blood transfusion Flashcards
collection process
- blood collection
- testing of blood for infectious disease ->
-blood component preparation ->
-identification of appropriate components for treatment ->
-assessment of donor recipient compatibility
-if necessary treatment of component prior to transfusion to minimize adverse effects
-after correct identification of the pt and the product intended for transfusion (2 people must sign off), transfusion of the pt ->
-evaluation of the pt for complications of transfusion and response to transfusion
RBC transfusion decision in adults
1) do clinical and laboratory assessment
2) check Hb levels and give blood based on Hb and comorbidities
UNDER 7:
- give blood!!!
7-10: Give blood under these conditions
- acute MI
- anemia: hemodynamically unstable (bp, ABCs abnormal) or respiratory/cardiac sx
- GI bleeding: 7
- ICU pt: 7
- cardiac surgery: 7.5
- pre-existing CAD: 8
- non-cardiac surgery: 8
- oncology pt in tx: 8
ABOVE 10: give blood if rapidly declining
- pt with symptomatic with anemia: hemodynamically unstable, MI, no response to fluid
- rapid bleed > 2g/dL drop per day
when to transfuse: hmg 7-10
- acute MI
- anemia: hemodynamically unstable (bp, ABCs abnormal) or respiratory/cardiac sx
- GI bleeding: 7
- ICU pt: 7
- cardiac surgery: 7.5
- pre-existing CAD: 8
- non-cardiac surgery: 8
- oncology pt in tx: 8
blood collection summary:
-volunteer only for donation, NO payment
-questionnaire- screened for behaviors and medical conditions
Must check vitals:
- temp, bp, pulse
- hmg: must be over 13 for males, over 12.5 females*
-cross check donor for prior disqualification
Blood collection:
-disinfected, initial collection for screening and then 450-500 ml donation
-no more than 15 MINUTES, 10% of blood volume -> K+ release, sheer force hemolysis, clot
apheresis
Process that removes whole blood -> centrifugation to separate components -> desired components collected -> rest of the blood returned to the donor
Use:
- very expensive
-plasma, platelets, WBC, RBC taken out by centrifugation
-gives a lot more platelets than a typical spun down whole blood
preparation of whole blood: how to do you separate the compoents and what components are there
1) centrifuge whole blood into: RBCs + plasma/platelets
- RBCs stored in 1-6 degree C
2) centrifuge plasma/platelets: Platelets + plasma
- store platelets: 20-24 degrees C
-plasma can then be stored as FFP or separated out more into cryoprecipitate
- remaining components after cryoprecipitate = cryo-poor plasma
plasma components
fresh frozen plasma, FFP
-FFP given to pts bleeding out
-contains cryoprecipitate + cryo-poor components
Cryoprecipitate components:
-Fibrinogen*
-Factor VIII
-Factor XII
-Von Willebrand factor
Cryo-poor plasma:
-Albumin
-Immunoglobulins
routine infectious testing
-Syphilis
-Hiv
-Hepatitis c
-Hepatitis B
-Human t-cell leukemia lymphoma virus (htlv)
-Zika
-West nile
-Trypanosoma cruzi (Chagas disease)
-Bacteria
9 tests: check for infectious ds in blood
S HHHH ZW TB
testing of donated blood: what do you need to identify
-ABO
-Rh Type
-Rbc alloantibodies
(also check correct pt and specimen)
ABO typing: what is the blood compatibility, what antigens, antibodies present in each cell, who can get blood from who, who can you give blood to? etc
test for A or B antibodies
-A type: antigens to A
-B type: antigens to B
-AB type: antigens to A and B
-O type: no antigens
Rh Typing
Rh+: Rh antigen is present on RBCs
- can SAFELY RECEIVE Rh+ blood*
Rh-: no Rh antigen and can produce an immune response (alloantibodies) against Rh+ blood
- can be exposed through transfusion or pregnancy and develop alloantibodies -> subsequent exposure causes HEMOLYTIC RXN
blood cross match
use: to determine if donor blood is suitable by check for AGGLUTINATION or HEMOLYSIS when mixed together
Steps:
-pt serum mixed with RBC from donor -> centrifugation -> incubation -> addition of other reagents
-sample check for hemolysis or agglutination -> incompatible
-see if its clots (agglutinates): + means pt has alloantibody to donor
-+ for hemolysis or agglutination -> incompatible
-neg for hemolysis or agglutination -> compatible
ABO/Rh typing: forward typing
Function: to detect ANTIGENS on RBCs
-add antibodies to A, B, and Rh antigens in 3 separate tubes (1 for A, 1 for B, 1 for Rh) containing pt RBC
Outcome:
-clumping of RBC = + presence of antigen
-failure to clump = absence of antigen on RBC
ABO/Rh typing: reverse typing
Function: to detect ANTIBODIES in serum which can bind to RBC antigens
-add pt serum with or without anti-A and anti-B antibodies to A+ and to B+ RBC blood type (A cells in 1 tube and B cells in another)
outcome:
-clumping of RBC = presence of antibody to RBC antigen on cells used (either A or B blood type)
-failure to clump indicates absence of antibody to RBC antigen (AB)
Rh factor- pregnancy
Rh- mother carrying an Rh+ fetus can develop antibodies against the fetus’s RBCs
-during pregnancy or childbirth -> small amount of fetal blood enters mothers circulation
-over next several weeks women develops alloantibodies and an immune memory against Rh +antigen
-when women becomes pregnant with her second Rh+ child -> immune system quickly produces antibodies that attack the fetus’s red blood cells -> HEMOLYTIC RXN
-Rh- baby and Rh+ mom -> no issue
platelet transfusion indications + what to check
Indications:
-Patients who are thrombocytopenic (production or loss)
-Given to cease or prevent bleeding
-prophylactically for <10,000 adult, <50,000 neonate
-<30,000 and bleeding or minor bedside procedure
-<50,000 and intraoperative or postoperative bleeding
-<100,000 and bleeding post cardiopulmonary bypass
-if platelets are low due to excessive clotting -> DO NOT transfuse (purpura, heparin induced thrombocytopenia)
Can be given whole blood or apheresis
what to check:
-ABO preferred, not necessary
FFP transfusion indications, CI
INR is 2+ and:
-active bleeding
-bedside procedure
Prophylaxis (nonbleeding) with INR >= 10
Thrombotic thrombocytopenic purpura
FFP NOT indicated for:
- pts with INR <1.5* ( normal limit and blood will clot)
-pt may have high INR in cases of coagulopathy, warfarin, liver failure -> dont transfuse FFP, use reversal agents or modify dose
cryoprecipitate transfusion indications and what to check
Bleeding in setting of:
-dysfibrinogenemia
-fibrinogen <100; fibrinogen deficiency (DIC)
-von willebrand disease: genetic ds that affects clotting
- Factor XIII deficiency
explanation:
-these conditions need to correct clotting factor deficiencies and allow hemostatis/clotting
What to check:
-ABO preferred, not necessary. No crossmatch. Rh type not considered
RBC transfusions: when is it indicated + what must you check beforehand
Indications
-Tx of anemia
-Sickle cell crisis
-Hemolytic disease of the newborn
What must be checked:
-Must be ABO and Rh compatible and cross matched!
-Can be leukoreduced (remove WBCs) for those with febrile reactions or CMV
-a few WBCs that got into the RBCs -> can cause fever
fresh frozen plasma: description and what to check
Description:
-Frozen within 8 hours of collection
-Whole donation or Apheresis
-Significant levels of coagulation factors
-Controls bleeding, restores plasma proteins
-Not for blood volume
Check:
-Should be ABO compatible, no crossmatch, no rh type
FFP = INR + ABO compatible
granulocytes transfusion
Type: single donor during apheresis
-Given to patient who is NEUTROPENIC and has an infection that is not mounting an immune response
-More effective in infants
Must check:
-Must crossmatch (RBCs can leak into the product)
-dont really do much bc we have injections for this
relation of non-chemo related neutropenia and infection risk
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complications of transfusions:
3% complication rate
- First complaint usually: back pain* -> hemolysis in the kidneys
Immune hyemolytic transfusion reaction: 24 hr to 21 days
- infused RBCs are destroyed by the recipient’s immune system
-REACTION: rash, elevated temp, aches, chills, tachycardia, inspirations rapid, oliguria, nausea
-blood in urine
-hot around transfused vein entry point
Allergic: Hypersensitivity rxn - hives, anaphylaxis
WBC Reaction
-non hemolytic febrile reaction*
-Transfusion related Acute Lung
-Platelet reactions
Infectious: small risk despite screening
what to do in blood reaction
-2 wide bore IVs in separate arms
-if you have rxn in arm your transfusions -> stop that and start the other
-if IV you are using for transfusion only normal saline can be used in that same IV
-fluids going in other arm
-HF- dont volume overload
-flush the tubing
-premedicate if concerned with mild transfusion reaction - Benadryl, tylenol (fever), lasix (volume overload)
-if reaction -> STOP disconnect and rapidly run normal saline
-monitor, vitals every 5 mins
-aggressive steroid therapy
-if acute hemolytic rxn -> respiratory measures
-look for hemolysis- urine, labs
-do not throw out tubing -> goes to lab to find out if blood was mislabeled and what happened
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