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Hematology > Blood Component Therapy > Flashcards

Blood Component Therapy Flashcards

1
Q

What are the two methods to get blood?

A

Donations

Apheresis

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2
Q

What is apheresis?

A

Drawing off plasma from RBCs

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3
Q

What happens to a unit of donated blood after it is spun?

A

Draw off plasma/platelets, and spin that to just get plasma

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4
Q

pRBC are used for what?

A

Transfusions for Hb, or replaced after acute bleeding

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5
Q

What happens to potassium are pRBCs are stored

A

Increased

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6
Q

What happens to RBC deformability are pRBCs are stored

A

Decreased

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7
Q

What happens to 2,3 BPG are pRBCs are stored

A

Decreased

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8
Q

What happens to ATP are pRBCs are stored

A

Decreased

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9
Q

What happens to glutathione are pRBCs are stored

A

Decreased

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10
Q

What happens to NO levels are pRBCs are stored

A

Decreases

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11
Q

Is there a clinical difference if giving older pRBCs compared to fresh pRBCs?

A

No

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12
Q

Which is has shown to provide better outcomes: transfusing at low Hb thresholds, or higher ones?

A

Lower

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13
Q

What is the Hb threshold for: a symptomatic pt?

A

10 g/dL

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14
Q

What is the Hb threshold for: preexisting CAD?

A

8 g/dL

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15
Q

What is the Hb threshold for: acute coronary syndromes?

A

8-10 g/dL

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16
Q

What is the Hb threshold for: heart failure?

A

8-8 g/dL

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17
Q

What is the Hb threshold for: ICU pts?

A

7 g/dL

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18
Q

What is the Hb threshold for: GI bleeds (stable)?

A

7 g/dL

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19
Q

What is the Hb threshold for: pts with non-cardiac surgery

A

8g/dL

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20
Q

What is the Hb threshold for: cardiac surgery

A

7-8 g/dL

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21
Q

What is the Hb threshold for: oncology pts in treatment?

A

7-8 g/dL

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22
Q

What is the Hb threshold for: the palliative care setting?

A

PRN for symptom management

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23
Q

What is the purpose of leuko-reducing units of blood?

A

Prevent fever, HLA alloimmunization, viruses

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24
Q

What is the specific virus that is concerning and a reason for performing a leukoreduction? Why?

A

CMV–carried in WBCs

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25
Q

True or false: Leukoreduced units are considered CMV negative

A

True

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26
Q

True or false: you have to specifically request leukoreduced RBC units in the US

A

False–virtually all RBC units in the US are leukoreduced

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27
Q

What is the purpose of irradiating pRBCs?

A

Prevent transfusion associated GVHD

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28
Q

What is the major indication for irradiating pRBCs?

A

If the pt is immunocompromised

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29
Q

What is the purpose of washing RBCs?

A

Remove IgA, or other allergic parts of plasma

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30
Q

What is volume reduction used for?

A

When circulatory overload is a concern

31
Q

What are the indications for giving plasma?

A
  1. Coagulation factor replacement
  2. Massive tranfusions
  3. TTP
32
Q

True or false: it is rare that pts make antibodies to transfused platelets

A

True

33
Q

What are the two antigens that pts make antibodies against when given platelets?

A

Anti-HLA

Anti-HPA

34
Q

What is the concern with developing an immune rxn to platelets?

A

In future transfusions, the transfused platelets may be quickly destroyed

35
Q

What is the treatment for refractory platelets?

A
  1. Give random platelets units
  2. Crossmatch
  3. Find platelets that do not have the antigen that the antibody is directed toward
36
Q

What is alloimmune platelet refractoriness?

A

Destruction of transfused platelets

37
Q

What is non-alloimmune platelet refractoriness?

A

Splenomegaly/sepsis/DIC

38
Q

What is in cryoprecipitate?

A

Factor VIII
Fibrinogen
vWF
Factor XIII

39
Q

When is cryoprecipitate used?

A

Fibrinogen replacement in bleeding pts

vWF disease

40
Q

What is the process to make plasma derivatives?

A

Plasma fractionation

41
Q

What is prothrombin complex concentrate?

A 
plasma concentrate that has factors 
2
7
9
10
42
Q

What fraction of the plasma concentrate does factor VIII come from?

A

1

43
Q

What fraction of the plasma concentrate does IgG come from?

A

II and III

44
Q

What fraction of the plasma concentrate does factor albumin come from?

A

V

45
Q

When is prothrombin complex concentrate given?

A

To pts with hemophilia

46
Q

When is recombinant factor VIII given?

A

Pts with hemophilia A

47
Q

What is IVIG given?

A

Primary humoral immunodeficiencies

48
Q

When is albumin given?

A

PRotein losing enteropathy
liver failure
Nephrotic syndrome

49
Q

What is a massive transfusion?

A

replacement of entire RBC volume in 24 hours

REplacement of 50% of a pts total blood volume in 3 hours

50
Q

What is the major issues with massive transfusions?

A

Coagulation abnormalities caused by dilution of existing platelets

51
Q

What is the major issue with directed donation?

A

Riskier since the donor is more likely to be untruthful (since they want to help pt)

52
Q

True or false: whole blood is rarely used in the US

A

True

53
Q

What is the primary advantage of giving whole blood?

A

Has all three components of the blood

54
Q

When is whole blood generally used?

A

Traumas

55
Q

What is the first step to take if you suspect a transfusion rxn?

A

Stop the transfusion and keep the line open with saline

56
Q

What is the pathophysiology of febrile transfusion reactions?

A

Cytokine release from leukocytes in the transfused blood

57
Q

What is the presentation of febrile transfusion rxns?

A

Temp increase of >1C above 37C with no other etiology

58
Q

How long can febrile transfusions present after transfusion?

A

up to 4 hours after

59
Q

How do you prevent febrile transfusion reactions?

A

Leukoreductions

60
Q

What is the pathophysiology of an allergic TR?

A

Preformed IgE against the RBCs that are transfused

61
Q

What type of transfused material usually causes an allergic TR?

A

Plasma d/t platelets

62
Q

What specific disease is a common cause of anaphylaxis post transfusion

A

IgA deficiency

63
Q

Does pretreatment work for allergic reactions to transfusions?

A

No

64
Q

What is the treatment for allergic TR?

A

Diphenhydramine

65
Q

What is transfusion-associated circulatory overload?

A

Volume overload d/t transfusion

66
Q

What is the most presentation of TACO?

A

increased BP and HR

67
Q

What is the platelet transfusion threshold for: an active bleed?

A

50,000

68
Q

What is the platelet transfusion threshold for: DIC or a CND bleed?

A

100,000

69
Q

What is the platelet transfusion threshold for: neurosurgery?

A

100,000

70
Q

What is the platelet transfusion threshold for: eye surgery?

A

less than 100,000

71
Q

What is the platelet transfusion threshold for: major surgery (outside of eye or neurosurgery)

A

less than 50,000

72
Q

What is the platelet threshold for central line placement?

A

less than 20,000

73
Q

What is the platelet threshold for the prevention of spontaneous bleeding?

A

less than 5,000

Hematology (32 decks)

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