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Pharm > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

Universal Donor/Recipient

A

Donor : O-
Plasma Donor: AB+
Recipient: AB+
Plasma Recipient: O-

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2
Q

Rh System

A 
46 rhesus red cell surface antigens 
with D rhesus antigen = Rh+
will not develop the antibody unless exposed 
- transfusion of Rh+ to an Rh- 
-pregnancy with an Rh+ baby to a Rh- mom
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3
Q

Compatibility Testing

A

ABO-Rh: 5 min, 0.2% risk of reaction after this. ABO incompatibility = most severe transfusion reactions

Antibody screen: to detect non-ABO antigens, 45 min

Crossmatch: mimics transfusion, 45 mins. ensures optimal safety. detects low titer antibodies

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4
Q

Emergency Transfusion without crossmatch

A
  • if known blood type partial 5 min abbreviated crossmatch, confirms ABO
  • if unknown O - uncrossmatched (will contain some anti-A anti-B antibodies)
  • after 2+ units transfused of O - must continue with it
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5
Q

Massive Transfusion Protocol

A

1:1:1 RBC: FFP: Platelets
fibrinogen 10 units should increase by 75mg/dL
TXA 1g during infusion, 1 g within 8 hrs after. max
Calcium 1 round (6units RBCs) 1gCaCl or 3g CaGlucaonte

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6
Q

Normals -PT, PTT, Fibrinogen

A

11-13
25-35
130-330

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7
Q

FFP

A

All plasma proteins + all coag factors + fibrinogen

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8
Q

FFP Indications

A 
Urgent reversal of warfarin 5-8ml/kg
PT > 1.5x normal (>18)
PTT > 1.5x normal (>55)
Antithrombin III deficiency 
Massive Blood Transfusion 
C1 Esterase Deficiency 
DIC 
Coag factor assay < 25% (10-20ml/kg coagulopathy)
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9
Q

Platelets

A

thrombocytopenia < 50,000
eye & neurosurgery < 100,000
known platelet dysfunction

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10
Q

Platelets Considerastions

A

bacterial infection - sepsis risk stored at room temp (5 days)
1 pack per 10kg of weight
1 unit increase by 10,000
loose ability to aggregate when refrigerated

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11
Q

Cryoprecipitate

A

fibrinogen, vWB, factor VIII & XIII
VIII - is antihemophillic factor

cryo is slow thawed FFP

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12
Q

Cryo Indications

A

Hemophilia A
vWB disease
consumption coagulopathy - main use
fibrinogen deficiency (<80-100mg/dL)

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13
Q

Cryo considerations

A

5 bag pool
admin through filter
complete within 6 hrs of thawing

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14
Q

Whole Blood

A 
RBCs
WBCs
Plasma 
Platelet debris 
Fibrinogen

RBC & blood volume replacement

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15
Q

Fibrinogen

A

factor I
dose 70 mg/kg
adverse reaction - HA, erythema, N/V, fever, weakness

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16
Q

Prothrombin Complex Concentrates (Kcentra)

A

factor IX (II, VII, X)
hemophilia B
reversal of anticoagulant agents (warfarin)

17
Q

DDAVP - desmopressin

Dose and MOA

A 
0.3 mcg/kg
stimulates release of vWF 
releases tPA
2-20 fold increase in VIII - speeds activation of X by IXa
releases prostacyclin
18
Q

DDAVP indications

A

hemophilia A & vWB disease

ASA induced platelet dysfunction

19
Q

Recombinant Factor VII

A

enhances thrombin generation on active platelets
approved for hemophilia A
has thrombotic complications

20
Q 
Aminocaporic Acid (AMICAR)
Dose and MOA
A

synthetic lysine inhibitor of plasminogen.
inhibits fibrinolysis - significant reduction in blood loss & transfusion requirements
dosing: 100mg/kg max 5g over 15 min
OR 10mg/kg/hr throughout surgery

21
Q

Tranexamic Acid

A

competitive inhibitor of plasminogen.

rate of DVT unaffected. blood loss in surgery decreased and transfusion requirement decreased.

22
Q

Hydroxylethyl Starch

A

Volume expander - polysaccharide
Improve blood rheology - biophysical properties and flow
Acute normovolemic hemodilution

Side Effect: coagulopathy (decreases VIII & vWF)

23
Q

Dextran

A

Glucose polymer water soluble
Replace intravascular volume
Stays for 12 hrs
Colloid osmotic pressure 340

Side Effects: allergic reactions, increased bleeding time (decreases platelet adhesion), non cardiogenic pulmonary edema

24
Q

Acute Normovolemic Hemodilution

A

Removal of pt whole blood prior to surgery & replacement with non red cell volume.

Improves oxygenation
Prevents hemostasis.

Criteria: high transfusion liklihood, Hgb<12, no infection or significant comorbidities

25
Q

Transfusion Reaction S/S

A

Seen under anesthesia: hemoglobinuria, hypotension, fever, flushing, bleeding

Masked by anesthesia: dyspnea, chills, nausea, chest pain

26
Q

Transfusion Reaction Manifestations

A

AKI - free hgb in renal tubules = mechanical obstruction. acidic urine increases precipitation

DIC- erythrocin released from RBC activates intrinsic clotting cascade. uncontrolled fibrin formation. consumption of factors I, II, V, VII

Hemodynamic Instability: free hgb activates kalikrinen system = bradykinin. vasodilation

27
Q

Treating transfusion reaction

A 
stop transfusion 
alkalize urine - bicarb
maintain UOP : IVF, mannitol, lasix
sen during & plasma hgb samples to lab
check PT, PTT, fibrinogen 
send unused blood to bank
support hemodynamics
28
Q

Troublesome Events of blood transfusion

A 
alloimmunization
HLA antigens
allergic and febrile reactions
ABT - related mortality (TRALI, TAS, HTI, TTI) 
intravascular hemolysis
29
Q

TRALI

A

indicated with all plasma contains products - primarily PRBCs despite small amount of plasma.
donor anti-HLA antibodies = neutrophil chemotaxis = endothelial damage & capillary leak
- Non-cardiogenic pulmonary edema, dyspnea, cough, fever
-commonly mistaken for TACO
- seen more with blood from multipara women

30
Q

Hemolytic Transfusion Reactions

A

ABO antigens or other RBC antigens - donor RBCs ar attack by recipients antibodies

  • acute within 24 hrs
  • delayed > 24 hrs
31
Q

TRIM - transfusion related immodulation

A

occurs against HLA antigens
nonspecific and antigen specific immunosuppression
impaired T cells & decreased macrophages
altered cytokines - IL 1, IL8, TNF
- primary cause is leukocytes within the cells (most PRBCs are leukocyte reduced)

= better outcomes in renal allografts
may increase tumor reoccurrence

32
Q

Adaptation to Anemia

A
  • oxyhemoglobin shift R - increase 2,3 DPG
  • CO increases
  • microvasculature alterations - tone
  • RAAS - retain Na+ & water
33
Q

Impact of Pre-op anemia on post-op outcomes

A

adverse renal and neurological outcomes
o Pre-op anemia and intraoperative blood transfusion are both independent risk factors for adverse outcomes
o Incidence increase with the increase in number of units transfused

34
Q

Banked Blood

A 
metabolic acidosis - high lactate, low pH
low 2,3 DPG
low ATP 
low GSH (antiox)
low SNO hb
Ical & Mag = 0
35
Q

Physical Changes Banked Blood

A

decreased deformability
membrane area decreased
30% dead on arrival

36
Q

Oxidative Issues banked blood

A

Hgb oxidation - methgb
Hgb denaturation = free radicals
Bioactive substances in supernatant - cytokines, histamines, lipids, HLA

Pharm (11 decks)

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