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FU17 Hematology > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

When a person donates blood for another, specific person

A

Directed donation

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2
Q

When person donates blood to a bank for an unknown recipient

A

Allogenic donation

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3
Q

When a person donates blood for a bank to store for themselves

A

Autologous donation

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4
Q

Blood products

A
  1. Packed red blood cells
  2. Platelets
  3. Fresh frozen plasma
  4. Cryoprecipitate
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5
Q

PRBCs preparation

A

Centrifuged to remove 80% of the plasma

Goal is to reduce rxns from plasma components and increase concentration of nutrients

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6
Q

PRBC information

A

1 unit = 3% hct rise, 200 mg iron

Common to transfuse 2-4 u

Must type and screen or cross match

If cant wait- O- is given

Shelf life is 3-6 weeks

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7
Q

Plateletpherisis

A

Process of collecting platelets of whole blood exclusively from one donor

1 unit of platelets can increase platelets 50k

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8
Q

Threshold for platelet transfusion

Active bleeding

A

Platelets reach 50,000

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9
Q

Threshold for platelet transfusion

DIC or CNS bleed

A

100,000

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10
Q

Threshold for platelet transfusion

Prophylaxis to prevent spontaneous bleed

A

20,000

PANIC value

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11
Q

Threshold for platelet transfusion

Neuro, ocular, cardiac surgery

A

100,000 +

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12
Q

Threshold for platelet transfusion

Major surgery

A

80,000-100,000

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13
Q

Threshold for platelet transfusion

Minor surgery

A

50,000 - 80,000

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14
Q

Threshold for platelet transfusion

Invasive procedure

A

> 20,000

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15
Q

Alloimmunized

A

When a person is a carrier of various different antigens due to repeated platelet transfusions

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16
Q

Contraindications to transfusion of platelets

A

TTP

HIT

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17
Q

FFP

A

Plasma obtained after separation of whole blood from erythrocytes and platelets

200-250 per mL

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18
Q

When is FFP transfused?

A 
Massive bleeding 
Isolated factor deficiencies 
* reversal of excessive Coumadin*
Correction of coagulopathies 
DIC
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19
Q

Is FFP given prophylactically?

A

No

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20
Q

How much does one unit of FFP increase?

A

Increases level of ea. Factor 2-3% in adults

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21
Q

Cryoprecipitate

A

Insoluble protein of FFB

Contains fibrinogen, Factor VIII, vWF

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22
Q

Who benefits from cryoprecipitate?

A

Patients with liver dz, DIC, dilution coagulopathy

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23
Q

Universal donor?

A

O negative

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24
Q

Universal receiver?

A

AB positive

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25
Purpose of transfusion?
Volume replacement -- to maintain and improve tissue oxygenation
26
Treatments that can be done on blood products (4)
1. Leukocyte (reduced PRBC and Platelet) 2. irradiated 3. Washed 4. Frozen
27
Leukocyte treatment
Removal of WBCs Done to platelets and PRBCs In order to avoid non-hemolytic fever reaction and prevent sensitization to potential bone marrow patients and virus transmission
28
Who receives leukocyte reduced products (5)
``` Chronically transfused Pts with cardio surgery Organ transplant receivers Pts with febrile non hemolytic reactions Immune compromised ```
29
Irritated treatment
PRBCs Eliminates capacity of t lymphocytes to proliferate (decreases GVHD) Used in immunocompromised, transplant pts, and neonates
30
Washed
Done to PRBCs and platters Used for patients who had allergic reactions to plasma and those with IgA def.
31
What must be done on transfusion order
1. Type and screen 2. Type and cross 3. Transfuse
32
What to do in massive blood loss?
Ratio = 1:1:1 RBC:platelet:FFP O negative blood
33
Other tests to consider running (6)
1. CBC 2. BMP 3. LFT 4. PT/INR 5. PTT 6. Iron Studies, Folate, serum calcium
34
When do you consider to transfuse?
Need to incorporate patient medical history, symptoms and wishes
35
HgB transfusion threshold
Not recommended for HgB levels >10 (unless hemo stable and active bleeding) Reserved for patients with HgB 7-8 + symptomatic + stable coronary artery disease or active bleed Everyone with HgB less than 6
36
When is a restrictive transfusion recommended? Except?
Hemodynamically stable medical and surgical patients with HgB b/t 7-8 EXCEPTin patient with acute coronary syndromes or patients with massive bleeding or trauma
37
Guidelines Transfusion recommended
HgB <6
38
Guideline Transfusion likely
HgB 6-7
39
Guideline Transfusion considered in post-op surgery pts (+ stable CV dz)
7-8
40
Guidelines Transfusion not indicated but considered for those with anemia, ongoing bleeding, ACS
HgB 8-10
41
Rate of transfusion
First 30 min of transfusion is preformed slowly to monitor for adverse rxn *unless there is massive hemorrhage
42
CAD Transfusion threshold
Consider the nature acute coronary syndromes - different threshold than those with stable CAD
43
Acute coronary syndrome Transfusion threshold
Recommened to transfuse if < 10 HgB and maintain HgB at >10
44
Heart failure + chronic anemia
Not routinely recommended to correct anemia with transfusion or ESA bc you could cause volume overload
45
ICU transfusion threshold
Safe in medical patients who are in ICU and hemodynamically stable Use 7 HgB
46
Transfusion threshold GI bleed
If hemodynamically stable Give if less than 6 if rapid access to endoscopic treament
47
Post operative surgery Transfusion threshold
Restrictive with less than 8g/dl Surgery + asymptomatic anemia
48
Oncology patients Two major groups indicating transfusion
1. Pts with meylosuppresive chemo | 2. Pts terminal cancer receiving palliative care (bump for a big day)
49
Acute adverse reactions (4)
1. Acute hemolytic transfusion reactions 2. Febrile non hemolytic transfusion rxn 3. Transfusion related ALI
50
Acute hemolytic transfusion reaction Cause, symptoms
Caused by errors made during processing Immediate onset of reaction (hypotension, tachycardia, fever, joint and back pain)
51
Acute hemolytic transfusion reaction Management
DC transfusion and get new sample Send for hemolytic testing Evaluate for hemogolbinuria (DIC) Start IV fluids (prevent shot)
52
Febrile Non-hemolytic Transfusion reaction
MC and least worrisome Fever chills, rigors, headache w/o hemodynamic instability and respiratory problem
53
If pt with first transfusion shows fever, do yo treat as Febrile Non-hemolytic Transfusion reaction or acute hemolytic rxn?
Acute hemolytic
54
Management of Febrile Non-hemolytic Transfusion reaction
Stop transfusion and give antipyretic Diagnosis of exclusion
55
Allergic transfusion reaction
Caused by IgE response of recipient against donor serum protein Urticaria to anaphylaxis (occurs immediately)
56
Transfusion ACute lung injury
Change in the epithelial cels in alveoli causing accumulation of fluid and surfactant More common in critically ill
57
Clinical features of TRALI
Fever, tachycardia, dyspnea Respiratory distress with diffuse, bilateral alveolar and interstitial infiltrates on CXR
58
Delayed transfusion reactions
1. Delayed hemolytic mediated reactions 2. Graft v host disease 3. Alloimmunization 4. Infectious complications
59
DhTR
Less severe than acute version Asymptomatic to mild fever and recurrent anemia
60
GVHD
Donor lymphocytes engraft and proliferate in recipient bone marrow which will cause severe graft mediated reaction against tissue Fatal in > 90% cases
61
How to prevent GVHD
Blood products given to immunocompromised should be leukocyte reduced and irradiated * esp. if donated by 1st degree relatives
62
Alloimmunization
Formation of antibodies against antigens from previously donated blood problems
63
MC bacteria isolated in transfusions
Yersinia enterocolitica
64
Common viral agents in transfusion
``` HIV Human T cell lymphotrophic Hep B Hep C Parvo ``` CMV is popular

FU17 Hematology (10 decks)

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