Blood Components

Question 1

What are the two ways that we can get blood?

Answer 1

Whole blood

Apheresis

Question 2

What is apheresis?

Answer 2

When you suck out blood, it is spun while its going on then separated into plasma, wbc, and rbc

Question 3

WHy should you give rbc?

Answer 3

anemic

after bleed

Question 4

What hgb level should you transfuse someone?

Answer 4

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.)

Question 5

When do you give plasm?

Answer 5

1. Major bleeding (INR super high, warfarin, vit K def)
2. Someone doesnt have coagualtion factors (DIC, Liver dz,)
3. Massive transfusions

Question 6

How low do you let platelets get before you transfuse?

Answer 6

100,000 if its neuro/eye sx
50,000 if active bleed, other sx
5,000 if spontaneous bleed

Question 7

What is in cryoprecipitate?

Answer 7

Factor Viii, XIII, Fibrinogen, VWF

Question 8

WHen do you use cryoprecipitate?

Answer 8

1. Fibrinogen for bleeding patients
2. When normal tx not availiable for
   - VWD, Factor VIII def

Question 9

When do you give Recombinant Factor VIII

Answer 9

1. Hemophilia A - control bleeding/getting sx

Question 10

When do you use Prothrombin Complex Concentrate?

Answer 10

It contains Vitamin K dependent factors - X, IX, VII, II

For pnts with hemophilia who are hemorrhagign or getting sx

Question 11

When do you give IVIG

Answer 11

Primary Humoral Immunodeficiencies - SCIDS, Congenital agammaglobulinemia (not making IgG)
Pnt has ITP (ab against platelets)
CIDP (myelin destroyed by ab)
Hypogammaglobulinemia

Question 12

When use Albumin?

Answer 12

1. Hypoalbuminemia (chron malnutrition, low prot, liver fail, nephrotic syndrome)
2. Volume replacement

Question 13

What are the 4 ways to modify Blood transfusion?

Answer 13

1. 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
2. Irradiation: Prevent transfusion associated Graft vs Host disease. (mostly for immunocompromised/young)
3. 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)
4. Volume Reduction - Centrifuge and take out a lot of solution, for when volume overload is a concern. (heart failure/renal failure)

Question 14

What is Platelet refractoriness?

Part of Leukoreduction

Answer 14

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)

Question 15

What is Massive transfusion for?

Answer 15

During sx, or when there is a lot of blood loss

Question 16

What are the coagulation abnormalities of Massive Transfusions?

Answer 16

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.

Question 17

WHat is directed donation?

Answer 17

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.

Question 18

What should you do if transfusion reactions?

Answer 18

first thing that you should do is STOP THE TRANSFUSION!

keep saline flowing

Question 19

What is premedication?

Answer 19

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.

Question 20

WHat is the criteria for febrile Transfusion Rxn?

Answer 20

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

Question 21

When do yo see allergic tr?

Answer 21

When product has more plasma
It is within 4 hours, urticaira, Pruritis
Tx: benadryl, you can restart after give benadryl.

Question 22

When are you going to see anaphylaxis?

Answer 22

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

Question 23

What is Transfusion Associated Cardiovascular Overload? TACO

Answer 23

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!!

Question 24

What is Transfusion related acute lung injury (TRALI)?

Answer 24

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

Question 25

WHat are diff between TACO and TRALI?

Answer 25

Common: Both within 6 hours, Difficulty breathing, Inc lung sounds, bilateral infiltrates on x ray.
Diff: TACO: risk of VOlume overload, INC BP, Positive Fluid Balance,
TRALI: Fever/Chills

Question 26

What is Acute Hemolytic TR?

Answer 26

Antibodies attacking RBCs.
almost always ABO discrepincy, clerical error
Present: Classic triad: fever, flank pain (kidney), Hemoglobinuria
THis is EMERGENCY
Tx: STOP, IV saline to urinate as much bad as possible
Prevention: multiple checks, technology.

Question 27

What is Delayed Hemolytic TR?

Answer 27

Patho: Patient is developing NEW aB agains the RBCs, or pnt had a very low titer and takes a while for the abs to build up agains transfusion
Present: 3-30 days after transfusion
Tx: supportive
Prevent: know if they had ab previously, INFORM the pnt of the antibody to keep in personal records.

Question 28

What is Posttransfusion Purpura?

Answer 28

When pnt receives platelets and makes abs against them, these then attack teh pnts own natural platelets.
Present: 9 days after, thrombocytopenia, purpura, pee blood
Tx: IVIg, corticosteroids,
Prev: give good platelets

Question 29

What is Transfusion associated Graft vs Host Disease

Answer 29

Immunosuppressed pnt gets transfusion of pnt that has diff HLA type. Viable T cells in component attack the pnt, but the pnt cant fight back.
Present: 3-30 days after, cough abdominal pain, etc. Symptoms can easily be attributed to other conditions.
Rash extends, elev LFTs, Pancytopenia,
Tx: 90% fatal, no tx
Prev: irradiation

Question 30

What is Transfusion Transmitted Infection?

Answer 30

Give pnt bug via transfusion
Presentation: immediately after
Usually platelets - stored at room temperature and good for culuture
Freq; the odds of pnt getting septic are very low bc stored at cold temp.
Tx: culture the pnts blood after STOP
Prevent: ask donors qs, scrub donor well, discard skin plug

Question 31

What is Hemolytic Disease of the Fetus and Newborn?

Answer 31

Rh problem iwth second baby.
antibodies can flow throug placenta - bad for baby 2
Rh(D) Immune globulin Rhogam: destroys the antibodies formed against baby’s cells.
WHen do we give Rhogam: NOT for when mom has already developed anti-Rh abs. Do when mom is Rh- and dad is Rh+. Mom is Rh- and dad is unknown, or when find that baby is Rh+.