Blood Components Flashcards
What are the two ways that we can get blood?
Whole blood
Apheresis
What is apheresis?
When you suck out blood, it is spun while its going on then separated into plasma, wbc, and rbc
WHy should you give rbc?
anemic
after bleed
What hgb level should you transfuse someone?
The Restrictive strategies show that waiting until it reaches 7 is better than doing it earlier
Unless they are symptomatic
Even if they are hospitalized you can wait until 7-8 (GI bleed, Cardiac surgery, etc.)
When do you give plasm?
- Major bleeding (INR super high, warfarin, vit K def)
- Someone doesnt have coagualtion factors (DIC, Liver dz,)
- Massive transfusions
How low do you let platelets get before you transfuse?
100,000 if its neuro/eye sx
50,000 if active bleed, other sx
5,000 if spontaneous bleed
What is in cryoprecipitate?
Factor Viii, XIII, Fibrinogen, VWF
WHen do you use cryoprecipitate?
- Fibrinogen for bleeding patients
- When normal tx not availiable for
- VWD, Factor VIII def
When do you give Recombinant Factor VIII
- Hemophilia A - control bleeding/getting sx
When do you use Prothrombin Complex Concentrate?
It contains Vitamin K dependent factors - X, IX, VII, II
For pnts with hemophilia who are hemorrhagign or getting sx
When do you give IVIG
Primary Humoral Immunodeficiencies - SCIDS, Congenital agammaglobulinemia (not making IgG)
Pnt has ITP (ab against platelets)
CIDP (myelin destroyed by ab)
Hypogammaglobulinemia
When use Albumin?
- Hypoalbuminemia (chron malnutrition, low prot, liver fail, nephrotic syndrome)
- Volume replacement
What are the 4 ways to modify Blood transfusion?
- Leukoreduction - blood passes through a filter (wbc wont pass through) prevents issues that may arise from WBCs (FEVER, HLS AB, VIRUSES THAT WBCs carry CMV), all products are leukoreduced
- Irradiation: Prevent transfusion associated Graft vs Host disease. (mostly for immunocompromised/young)
- Washing - get rid of as much as plasma as possible. recommended for pnts with IgA def, Pnt that have allergic rxn to blood product, do just before transfusion)
- Volume Reduction - Centrifuge and take out a lot of solution, for when volume overload is a concern. (heart failure/renal failure)
What is Platelet refractoriness?
Part of Leukoreduction
When pnts who receive platelets make ab against antigens on those platelets. anti HLA, Anti HLP ab.
In future patient transfusions the transfused platelet may be quickly destroyed
Tx: need to find compatible platelets (give random platelts, crossmatch, find platelets that dont have antigens)
What is Massive transfusion for?
During sx, or when there is a lot of blood loss
What are the coagulation abnormalities of Massive Transfusions?
Replacement of blood loss will lead to a dilution of coagulation factors (inc PT and aPTT) in which case you can give plasma to replace coagulation factors or Cryo for the fibrinogen.
WHat is directed donation?
donation for a specific patient. More risky for both donor and patient.
The donor is more likely to be untruthful when screened bc they want to help someone.
What should you do if transfusion reactions?
first thing that you should do is STOP THE TRANSFUSION!
keep saline flowing
What is premedication?
give benadryl or tylenol before transfusion. DONT DO IT!
They dont prevent, and if there was a rxn, we dont want it to be masked by drugs.
WHat is the criteria for febrile Transfusion Rxn?
Temp inc by 1 degree C and greater than 38 degrees C
During or withing 4 hours after transfusion
This is the most common TR
more likely in products with more plasma
Tx: give tylenol
Prevent with Leukoreduction
When do yo see allergic tr?
When product has more plasma
It is within 4 hours, urticaira, Pruritis
Tx: benadryl, you can restart after give benadryl.
When are you going to see anaphylaxis?
antibodies to something in the component, most likely IgA.
Present: cardio is most serious, bp low. shock
Tx Stop transfusion, tilt back to reduce bp,
If pnt is IgA defieicnet ask for WASHED blood products
What is Transfusion Associated Cardiovascular Overload? TACO
When the patient is already volume overloaded, heart unable to pump. extra volume.
occurs within 6 hours of transfusion stop.
this causes pulmonary edema, decreased oxygenation, cyanosis,
BOTH BP and HR increased
x ray; bilateral infiltrates
more likely in pnts at risk for volume overload (ICU, fluids already, pnts cant handle more volume well.)
Tx: STOP, tilt the other way to get volume to feet
Prevent: Administer component really slowly!!
What is Transfusion related acute lung injury (TRALI)?
Pathophysiology: Two hit mechanism
Hit 1 - Neutrophil sequestering and priming (neutrophils gather and become more likely to respond to a normal event)
Hit 2 - Neutro-hil activation: antibodies, biological response modifiers. destroy vessels around it, fluid leaks into alveoli.
Presentation: pulmoanry edema, FEVER CHILLS,
Dx: 6 Criteria
- No evidence of previous lung infiltrates
- within 6 hours of transfusion
- Hypoxemia
- Bilateral infiltrates - x ray
- No evidence of TACO
- No risk factors for ALI
LEADING CAUSE OF TRANSFUSION RELATED DEATHS
Tx: STOP, dont give diuretics (Like TACO), pnts already hypovolemic
