blood transfusion

Question 1

what is fresh whole blood

Answer 1

blood taken within 8 hours

Question 2

what are all the components of FWB

Answer 2

RBCs, WBCs, platelets, plasma proteins, clotting factors

Question 3

what patients would we want to use FWB on

Answer 3

Active hemorrhage, anemic pts with thrombocytopenia or thrombopathia, anemia with CF deficits, massive hemorrhage

Question 4

what is massive transfusion and which patients do we use it for

Answer 4

replacement of more than half the total blood volume in 4 hours
• Indicated for patients with massive, uncontrolled hemorrhage

Question 5

what is the storage temperature for stored whole blood and amount of time good for

Answer 5

o Storage: 1°C to 6°C, 22 days to a month

Question 6

what should we know about SWB

Answer 6

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

Question 7

what patients may we want to use for SWB

Answer 7

➢ O2 carrying support
➢ CFs
➢ IV volume expansion

Question 8

what are packed RBCs blood

Answer 8

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

Question 9

what patients may we want to use for Packed RBCs

Answer 9

➢ Anemia with clinical signs ( weakness, dull mentation, compensatory signs)
➢ PCV less than 20%
➢ Not indicated to pts with chronic anemia
➢ Extra benefit

Question 10

what should we know about fresh frozen plasma

Answer 10

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

Question 11

what should we know about stored frozen plasma

Answer 11

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

Question 12

what should we know about platelet-rich plasma

Answer 12

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

Question 13

what should we know about cryoprecipitate

Answer 13

o FPP slowly thawed at 1-6°C, precipitated material
o Von Willebrand factor, FVIII, FXIII, fibrinogen
o Useful for Von Willebrand animals

Question 14

what should we know about cryosupernatant

Answer 14

o Plasma portion of CRYO (cryo-poor plasma)
o Vitamin K-dependent factors, albumin, globulin, etc.
o Hemophilia B (FIX deficiency)

Question 15

what should we know about administration of blood products

Answer 15

• 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

Question 16

how fast can blood be given

Answer 16

• Deliver within 4 hours
• 5-10ml/kg/hr, up to 22ml/kg/hr
• 2-4ml/kg/hr (at risk)

Question 17

what should we do for admin of blood products

Answer 17

• Test Dose – 0.25-1ml/kg/hr for ~15 mins
• No food or medication during transfusion
• Monitor Monitor Monitor!

Question 18

what should we know about blood aministration

Answer 18

• 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

Question 19

what should we know about canine blood types

Answer 19

• 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.

Question 20

what should we know about feline blood types

Answer 20

• 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!

Question 21

what is neonatal isoerthyolysis

Answer 21

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

Question 22

what are the two blood typing methods

Answer 22

• 1st Transfusion

* Subsequent Transfusion(s)

Question 23

what should we know about cross matching

Answer 23

•	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

Question 24

what is Acute hemolytic transfusion reaction (AHTR)

Answer 24

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)

Question 25

what is Delayed hemolytic transfusion reactions (DHTR)

Answer 25

o Precipitous drop in PCV with clinical signs of anemia days to weeks post-transfusion

Question 26

what is Non-hemolytic transfusion reaction

Answer 26

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

Question 27

what is Non-immunological Transfusion Reactions

Answer 27

o Circulatory overload
o Hypothermia
o Contamination
o Infectious Disease