Blood products and transfusion Flashcards
Available products for transfusion (5)
Red blood cells Platelets Coagulation products Cryoprecipitate Factor concentrates
Available products for transfusion (5)
Red blood cells Platelets Coagulation products Cryoprecipitate Factor concentrates
Centrifugation separates blood in to what components
RBC and platelet rich plasma
What is FFP
Plasma frozen within 24 hours of collection
What is cryoprecipitate
High MW component of FFP is thawed at low temperature
When are irradiated blood products used
Immunocomporomised Chemotherapy First degree relative HLA matched products IU products
When is CMV negative blood required (4)
Possible transplant recipients
Neonates
Seronegative pregnant women
AIDS
How much is the Hb expected to rise for each unit of pRBC given
Hb rise 10 for each unit (4%)
At what Hb would pRBC be indicated
During active bleeds what Hb is desirable
> 70-100
When should Hb be kept higher
CAD/unstable angina
Active/unpredictable bleeds
Impaired pulmonary function
Increased oxygen consumption
When pRBC are anticipated, what should be ordered
Group and screen
Cross match
What options are available for pRBC transfusion
First line- group and screen, cross match
- Same group and Rh status
- O- for females of reproductive age, O+ for males
Platelet products available and indications
Pooled random->thrombocytopenia w/ bleeding
Single donor->potential BMT recipients
HLA matched->refractory to pooled or single, presence of HLA antibodies
How much does PLT increase from random donor pool and single donor
> 15 X 10^9 for pooled
40-60 X 10^9 for single
Indications for platelet transfusion at levels
500
relative contraindications of PLT transfusion (4)
ITP
TTP
Post-transfusion -ve PLT
HELLP
Indications for FFP
Depletion of multiple coag factors
Emergency reversal of life-threatening bleeding secondary to warfarin overdose.
Etiology of multiple depleted coagulation factors
Sepsis DIC Liver disease TTP/HUS Dilution
Indications for cryoprecipitate
Factor 8 deficiency
vWF deficiency
Hypofibrinogenemia
Causes of immune acute blood transfusion reaction
Acute hemolytic transfusion reaction
Febrile non hemolytic transfusion reactions
Allergic nonhemolytic transfusion
Transfusion related acute lung injury
Causes of acute blood transfusion reaction
Acute hemolytic transfusion reaction
Febrile non hemolytic transfusion reactions
Allergic nonhemolytic transfusion
Transfusion related acute lung injury
DDX of post-transfusion dyspnea
Circulatory overload
TRALI
Allergy->bronchospasm, anaphylaxis
DDX of post-transfusion dyspnea
Circulatory overload
TRALI
Allergy->bronchospasm, anaphylaxis
Centrifugation separates blood in to what components
RBC and platelet rich plasma
What is FFP
Plasma frozen within 24 hours of collection
What is cryoprecipitate
High MW component of FFP is thawed at low temperature
When are irradiated blood products used
Immunocomporomised Chemotherapy First degree relative HLA matched products IU products
When is CMV negative blood required (4)
Possible transplant recipients
Neonates
Seronegative pregnant women
AIDS
How much is the Hb expected to rise for each unit of pRBC given
Hb rise 10 for each unit (4%)
At what Hb would pRBC be indicated
During active bleeds what Hb is desirable
> 70-100
When should Hb be kept higher
CAD/unstable angina
Active/unpredictable bleeds
Impaired pulmonary function
Increased oxygen consumption
When pRBC are anticipated, what should be ordered
Group and screen
Cross match
Management of FNHTR
Stop transfusion
If 38 T, stop, paracetamol and anti-histamine
Platelet products available and indications
Pooled random->thrombocytopenia w/ bleeding
Single donor->potential BMT recipients
HLA matched->refractory to pooled or single, presence of HLA antibodies
How much does PLT increase from random donor pool and single donor
> 15 X 10^9 for pooled
40-60 X 10^9 for single
Indications for platelet transfusion at levels
500
relative contraindications of PLT transfusion (4)
ITP
TTP
Post-transfusion -ve PLT
HELLP
Indications for FFP
Depletion of multiple coag factors
Emergency reversal of life-threatening bleeding secondary to warfarin overdose.
Etiology of multiple depleted coagulation factors
Sepsis DIC Liver disease TTP/HUS Dilution
Indications for cryoprecipitate
Factor 8 deficiency
vWF deficiency
Hypofibrinogenemia
How to categorise transfusion reactions
Acute vs Delayed
Immune vs non immune
Causes of acute blood transfusion reaction
Acute hemolytic transfusion reaction
Febrile non hemolytic transfusion reactions
Allergic nonhemolytic transfusion
Transfusion related acute lung injury
DDX of post-transfusion fever
AHTR
FNHTR
Bacterial contamination
Allergy
DDX of post-transfusion dyspnea
Circulatory overload
TRALI
Allergy->bronchospasm, anaphylaxis
Management of TRALI
Supportive->02, fluid if required
What is AHTR
Hemolysis due to ABO incompatability
Most common cause of AHTR
Patient misidentification
Onset of AHTR
Immediately
How does AHTR present
Fever, chills, hypotension, flank/back pain, dyspnea, haemaglobinuria
Severe complications of AHTR
Acute renal failure
DIC
Management of AHTR
Stop transfusion and notify
Maintain BP, urine output->IV fluids, catheter, ionotropes, diuretics
What is febrile non-hemolytic transfusion reactions
Due to alloautoantibodies against WBC, platelets, other antigens->cause cytokine release
Onset of FNHTR
1-6 hours after transfusion
Risk of minor and severe FNHTR
Minor 1 in 100
Major 1 in 10 000
How does the patient with FNHTR present
Fever, rigors, myalgia, hypotension
Management of FNHTR
Stop transfusion
If 38 T, stop, paracetamol and anti-histamine
What is allergic nonhemolytic transfusion reactions
IgE against plasma antigens which cause activation of mast cells and release of histamine
ANTR more common in which type of patients (2)
History of multiple transfusions and multiparity
Risk of ANTR
1 in 100
How does ANTR usually present and more seriously
Urticaria and pruritis
Angioedema
Bronchospasm
Hypotension
Management of ANTR if mild and moderate-severe
Mild- slow transfusion rate, give diphenyhydramine
Moderate-severe- stop transfusion, give IV diphenyhydramine, steroids, epinephrine, IV fluids, bronchodilators
What is TRALI
Acute lung injury during/shortly after transfusion
When does TRALI occur
During, within 6 hours of transfusion
What are the important features in TRALI (5)
Profound hypoxemia Pulmonary insuffienciecy Bilateral pulmonary infiltrates on CXR Capillary wedge pressure not + No evidence of atrial hyperplasia
What is pathogenesis of TRALI
Donor antibodies activatio WCC of recipient->+permeability and fluid shift
When does TRALI resolve
Usually within 24-72 hours
Risk of TRALI
1 in 10 000
Management of TRALI
Supportive->02, fluid if required
How can TGVHD be prevented
Giving irradiated products- eliminates lymphocytes
Risk of bacterial infection
1 in 100 000 for RBC
1 in 10 000 for platelets
management of bacterial infection
Stop transfusion Antibiotics Fluids Contact blood bank Blood cultures
What are the contributing factors to TACO
Poor cardiac function
Overload
Incidence of TACO
1 in 700
Clinical presentation of TACO
Breathless, orthopnea, PND, edema, crackles
Management of TACO
Transfuse at lower rate
Oxygen
Sit up
Diuretics
What causes hyperkalemia in transfusion reactions
Hemolysis of RBC
Occurence of hyperkalemia in massively transfused patients
5%
When can citrate toxicity occur
In people with +transfusion and poor liver function as not excreted
Management of citrate toxicity
Calcium gluconate
When does dilutional coagulopathy occur
Transfusion >10 units
Why does dilutional coagulopathy occur
RBCs do not contain coagulation factors, fibrinogen, platelets
Management of dilutional coagulopathy
FFR, platelets, cryoprecipitate
Types of delayed immune transfusion reactions
Delayed hemolytic TR
What is delayed hemolytic
Antibodies against minor antigens, at transfusion not enough to cause reaction, as time progresses level increase
Pathogenesis of delayed hemolytic
At transfusion antibodies level not increased enough, but after 5-7 days levels high enough
When does delayed hemolytic occur
5-7 days following transfusion
How does delayed hemolytic reaction present
Anemia
Jaundice
Management of delayed hemolytic
Nothing
Monitor Hb levels
Note reaction for future trasfusions
What is transfusion GVHD
T lymphocytes from donor attack recipient
When does TGVHD occur
4-30 days post transfusion
How does TGVHD present
Fever
Diarrhea
Liver function abnormalities
Pancytopenia
How can TGVHD be prevented
Giving irradiated products- eliminates lymphocytes
Causes of delayed non-immune transfusion reaction
Iron overload
Viral infection
How does iron overload in TR occur
Multiple, repeated transfusions over long period of time
What is a complication of repeated, long term transfusion
Secondary hemochromatosis
Management of iron overload with transfusion
Iron chelators
Phlebotomy
