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heme/onc > Blood blank transfusion > Flashcards

Blood blank transfusion Flashcards

1
Q

whole blood is filtered to remove white blood cells

A

yep

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2
Q

what are a few of the transmissible disease that we test

A
  1. Hep B and C
  2. HIV 1 and 2
  3. HTLV
  4. syphilis
  5. Chagas
  6. West Nile virus
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3
Q

Platelets require constant agitation to decrease_______

A

platelet activation

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4
Q 
Storage
1. RBCs:
2. Platelets: 
3. FFP and cryoprecipitate:
Shelf life
1. RBCs: 
2. Platelets:
A 
Storage
1. RBCs: 4-6o C
2. Platelets: 25o C (room temp)
3. FFP and cryoprecipitate: - 65o C
Shelf life
1. RBCs: 42 days
2. Platelets: 5 days
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5
Q

Blood groups or blood types refer to the __________ present on the surface of the patient’s RBCs

A

Blood groups or blood types refer to the antigens present on the surface of the patient’s RBCs

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6
Q

Two major blood group antigens on RBCs

A
  1. ABO (blood types A, B, AB, O)

2. Rh (Rh+ or Rh-)

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7
Q

ABO are antibodies that are naturally occurring in one’s body.

They are a mix of ___ (predominantly) and ___ antibodies directed against A or B antigens

A

They are a mix of IgM (predominantly) and IgG antibodies directed against A or B antigens

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8
Q

The Rh blood group is a group of approximately 50 different antigens

A

yep

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9
Q

The ___ antigen is primarily responsible for hemolytic disease when an Rh- mother is exposed to Rh+ blood and develops antibodies

A

The D antigen is primarily responsible for hemolytic disease when an Rh- (or D negative) mother is exposed to Rh+ (or D positive) blood and develops antibodies

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10
Q

Rh hemolytic disease in pregnancy

A

Rh- mothers is exposed and sensitized to D antigens causing her to make IgG antibodies.

second pregnancy the re-exposure causes her to produce this IgG which is able to cross the placenta and cause hemolysis, anemia and CHF in the fetus

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11
Q

Rh- mothers receive anti-D immune globulin prophylactically during any pregnancy and at delivery to prevent ____________

A

alloimmunization

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12
Q

Classically less severe than hemolytic disease due to D antigen

A

e-antigen

With widespread administration of anti-D immune globulin hemolytic disease due to antibody to D antigen is less common
Clinically we see cases of antibody to E antigen

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13
Q

the patient’s sample is mixed with anti-A and anti-B antibodies to check for agglutination – tests for the presence of A or B antigen (or both) on the surface of RBCs

A

Front typing

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14
Q

determines if anti-A or anti-B antibodies are present in the patient’s serum

A

back typing

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15
Q

Prior to Release of Blood from Blood Bank :

  1. Donor units are identified based on ____and _____compatibility
  2. Blood from the blood bank is __________ with the recipient’s serum
  3. An indirect ________ test is performed to identify an unexpected antibody
  4. In addition to the ABO and Rh systems there _____other blood group systems
  5. Crossmatching is especially important in ________
  6. Because new antibodies can develop at any time a type and cross must be sent every
A
  1. Donor units are identified based on ABO and Rh compatibility
  2. Blood from the blood bank is crossmatched with the recipient’s serum
  3. An indirect Coomb’s test is performed to identify an unexpected antibody
  4. In addition to the ABO and Rh systems there 28 other blood group systems
  5. Crossmatching is especially important in multiply transfused patients
  6. Because new antibodies can develop at any time a type and cross must be sent every 72 hours for patients
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16
Q

PRBC transfusion is indicated for an anemic patient with

A

unstable vital signs

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17
Q

Indications for transfusion:

A
  1. Prophylactically with severe thrombocytopenia – platelet count < 10,000 (normal 150-450,000/ul)
  2. Bleeding and thrombocytopenia
  3. Bleeding and platelet dysfunction
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18
Q

Lower risk of infection with SDU or pooled random donor platelets – approx. 85% of transfused platelets in the U.S.

A

SDU- are single donor thus lower risk of infection

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19
Q

Platelets do not need to be transfused according to the rules of ABO or Rh compatibility. platelet preparation contain few RBCs. why is this controversial?

A

there can still be ABO incompatibility resulting in:

  1. response to transfusion affected
  2. hemolysis
  3. Rh sensitization
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20
Q

Platelet Alloimmunization:

  1. Alloimmunization to HLA antigens can make patients ________
  2. Defined as less than
  3. Occurs in _____% of multiply transfused patients (AML, bone marrow transplant)
  4. Must rule out causes of increased platelet consumption:
  5. _____________ can help identify alloimmunization
A
  1. Alloimmunization to HLA antigens can make patients refractory to platelet transfusions
  2. Defined as less than 2,000 increase in platelet count with platelet transfusion two days in a row
  3. Occurs in 30-40% of multiply transfused patients (AML, bone marrow transplant)
  4. Must rule out causes of increased platelet consumption:
    DIC, sepsis, splenomegaly
  5. Platelet count 15 min post platelet transfusion can help identify alloimmunization
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21
Q

Fresh frozen plasma (FFP) contains all of the coagulation proteins (2)

A
  1. thrombus formation

2. promote fribrinolysis

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22
Q

FFP contains antibodies and thus must be transfused according to rules of ABO compatibility

A

yep

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23
Q

Indications for FFP Transfusion(3)

4.Not indicated for correction of

A
  1. Deficiencies of coagulation proteins in which specific factor concentrates are unavailable or the specific factor deficiency is unknown
  2. Treatment of multiple coagulation protein deficiencies in the bleeding patient
  3. Emergent reversal of warfarin
  4. Not indicated for correction of INR in patient that is not actively bleeding
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24
Q

is the precipitate left over after thawing FFP

A

cryoprecipitate

25
Q

cryoprecipitate is rich in these clotting factors (4) and it is primarily transfused for bleeding patients with

A
  1. FVIII
  2. vWF
  3. FXIII
  4. fibrinogen

Primarily transfused for bleeding patients with low fibrinogen

26
Q

factor VII concentrates used for (2) and there are two types

A
  1. Hemophilia A
  2. vWd

two types:

  1. plasma derived
  2. recombinant
27
Q
  1. Produced by genetically modified mammalian cells (hamster ovary and kidney) to produce Factor VIII
  2. No risk of viral transmission
  3. Does not contain von Willebrand antigen
A

recombinant FVIII concentrates

28
Q
  1. Produced from pooled plasma of blood donors
  2. Infection risk decreased through screening of donors and viral inactivation
  3. Plasma derived products contain von Willebrand antigen
A

plasma derived FVIII concentrates

29
Q

chronic RBC transfusion can lead to ______ which lead to deposits in liver, heart, pancreas and gonads. And those that have highest ricks are those with sickle cell, thal, aplastic anemia and cancer patients

A

iron overload

30
Q

amnestic response

A

Upon re-exposure to the RBC antigen the antibody is produced again

31
Q

delayed hemolytic transfusion reaction:

  1. why it occured
  2. why was the ab not picked up
  3. symptoms
  4. when does it start
A
  1. Patient has been alloimmunized to RBC antigens in the past (prior transfusion or pregnancy)
  2. Because the exposure was in the distant past the antibody may not be readily detected
  3. Extravascular hemolysis, fever, increased bilirubin, anemia
  4. Symptoms several days after transfusion
32
Q

acute hemolytic transfusion reaction:

  1. major cause of acute hemolytic rxn
  2. symptoms
  3. Result of ___________ intravascular hemolysis
A
  1. ABO incompatibility is the major cause of acute hemolytic reaction
  2. Fever, hemodynamic instability, hemoglobinuria, back and chest pain
  3. Result of IgM mediated intravascular hemolysis
33
Q

Transfusion-associated Circulatory Overload (TACO)

  1. occurs
  2. clinical sign/symptoms
  3. HTN
  4. what dictates the rate of transfusion
A
  1. Occurs in patient with pre-existing congestive heart failure
2.Clinical signs and symptoms:
Dyspnea
Tachycardia 
Hypertension 
Volume overload

3.Hypertension
TACO (present)
TRALI (absent)

4.Patient specific factors dictate the rate of transfusion

34
Q

Results from donor antibodies in the transfused product binding to and activating recipient leukocytes within the lungs

A

transfusion-related acute lung injury- TRALI

35
Q

TRALI is a diagnosis of

A

exclusion

36
Q

Fever can be a sign:

A
  1. Simple allergic reaction
  2. Hemolytic transfusion reaction
  3. Bacterial contamination of transfused blood product
37
Q

febrile rxn require you to

A
  1. Stop transfusion, examine patient, and notify blood bank

2. Blood bank will re-test the patient’s serum against the patient’s sample to confirm compatibility

38
Q

Allergic and Anaphylactic Reactions:

  1. Simple allergic reaction – _________
  2. allergic rxn are due to
  3. Treat with ____________
  4. Severe allergic reaction – occurs within
  5. it can occur on ____ deficient patients (1 in 300-500 patients)
A
  1. Simple allergic reaction – hives and itching
  2. Due to WBC in transfused blood product
  3. Treat with antihistamines
  4. Severe allergic reaction – occurs within seconds to minutes of initiating blood transfusion
  5. IgA deficient patients (1 in 300-500 patients)
39
Q

Non-Infectious Transfusion Complications

A

Specimen identification – sample for type and cross must be signed and dated at bedside

40
Q
  1. Process by which a family member or friend donates blood specific to a recipient
  2. No safer than blood products from volunteer donors
  3. Social pressure to donate may actually decrease safety of product
A

directed donation

41
Q

Transfusion Transmitted Infectious Diseases

  1. Bacterial infection
    - 1 in 75,000 platelet products
    - Platelets stored at____temperature
    - ___________ should be considered in the patient receiving platelets who develops a febrile transfusion reaction
  2. Viral infection
    - Hepatitis ___: 1 in 200,000
    - Hepatitis __: 1 in 1.5 million
    - ____: 1 in 2 million
A
  1. Bacterial infection
    - 1 in 75,000 platelet products
    - Platelets stored at room temperature
    - Bacterial sepsis should be considered in the patient receiving platelets who develops a febrile transfusion reaction
  2. Viral infection
    - Hepatitis B: 1 in 200,000
    - Hepatitis C: 1 in 1.5 million
    - HIV: 1 in 2 million
42
Q

Filters remove white blood cells from whole blood prior to storage of RBCs and platelets

A

leukodepletion

43
Q

Only blood donated from a donor known to be CMV negative can be declared “CMV-negative”

A

yep

44
Q

Leukodepletion renders the blood product as “CMV safe”

A

yep

45
Q

Leukodepletion increases the risk of allergic transfusion reactions

A

NOPE! Leukodepletion reduces the risk of allergic transfusion reactions

46
Q

Performed to reduce the risk of transfusion related graft versus host disease (GVHD) and targets donor lymphocytes

A

irradiation of blood products

47
Q

all hospital irradiate blood

A

nope some us a risk based strategy

48
Q

Novo 7 –

A

activated recombinant factor VII

49
Q

Used to treat hemophilia patients with bleeding who have inhibitors to factor VIII or factor IX

A

recombinant FVIIa

50
Q

recombinant FVIIa

  1. used in
  2. bypasses
  3. rapid
A
  1. Congenital factor VII deficiency
  2. Bypasses intrinsic coagulation system
  3. Rapid hemostasis
51
Q

Sterile pooled product of IgG directed against the D antigen of the Rh complex
Used to prevent sensitization to D antigen by Rh- pregnant women

A

Rh (D) immune globulin

52
Q

Used for replacement of IgG in immunocompromised patients

A

IVIG

53
Q

IVIG:

  1. used in
  2. Produced from
  3. Sterilized through
  4. No risk of viral transmission
A
  1. ITP (idiopathic thrombocytopenia purpura)
    Kawasaki disease (a vasculitis) in children
  2. Produced from pooled plasma
  3. Sterilized through filtration, pastuerization, and detergents
  4. No risk of viral transmission- true
54
Q
  1. Prepared from pooled human plasma
  2. Viral inactivation by pasteurization
  3. Use as a volume expander in critically ill patients with hypoalbuminemia and capillary leak is controversial and expensive
A

albumin

55
Q

Purified pooled plasma products used:

  1. Rapid control of bleeding in those on vitamin K antagonists (warfarin)
  2. For patients with hemophilia and acquired inhibitors
A
  1. Rapid control of bleeding in those on vitamin K antagonists (warfarin)
  2. For patients with hemophilia and acquired inhibitors
56
Q

factor VIII inhibitor bypassing activity

Enriched with factors II, VII, IX, X

A

FEIBA

57
Q

Enriched with factors II, VII, IX, X, proteins C & S

A

Kcentra

58
Q

giving prothrombin complex concentrates scan increase the risk of

A

thrombosis

heme/onc (30 decks)

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