AIH1 Flashcards
What is accepted for orders
complete accurate legible oral paper or electronic requests
How is the blood sample labelled
two independent identifiers, mechanism to identify phlebotomist and date/time of collection
How many determinants of blood group for allogeneic transfusion
two: 2nd sample taken at separate time or retest same sample if using electronic patient verification
How long to keep patient samples and segments
Saved for at least 7 days from the last possible day of transfusion
Neonate testing
Initial sample to test ABO and Rh and antibody screen using maternal or neonate serum, repeat not needed if same hospital stay within 4 months
Neonate has initial antibody screen negative, what to crossmatch?
Crossmatch not required up to 4 months
Neonate has initial antibody screen positive, what to crossmatch?
AHG compatible or antigen negative until antibody NLD
Non group O neonate is receiving non group O RBC that is not compatible with the maternal ABO group, what to test
Test neonate’s serum for anti-A, anti-B by AHG
ARDP participation requirements
- Ship 15 units through the ARDP
- Register at least 10 donors
- Screen at least 1000 donors for high prevalence antigens
- Provide anti-sera to another ARDP member
- Perform at least 1 family study
ARDP submission requirements
High prevalence: all ABO groups acceptable, all common antigen negative results tested x 2, molecular (e variants, DO)
Multiple common antigen negative: Group O and A (Caucasian), Group O, A and B (African)
IgA deficient: IgA < 0.05mg/dL on 2 occasions
ARDP uncommon donor requirements
- R1R1, R2R2, R0, or rr and K- and one negative in Ss, Duffy, Kidd
- R1R1, R2R2, rr and K- and Fya-b-
ARDP Top 10 High prevalence antigen negative requests
- U
- Lub
- hrB
- Yta
- Jsb
- JK3
- k
- Vel
- Hy
- Joa
Needle for transfusion
Adult: 18-19g
Child: 21-23g
Requirements for consent
Informed consent obtained and documented (description of risks, opportunity to ask questions, right to accept or refuse transfusion)
Pretransfusion medications
Antihistamines (mild allergic reactions)
Corticosteroids (severe allergic reactions)
Antipyretics (febrile reactions)
Pretransfusion unit verification at bedside
2 licensed staff members must check, patient must state name, baseline vitals (temp not above 99F, pulse, blood pressure)
IV solutions
Normal 0.9% saline only
D5W: causes RBC to swell, possible clumping
Ringers lactate: contains calcium, gelling effect
Drugs: unknown pH can cause hemolysis
Hypertonic/hypotonic: hemolysis
Filters
Routine 150-260 micron
Pressure infusion devices
Never use more than 300 mm Hg
Smaller the needle bore, the less pressure can be used (or will cause hemolysis)
Adult infusion rates
first 15 min: 2mL/min
Complete within 4 hours
Pediatric infusion rates
RBC: 2-5mL/kg/hr
PLT/FFP: 60-120mL/hr
Cryo: as rapidly as tolerated
Rapid transfusion
Pressure infusion, large bore, type 8 FR double lumen intravenous catheters
Liver transplant stages
Pre-anhepatic (prep), anhepatic (transplant), post anhepatic (blood flow assessed)
Minor mismatch
Donor antibodies against patient
Major mismatch
Recipient antibodies against donor
Describe the bloody vicious cycle of massive transfusion
Hemorrhage –> hemodilution –> coagulopathy
Massive transfusion complications
coagulopathy, hypothermia, acidosis (from shock), acidemia, hypocalcemia, hyperkalemia
Disaster response
- Contact AABB task force within 1 hour (convenes conference call with level 1 members)
- Determine what is the hospital admissions, current O inventory
TA anticoagulant of choice
Citrate
Physiological effects of citrate
Transient hypocalcemia
Management: IV infusion of calcium gluconate
TA adverse effect
Vasovagal reaction, hematoma, leukapheresis (fluid retention from HES), allergic reaction
TA Class I
TA is standard and acceptable: TTP/HUS, acute sickle stroke
TA Class I
TA is generally acceptable: renal transplantation antibody mediated rejection
TA Class III
Evidence is insufficient: acute liver failure
TA Class IV
TA is discouraged: ITP, atypical HUS
ITP description
Platelet specific autoantibodies bind to platelets then cleared by the spleen
ITP clinical picture
Petechiae, intracranial hemorrhage, gingival bleeding, spontaneous bleeding, epixtaxis
ITP laboratory picture
Low platelets, abnormal size, MPV increased
Acute ITP
Childhood disease proceeded by infection (VZ, EBV)
Usually self limiting & benign
Chronic ITP
Females 2x as likely as males
Child ITP treatment
IVIG to flood Fc receptors, short cause of steroids
Adult ITP treatment
Steroids, high IVIG dose, rituximab (causes B cell depletion)
TTP description
Autoimmune inhibitors or ADAMTS13 or reduced activity
TTP clinical picture
MAHA, thrombi, neurologic abnormalities, renal dysfunction, petechiae, purpura
TTP syndrome triad
- Thrombocytopenia and mucous membrane bleeding
- MAHA sufficient to cause jaundice
- Neurologic abnormalities
TTP laboratory picture
Schistocytes, intravascular hemolysis, severe thrombocytopenia
TTP treatment
Plasma exchange
Never give platelets
Granulocyte transfusion reason
Provide granulocytes to phagocytize and kill bacteria
Granulocyte collection by apheresis drugs
HES: sedimentation and increase removal
Corticosteroids: increase production
G-CSF
Granulocyte collection
TTD testing done beforehand
CMV negative required for immunocompromised patient
20-24C >24 hours no agitation irradiated
Granulocyte indication
Neutropenia <500/uL associated with fever unresponsive to antibiotic treatment, neonate with sepsis
Granulocyte transfusion side effects
HLA alloimmunization, GVHD, transmission of CMV
How much blood loss can be controlled with crystalloid solutions?
20%, losing 30% or more can cause hypovolemic shock
Diastole
Relaxation of the heart
Systole
Contraction of the heart
Diastolic pressure
80mmHg average, lowest systemic arterial pressure
Systolic pressure
120mmHg average, highest systemic arterial pressure
Blood volue
5L average
Pulse pressure
maximum systemic arterial pressure - minimum systemic arterial pressure (systolic - diastolic)
Mean arterial pressure
Average pressure during a cardiac cycle, 60mmHg minimum
