B3.050 Prework 2 Transfusion Components, Triggers and Reactions Flashcards
what process is used to collects RBCs?
whole blood
what process is used to collect platelets?
apheresis
shelf life of RBCs
CPD = 21 d
CPDA = 35 d
AS (additive solutions) = 42 d
expected Hc increment after 1 unit of RBC
1 g/ dL
what is RDP?
random donor platelet
platelets from whole blood donation
5.5 x 10^10 platelets/bag
what is SDP?
single donor platelets
platelets from apheresis
3 x 10^11 platelets/bag
1 unit SDP = ?
6 units RDP (1 dose RDP)
what is leukoreduced product?
leukocytes removed
why do we need LR product?
prevent:
- febrile non hemolytic transfusion reaction (FNHTR)
- CMV
- HLA-alloimmunization
what is irradiation?
kill T cells in donor blood
why do we need irradiation?
prevent TA-GVHD
transfusion associated graft versus host disease
donor T cells attack recipient skin, oral/GI, lung, ad marrow
what is washing?
removes potassium, cytokines, antibodies, and allergens from unit
IgA deficient recipient
how do you wash blood?
saline, 30-40 min
double wash for IgA def patients
problems with washing
lose 15% RBCs
outdated after 24 h
discuss the TRICC trial
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
AABB 2016 Guidelines for RBC transfusion
Hb 7 = hospitalized patients who are hemodynamically stable
Hb 8 = patients under going surgery or with preexisting cardiovascular disease
indications for platelet transfusion
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
indications for FFP
to control or prevent bleeding in patients with a documented clotting factor def
- active bleeding, invasive procedure and massive transfusion with INR >2
- emergency of warfarin
- TTP - plasmapheresis
- antithrombin 3 def, or protein C, S or heparin cofactor 2 def
contraindications for FFP
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
top 3 causes of transfusion related death
TRALI (38%)
TACO (24%)
HTR (21.5%)
what do you do If you suspect a transfusion reaction?
- stop transfusion
- keep IV open with saline
- product tags and pt ID
- notify blood bank and physician
- collect and send blood and urine samples to blood bank
- send the unit, tags, and admin set to blood bank
information needed by blood bank physician
products
premedication
vitals (before and after)
symptoms
acute hemolytic transfusion reactions etiology
1:25,000-50,000 transfusions incompatible blood usually due to misidentification 10-20% mortality >50% acute renal failure
HTR signs and symptoms
fever and chills
back pain, chest pain, nausea, flushing, dyspnea, DIC, hemoglobinuria, acute renal failure
HTR management
steps 1-6
aggressive fluid
furosemide to increase renal blood flow/urine output
red cell exchange if feasible
FNHTR signs and symptoms
fever chill/rigor dyspnea and wheezing due to high O2 demand hypertension due to rigor flushing due to cytokines
FNHTR etiology
cytokine and WBC in the bag
FNHTR management
steps 1-6
r/o hemolysis, DAT, CXR
Tylenol, meperidine for chill/rigor
FNHTR prevention
leukoreduction and premedication (Tylenol)
sepsis signs and symptoms
fever
chills
hypotension- may progress rapidly to endotoxic shock
sepsis etiology
bacterial contamination of the unit
usually skin flora
sepsis management
steps 1-6
draw blood cultures
sent unit to blood bank for culture
IV antibiotics, fluids, pressors
sepsis prevention
careful donor screening
thorough cleansing of phlebotomy site
bacterial screening
allergic rxn signs and symptoms
uticaria and local erythema
pruitis
no fever
etiology of allergic rxn
allergic reaction to transfuses plasma proteins
management of allergic rxn
stop transfusion
administer antihistamine
if symptoms subside MAY RESTART slowly and observe
prevention of allergic rxn
antihistamine premed
anaphylaxis signs and symptoms
hypotension/shock
wheezing/resp distress
laryngeal edema
anaphylaxis etiology
anti IgA Abs in IgA deficient recipients (naturally occurring)
rarely Abs to other plasma proteins (haptoglobin) or drugs
anaphylaxis management
steps 1-6
vigorously treat hypotension
subQ epinephrine
anaphylaxis prevention
premed with antihistamines and steroids
for cellular components, washed products are indicated
for plasma, IgA deficient donors are required (hard to get)
TRALI signs and symptoms
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
TRALI criteria
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
TRALI pathophys
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)
tests for TRALI
CXR, EKG, troponin, Echo, blood culture, BNP
TRALI management
steps 1-6 oxygen and mechanical ventilation ICU support most recover w/in 4 days mortality 5-25%, up to 58% in critically ill
TRALI risk factors
recipient related: inflammatory insult
transfusion related: high plasma volume products
donor related: HLA or HNA antibody (related to number of pregnancies)
TRALI prevention
male donor plasma only
defer TRALI confirmed donors
TACO signs and symptoms
dyspnea, orthopnea, cough positive fluid balance cardiogenic pulmonary edema on CXR elevated central venous pressure elevated serum BNP, may have elevated pro-BNP
TACO etiology
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
TACO vs TRALI
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
TACO management/prevention
cautious transfusion in patients with cadiopulm status
stopping or slowing transfusion
diuretics and oxygen
phlebotomy in emergencies
TA-GVHD etiology
engraftment and proliferation of donor T-cells > attack recipient tissues including bone marrow
TA-GVHD signs/symptoms
begins 8-10 days post transfusion
fever, rash, enterocolitis, hepatitis, pancytopenia
TA-GVHD risk/prevention
does not occur in AIDs patients
degree of HLA similarity between donor and recipient
prevent with irradiation
usually fatal 90% mortality
delayed hemolytic transfusion reactions
accelerated clearance/extravascular hemolysis of crossmatch compatible RBCs, usually due to anamnestic antibody response in a previously sensitized patient
delayed hemolytic transfusion reaction pathophys
transfused foreign RBC antigens stimulate production of Ab > hemolysis of transfused cells, extravascular
DHTR symptoms
mild, may be undetectable
DAT positive
Ab detectable in serum or eluate
DHTR treatment
IV fluids to maintain urine output
