72 hours.
•C. T+S screens the patient for antibodies to several clinically significant blood groups antigens.
•D. T+C is performed in test tubes and is based on gross, visual examination for clumping (agglutination).

Answer 5

A. T+S screens the patient for compatible red cell units.

Question 6

3 types of written orders involving blood typing and transfusions

Answer 6

T+S: Write, “Type and Screen,” when there is a small chance that the pt will need blood products of any kind (RBCs, FFP, platelets, cryoprecipitate). Small means <50%. REMEMBER: we do not reserve blood in the blood bank with a T+S order, so don’t ever write, “T+S 2U RBCs.” this order is meaningless.

T+C: Write, “Type and Cross 2U RBCs,” when there is ≥50% chance the pt will need a red cell transfusion. You can order any number of RBCs for XM.

Transfusing RBCs: Write, “Transfuse 2U RBCs.” Now, the patient will actually receive the blood.

Question 7

Which order is most appropriate for a 45 yo male with mild von Willebrand Disease having an inguinal hernia repair?

• A. T+C 4U RBCs
• B. T+S 2U RBC
• C. Transfuse 2U FFP
• D. T+S

Answer 7

T+S

Question 8

Effect of 1 unit of RBS on Hgb/HCT

Answer 8

RBCs: In the stable patient who is not bleeding, one unit of PRBCs will raise the hemoglobin by 1g/dL and the hematocrit by 3%

Question 9

FFP on INR

Answer 9

We know this: the impact of FFP on the INR is much greater when the INR is high, like 8-10 or higher, than it is when the INR is closer to normal, like <2.5.

The impact of FFP on clinical bleeding is ultimately more important than its impact on lab values.

Question 10

1 unit of platelets raises platelet count by how much?

Answer 10

Platelets: in the stable, non-bleeding patient, one unit of platelets will raise the platelet count by approximately 30, 000/uL.