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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
Q

Purpose of transfusion?

A

Volume replacement

– to maintain and improve tissue oxygenation

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26
Q

Treatments that can be done on blood products (4)

A
  1. Leukocyte (reduced PRBC and Platelet)
  2. irradiated
  3. Washed
  4. Frozen
27
Q

Leukocyte treatment

A

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
Q

Who receives leukocyte reduced products (5)

A 
Chronically transfused 
Pts with cardio surgery 
Organ transplant receivers 
Pts with febrile non hemolytic reactions 
Immune compromised
29
Q

Irritated treatment

A

PRBCs

Eliminates capacity of t lymphocytes to proliferate (decreases GVHD)

Used in immunocompromised, transplant pts, and neonates

30
Q

Washed

A

Done to PRBCs and platters

Used for patients who had allergic reactions to plasma and those with IgA def.

31
Q

What must be done on transfusion order

A
  1. Type and screen
  2. Type and cross
  3. Transfuse
32
Q

What to do in massive blood loss?

A

Ratio = 1:1:1 RBC:platelet:FFP

O negative blood

33
Q

Other tests to consider running (6)

A
  1. CBC
  2. BMP
  3. LFT
  4. PT/INR
  5. PTT
  6. Iron Studies, Folate, serum calcium
34
Q

When do you consider to transfuse?

A

Need to incorporate patient medical history, symptoms and wishes

35
Q

HgB transfusion threshold

A

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
Q

When is a restrictive transfusion recommended?

Except?

A

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
Q

Guidelines

Transfusion recommended

A

HgB <6

38
Q

Guideline

Transfusion likely

A

HgB 6-7

39
Q

Guideline

Transfusion considered in post-op surgery pts (+ stable CV dz)

A

7-8

40
Q

Guidelines

Transfusion not indicated but considered for those with anemia, ongoing bleeding, ACS

A

HgB 8-10

41
Q

Rate of transfusion

A

First 30 min of transfusion is preformed slowly to monitor for adverse rxn *unless there is massive hemorrhage

42
Q

CAD

Transfusion threshold

A

Consider the nature

acute coronary syndromes - different threshold than those with stable CAD

43
Q

Acute coronary syndrome

Transfusion threshold

A

Recommened to transfuse if < 10 HgB and maintain HgB at >10

44
Q

Heart failure + chronic anemia

A

Not routinely recommended to correct anemia with transfusion or ESA bc you could cause volume overload

45
Q

ICU transfusion threshold

A

Safe in medical patients who are in ICU and hemodynamically stable

Use 7 HgB

46
Q

Transfusion threshold

GI bleed

A

If hemodynamically stable

Give if less than 6 if rapid access to endoscopic treament

47
Q

Post operative surgery

Transfusion threshold

A

Restrictive with less than 8g/dl

Surgery + asymptomatic anemia

48
Q

Oncology patients

Two major groups indicating transfusion

A
  1. Pts with meylosuppresive chemo

2. Pts terminal cancer receiving palliative care (bump for a big day)

49
Q

Acute adverse reactions (4)

A
  1. Acute hemolytic transfusion reactions
  2. Febrile non hemolytic transfusion rxn
  3. Transfusion related ALI
50
Q

Acute hemolytic transfusion reaction

Cause, symptoms

A

Caused by errors made during processing

Immediate onset of reaction (hypotension, tachycardia, fever, joint and back pain)

51
Q

Acute hemolytic transfusion reaction

Management

A

DC transfusion and get new sample

Send for hemolytic testing

Evaluate for hemogolbinuria (DIC)

Start IV fluids (prevent shot)

52
Q

Febrile Non-hemolytic Transfusion reaction

A

MC and least worrisome

Fever chills, rigors, headache w/o hemodynamic instability and respiratory problem

53
Q

If pt with first transfusion shows fever, do yo treat as Febrile Non-hemolytic Transfusion reaction or acute hemolytic rxn?

A

Acute hemolytic

54
Q

Management of Febrile Non-hemolytic Transfusion reaction

A

Stop transfusion and give antipyretic

Diagnosis of exclusion

55
Q

Allergic transfusion reaction

A

Caused by IgE response of recipient against donor serum protein

Urticaria to anaphylaxis (occurs immediately)

56
Q

Transfusion ACute lung injury

A

Change in the epithelial cels in alveoli causing accumulation of fluid and surfactant

More common in critically ill

57
Q

Clinical features of TRALI

A

Fever, tachycardia, dyspnea

Respiratory distress with diffuse, bilateral alveolar and interstitial infiltrates on CXR

58
Q

Delayed transfusion reactions

A
  1. Delayed hemolytic mediated reactions
  2. Graft v host disease
  3. Alloimmunization
  4. Infectious complications
59
Q

DhTR

A

Less severe than acute version

Asymptomatic to mild fever and recurrent anemia

60
Q

GVHD

A

Donor lymphocytes engraft and proliferate in recipient bone marrow which will cause severe graft mediated reaction against tissue

Fatal in > 90% cases

61
Q

How to prevent GVHD

A

Blood products given to immunocompromised should be leukocyte reduced and irradiated * esp. if donated by 1st degree relatives

62
Q

Alloimmunization

A

Formation of antibodies against antigens from previously donated blood problems

63
Q

MC bacteria isolated in transfusions

A

Yersinia enterocolitica

64
Q

Common viral agents in transfusion

A 
HIV 
Human T cell lymphotrophic 
Hep B
Hep C 
Parvo

CMV is popular

FU17 Hematology (10 decks)

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