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IBI Test 3 > B3.050 Prework 2 Transfusion Components, Triggers and Reactions > Flashcards

B3.050 Prework 2 Transfusion Components, Triggers and Reactions Flashcards

1
Q

what process is used to collects RBCs?

A

whole blood

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2
Q

what process is used to collect platelets?

A

apheresis

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3
Q

shelf life of RBCs

A

CPD = 21 d
CPDA = 35 d
AS (additive solutions) = 42 d

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4
Q

expected Hc increment after 1 unit of RBC

A

1 g/ dL

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5
Q

what is RDP?

A

random donor platelet
platelets from whole blood donation
5.5 x 10^10 platelets/bag

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6
Q

what is SDP?

A

single donor platelets
platelets from apheresis
3 x 10^11 platelets/bag

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7
Q

1 unit SDP = ?

A

6 units RDP (1 dose RDP)

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8
Q

what is leukoreduced product?

A

leukocytes removed

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9
Q

why do we need LR product?

A

prevent:

  1. febrile non hemolytic transfusion reaction (FNHTR)
  2. CMV
  3. HLA-alloimmunization
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10
Q

what is irradiation?

A

kill T cells in donor blood

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11
Q

why do we need irradiation?

A

prevent TA-GVHD
transfusion associated graft versus host disease
donor T cells attack recipient skin, oral/GI, lung, ad marrow

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12
Q

what is washing?

A

removes potassium, cytokines, antibodies, and allergens from unit
IgA deficient recipient

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13
Q

how do you wash blood?

A

saline, 30-40 min

double wash for IgA def patients

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14
Q

problems with washing

A

lose 15% RBCs

outdated after 24 h

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15
Q

discuss the TRICC trial

A

restrictive group: transfused when Hgb <7
liberal group: transfused when Hgb <10
no demonstrable benefit to a liberal strategy
in younger patients, mortality higher in liberal group

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16
Q

AABB 2016 Guidelines for RBC transfusion

A

Hb 7 = hospitalized patients who are hemodynamically stable

Hb 8 = patients under going surgery or with preexisting cardiovascular disease

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17
Q

indications for platelet transfusion

A

to control or prevent bleeding due to def of platelet number or function
platelet count without active bleeding = <10-20K
platelet count with bleeding or invasive procedure = <50K
massive transfusion and bleeding
bleeding w evidence of platelet dysfunction

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18
Q

indications for FFP

A

to control or prevent bleeding in patients with a documented clotting factor def

  1. active bleeding, invasive procedure and massive transfusion with INR >2
  2. emergency of warfarin
  3. TTP - plasmapheresis
  4. antithrombin 3 def, or protein C, S or heparin cofactor 2 def
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19
Q

contraindications for FFP

A

not for volume or protein replacement
not bleeding or low risk procedure
if elevated INR and bleeding not controlled after receiving plasma, consider other possibilities

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20
Q

top 3 causes of transfusion related death

A

TRALI (38%)
TACO (24%)
HTR (21.5%)

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21
Q

what do you do If you suspect a transfusion reaction?

A
  1. stop transfusion
  2. keep IV open with saline
  3. product tags and pt ID
  4. notify blood bank and physician
  5. collect and send blood and urine samples to blood bank
  6. send the unit, tags, and admin set to blood bank
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22
Q

information needed by blood bank physician

A

products
premedication
vitals (before and after)
symptoms

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23
Q

acute hemolytic transfusion reactions etiology

A 
1:25,000-50,000 transfusions
incompatible blood
usually due to misidentification
10-20% mortality
>50% acute renal failure
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24
Q

HTR signs and symptoms

A

fever and chills

back pain, chest pain, nausea, flushing, dyspnea, DIC, hemoglobinuria, acute renal failure

25
Q

HTR management

A

steps 1-6
aggressive fluid
furosemide to increase renal blood flow/urine output
red cell exchange if feasible

26
Q

FNHTR signs and symptoms

A 
fever
chill/rigor
dyspnea and wheezing due to high O2 demand
hypertension due to rigor
flushing due to cytokines
27
Q

FNHTR etiology

A

cytokine and WBC in the bag

28
Q

FNHTR management

A

steps 1-6
r/o hemolysis, DAT, CXR
Tylenol, meperidine for chill/rigor

29
Q

FNHTR prevention

A

leukoreduction and premedication (Tylenol)

30
Q

sepsis signs and symptoms

A

fever
chills
hypotension- may progress rapidly to endotoxic shock

31
Q

sepsis etiology

A

bacterial contamination of the unit

usually skin flora

32
Q

sepsis management

A

steps 1-6
draw blood cultures
sent unit to blood bank for culture
IV antibiotics, fluids, pressors

33
Q

sepsis prevention

A

careful donor screening
thorough cleansing of phlebotomy site
bacterial screening

34
Q

allergic rxn signs and symptoms

A

uticaria and local erythema
pruitis
no fever

35
Q

etiology of allergic rxn

A

allergic reaction to transfuses plasma proteins

36
Q

management of allergic rxn

A

stop transfusion
administer antihistamine
if symptoms subside MAY RESTART slowly and observe

37
Q

prevention of allergic rxn

A

antihistamine premed

38
Q

anaphylaxis signs and symptoms

A

hypotension/shock
wheezing/resp distress
laryngeal edema

39
Q

anaphylaxis etiology

A

anti IgA Abs in IgA deficient recipients (naturally occurring)
rarely Abs to other plasma proteins (haptoglobin) or drugs

40
Q

anaphylaxis management

A

steps 1-6
vigorously treat hypotension
subQ epinephrine

41
Q

anaphylaxis prevention

A

premed with antihistamines and steroids
for cellular components, washed products are indicated
for plasma, IgA deficient donors are required (hard to get)

42
Q

TRALI signs and symptoms

A 
during or w/in 6 hours of transfusion
resp distress and severe hypoxemia
non cardiogenic pulmonary edema (lung infiltrates on CXR)
fever and chills
hypotension
43
Q

TRALI criteria

A

no evidence of acute lung injury (ALI) before transfusion
onset during or within 6 hours of transfusion
hypoxemia
bilateral infiltrates
no evidence of circulatory overload

44
Q

TRALI pathophys

A

2 hit: patient needs inflammatory insult + transfusion
-inflammatory insult = neutrophils primed for trauma, sepsis
immune: anti-WBC Abs (HLA or HNA) in the transfused blood component
non-immune: non-Ab component in the blood (phospholipis)

45
Q

tests for TRALI

A

CXR, EKG, troponin, Echo, blood culture, BNP

46
Q

TRALI management

A 
steps 1-6
oxygen and mechanical ventilation
ICU support
most recover w/in 4 days
mortality 5-25%, up to 58% in critically ill
47
Q

TRALI risk factors

A

recipient related: inflammatory insult
transfusion related: high plasma volume products
donor related: HLA or HNA antibody (related to number of pregnancies)

48
Q

TRALI prevention

A

male donor plasma only

defer TRALI confirmed donors

49
Q

TACO signs and symptoms

A 
dyspnea, orthopnea, cough
positive fluid balance
cardiogenic pulmonary edema on CXR
elevated central venous pressure
elevated serum BNP, may have elevated pro-BNP
50
Q

TACO etiology

A

volume infusion not tolerated by patient
-high infusion rate or volume
-underlying cardiopulm disease
albumin/plasma infusion may shift large volumes of extracellular fluid into vascular space, acutely expanding blood volume

51
Q

TACO vs TRALI

A

TACO- heart failure, transudate trach tube, diuretic response, no WBC change, elevated BNP
TRALI- no heart failure, exudate trach tube, minimal diuretic response, decreased WBC, normal BNP

52
Q

TACO management/prevention

A

cautious transfusion in patients with cadiopulm status
stopping or slowing transfusion
diuretics and oxygen
phlebotomy in emergencies

53
Q

TA-GVHD etiology

A

engraftment and proliferation of donor T-cells > attack recipient tissues including bone marrow

54
Q

TA-GVHD signs/symptoms

A

begins 8-10 days post transfusion

fever, rash, enterocolitis, hepatitis, pancytopenia

55
Q

TA-GVHD risk/prevention

A

does not occur in AIDs patients
degree of HLA similarity between donor and recipient
prevent with irradiation
usually fatal 90% mortality

56
Q

delayed hemolytic transfusion reactions

A

accelerated clearance/extravascular hemolysis of crossmatch compatible RBCs, usually due to anamnestic antibody response in a previously sensitized patient

57
Q

delayed hemolytic transfusion reaction pathophys

A

transfused foreign RBC antigens stimulate production of Ab > hemolysis of transfused cells, extravascular

58
Q

DHTR symptoms

A

mild, may be undetectable
DAT positive
Ab detectable in serum or eluate

59
Q

DHTR treatment

A

IV fluids to maintain urine output

IBI Test 3 (19 decks)

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