Blood blank transfusion Flashcards
whole blood is filtered to remove white blood cells
yep
what are a few of the transmissible disease that we test
- Hep B and C
- HIV 1 and 2
- HTLV
- syphilis
- Chagas
- West Nile virus
Platelets require constant agitation to decrease_______
platelet activation
Storage 1. RBCs: 2. Platelets: 3. FFP and cryoprecipitate: Shelf life 1. RBCs: 2. Platelets:
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
Blood groups or blood types refer to the __________ present on the surface of the patient’s RBCs
Blood groups or blood types refer to the antigens present on the surface of the patient’s RBCs
Two major blood group antigens on RBCs
- ABO (blood types A, B, AB, O)
2. Rh (Rh+ or Rh-)
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
They are a mix of IgM (predominantly) and IgG antibodies directed against A or B antigens
The Rh blood group is a group of approximately 50 different antigens
yep
The ___ antigen is primarily responsible for hemolytic disease when an Rh- mother is exposed to Rh+ blood and develops antibodies
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
Rh hemolytic disease in pregnancy
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
Rh- mothers receive anti-D immune globulin prophylactically during any pregnancy and at delivery to prevent ____________
alloimmunization
Classically less severe than hemolytic disease due to D antigen
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
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
Front typing
determines if anti-A or anti-B antibodies are present in the patient’s serum
back typing
Prior to Release of Blood from Blood Bank :
- Donor units are identified based on ____and _____compatibility
- Blood from the blood bank is __________ with the recipient’s serum
- An indirect ________ test is performed to identify an unexpected antibody
- In addition to the ABO and Rh systems there _____other blood group systems
- Crossmatching is especially important in ________
- Because new antibodies can develop at any time a type and cross must be sent every
- Donor units are identified based on ABO and Rh compatibility
- Blood from the blood bank is crossmatched with the recipient’s serum
- An indirect Coomb’s test is performed to identify an unexpected antibody
- In addition to the ABO and Rh systems there 28 other blood group systems
- Crossmatching is especially important in multiply transfused patients
- Because new antibodies can develop at any time a type and cross must be sent every 72 hours for patients
PRBC transfusion is indicated for an anemic patient with
unstable vital signs
Indications for transfusion:
- Prophylactically with severe thrombocytopenia – platelet count < 10,000 (normal 150-450,000/ul)
- Bleeding and thrombocytopenia
- Bleeding and platelet dysfunction
Lower risk of infection with SDU or pooled random donor platelets – approx. 85% of transfused platelets in the U.S.
SDU- are single donor thus lower risk of infection
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?
there can still be ABO incompatibility resulting in:
- response to transfusion affected
- hemolysis
- Rh sensitization
Platelet Alloimmunization:
- Alloimmunization to HLA antigens can make patients ________
- Defined as less than
- Occurs in _____% of multiply transfused patients (AML, bone marrow transplant)
- Must rule out causes of increased platelet consumption:
- _____________ can help identify alloimmunization
- Alloimmunization to HLA antigens can make patients refractory to platelet transfusions
- Defined as less than 2,000 increase in platelet count with platelet transfusion two days in a row
- Occurs in 30-40% of multiply transfused patients (AML, bone marrow transplant)
- Must rule out causes of increased platelet consumption:
DIC, sepsis, splenomegaly - Platelet count 15 min post platelet transfusion can help identify alloimmunization
Fresh frozen plasma (FFP) contains all of the coagulation proteins (2)
- thrombus formation
2. promote fribrinolysis
FFP contains antibodies and thus must be transfused according to rules of ABO compatibility
yep
Indications for FFP Transfusion(3)
4.Not indicated for correction of
- Deficiencies of coagulation proteins in which specific factor concentrates are unavailable or the specific factor deficiency is unknown
- Treatment of multiple coagulation protein deficiencies in the bleeding patient
- Emergent reversal of warfarin
- Not indicated for correction of INR in patient that is not actively bleeding
is the precipitate left over after thawing FFP
cryoprecipitate
cryoprecipitate is rich in these clotting factors (4) and it is primarily transfused for bleeding patients with
- FVIII
- vWF
- FXIII
- fibrinogen
Primarily transfused for bleeding patients with low fibrinogen
factor VII concentrates used for (2) and there are two types
- Hemophilia A
- vWd
two types:
- plasma derived
- recombinant
- Produced by genetically modified mammalian cells (hamster ovary and kidney) to produce Factor VIII
- No risk of viral transmission
- Does not contain von Willebrand antigen
recombinant FVIII concentrates
- Produced from pooled plasma of blood donors
- Infection risk decreased through screening of donors and viral inactivation
- Plasma derived products contain von Willebrand antigen
plasma derived FVIII concentrates
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
iron overload
amnestic response
Upon re-exposure to the RBC antigen the antibody is produced again
delayed hemolytic transfusion reaction:
- why it occured
- why was the ab not picked up
- symptoms
- when does it start
- Patient has been alloimmunized to RBC antigens in the past (prior transfusion or pregnancy)
- Because the exposure was in the distant past the antibody may not be readily detected
- Extravascular hemolysis, fever, increased bilirubin, anemia
- Symptoms several days after transfusion
acute hemolytic transfusion reaction:
- major cause of acute hemolytic rxn
- symptoms
- Result of ___________ intravascular hemolysis
- ABO incompatibility is the major cause of acute hemolytic reaction
- Fever, hemodynamic instability, hemoglobinuria, back and chest pain
- Result of IgM mediated intravascular hemolysis
Transfusion-associated Circulatory Overload (TACO)
- occurs
- clinical sign/symptoms
- HTN
- what dictates the rate of transfusion
- 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
Results from donor antibodies in the transfused product binding to and activating recipient leukocytes within the lungs
transfusion-related acute lung injury- TRALI
TRALI is a diagnosis of
exclusion
Fever can be a sign:
- Simple allergic reaction
- Hemolytic transfusion reaction
- Bacterial contamination of transfused blood product
febrile rxn require you to
- 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
Allergic and Anaphylactic Reactions:
- Simple allergic reaction – _________
- allergic rxn are due to
- Treat with ____________
- Severe allergic reaction – occurs within
- it can occur on ____ deficient patients (1 in 300-500 patients)
- Simple allergic reaction – hives and itching
- Due to WBC in transfused blood product
- Treat with antihistamines
- Severe allergic reaction – occurs within seconds to minutes of initiating blood transfusion
- IgA deficient patients (1 in 300-500 patients)
Non-Infectious Transfusion Complications
Specimen identification – sample for type and cross must be signed and dated at bedside
- Process by which a family member or friend donates blood specific to a recipient
- No safer than blood products from volunteer donors
- Social pressure to donate may actually decrease safety of product
directed donation
Transfusion Transmitted Infectious Diseases
- 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 - Viral infection
- Hepatitis ___: 1 in 200,000
- Hepatitis __: 1 in 1.5 million
- ____: 1 in 2 million
- 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 - Viral infection
- Hepatitis B: 1 in 200,000
- Hepatitis C: 1 in 1.5 million
- HIV: 1 in 2 million
Filters remove white blood cells from whole blood prior to storage of RBCs and platelets
leukodepletion
Only blood donated from a donor known to be CMV negative can be declared “CMV-negative”
yep
Leukodepletion renders the blood product as “CMV safe”
yep
Leukodepletion increases the risk of allergic transfusion reactions
NOPE! Leukodepletion reduces the risk of allergic transfusion reactions
Performed to reduce the risk of transfusion related graft versus host disease (GVHD) and targets donor lymphocytes
irradiation of blood products
all hospital irradiate blood
nope some us a risk based strategy
Novo 7 –
activated recombinant factor VII
Used to treat hemophilia patients with bleeding who have inhibitors to factor VIII or factor IX
recombinant FVIIa
recombinant FVIIa
- used in
- bypasses
- rapid
- Congenital factor VII deficiency
- Bypasses intrinsic coagulation system
- Rapid hemostasis
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
Rh (D) immune globulin
Used for replacement of IgG in immunocompromised patients
IVIG
IVIG:
- used in
- Produced from
- Sterilized through
- No risk of viral transmission
- ITP (idiopathic thrombocytopenia purpura)
Kawasaki disease (a vasculitis) in children - Produced from pooled plasma
- Sterilized through filtration, pastuerization, and detergents
- No risk of viral transmission- true
- Prepared from pooled human plasma
- Viral inactivation by pasteurization
- Use as a volume expander in critically ill patients with hypoalbuminemia and capillary leak is controversial and expensive
albumin
Purified pooled plasma products used:
- Rapid control of bleeding in those on vitamin K antagonists (warfarin)
- For patients with hemophilia and acquired inhibitors
- Rapid control of bleeding in those on vitamin K antagonists (warfarin)
- For patients with hemophilia and acquired inhibitors
factor VIII inhibitor bypassing activity
Enriched with factors II, VII, IX, X
FEIBA
Enriched with factors II, VII, IX, X, proteins C & S
Kcentra
giving prothrombin complex concentrates scan increase the risk of
thrombosis
