blood transfusion Flashcards
what is fresh whole blood
blood taken within 8 hours
what are all the components of FWB
RBCs, WBCs, platelets, plasma proteins, clotting factors
what patients would we want to use FWB on
Active hemorrhage, anemic pts with thrombocytopenia or thrombopathia, anemia with CF deficits, massive hemorrhage
what is massive transfusion and which patients do we use it for
replacement of more than half the total blood volume in 4 hours
• Indicated for patients with massive, uncontrolled hemorrhage
what is the storage temperature for stored whole blood and amount of time good for
o Storage: 1°C to 6°C, 22 days to a month
what should we know about SWB
o Platelet function is lost after 24 hrs
o Concentration of labile (weaker) clotting factors decreases (V and VIII)
o Content:
➢ RBCs, stable CFs, plasma proteins
what patients may we want to use for SWB
➢ O2 carrying support
➢ CFs
➢ IV volume expansion
what are packed RBCs blood
o Hypoxic pts attributable to the deficiency of circulating RBC mass
➢ Blood loss
➢ RBC destruction
➢ Reduced RBC production
o PCV ~ 70-80% (ideal)
o Storage~ 1 month
o Co-administered with physiological saline to reduce the viscosity
what patients may we want to use for Packed RBCs
➢ Anemia with clinical signs ( weakness, dull mentation, compensatory signs)
➢ PCV less than 20%
➢ Not indicated to pts with chronic anemia
➢ Extra benefit
what should we know about fresh frozen plasma
o -18°C within 8-24 hours of collection
o Retain most CF efficacy for ~12 months
o Coagulation factors and plasma proteins
o Indications:
➢ Coagulopathies (acquired or hereditary)
➢ Hypoproteinemia (protein-losing nephropathies and enteropathies), decreased COP
what should we know about stored frozen plasma
o Harvested anytime (before due date) / FFP not used within 12 months
o No platelets or labile coagulation factors
o Colloidal support, vitamin K-dependent factors
o Stored for ~ 5 years
o Indications:
➢ Hypoproteinemia
what should we know about platelet-rich plasma
o Harvested from FWB < 8hrs, has not been cooled below 20°C
o Platelet concentrate
➢ Removal of most of the supernatant plasma
o Advantage:
➢ Reduced volume required
➢ Decreasing risk of fluid overload
➢ Minimizing immunologic complications
o Indications:
➢ Thrombocytopenia, thrombopathia or both
➢ Massive hemorrhage, acute bleeding into vital structure
what should we know about cryoprecipitate
o FPP slowly thawed at 1-6°C, precipitated material
o Von Willebrand factor, FVIII, FXIII, fibrinogen
o Useful for Von Willebrand animals
what should we know about cryosupernatant
o Plasma portion of CRYO (cryo-poor plasma)
o Vitamin K-dependent factors, albumin, globulin, etc.
o Hemophilia B (FIX deficiency)
what should we know about administration of blood products
• 20 gauge catheter (IV,IO), if hypovolemic may possibly use a 22g
• In-line blood filter
o 170 to 260um to trap cells, cellular debris, coagulated protein
• Warming of blood products
o Not required unless contraindicated (pediatric patient etc.)
• Gravity flow
how fast can blood be given
- Deliver within 4 hours
- 5-10ml/kg/hr, up to 22ml/kg/hr
- 2-4ml/kg/hr (at risk)
what should we do for admin of blood products
- Test Dose – 0.25-1ml/kg/hr for ~15 mins
- No food or medication during transfusion
- Monitor Monitor Monitor!
what should we know about blood aministration
• Antigen on the red blood cell’s surface
o Genetically determined
o Species specific
o Alloantibodies – antibodies formed against foreign antigens from one’s own species
what should we know about canine blood types
• Canine – Dog Erythrocyte Antigen (DEA)
(ex: DEA 1.1 positive or DEA 1.1 negative)
o Most antigenic = DEA 1.1
o Naturally occurring alloantibodies are rare in dogs → reaction rarely seen with 1st transfusion
o DEA 1.1 is most lethal because it contains a medium
o 1st transfusion you can give them a different one that way they can develop alloantibodies and then can receive it a second time because now they have them.
what should we know about feline blood types
• Feline – A, B and AB (MIK)
• Naturally occurring alloantibodies (born with them already and circulating)
o Type A - low titer of anti-B antibodies
• Reaction = mild
o Type B - high titer of anti-A antibodies (rare 20% more exotic types have it)
• Reaction – severe!
what is neonatal isoerthyolysis
o A queen with type B blood bred to a tom with type A blood è Type A kittens
o Anti-A alloantibodies through colostrum
what are the two blood typing methods
- 1st Transfusion
* Subsequent Transfusion(s)
what should we know about cross matching
• Detects the serologic compatibility between the recipient and potential donor • Look for presence or absence of alloantibodies Major crossmatch o Recipient plasma + donor RBC Minor crossmatch o Donor plasma + recipient RBC What to look for? o Macro/micro agglutination o Hemolysis
what is Acute hemolytic transfusion reaction (AHTR)
o When patient has significant levels of antibodies before a transfusion
o Fever, tachycardia, dyspnea, shock, V/D, hemolysis
o Tx: stop transfusion, supportive care (shock treatment, steroid)
what is Delayed hemolytic transfusion reactions (DHTR)
o Precipitous drop in PCV with clinical signs of anemia days to weeks post-transfusion
what is Non-hemolytic transfusion reaction
o Hypersensitivity reaction (Type 1)
➢ Pruritus, erythema, edema, V/D, dyspnea, facial swelling, urticaria
➢ Tx: stop transfusion, Antithistamines +/- steroid
o Febrile non-hemolytic transfusion reaction
➢ Rx to leukocytes, cytokines
➢ ↑ in temp by > 1 ˚C
➢ May last up to ~ 20 hrs post-transfusion
➢ Leukoreduction
what is Non-immunological Transfusion Reactions
o Circulatory overload
o Hypothermia
o Contamination
o Infectious Disease
