Blood Transfusion Flashcards
When a person donates blood for another, specific person
Directed donation
When person donates blood to a bank for an unknown recipient
Allogenic donation
When a person donates blood for a bank to store for themselves
Autologous donation
Blood products
- Packed red blood cells
- Platelets
- Fresh frozen plasma
- Cryoprecipitate
PRBCs preparation
Centrifuged to remove 80% of the plasma
Goal is to reduce rxns from plasma components and increase concentration of nutrients
PRBC information
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
Plateletpherisis
Process of collecting platelets of whole blood exclusively from one donor
1 unit of platelets can increase platelets 50k
Threshold for platelet transfusion
Active bleeding
Platelets reach 50,000
Threshold for platelet transfusion
DIC or CNS bleed
100,000
Threshold for platelet transfusion
Prophylaxis to prevent spontaneous bleed
20,000
PANIC value
Threshold for platelet transfusion
Neuro, ocular, cardiac surgery
100,000 +
Threshold for platelet transfusion
Major surgery
80,000-100,000
Threshold for platelet transfusion
Minor surgery
50,000 - 80,000
Threshold for platelet transfusion
Invasive procedure
> 20,000
Alloimmunized
When a person is a carrier of various different antigens due to repeated platelet transfusions
Contraindications to transfusion of platelets
TTP
HIT
FFP
Plasma obtained after separation of whole blood from erythrocytes and platelets
200-250 per mL
When is FFP transfused?
Massive bleeding Isolated factor deficiencies * reversal of excessive Coumadin* Correction of coagulopathies DIC
Is FFP given prophylactically?
No
How much does one unit of FFP increase?
Increases level of ea. Factor 2-3% in adults
Cryoprecipitate
Insoluble protein of FFB
Contains fibrinogen, Factor VIII, vWF
Who benefits from cryoprecipitate?
Patients with liver dz, DIC, dilution coagulopathy
Universal donor?
O negative
Universal receiver?
AB positive
Purpose of transfusion?
Volume replacement
– to maintain and improve tissue oxygenation
Treatments that can be done on blood products (4)
- Leukocyte (reduced PRBC and Platelet)
- irradiated
- Washed
- Frozen
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
Who receives leukocyte reduced products (5)
Chronically transfused Pts with cardio surgery Organ transplant receivers Pts with febrile non hemolytic reactions Immune compromised
Irritated treatment
PRBCs
Eliminates capacity of t lymphocytes to proliferate (decreases GVHD)
Used in immunocompromised, transplant pts, and neonates
Washed
Done to PRBCs and platters
Used for patients who had allergic reactions to plasma and those with IgA def.
What must be done on transfusion order
- Type and screen
- Type and cross
- Transfuse
What to do in massive blood loss?
Ratio = 1:1:1 RBC:platelet:FFP
O negative blood
Other tests to consider running (6)
- CBC
- BMP
- LFT
- PT/INR
- PTT
- Iron Studies, Folate, serum calcium
When do you consider to transfuse?
Need to incorporate patient medical history, symptoms and wishes
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
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
Guidelines
Transfusion recommended
HgB <6
Guideline
Transfusion likely
HgB 6-7
Guideline
Transfusion considered in post-op surgery pts (+ stable CV dz)
7-8
Guidelines
Transfusion not indicated but considered for those with anemia, ongoing bleeding, ACS
HgB 8-10
Rate of transfusion
First 30 min of transfusion is preformed slowly to monitor for adverse rxn *unless there is massive hemorrhage
CAD
Transfusion threshold
Consider the nature
acute coronary syndromes - different threshold than those with stable CAD
Acute coronary syndrome
Transfusion threshold
Recommened to transfuse if < 10 HgB and maintain HgB at >10
Heart failure + chronic anemia
Not routinely recommended to correct anemia with transfusion or ESA bc you could cause volume overload
ICU transfusion threshold
Safe in medical patients who are in ICU and hemodynamically stable
Use 7 HgB
Transfusion threshold
GI bleed
If hemodynamically stable
Give if less than 6 if rapid access to endoscopic treament
Post operative surgery
Transfusion threshold
Restrictive with less than 8g/dl
Surgery + asymptomatic anemia
Oncology patients
Two major groups indicating transfusion
- Pts with meylosuppresive chemo
2. Pts terminal cancer receiving palliative care (bump for a big day)
Acute adverse reactions (4)
- Acute hemolytic transfusion reactions
- Febrile non hemolytic transfusion rxn
- Transfusion related ALI
Acute hemolytic transfusion reaction
Cause, symptoms
Caused by errors made during processing
Immediate onset of reaction (hypotension, tachycardia, fever, joint and back pain)
Acute hemolytic transfusion reaction
Management
DC transfusion and get new sample
Send for hemolytic testing
Evaluate for hemogolbinuria (DIC)
Start IV fluids (prevent shot)
Febrile Non-hemolytic Transfusion reaction
MC and least worrisome
Fever chills, rigors, headache w/o hemodynamic instability and respiratory problem
If pt with first transfusion shows fever, do yo treat as Febrile Non-hemolytic Transfusion reaction or acute hemolytic rxn?
Acute hemolytic
Management of Febrile Non-hemolytic Transfusion reaction
Stop transfusion and give antipyretic
Diagnosis of exclusion
Allergic transfusion reaction
Caused by IgE response of recipient against donor serum protein
Urticaria to anaphylaxis (occurs immediately)
Transfusion ACute lung injury
Change in the epithelial cels in alveoli causing accumulation of fluid and surfactant
More common in critically ill
Clinical features of TRALI
Fever, tachycardia, dyspnea
Respiratory distress with diffuse, bilateral alveolar and interstitial infiltrates on CXR
Delayed transfusion reactions
- Delayed hemolytic mediated reactions
- Graft v host disease
- Alloimmunization
- Infectious complications
DhTR
Less severe than acute version
Asymptomatic to mild fever and recurrent anemia
GVHD
Donor lymphocytes engraft and proliferate in recipient bone marrow which will cause severe graft mediated reaction against tissue
Fatal in > 90% cases
How to prevent GVHD
Blood products given to immunocompromised should be leukocyte reduced and irradiated * esp. if donated by 1st degree relatives
Alloimmunization
Formation of antibodies against antigens from previously donated blood problems
MC bacteria isolated in transfusions
Yersinia enterocolitica
Common viral agents in transfusion
HIV Human T cell lymphotrophic Hep B Hep C Parvo
CMV is popular