Blood products Flashcards
Type 0 Antigen present on erythrocyte and Antibody present in serum
none
Anti-A, Anti-B
Type AB Antigen present on erythrocyte and
Antibody present in serum
A and B
None
Type B Antigen present on erythrocyte and
Antibody present in serum
B
Anti-A
Type A Antigen present on erythrocyte and
Antibody present in serum
A
Anti- B
RBC specific gravity
1.08-1.09
Plat Specific gravity
1.03-1.04
Blood Components Preparation based on
different specific gravities
By using differential centrifugated blood components separated into layers
AB donors reactions to serum of recipient
AB; -
B; +
A; +
O +
B donor cells reactions to serum of recipient
AB; -
B; -
A; +
O +
A donor cells reactions to serum of recipient
AB; -
B; +
A; -
O +
O donor cells reactions to serum of recipient
AB; -
B; -
A; -
O -
What settles at the bottom of the blood bag?
Plt is heavier than plasma & will settled at the bottom of the bag.
What settles at the bottom of the blood bag?
Plt is heavier than plasma & will settled at the bottom of the bag.
Saline was OG designed for…..
chlorea
OG name for ARDS….
blood product with shortest half life
plat
Storage of blood is achieved by adding …..
Citrate phosphate dextrose adenine (CPDA-1) (anticoagulant by chelation of ca)
Phosphate as a buffer
Dextrose as a fuel source
Adenine as a substrate for the synthesis of ATP extending storage time from 21 to 35 days
What happens to pts electrolytes from blood transfusion
calcium decreases = clotting issues
dextrose = increase bg
potassium increases from cells break down =
Packed red blood cells (PRBCs) are derived from …..
whole blood from which the plasma has been removed. “new life for whole blood”
Prepared by removing 200-250ml of plasma from a unit of W.B.
normal …..
500 ml
PRBC volume
200-350 ml
1 unit: increase Hb level about ….
1g/dL (10g/L)& Hct by 3%.
Fresh Frozen Plasma volume
200-250 mL
Fresh Frozen Plasma expires
Expires 12 months after donation
FFP dose
10-15 ml/kg
FFP stored at
-18C or below
Requires thawing which takes time
Each unit of FFP=increase the level of each clotting fx by….
2-3% in adults.
FFP contains….
Water, carbohydrates, fats, minerals
Proteins(all labile & stable clotting fx).
Treatment for angioedema
FFP and TXA
INR of FFP
1.5-1.8
What is Cryoprecipitate
Protein fraction taken off the top of the FFP when being thawed
Cryoprecipitate contains…..
Factor VIII: C
Factor VIII: vWF
Factor XIII
Fibrinogen
Cryo stored at
Stored at –18C & below.
Then refrozen for up to 1 year
Platelets prepared by
cytapheresis/by separating PRP from a unit of W.B w/in 8H of collection & recentrifuged to remove plasma.
Platelets contrains
plt only
One bag pheresis of plat
250-300 mL
One unit of plt increases PLT by
5,000 - 10,000
Spont bleeding starts at what plt level
<35,0000 = spont hemorrhage, no LP, no peripheral nerve block,
Lethal triad
Hypothermia
coagulopathy
acidosis
PH of saline
5.5
Preferred fluid to give with blood
Normosol
plasmalyte
NS
Blood product that is not warmed
plat
WHOLE BLOOD volume
400-500 ml
WHOLE BLOOD storage
1-6 C
indications for whole blood
to maintain blood volume & O2 carrying capacity in acute,massive blood loss.
Actively bleeding pt>20% of body blood volume.
immunologic transufsion rxn
febrile nonhemolytic
allergic
noncardiogenic pulmonary
nonimmunologic transfusion rxn
bacterial contamination
circulatory overload
physical/ chemical hemolysis
Hemolytic transfusion reactions
Mediators
IgM A/b (usually ABO), complement
Hemolytic transfusion reactions s/s
fever, chill, hemoglobinemia, hemoglobinuria, hypotension, dyspnea…..consider what anesthesia will mask
Hemolytic transfusion reactions
tx and prevention
decrease opportunities for error, treat ARF & DIC.
Nonhemolytic febrile transfusion reactions
mediators
A/b to HLA Class I Ag.
Nonhemolytic febrile transfusion reactions
s/s
fever, chill.
Nonhemolytic febrile transfusion reactions
Treatment and Prevention
antipyretics, leukocyte reduced.
Allergic transfusion reactions.
mediators
plasma proteins(mild reactions), A/b to IgA(anaphylactic reactions).
Allergic transfusion reactions.
s/s
urticaria, erythema, itching, anaphylaxis.
Allergic transfusion reactions.
Tx and preventions
antihistamines; treat sx, transfuse IgA-deficient components
Noncardiogenic pulmonary transfusion reactions
mediators
donor/recipient WBC A/b.
Noncardiogenic pulmonary transfusion reactions s/s
ARDS, fever, chill, cyanosis, hypotension, noncardiogenic pulmonary edema.
Noncardiogenic pulmonary transfusion reactions Treatment and Prevention
vigorous respiratory support (PEEP), steroids.
TRALI is a ….
defined as an acute lung injury that is temporally related to a blood transfusion; specifically, it occurs within the first six hours following a transfusion
Transfusion Related Acute Lung Injury occur in….
in 1:1300 to 1:5000 transfusions of plasma containing products
The mortality rate from TRALI ranges from ….
5% to 25% with most patients recovering within 72 hours.
Criteria for TRALI
Acute onset hypoxemia.
Ratio of Pao2/FiO2 <300 or SpO2 <90% on room air.
Occur during or within 6 hours of transfusion.
B/L diffuse pulmonary infiltrates
No evidence of left atrial hypertension(i.e. circulatory overload).
Immediate Management for TRALI
stop transusion
support pt
cbc/chest xray/ pulmonary aspirate
notify blood bank
Immediate Management for TRALI
stop transfusion
support pt
cbc/chest xray/ pulmonary aspirate
notify blood bank
ACUTE NONIMMUNOLOGIC EFFECTS bacterial contamination Mediators
endotoxins produced by GN bact.
ACUTE NONIMMUNOLOGIC EFFECTS bacterial contamination s/s
fever, shock, hemoglobinuria.
ACUTE NONIMMUNOLOGIC EFFECTS bacterial ocntramination tx and prevention
IV ABX; treat hypotension & DIC
TACO; Transfusion Associated Circulatory Overload
mediators
fluid overload
Transfusion Associated Circulatory Overload s/s
coughing, cyanosis, orthopnea, severe headache, peripheral edema, diff breathing.
TACO tx and prevention
administer subsequent Tx slowly & in a small volume.
Hemolysis d/t physical/chemical means mediators
exogenous destruction of RBC.
Hemolysis d/t physical/chemical means s/s
hemoglobinuria
Hemolysis d/t physical/chemical means tx and prevention
document & rule out hemolysis d/t other causes; treat DIC.
DELAYED IMMUNOLOGIC EFFECTS Hemolytic transfusion reactions mediators
IgG A/b.
DELAYED IMMUNOLOGIC EFFECTS Hemolytic transfusion reactions s/s
shortened RBC survival, decreased Hb, fever, jaundice, hemoglobinuria
DELAYED IMMUNOLOGIC EFFECTS Hemolytic transfusion reactions tx and prevention
Ig-negative blood for further transfusions.
Transfusion associated Graft-versus-host disease mediators
viable donor lymphocytes.
Transfusion associated Graft-versus-host disease s/s
fever, skin rash, desquamation, anorexia, nausea, vomiting, diarrhea, hepatitis, pancytopenia
Transfusion associated Graft-versus-host disease tx and prevention
gamma irradiation of cellular components.
Post-transfusion purpura MOA
platelet specific A/b.
Post-transfusion purpura s/s
thrombocytopenia, clinical bleeding.
Post-transfusion purpura tx and prevention
IV Ig, plasma exchange, corticosteroids
TRALI characteristics
Fever
Hypotension
Acute dyspnea
JVP unchanged
Auscultation- rales
X-Ray- diffuse b/l infiltrates
EF- normal
Response to diuretic minimal
TACO characteristics
No fever
Hypertension
Acute dyspnea
JVP Can be changed
Rales + S3
Diffuse b/l infiltrates
Decreased
Significant improvement
Transfusion-Induced Hemosiderosis. MOA
Iron overload.
Transfusion-Induced Hemosiderosis.
s/s
subclinical to death.
Transfusion-Induced Hemosiderosis.
tx and prevention
decrease frequency of transfusion, neocytes, iron chelation therapy.
STEPS TO BE FOLLOWED with transfusion rxn
- Discontinue the transfusion.
- Keep the IV line open.
- Check all labels, forms & pt identification.
- Report to Blood Bank personnel.
- Send requested blood samples.
Class 1 and 2 shock fluid replacement (3:1) rule
cystalloid
Class 3 and 4 shock fluid replacement (3:1) rule
crystalloid and blood
MTP in Adults
1) Total blood volume is replaced within 24 hours
2) 50% of total blood volume is replaced in 3 hours
3) Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss
MTP in Children =
> 40 mL/kg transfusion
balanced resuscitation is ….
1:1:1 ratio (platelets:plasma:RBC)
Multiple blood components ”reconstituted” whole blood
Significant losses of …..with MTP
coagulation factor + platelet function in reconstituted products
More anemic + thrombocytopenic + coagulopathic
LTOWB levels in WB
1000 mg
FFP levels in WB
400 mg
CRY levels in WB
2500 mg
Stored Whole blood (SWB) contains….
all components of blood products
Smaller amounts of anticoagulants
Stored Whole blood (SWB) storage
Cold - 2-6 degrees C
for 21-35 days
Stored Whole blood (SWB) Hemostatic capability
14-21 days
Low-titer o Whole blood (LTOWB) is…..
Stored whole blood = preferred resuscitation product
Universal donor = Low-titer o Whole blood (LTOWB)
what do you do with Trauma patients with unknown blood types
Pre-transfusion blood sample -> determine blood type
Additional transfusions require LTOWB or group O RBCs for 1 month after the initial transfusion
TEG-ACT normal
80-140 seconds
TEG-ACT description
activated clotting time to initial fibrin formation
TEG- ACT measures
CLotting factors (extrinsic/ intrinsic pathways)
R time (conventional) normal
5-10 min
R time (conventional) description
reaction time to initial fibrin formation
R time (conventional) measures
clotting factors (intrinsic pathway)
K time normal
1-3 min
K time description
“Kinetic time” for fibrin cross linkage to reach 20 mm clot strength
K time measures
fibrinogen, platelet number
alpha angle normal
53.0 - 72.0 degrees
alpha angle description
Angle from baseline to slop of tracing that represents clot formation
Alpha angle measures
fibrinogen, platelet number
MA normal
50.0 - 70.0 mm
MA description
Maximum amplitude of tracing
MA measures
platelet number and function
G value normal
5.3 - 12.4 dynes/cm2
G value description
Calculated value of clot strength
G value measures
entire coagulation cascade
LY 30 normal
0 - 3%
Ly 30 description
Clot lysis at 30 minutes following MA
LY 30 measures
fibrinolysis
TEG-ACT>140
transfuse
FFp
R time >10
transfuse
FFP
K time > 3 transfuse
Cryoprecipitate
Alpha angle <53 transfuse
Cryoprecipitate +/- Platelets
MA<50 transfuse
Platelets
LY30>3% transfuse
tranexamic acid
