Blood Products

Question 1

What does FFP have in it?

Answer 1

ALL of the coagulation factors including 5 and 8

Question 2

What does cryo have in it?

Answer 2

Fibrinogen, VWF, and Factor 13

Question 3

Which two products should be warmed? which two should not be warmed?

Answer 3

PRBC and FFP= warmed

Platelets and Cryo=not warmed

Question 4

One unit of packed RBC increases the hgb and hct by what?

Answer 4

Hgb by 1, and Hct by 2-3%

Question 5

When do you transfuse platelets? One unit of platelets increases platelet count by how much? Do platelets need to be ABO compatible?

Answer 5

Usually when count is less than 50,000 in the presence of active bleeding, and prophylactic transfusion between 10-20,000.
One unit of platelets increases the platelet count by 5-10,000
ABO compatibility is preferred but not required

Question 6

Indications for transfusion of FFP?

Answer 6

• Urgent warfarin reversal (if not emergent-Vit K and withdrawal of warfarin is preferred)
• Correction of factor deficiencies for which specific concentrates are unavailable
• After massive blood transfusions
• Can give when pts have anti-thrombin deficiency
• INR above 2, PT greater than 1.5x normal, and PTT greater than 2x normal

Question 7

Does FFP have to be ABO compatible?

Answer 7

Yes

Question 8

FFP should be given in doses sufficient for what? and what is that dose?

Answer 8

in doses sufficient to achieve a minimum of 30% of plasma factor concentration. This usually means 10-15 mL/kg of FFP

Question 9

indications for transfusion of cryoprecipitate (and what is the normal fibrinogen level?!)

Answer 9

Congenital fibrinogen deficiency (normal levels are 200-400 mcg)
Microvascular bleeding with a fibrinogen level <80-100
VW diseases when factors aren’t available

Question 10

Is ABO compatibility necessary for Cryo? How much does one unit of fibrinogen increase serum fibrinogen?

Answer 10

It is preferred but not required

One unit of cryo: 200 mg of fibrinogen

Question 11

What are infectious causes of blood transfusions?

Answer 11

Bacterial contamination, viral disease (CMV, Hep B, Hep C, HIV)

Question 12

Acute hemolytic transfusion reactions-why does this happen? what does it represent?

Answer 12

Usually a result of ABO incompatibility

Represents immunologic destruction of transfused red cells due to ABO incompatibility

Question 13

Signs of Acute hemolytic transfusion rxn:

How do you make the diagnosis?

Answer 13

tachycardia, hypotension, elevated peak airway pressures

Diagnosis: Direct Coombs test, decreased platelet count, prolongation of coags

Question 14

Treatment of acute hemolytic reactions?

Answer 14

Stop transfusion
0.9% saline given IV to maintain urine output of 100 mL/hr
Dopamine to support blood pressure
Maintain volume and BP
Diuretics-mannitol and furosemide
Sodium bicarbonate to alkalinize the urine

Question 15

What is a delayed hemolytic reaction? What are signs?

Answer 15

Extravascular hemolysis of donor RBCs by recipient antibodies upon RE-EXPOSURE to an RBC antigen-low grade fever, mild jaundice, and elevated bilirubin

Question 16

Allergic reactions with transfusions-why does it happen, and how do you treat?

Answer 16

Reaction to the proteins in the donor plasma that occur after the transfusion of plasma. 
Treatment: 
stop the transfusion 
IV fluids
IV epinephrine
Methylprednisolone 
diphenhydramine

Question 17

How to treat febrile reactions to donor leukocytes?

Answer 17

APAP

Question 18

What’s TRALI? Treatment?

Answer 18

Form of non-cariogenic pulmonary edema as a result of activation of host leukocytes by donor antibodies
Tx: supportive with mechanical ventilation as needed

Question 19

Graft vs Host disease: what is it? how do you prevent?

Answer 19

Passenger donor lymphocytes establish an immune response against an immunocompromised host. Pancytopenia develops rapidly, irradiation of blood products is the only way to prevent it?

Question 20

Post-transfusion purpura-what happens, and how do you treat it?

Answer 20

Thrombocytopenia is due to destruction of patient’s own platelets by all antibodies. IV immunoglobulin is the tx of choice

Question 21

What are complications of massive blood transfusion?

Temp? Volume? Coag? Electrolytes? Left shift? Acid/base disturbances?

Answer 21

Hypothermia
Volume overload
Dilutional coagulopathy (decrease in fibrinogen, factors 2, 5, 7, and platelets)-this is why you need to give platelets and FFP with lots of blood.
Electrolytes: hypocalcemia (citrate) and hyperkalemia
Left shift of 2,3, DPG due to decrease in 2,3 DPG of stored RBC
Metabolic acidosis with transfusion of stored blood followed by metabolic alkalosis as lactate and citrate in transfused blood are being converted to bicarbonate in the liver.

Question 22

As far as emergency transfusions-when cross matched blood is unavailable, use ____
If the answer to what you put above is unavailable, then what?
And then if that is unavailable, then what?

Answer 22

• type specific partially cross matched blood
• If type specific partially cross matched blood is unavailable, use type specific, uncross-matched blood
• if type specific blood is unavailable, use type O Rh negative blood (the universal donor)

Question 23

Can you withhold RH positive blood from an exsanguinating Rh negative patient if Rh negative blood is unavailable?

Answer 23

No. Give it to them. its ok to give O positive blood to an o negative recipient in an emergent situation.

Question 24

If 10-12 units of O negative blood have been given to a non group O patient, what do you do if more blood becomes available?

Answer 24

Keep with o negative blood unless blood bank confirms that anti A or anti B antibodies are present in low titers.

Question 25

Things to keep in mind when you’re gonna be transfusing:

Answer 25

At least 2 large bore IVs, Foley catheter, treat hypothermia aggressively! Monitor vital signs, temp, acid base status, hgb/hct

Question 26

What is the problem with recombinant factor 7a therapy?

Answer 26

It’s used for uncontrolled bleeding in hemophilia patients, but has an increased risk of DVT, PE and MI

Question 27

TACO vs TRALI:

Answer 27

TACO is usually associated with hypertension and responds well to diuretics, TRALI is often associated with hypotension and diuretics have a minimal effect. A normal natriuretic peptide level post-transfusion is seen with TRALI but not with TACO.