Blood Products Flashcards
Appropriate hemoglobin for coronary ischemia
hgb 10-12 adequate
Appropriate hemoglobin for ongoing blood loss
hgb 10-12 (target: room for loss)
Appropriate hemoglobin for critical illness
hgb 7-9 adequate
1 unit of PRBC raises hgb by how much
1gm/dl
What is PRBC stored in for preservation and what electrolyte decreases with massive transfusion
citrate (CDPA) and can get hypocalcemia
how long do PRBC’s last
3 weeks, storage decreases 2,3 DPG, decreases pH, and increases potassium and lactic acid
what is the max temperature PRBC can be stored at?
49 C because protein denaturation occurs at temps higher than this
Indications for platelet transfusion
<50 w/ active bleeding or preop
Contraindications to platelets
TTP, HUS, HELLP, HITT (may need to give plts to control severe bleeding)
how much does a 6 pack of platelets increase platelet lab value by
50,000
If there is a <5000 increase with a 6 pack of platelets this suggests what
alloimmunization, so tx is ABO matched platelets, and if still < 5000 check panel reactive antibody for HLA antibodies (may need HLA matched platelets)
Fresh frozen plasma contains what
all coagulation factors (includes factor C, S, and ATIII) good for deficiencies of all factors (dilutional coagulopathy from massive transfusion, DIC, liver disease, Warfarin, PT > 17 preop
what blood product has highest levels of vWF, fibrinogen, Factor VIII, and Factor XIII
cryoprecipitate, good for bleeding with low fibrinogen < 100 or bleeding in vWD
What are irradiated blood products for
Kills T cells in blood product, used in pts at risk for transfusion related graft versus host disease (hematopoietic stem cell TXP, hematologic malignancies, congenital immunodeficiency)
what are CMV negative used for?
(from CMV neg donors), used for CMV sero neg pregnancy, organ and bone marrow txp candidates/recipients, AIDS, low birth weight infants
what are leukoreduced used for
WBCs can cause HLA allo immunization, fever (cytokine release) and carry CMV, used for chronically transfused pts, potential txp recipients, previous febrile non hemolytic transfusion reaction, or when CMV products are desirable but unavailable
what are immunoglobulin products used for?
(intravenous, IV-Ig), used for post exposure prophylaxis (eg Hep A), some autoimmune D/Os (eg ITP, myasthenia gravis)
What is plasmapheresis used for
removes immunoglobulins (eg TTP)
symptoms and tx for febrile non hemolytic transfusion reaction
MC transfusion reaction, Sx’s of fever and rigors 0-6 hrs after transfusion, preformed recipient Ab’s against donor WBC’s, causes cytokine release, tx=stop transfusion, tylenol (R/O infx, and hemolysis), WBC filters for subsequent transfusions.
symptoms and tx for transfusion allergic reaction
MC sx - urticaria (rash), rare anaphylaxis (sx’s - bronchospasm and hypotension) reaction to plasma proteins in blood product, MCC - IgA deficient pt (w/ preformed Ab’s to IgA) receiving IgA blood, Tx: urticaria - diphenhydramine, H2 blockers, and Anaphylaxis - epinephrine, fluids, possible steroids.
Sx and tx for delayed hemolytic transfusion reaction?
sx’s-usually minimal (often goes unnoticed), possibly unexplained fever, jaundice, or drop in hct, usually get sx’s 5-10 days after transfusion. Preformed recipient Ab’s against donor minor RBC antigens HLA, urinalysis shows urobilinogenuria, W/U includes LFT’s, clotting and red cell antibody screens, Tx: nonspecific, Dx important for future transfusion HLA match next time.
Sx and Tx of transfusion related acute lung injury (TRALI)
Sx’s - hypoxia, diffuse alveolar infiltrates, fever, non cardiogenic pulmonary edema < 6 hours after transfusion, Donor Ab’s bind recipient WBCs and lodge in lung release mediators causing increased capillary permeability. Tx: may require intubation, tx same as ARDS
Sxs, Dx and Tx for acute hemolytic transfusion reaction
sx’s: fever, hypotension, tachycardia, flank pain, hematuria, can lead to renal failure, shock and DIC, anesthetized pts can present as diffuse bleeding.
Cause: ABO incompatibility, preformed recipient Ab’s against donor RBCs, results in acute hemolysis.
Dx: haptoglobin < 50 (binds Hgb, then gets degraded), free hemoglobin > 5, increased unconjugated bilirubin.
Tx: stop transfusion, fluid resuscitation for BP and to maintain good UOP, Diuretics (lasix and mannitol), HCO3 to prevent Hgb precipitation in kidney and ATN, Pressors for refractory hypotension.
what is incidence of fatal hemolytic transfusion reaction
1:500,000
MCC of death from transfusion reaction
clerical error resulting in ABO compatibility
what causes non immune hemolysis
from squeezing the blood bag and severity of transfusion reactions are inversely proportional to frequency
What is rate of bacterial infection complication in platelets transfusion
1:50,000
what is rate of bacterial infection complication in pRBC transfusions
1:500,000
What is rate of Hep B complications with transfusions
1:200,000
What is rate of Hep C infectious complication with transfusions
1:2,000,000
what is rate of HIV in transfusions
1:2,000,000
Platelets are stored at what temperature
room temperature
How long are platelets stored for
5 days
what is MC bacterial contaminant in transfusions
GNRs (MC E. coli)
What transfusion problems does cold body temp cause
poor clotting due to slowing of enzymatic reactions
What is treatment for dilutional thrombocytopenia due to pRBC transfusion
platelets
Treatment for hypocalcemia due to massive transfusion
calcium for Ca is required for clotting cascade
What type of antibodies develop in 20% after 10-20 plt transfusion
antiplatelet antibodies
Fx of hetastarch (he span)
volume expander, can use up to 1L without risk of bleeding complications
All blood products carry risk of HIV and Hepatitis except
albumin and immunoglobulins (these are heat treated)
chagas disease can be transmitted with ?
blood transfusions
What can be used to raise hemoglobin without giving blood (eg Jehovah’s Witness)
Epoeitin, Fe supplementation, which should raise hgb 1-2 pts/wk
What should be screened for in an iron deficient anemia post menopausal female or male
colon CA or another GI source
