Blood Component Therapy

Question 0

What is the component of choice to increase hemoglobin levels?

Answer 0

PRBCs

One unit increases hb by 1

Question 1

When is whole blood used?

Answer 1

When both improved oxygen carrying capacity and volume expansion are needed

Question 2

When are leukoreduced RBCs indicated?

Answer 2

Patients who have had non hemolytic febrile transfusion reactions, for exchange transfusions, patients requiring CMV negative when its not available, and for possible prevention of platelet alloimmunization

Question 3

What is included in FFP?

Answer 3

All factors but factor VIII

Question 4

When should FFP be given?

Answer 4

Factor deficiencies when specific factor not available
Multifactorial deficiency states
Warfarin reversal

Question 5

How many platelet concentrates are used in adults? And why?

Answer 5

5-6 because each in cases by 10 and 50 achieves adequate hemostasis

Question 6

What are apharesis platelets?

Answer 6

Only platelets collected
One donation enough
Minimizes infectious and immunogenic risks to recipient

Question 7

How are platelets stored?

Answer 7

Room temp
Only for five days because of risk of bacterial growth
Kept shaking

Question 8

Why might certain patients not be able to increase platelet counts even after transfusion?

Answer 8

Splenic sequestration
HLA directed platelet destruction or clearance by RES
platelet specific antigen alloimmunization

Question 9

What is cryoprecipitate?

Answer 9

Gradual thawing of FFP

Contains factor VIII, VWF, fibrinogen, fibronectin, and fXIII

Question 10

When is cryoprecipitate used?

Answer 10

Source of fibrinogen in acute DIC
Massive transfusion therapy during trauma
Treatment of uremic bleeding 
Cardio thoracic surgery 
Obstetric emergencies 
FXIII. def

Question 11

When must granulocytes be used?

Answer 11

Within 24 hrs of harvest

Rarely used

Question 12

What symptoms are suggestive of a transfusion reaction?

Answer 12

Chills
Rigors
Fever
Dyspnea 
Lightheadedness
Urticaria
Itching
Flank pain

Question 13

How does the degree of renal failure determine the prognosis of an AHTR?

Answer 13

Diuresis and decreasing BUN usually portend recovery
Prolonged oliguria and shock are poor signs
No diuretic response within 2-3 hrs could mean acute tubular necrosis

Question 14

What may be the only clue to a DHTR?

Answer 14

Drop back to original hb values in weeks post transfusion

Question 15

What are the most common types of DHTR?

Answer 15

Secondary response within 3-7 days due to production of antibodies by memory cells that were too low to detect in screenings

Question 16

What are two possible causes of febrile non hemolytic transfusion reactions?

Answer 16

Antibodies against WBC HLA from otherwise compatible donor

Cytokines released from WBCs during storage

Question 17

When is whole blood contraindicated and why?

Answer 17

Cardiac or renal insufficiency patients
To avoid circulatory volume overload
Infuse RBCs slowly and watch carefully

Question 18

What is TRALI?

Answer 18

Transfusion related acute lung injury
Anti HLA or anti granulocyte antibodies in donor plasma that agglutinate and degranulation recipient WBCs within lung capillaries
Donor specific issue
Antigen antibody complex forms

Question 19

When can TA-GVHD happen?

Answer 19

If patient receives blood from a donor who is homozygous for an HLA haplotype for which patient is heterozygous

Question 20

When does TA-GVHD occur and how is it diagnosed?

Answer 20

4-30 days after transfusion

Clinical suspicion, skin and bone marrow biopsies

Question 21

What are some complications of massive transfusion (one blood volume in 24 hrs)?

Answer 21

Dilutional thrombocytopenia
Microvascular bleeding - correct with dose of platelets or FFP or cryoprecipitate
Hypothermia causing arrhythmias or cardiac arrest
Citrate and K+ toxicities - amplified by hypothermia, but k+ usually insignificant unless blood stored for more than a week)

Question 22

What are infectious complications of transfusions?

Answer 22

Bacterial infection (syphilis and secondary rash)
Viral infections (hepatitis)
HIV infection
CMV
HTLV-1
Creutzfeldt-Jakob disease 
Parasitic infection (malaria)