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Heme/Onc Exam 3 > Blood products and transfusion therapy > Flashcards

Blood products and transfusion therapy Flashcards

1
Q

In the US, ___ million units of blood are transfused annually

A

15
About 1 out of every 3 Americans will require a blood transfusion during their lifetime

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2
Q

The standard blood donation involves removal of approximately ____ of blood through a large-bore IV

A

450 mL

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3
Q

Additive to blood donations

A

Citrate-Phosphate-Dextrose
Solution with Adenine, used to
to help prevent the clotting of the
blood, provide energy, and ensure
longevity of the sample

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4
Q

What does each part of the blood transfusion additive do?

A

● Citrate – prevents coagulation
● Phosphate – buffer maintains pH
● Dextrose – source of energy
● Adenine – enhances viability of RBCs

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5
Q

To separate the whole blood donation into different blood products, there are a few steps, including two centrifuge spins:

A

Soft spin: Results in separation of Packed RBCs and Platelet-Rich Plasma
Hard spin: Results in separation of Platelet Concentrate (sensitive to cold) and Cell-Free Plasma which is frozen to form Fresh Frozen Plasma (FFP)

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6
Q

Why are the WBCs removed in transfusion samples?

A

It will be spun off because they tend to cause more transfusion reactions

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7
Q

Pretransfusion testing process includes

A

● Recipient and donor blood undergoes the same ABO and D typing. In addition, the patient’s serum is tested for the presence of alloantibodies other than anti-A and anti-B (MANY of them)
● Each selected donor unit is also tested against serum from the patient
● This whole process is called “Type and Crossmatch”

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8
Q

Type and Screen

A

Screen recipient blood for specific antigens and their
alloantibodies in addition to ABO/Rh typing

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9
Q

Type and Cross

A

■ Final safeguard
■ Blood from donor is mixed with recipients blood to ensure it is fully compatible

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10
Q

Whole Blood

A

● Provides good source of RBCs, clotting factors and volume for hemorrhage
when rapid transfusion is needed
● Can be stored at 4 C for about 21- 35 days
● Donor and recipient must be compatible

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11
Q

Whole blood indications

A

○ Autologous donation (for elective surgery)
○ Hemorrhage
■ Rapid correction of anemia
■ Coagulopathy
■ Major trauma

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12
Q

What can be given as a Transfusion?

A

Whole Blood
Packed Red Blood Cells (PRBC)
Fresh Frozen Plasma (FFP)
Platelets (Platelet Concentrate)
Platelet Rich Plasma

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13
Q

Whole Blood contraindications

A

○ Heart Failure – Potential for volume overload.
○ Whole blood should not be used when other blood products (separated blood components) are indicated, such as…
■ PRBC for anemia, FFP for coagulopathy, etc.

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14
Q

Whole blood side effects

A

○ Volume overload
○ Arrhythmias
○ Heart failure
○ Hypothermia

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15
Q

Packed Red Blood Cells

A

● Used to increase O2 carrying capacity
● Helps body get rid of CO2
● 1 unit of PRBCs increases Hgb by 1-1.5 g/dL and HCT by 2-3%

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16
Q

Packed Red Blood Cells indications

A

○ Anemia and/or hypoxia
■ When? Hgb < 7. (If 7- 10, it’s a clinical call, if > 10, not indicated)
■ Severe Thalassemia – abnormal Hgb
■ Sickle cell anemia

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17
Q

Packed Red Blood Cells contraindications

A

○ Not for use if anemia can be corrected with supplements
■ Ferrous sulfate, B12, Folate
○ An illegal use to increase O2 carrying capacity for
sports – “blood doping”

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18
Q

What transfusion type is used with “blood doping?”

A

Packed Red Blood Cells

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19
Q

Packed Red Blood Cells side effects

A

○ Volume overload
○ Heart failure
○ Hypothermia

20
Q

Fresh Frozen Plasma

A

Concentrated plasma without platelets or RBCs
○ Contains multiple coagulation factors and other important proteins
○ Can store at -18 C for up to 1 year

21
Q

Fresh Frozen Plasma indications

A

○ Liver disease coagulopathy
○ TTP - Plasma exchange
○ Manage bleeding in Pts that require replacement of multiple coag factors
(like in DIC)
○ Patients on Warfarin with bleeding or anticipating surgery
○ Rare specific plasma protein deficiencies
○ Occasionally after surgeries, like cardiac surgery

22
Q

Fresh Frozen Plasma contraindications

A

○ Not indicated for correcting labs (PT/ PTT) without active bleeding being present
○ Not to be used alone to reverse Warfarin if Vitamin K can be used
○ Not to be used in Protein S deficiency

23
Q

Fresh Frozen Plasma side effects

A

○ Headaches
○ Paresthesias
○ Pruritus
○ Urticaria

24
Q

Platelet Concentrate

A

● Concentration of platelets, with either 1 unit obtained from a pooling from 6 donors, or from a single donor through the process of apheresis
● Irradiated platelets are given to immunocompromised
● Stored at room temp for up to 5 days only
○ Platelets lose function when refrigerated
○ Increased risk for bacterial infection
● Platelet transfusions should be administered sparingly, only when truly indicated

25
Q

Platelet Concentrate indications

A

○ Significant Thrombocytopenia
○ Treat of active bleeding due to platelet dysfunction or absence
○ Prophylaxis in those at risk for bleeding – thrombocytopenia
○ Leukemia patients with thrombocytopenia
○ Aplastic anemia
○ ITP – autoimmune destruction of platelets

26
Q

Platelet Concentrate contraindications

A

○ Microangiopathic Hemolytic processes
■ TTP – Thrombotic thrombocytopenic purpura
■ HUS – Hemolytic uremic syndrome
○ HIT – Heparin induced thrombocytopenia
○ History of PTP- post transfusion purpura
○ Avoid in DIC as it can make conditions worse

27
Q

A rare adverse reaction where the body quickly destroys newly transfused platelets (which leads to worsening thrombocytopenia)

A

PTP - post transfusion purpura

28
Q

Platelet Rich Plasma

A

● PRP is plasma with concentrated platelets and growth factors
● These growth factor proteins are believed to promote healing of joints and soft tissue
● Blood is drawn from patient, centrifuged, and PRP removed and concentrated
● The PRP is then injected into the injured area

29
Q

Transfusion Process

A

● Informed consent must be obtained
● Check vital signs
● Type and Crossmatch
● Check expiration date of blood product
● Obtain blood samples within 30 minutes of beginning
● Compare name and ID number on label and wristband
● Double check ABO blood type and Rh compatibility

30
Q

Nurse must remain with patient for first ____ minutes to watch for signs and
symptoms of transfusion reaction

A

15

31
Q

You are most likely to have transfusion reactions in first ____

A

15 minutes

32
Q

Important transfusion reactions

A

○ Acute hemolysis
○ Febrile reaction
○ Allergic reactions
○ Anaphylaxis
○ Transfusion-Associated Circulatory Overload
○ Sepsis
○ Transfusion-Related Acute Lung Injury
○ Delayed hemolytic reaction - later transfusions

33
Q

How to deal with acute hemolysis of a transfusion reaction

A

Supportive care

34
Q

How to deal with a febrile reaction with transfusion

A

APAP

35
Q

How to deal with an allergic reaction with transfusion

A

Diphenhydramine

36
Q

How to deal with an anaphylaxis with transfusion

A

Epinephrine, prepare for ACLS

37
Q

How to deal with a Transfusion-Associated Circulatory Overload with transfusion

A

Diuretics and Oxygen

38
Q

How to deal with a Sepsis with transfusion

A

IV abx, IV fluids

39
Q

How to deal with a Transfusion-Related Acute Lung Injury with transfusion

A

O2, pressors if needed

40
Q

How to deal with a Delayed hemolytic reaction with transfusion

A

IVIG with possible EPO

41
Q

Hemolytic reaction: Acute

A

■ ABO Incompatibility
■ Severity depends on how much blood is given before the transfusion is
halted, particular problem in surgery
■ 1 in 70,000 units transfused
■ Fatal reaction is 1 in a million

42
Q

Hemolytic reaction: Delayed

A

■ Essentially incompatibility to a given antigen, but slower response, or
within days of the transfusion
■ Alloantibodies form to other antigens and present as a problem on future
transfusions. These are not as severe as ABO incompatibility

43
Q

T/F The donor blood is also screened for several blood-borne infectious
disorders, so as not to transmit the disease

A

T

44
Q

What diseases are screened for in a blood transfusion?

A

HIV
Hep B and C
Lymphotropic viruses
West nile
Syphilis
Chagas disease
Bacteria

45
Q

Transfusions should only be
given when ____

A

benefits outweigh
the risk

Heme/Onc Exam 3 (6 decks)

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