8. Transfusion therapy Flashcards
Routine AS RBC units are —- mL and have —% Hct
350 mL
60%
RBC increment
1 unit should increase Hgb 1 g/dL
apheresis unit platelet ct
3 x 10^11
random pooled unit platelet ct and dose
5 x 10^10
one dose is 6-10 units
platelet increment
1 unit should increase platelet count by 30-50,000
> 50,000 platelets
bleeding with procedure or trauma is unlikely
10-50,000 platelets
spontaneous bleed unlikely, likely with procedure or trauma
5-10,000 platelets
risk for spontaneous bleed
<5000 platelets
high risk for spontaneous bleed
platelet refractoriness
at least 2 transfusions fail to achieve ⅓ to ½ of expected increment
FFP increment
initial dose of 10-20 mL/kg expected to raise coagulation factors in a nonbleeding patient by 25-50%
—- FFP units usually control hemostasis
4-6
8-15 mL cryo contains…
150-250 mg fibrinogen
cryo increment
1 unit/10 kg expected to increase fibrinogen by 50 mg/dL if there is no ongoing consumption
usual cryo dose
10 units pooled
massive transfusion definition
replacement of patient’s total blood volume or more within 24 hours (8-10 units)
OR acute administration of 4-5 pRBC units in one hour
blood is drawn and stored prior to anticipated need; at least 72 hours before surgery
preoperative collection
blood is collected at the start of surgery and infused during or at the end; can contribute to decreased surgical bleeding by reducing hematocrit
acute normovolemic hemodiluation
shed blood is recovered from surgical field and then infused; surgical site cannot be abdominal due to bacterial contamination
intraoperative collection
blood is collected from drainage devices and infused
postoperative collection
only FDA approved usage is for heavy menstrual bleeding and short-term prevention in hemophilia pts
Transexamic acid (TXA)
sickle cell tx; (1) makes RBCs bigger, stabilizing them and making them less likely to take sickle shape; (2) blocks sickle Hb polymerization; both increase O2 carrying capacity and decrease adhesion (pain crises)
Hydroxyurea & Voxelotor
sterile, single use surgical tourniquet in use for bloodless orthopedic surgery
HemaClear
from large plasma pools; removal of antithrombin and FXI; 3-factor or 4-factor
prothrombin complex concentrate
HBV DNA confirmation
individual sample testing and alternative NAAT method
HBsAg confirmation
neutralization by anti-HBV
anti-HBc confirmation
No licenced confirmatory test
anti-HCV confirmation
licenced multi-antigen test (RIBA, HCV RNA)
HCV RNA confirmation
discriminatory NAAT and alternative NAAT
anti-HIV confirmation
Western blot; EIA (HIV 2); IFA (HIV 2)
HIV RNA confirmation
individual sample testing and alternative NAAT method
anti-HTLV confirmation
No licenced confirmatory test
WNV RNA confirmation
repeat NAAT; IgM anti-WNV; follow up seroconversion
syphilis confirmation
specific treponemal test (ie FTA)
T. cruzi confirmation
no licenced test, but RIPA or IFA may be used
Lookback
Donor center must be able to ID and notify transfusion services of blood from donors found to be subsequently at risk for TTD
Traceback
when recipient gets a possible TTD
HAV risk
1:1,000,000 TTD risk
HBV risk
1:220,000 TTD risk
HCV risk
1:2,000,000 TTD risk
HTLV risk
1:2,993,00 TTD risk
HIV risk
1:2,300,000 TTD risk
national surveillance of transfusion related adverse events
2009
National healthcare safety network hemovigilance module
GVHD time frame
2 days — 6 weeks
TRALI time frame
within 6 hours
TACO time frame
within 12 hours
AHTR time frame
within 24 hours
DHTR time frame
24 hours —28 days
Zika vectors
Aedes aegypti
Aedes albopictus
FNHTR time frame
during or within 4 hours
PTP time frame
within 3 weeks
TAD time frame
within 24 hours
