blood transfusion Flashcards

1
Q

collection process

A
  • 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
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2
Q

RBC transfusion decision in adults

A

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

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3
Q

when to transfuse: hmg 7-10

A
  • 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
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4
Q

blood collection summary:

A

-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

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5
Q

apheresis

A

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

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6
Q

preparation of whole blood: how to do you separate the compoents and what components are there

A

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

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7
Q

plasma components

A

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

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8
Q

routine infectious testing

A

-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

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9
Q

testing of donated blood: what do you need to identify

A

-ABO
-Rh Type
-Rbc alloantibodies

(also check correct pt and specimen)

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10
Q

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

A

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

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11
Q

Rh Typing

A

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

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12
Q

blood cross match

A

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

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13
Q

ABO/Rh typing: forward typing

A

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

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14
Q

ABO/Rh typing: reverse typing

A

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)

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15
Q

Rh factor- pregnancy

A

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

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16
Q

platelet transfusion indications + what to check

A

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

17
Q

FFP transfusion indications, CI

A

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

18
Q

cryoprecipitate transfusion indications and what to check

A

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

19
Q

RBC transfusions: when is it indicated + what must you check beforehand

A

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

20
Q

fresh frozen plasma: description and what to check

A

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

21
Q

granulocytes transfusion

A

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

22
Q

relation of non-chemo related neutropenia and infection risk

A

23
Q

complications of transfusions:

A

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

24
Q

what to do in blood reaction

A

-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