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N342 > Blood & Blood Products > Flashcards

Blood & Blood Products Flashcards

1
Q

A single unit of blood contains?

What is done to this blood? (I don’t really understand this…)
How do you maximize longevity of the blood?

A

• 450 ml of blood and 50ml of an anticoagulant

More economical to separate into primary components: erythrocytes, platelets and plasma (leukocytes rarely used)

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2
Q

How concentrated are packed red blood cells?

A

PRBC very conc bc plasma removed

- HCt ~70%

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3
Q

How is blood stored?

A

• Each component must be processed and stored differently to maximize longevity of the viable cells and factors within it
- Each has own shelf life

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4
Q

PRBCs stored at? For how long?

A

• PRBCs stored at 4 degrees safely up to 42 days

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5
Q

How long are platelets stored for? For how long?

A

• Platelets at room temp last up to 5 days (can’t be stored in cold)
o To prevent clumping they are gently agitated

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6
Q

How is blood plasma stored? For how long?

A

• Plasmas immediately frozen to maintain activity of the clotting factors within; lasts up to 1 yr
- alternatively can be pooled and processed futther into components such as albumin, immune globulin, factor VIII and factor IX

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7
Q

whole blood vs PRBCs? WHen is each used?

SEE Paul p. 1025 Chart….is very detailed and I don’t think we need to know it all/I don’t get it (but there are cards for the parts mentioned in the learning outcomes)

A

Whole: includes cells + plasma (HCt ~40%). Used in vol replacement and O2 carrying capacity. Usually only used in sig bleeding (>25% blood loss)

PRBC: RBCs with little plasma (Hct ~75%). Indicated to IInc RBC mass + symptomatic anemia (platelets in unit are non-functional and WBCs are non-functional and may cause rxn)

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8
Q

What is Factor VIII concentrate used for?

A

AKA antihemophilic factor

used in treated hemophilia A

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9
Q

Factor IX concentrate - what is it?

A

prothrombin complex
Contains factors II, VII, IX and X
Used primarily for tx of factor X deficiency (hemophilia B)

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10
Q

When is plasma albumin given?

A

• Plasma albumin is a large protein that is a major contributor to plasma oncotic pressure

used to expand blood volume of patients in hypovolemic shock and rarely to inc concentration of circulating albumin in patients with hypoalbuminemia.
Also used in burns

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11
Q

What is immune globulin?

A

[ ]’d solution of antibody IgG. Contains very little IgA or IgM. Is prepared from large pools of plasma

IVIG (IV form) is used in various clinical situations to replace inadequate amounts of IgG in pt’s who are at risk of recurrent bacterial infection + in some autoimmune disorders

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12
Q

What does a plasma infusion contain?

A

Plasma; all coagulation factors + complement

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13
Q

What does cryoprecipitate contain

What is it used for?

A

Fibrinogen > or equal to 150mg/bag. AHF (VIII:2) 80-110 units/bag, von Willebrand factor + fibronectin

Indications: von Willebrand disease, hypogibrinogenemia, hemophilia A

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14
Q

What is plasma admin used for?

A

Bleeding in pts with coagulation factor deficiencies, plasmapharesis

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15
Q

What exclusionary criteria exist for blood donors?

A

1) hx of viral hep or hx of close contat w pt who had dep or was undergoing dialysis w/in 6 months
2) hx of recieveing blood transfuion or an infeciton of any blood derivative (other than albumin) within 12 months
3) Previous transfusion in UK, Gibraltar, or Falkland Islands (cannot donate in US)
4) cumulative total stay since 1980 in UK for > 3months or any other european country for >6months
5) Hx of syphilis or malaria (if free of symptoms and off tx for 3 yrs following malaria can donate)
6) Hx of IVDU
7) Hx of possible exposure to HIV (anal sex, multiple sex partners IVDU, hemophilia)
8) Skin infection d/t risk of contaminating phlebotomy needle
9) Recent hx of asthma, urticaria, or allergy to meds (can pass hypersensitivity

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16
Q

What is the importance of recent ASA use in blood donor pts?

A

Asked if used aspirin products in last 3 days. If so, does not render donor ineligible but platelets my be dysfx and therefore not useful.
Aspirin use w/in 48-72hrs contraindicates platelet donation.
Aspirin doesn’t affect plasma or RBCs obtained from the donor

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17
Q

What is the

A

x

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18
Q

Donor requirements for blood donation:

1) weight
2) Age
3) Oral temp
4) Pulse
5) bp
6) Hg for men + women?

A

o Exceed 50kg for a standard donation of 450ml
o Older than 17
o Oral temp not exceed 37.5
o Pulse rate between 50-100
o Systolic 90-180 and diastolic 50-100
o Hg at least 1.94 for woman and 2.1 for men

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19
Q

Directed donation
What is it?
Is it safer than usual donation?

A

blood to friend or family but not necessarily safer bc might not be willing to identify any history of risk factors ie) HIV

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20
Q

What is phlebotomy?

What occurs in standard blood donation? (how much is taken + what occurs after?)

A

phlebotomy consists of venipuncture and blood withdrawl.

Withdrawal of 450 ml of blood usually takes up to 15 in Hold arm up after and apply firm pressure for 2-3 minutes. Donor remains recumbent until they feel able to sit up. Receies foods and fluid and stay for 15 minutes.

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21
Q

Blood donor instructed to do what?

A
  • leave drsg on
  • avoid heavy lifting for several hours
  • avoid smoking for 1 hr
  • avoid drinking for 3 hrs
  • Inc fluid intake for 2 days
  • eat healthy meals for at least 2 weeks
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22
Q

What is autologous dontation?

When is the blood collected?

A

patients own blood for future potential surgeries (orthopedic sx).

Ideally collected 4-6 weeks early. Iron supplements given to prevent iron depletion. Typically 1 unit of blood/week.

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23
Q

Up to what point before sx can pt make autologous donation?

A

Phlebotomies are not performed within 72 hours of surgery

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24
Q

If likelihood of transfusion is small, is autologous donation a good idea?

A

No - expensive, takes time, poor use of resources

Although eliminates risk of viral contamination, risk of bacterial contamination is same as in transfution from random donors

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25
Q

Contraindications for autologous donation?

A 
ACute infection
Severely debilitating chronic illness 
Low Hb
HCt <38%
unstable angina
acute CVD or cerebrovascular disease
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26
Q

Intraoperative Blood Salvage - what is it?

A

• provides replacement for patients who cannot donate blood before surgeru and for those underging vascular, orthopedic, or thoracic surgery
o During a surgical procedure, blood lose into a sterile cavity (hip joint0 is suctioned into a cell-saver macine. PRBCs or whole blood are washed with saline, filtered, and returned to patient as IV infusion
o Cant be stored bc bacteria cant be completely remoed

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27
Q

What is hemodilution (a kind of transfusion method)

A

• may be initiated before or after induction of anesthesia
o About 1-2 units are removed fromm patient through a venous or arterial line and replaced with a colloid or crystalloid solution. Blood is then reinfused after surgery
o Adv: pt loses fewer erythrocytes bc added IV solutions dilute th concentration of ertythrocytes and lower the Hct

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28
Q

What is a febrile nonhemolytic rxn?

Is this common?

A
  • Caused by antibodies to donor leukocytes that remain in the unit of blood or blood component.
  • Most common type of transfusion rxn (90%)
29
Q

Who does febrile nonhemolytic rxn most often occur in?

A

• Often occurs in pt who had previous transfusions (exposure to multiple antigens from blood products) and in rh neg woman who have borne Rh positive children (as they have raised antibody levels)

30
Q

How often does this occur in platelet and PRBC transfusions?

A

3% of PRBC transfusions

20% of platelet tranfusions

31
Q

Dx and S+S of febrile nonhemolytic rxns?

A

• Diagnosis is made by excluding other potential cause such as hemolytic reaction or bacterial contamination of the blood product.
• Signs and symptoms are chills (minimal to severe), fever, muscle stiffness
–> begins within 2hours after the transfusion

32
Q

Is febrile nonhemolytic rxn dangerous?

A

• Not life threatening but scary for pts

33
Q

How can febrile nonhemolytic rxn be prevented?

1 assessment to be done?

A

Can be diminished or prevented by ruther depleting leukocytes in donor blood first….Leukocute reduction filter diminishes potential for reaction.
Antipyretics can be given to prevent fever but don’t give ahead of time as don’t want to mask beginning of more serious rxn

• Monitor temp q4h

34
Q

What is the most dangerous type of blood transfusion rxn?

Describe it.

A

Acute hemolytic rxn

  • Most dangerous when blood types are incompatible
  • Antibodies already present in the recipients plasma rapidly combine with antigens on donors erythrocytes and the erythrocytes are destroyed in circulation (intravascular hemolysis)
35
Q

Most rapid hemolysis occurs in what kind of incompatibility?

A

ABO incomp

Rh incomp typically less severe

36
Q

How much incompatible blood would need to be admin’d before hemolytic rxn occurs?

A

• Can occur in as little as 10ml of PRBCs

37
Q

Most common cause of acute hemolytic rnx?

A

• Common cause are errors in labeling and pt ID

38
Q

Symptoms of acute hemolytic rnx?

A

fever, chills, low back pain, nausea, chest tightness, dyspnea, and anxiety

  • As erythrocytes are destroyed, th Hg is released from the cells and excreted by the kidneys, therefore hg appears in the urine (hemoglobinuria) hypotension, bronchospasm, and vascular collapse may result
  • Dimished renal perfusion results in ACF and DIC
39
Q

Tx of acute hemolytic rxn?

A
  • D/c transfusion immediately. Blood and urine specimens must be obtained
  • Maintain blood vol, renal perfusion and prevent and amage DIC
40
Q

Allergic rxn during transfusion:

What do you see?
What does it result from?

A
  • Some patients develop urticaria (hives) or generalized itching
  • Thought to be from sensitivity to plasma protein within blood component being transfused
  • Symp: itching, urticarial, and flushing
41
Q

Tx of allergic rxn during transfusion?

Can the tranfusion be continued?

A

If Responds to antihistamine, then continue transfusion

• If severe- epinephrine, corticosteroids, and vasopressor support

42
Q

If pt experiences allergic rxn during transfusion, what will be done prior to future rxns?

A

Give pt antihistamines before

If severe, future blood components washed to remove any remaining plasma proteins.

43
Q

What is done for pts at risk of or already experiencing circ overload from transfusion?

A

can get diuretics after transfusion or between units

44
Q

Are packed RBCs less risk for circ overload than whole blood?

A

Yes

45
Q

Circ overload S+S?

A

dyspnea, orthopnea, tachycardia, and sudden anxiety, JVD, crackles at base of lungs and inc in BP. PE may develop

46
Q

What is done for pt if severe circ overload develops in transfusion?

A

placed in upright position with feet in a dependent position and transfusion d/c. IV kept patent with NS at slow rate
Possible morphine + O2 if dyspnea severe

47
Q

When does bacterial contamination occur in trNSFUSIONS?

Is it common?

A

Can be at any stage of processing blood but most often from donor’s skin
Not common but does put recipient at significant risk

48
Q

by nature of storage instructions, what kind of blood product poses greatest risk of bacterial contamination?

A

platelets b/c stored at room temp

49
Q

PRBCs and whole blood to be admin’d within what time frame? Why?

A

• Should be administed within a 4 hour period bc warm room temp of product promotes bacterial growth

50
Q

Can you see that a contaminated blood product is contaminated?

A

May be normal or may be abnormal colour

51
Q

Tx for bacterial contamination of transfusion?

A
  • Signs: fever, chills, hypotension
  • Should treat w broad-spectrum abx, fluid or septic shock will occur
  • IVkept open with saline. Blood returned to bank and tested
  • Sepsis treated with fluids and abx, corticosteroids, and vasopressors
52
Q

Does bacterial contam signs + symptoms appear quickly?

A

May not occur until tranfusion complete or occassionally not until sever hours after transfusion. If not treated right away, septic shock can occur

53
Q

What is TRALI

A

Transfusion-Related Acute Lung Injury

54
Q

What is the most common transfusion related cause of death?

A

TRALI

55
Q

What is TRALI?

Patho?

A

• Potentially fatal, idiosyncratic reaction that occurs in less than 1 in 5000 transfusions

Patho is unknown

Thought to involve antibodies in plasma of donor to the leukocutes in the recipients blood. Sometimes reverse happes- abs in recipient agglutinates to anitgens on the few remaining leukocutes in blood component being transfused

  • Another theory- initial insult to patients vascular endothelium causes neutrophils to aggregate at the injured endothelium
  • Various substances within the transfused plasma (lipids, cytokines) then activate the netutrophils
  • End result of this process is interstitial and intra-alveolar edema, as well as extensive sequesteration of WBCs withn the pulm capillaries
56
Q

How quickly does TRALI occur?

A

• Onset abtupt- within 6hours. Usually within 2hrs

57
Q

TRALI signs + symptoms

A

SOB, hypoxia (arterial o2 sat), less than 90%, hypotensin, fever and pulm edema

58
Q

Diagnostic criteria of TRALI?

A

include hypoxemia, bilateral pulm infiltrates and no evidence of cardiac cause for the pul edema

59
Q

How not to die with TRALI?

A

• O2, intubation, fluid support to prevent death

60
Q

Which kinds of blood products are most likely to cause TRALI?

A

More likely to occur with plasma, then plateleets

61
Q

Prevention of TRALI?

A

• Preventative strategy is to limit freq ad amount of blood products transfused or getting platelets and plasma from men or from a women who has never been preg (less likely to have offending antibodies)

62
Q

What is Delayed hemolytic reaction

A
  • Occurs within 14 days when level of antibody has been increased to the extent that a reaction can occur
  • The hemolysis of the erythrocutes is extravascular via the RES and occurs gradually
63
Q

Is delayed hemolytic rxn dangerous?

Signs + symptoms?
Tx?

A
  • fever, anemia, inc bilirubin, dec haptoglobin and possibly jaundice
  • Subsequent transfusions can be more dangerous (as now have more antibodies)
  • Because amount of antibodies present can be too low to detect might be difficult to prevent reactions so no intervention necessary if mild
64
Q

What conditions would requires long term transfusion therapy?

A

MDS, thalassemia, aplastic anemia, sick cell anemia

65
Q

How much iron is in 1 unit of blood?

A

1 unit PRBCs contain 250mg of Iron

66
Q

Who is prone to getting iron overload?

What is the damage of this?

A

Problem unique to those who have long term PRBC transfusions

• Excess iron can cause organ damage particularily in liver, heart, testes and pancreas
Leads to endocrine failure (diabetes, hypothyroidism, hypogonadism etc)

67
Q

3 common types of long term PRBC tranfusion therapy?

WHy?

A

Infection
Iron overload
Tranfusion rxn

• Long term are at a greater risk for infection and more sensitive to donor antigens, bc exposed to more donors

68
Q

What infections are common problems w long term transfusion tx?

A

Hep B, C + Cytomegalovirus

69
Q

What is the preventative measure for iron overload?

A

Chelation therapy

N342 (5 decks)

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