Blood Products Flashcards
What does FFP have in it?
ALL of the coagulation factors including 5 and 8
What does cryo have in it?
Fibrinogen, VWF, and Factor 13
Which two products should be warmed? which two should not be warmed?
PRBC and FFP= warmed
Platelets and Cryo=not warmed
One unit of packed RBC increases the hgb and hct by what?
Hgb by 1, and Hct by 2-3%
When do you transfuse platelets? One unit of platelets increases platelet count by how much? Do platelets need to be ABO compatible?
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
Indications for transfusion of FFP?
- 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
Does FFP have to be ABO compatible?
Yes
FFP should be given in doses sufficient for what? and what is that dose?
in doses sufficient to achieve a minimum of 30% of plasma factor concentration. This usually means 10-15 mL/kg of FFP
indications for transfusion of cryoprecipitate (and what is the normal fibrinogen level?!)
Congenital fibrinogen deficiency (normal levels are 200-400 mcg)
Microvascular bleeding with a fibrinogen level <80-100
VW diseases when factors aren’t available
Is ABO compatibility necessary for Cryo? How much does one unit of fibrinogen increase serum fibrinogen?
It is preferred but not required
One unit of cryo: 200 mg of fibrinogen
What are infectious causes of blood transfusions?
Bacterial contamination, viral disease (CMV, Hep B, Hep C, HIV)
Acute hemolytic transfusion reactions-why does this happen? what does it represent?
Usually a result of ABO incompatibility
Represents immunologic destruction of transfused red cells due to ABO incompatibility
Signs of Acute hemolytic transfusion rxn:
How do you make the diagnosis?
tachycardia, hypotension, elevated peak airway pressures
Diagnosis: Direct Coombs test, decreased platelet count, prolongation of coags
Treatment of acute hemolytic reactions?
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
What is a delayed hemolytic reaction? What are signs?
Extravascular hemolysis of donor RBCs by recipient antibodies upon RE-EXPOSURE to an RBC antigen-low grade fever, mild jaundice, and elevated bilirubin
Allergic reactions with transfusions-why does it happen, and how do you treat?
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
How to treat febrile reactions to donor leukocytes?
APAP
What’s TRALI? Treatment?
Form of non-cariogenic pulmonary edema as a result of activation of host leukocytes by donor antibodies
Tx: supportive with mechanical ventilation as needed
Graft vs Host disease: what is it? how do you prevent?
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?
Post-transfusion purpura-what happens, and how do you treat it?
Thrombocytopenia is due to destruction of patient’s own platelets by all antibodies. IV immunoglobulin is the tx of choice
What are complications of massive blood transfusion?
Temp? Volume? Coag? Electrolytes? Left shift? Acid/base disturbances?
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.
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?
- 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)
Can you withhold RH positive blood from an exsanguinating Rh negative patient if Rh negative blood is unavailable?
No. Give it to them. its ok to give O positive blood to an o negative recipient in an emergent situation.
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?
Keep with o negative blood unless blood bank confirms that anti A or anti B antibodies are present in low titers.
Things to keep in mind when you’re gonna be transfusing:
At least 2 large bore IVs, Foley catheter, treat hypothermia aggressively! Monitor vital signs, temp, acid base status, hgb/hct
What is the problem with recombinant factor 7a therapy?
It’s used for uncontrolled bleeding in hemophilia patients, but has an increased risk of DVT, PE and MI
TACO vs TRALI:
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.
