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Internal Medicine > Blood products and transfusion > Flashcards

Blood products and transfusion Flashcards

1
Q

Available products for transfusion (5)

A 
Red blood cells
Platelets
Coagulation products
Cryoprecipitate
Factor concentrates
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2
Q

Available products for transfusion (5)

A 
Red blood cells
Platelets
Coagulation products
Cryoprecipitate
Factor concentrates
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3
Q

Centrifugation separates blood in to what components

A

RBC and platelet rich plasma

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4
Q

What is FFP

A

Plasma frozen within 24 hours of collection

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5
Q

What is cryoprecipitate

A

High MW component of FFP is thawed at low temperature

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6
Q

When are irradiated blood products used

A 
Immunocomporomised
Chemotherapy
First degree relative 
HLA matched products
IU products
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7
Q

When is CMV negative blood required (4)

A

Possible transplant recipients
Neonates
Seronegative pregnant women
AIDS

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8
Q

How much is the Hb expected to rise for each unit of pRBC given

A

Hb rise 10 for each unit (4%)

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9
Q

At what Hb would pRBC be indicated

A
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10
Q

During active bleeds what Hb is desirable

A

> 70-100

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11
Q

When should Hb be kept higher

A

CAD/unstable angina
Active/unpredictable bleeds
Impaired pulmonary function
Increased oxygen consumption

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12
Q

When pRBC are anticipated, what should be ordered

A

Group and screen

Cross match

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13
Q

What options are available for pRBC transfusion

A

First line- group and screen, cross match

  1. Same group and Rh status
  2. O- for females of reproductive age, O+ for males
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14
Q

Platelet products available and indications

A

Pooled random->thrombocytopenia w/ bleeding
Single donor->potential BMT recipients
HLA matched->refractory to pooled or single, presence of HLA antibodies

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15
Q

How much does PLT increase from random donor pool and single donor

A

> 15 X 10^9 for pooled

40-60 X 10^9 for single

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16
Q

Indications for platelet transfusion at levels

A

500

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17
Q

relative contraindications of PLT transfusion (4)

A

ITP
TTP
Post-transfusion -ve PLT
HELLP

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18
Q

Indications for FFP

A

Depletion of multiple coag factors

Emergency reversal of life-threatening bleeding secondary to warfarin overdose.

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19
Q

Etiology of multiple depleted coagulation factors

A 
Sepsis
DIC
Liver disease
TTP/HUS
Dilution
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20
Q

Indications for cryoprecipitate

A

Factor 8 deficiency
vWF deficiency
Hypofibrinogenemia

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21
Q

Causes of immune acute blood transfusion reaction

A

Acute hemolytic transfusion reaction
Febrile non hemolytic transfusion reactions
Allergic nonhemolytic transfusion
Transfusion related acute lung injury

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22
Q

Causes of acute blood transfusion reaction

A

Acute hemolytic transfusion reaction
Febrile non hemolytic transfusion reactions
Allergic nonhemolytic transfusion
Transfusion related acute lung injury

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23
Q

DDX of post-transfusion dyspnea

A

Circulatory overload
TRALI
Allergy->bronchospasm, anaphylaxis

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24
Q

DDX of post-transfusion dyspnea

A

Circulatory overload
TRALI
Allergy->bronchospasm, anaphylaxis

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25
Q

Centrifugation separates blood in to what components

A

RBC and platelet rich plasma

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26
Q

What is FFP

A

Plasma frozen within 24 hours of collection

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27
Q

What is cryoprecipitate

A

High MW component of FFP is thawed at low temperature

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28
Q

When are irradiated blood products used

A 
Immunocomporomised
Chemotherapy
First degree relative 
HLA matched products
IU products
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29
Q

When is CMV negative blood required (4)

A

Possible transplant recipients
Neonates
Seronegative pregnant women
AIDS

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30
Q

How much is the Hb expected to rise for each unit of pRBC given

A

Hb rise 10 for each unit (4%)

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31
Q

At what Hb would pRBC be indicated

A
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32
Q

During active bleeds what Hb is desirable

A

> 70-100

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33
Q

When should Hb be kept higher

A

CAD/unstable angina
Active/unpredictable bleeds
Impaired pulmonary function
Increased oxygen consumption

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34
Q

When pRBC are anticipated, what should be ordered

A

Group and screen

Cross match

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35
Q

Management of FNHTR

A

Stop transfusion

If 38 T, stop, paracetamol and anti-histamine

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36
Q

Platelet products available and indications

A

Pooled random->thrombocytopenia w/ bleeding
Single donor->potential BMT recipients
HLA matched->refractory to pooled or single, presence of HLA antibodies

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37
Q

How much does PLT increase from random donor pool and single donor

A

> 15 X 10^9 for pooled

40-60 X 10^9 for single

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38
Q

Indications for platelet transfusion at levels

A

500

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39
Q

relative contraindications of PLT transfusion (4)

A

ITP
TTP
Post-transfusion -ve PLT
HELLP

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40
Q

Indications for FFP

A

Depletion of multiple coag factors

Emergency reversal of life-threatening bleeding secondary to warfarin overdose.

41
Q

Etiology of multiple depleted coagulation factors

A 
Sepsis
DIC
Liver disease
TTP/HUS
Dilution
42
Q

Indications for cryoprecipitate

A

Factor 8 deficiency
vWF deficiency
Hypofibrinogenemia

43
Q

How to categorise transfusion reactions

A

Acute vs Delayed

Immune vs non immune

44
Q

Causes of acute blood transfusion reaction

A

Acute hemolytic transfusion reaction
Febrile non hemolytic transfusion reactions
Allergic nonhemolytic transfusion
Transfusion related acute lung injury

45
Q

DDX of post-transfusion fever

A

AHTR
FNHTR
Bacterial contamination
Allergy

46
Q

DDX of post-transfusion dyspnea

A

Circulatory overload
TRALI
Allergy->bronchospasm, anaphylaxis

47
Q

Management of TRALI

A

Supportive->02, fluid if required

48
Q

What is AHTR

A

Hemolysis due to ABO incompatability

49
Q

Most common cause of AHTR

A

Patient misidentification

50
Q

Onset of AHTR

A

Immediately

51
Q

How does AHTR present

A

Fever, chills, hypotension, flank/back pain, dyspnea, haemaglobinuria

52
Q

Severe complications of AHTR

A

Acute renal failure

DIC

53
Q

Management of AHTR

A

Stop transfusion and notify

Maintain BP, urine output->IV fluids, catheter, ionotropes, diuretics

54
Q

What is febrile non-hemolytic transfusion reactions

A

Due to alloautoantibodies against WBC, platelets, other antigens->cause cytokine release

55
Q

Onset of FNHTR

A

1-6 hours after transfusion

56
Q

Risk of minor and severe FNHTR

A

Minor 1 in 100

Major 1 in 10 000

57
Q

How does the patient with FNHTR present

A

Fever, rigors, myalgia, hypotension

58
Q

Management of FNHTR

A

Stop transfusion

If 38 T, stop, paracetamol and anti-histamine

59
Q

What is allergic nonhemolytic transfusion reactions

A

IgE against plasma antigens which cause activation of mast cells and release of histamine

60
Q

ANTR more common in which type of patients (2)

A

History of multiple transfusions and multiparity

61
Q

Risk of ANTR

A

1 in 100

62
Q

How does ANTR usually present and more seriously

A

Urticaria and pruritis
Angioedema
Bronchospasm
Hypotension

63
Q

Management of ANTR if mild and moderate-severe

A

Mild- slow transfusion rate, give diphenyhydramine

Moderate-severe- stop transfusion, give IV diphenyhydramine, steroids, epinephrine, IV fluids, bronchodilators

64
Q

What is TRALI

A

Acute lung injury during/shortly after transfusion

65
Q

When does TRALI occur

A

During, within 6 hours of transfusion

66
Q

What are the important features in TRALI (5)

A 
Profound hypoxemia
Pulmonary insuffienciecy
Bilateral pulmonary infiltrates on CXR
Capillary wedge pressure not +
No evidence of atrial hyperplasia
67
Q

What is pathogenesis of TRALI

A

Donor antibodies activatio WCC of recipient->+permeability and fluid shift

68
Q

When does TRALI resolve

A

Usually within 24-72 hours

69
Q

Risk of TRALI

A

1 in 10 000

70
Q

Management of TRALI

A

Supportive->02, fluid if required

71
Q

How can TGVHD be prevented

A

Giving irradiated products- eliminates lymphocytes

72
Q

Risk of bacterial infection

A

1 in 100 000 for RBC

1 in 10 000 for platelets

73
Q

management of bacterial infection

A 
Stop transfusion
Antibiotics
Fluids
Contact blood bank
Blood cultures
74
Q

What are the contributing factors to TACO

A

Poor cardiac function

Overload

75
Q

Incidence of TACO

A

1 in 700

76
Q

Clinical presentation of TACO

A

Breathless, orthopnea, PND, edema, crackles

77
Q

Management of TACO

A

Transfuse at lower rate
Oxygen
Sit up
Diuretics

78
Q

What causes hyperkalemia in transfusion reactions

A

Hemolysis of RBC

79
Q

Occurence of hyperkalemia in massively transfused patients

A

5%

80
Q

When can citrate toxicity occur

A

In people with +transfusion and poor liver function as not excreted

81
Q

Management of citrate toxicity

A

Calcium gluconate

82
Q

When does dilutional coagulopathy occur

A

Transfusion >10 units

83
Q

Why does dilutional coagulopathy occur

A

RBCs do not contain coagulation factors, fibrinogen, platelets

84
Q

Management of dilutional coagulopathy

A

FFR, platelets, cryoprecipitate

85
Q

Types of delayed immune transfusion reactions

A

Delayed hemolytic TR

86
Q

What is delayed hemolytic

A

Antibodies against minor antigens, at transfusion not enough to cause reaction, as time progresses level increase

87
Q

Pathogenesis of delayed hemolytic

A

At transfusion antibodies level not increased enough, but after 5-7 days levels high enough

88
Q

When does delayed hemolytic occur

A

5-7 days following transfusion

89
Q

How does delayed hemolytic reaction present

A

Anemia

Jaundice

90
Q

Management of delayed hemolytic

A

Nothing
Monitor Hb levels
Note reaction for future trasfusions

91
Q

What is transfusion GVHD

A

T lymphocytes from donor attack recipient

92
Q

When does TGVHD occur

A

4-30 days post transfusion

93
Q

How does TGVHD present

A

Fever
Diarrhea
Liver function abnormalities
Pancytopenia

94
Q

How can TGVHD be prevented

A

Giving irradiated products- eliminates lymphocytes

95
Q

Causes of delayed non-immune transfusion reaction

A

Iron overload

Viral infection

96
Q

How does iron overload in TR occur

A

Multiple, repeated transfusions over long period of time

97
Q

What is a complication of repeated, long term transfusion

A

Secondary hemochromatosis

98
Q

Management of iron overload with transfusion

A

Iron chelators

Phlebotomy

Internal Medicine (67 decks)

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