Blood Transfusion Therapy

Question 1

Packed Red Blood Cells increase the Hgb by how much? HCT?

Answer 1

HGB: 1g/dL
HCT: 3%

Question 2

Platelets increase the platelet count by how much?

Answer 2

5,000-10,000/uL

Question 3

FFP indications

Answer 3

correction of coagulopathies

rapid reversal of warfarin

supplying deficient plasma proteins

treatment of TTP

Question 4

Cryoprecipitate is a source of…

Answer 4

fibrinogen, Factor 8, vWF

Question 5

Acute Hemolytic Reaction

Answer 5

Intravascular: acute intravascular hemolytic transfusion reaction

Typically results from ABO incompatibility (human error)

Most dangerous acute transfusion reaction

Severe cases may result in pulmonary and renal failure with cardiovascular collapse

Question 6

Acute Hemolytic Reaction Clinical Manifestations

Answer 6

Sudden onset of (rapidly after initiation of transfusion):
Fever
Chills
Headache
Flushing
Nausea/vomiting
Lower back pain
Localized burning at the infusion site
Tachycardia and hypotension (possibly to extent of shock)
Hemoglobinuria
Hemoglobinemia

Question 7

Acute Hemolytic Reaction Diagnosis

Answer 7

Positive Direct Coombs
Hemoglobinemia
Hemoglobinuria

Question 8

Acute Hemolytic Reaction Management

Answer 8

Immediately stop the transfusion!!

Check paperwork for clerical error

Send donor bag back to blood bank – consider culture

Intravenous saline through new tubing (aggressive volume replacement)

Consider furosemide or mannitol (keep the kidneys working and help rid hemoglobin fragments from circulation)

Question 9

Febrile Non-Hemolytic Reaction & Clinical manifestations

Answer 9

Typically noted in patients with multiple prior transfusions or in multiparous women (prior exposure to WBC and platelet antigens)

Fevers and chills occurring soon after the initiation of the transfusion (Most common acute reaction)

Question 10

Febrile Non-Hemolytic Reaction

Management

Answer 10

Immediately stop transfusion
Intravenous saline via new tubing

Antipyretic administration (acetaminophen or ibuprofen)

May be done as pre-transfusion and/or post-transfusion

Future transfusions may require leukocyte-depleted blood

Question 11

Most dangerous acute transfusion reaction

Answer 11

Acute Hemolytic Reaction

Question 12

Most common acute reaction

Answer 12

Febrile Non-Hemolytic Reaction

Question 13

Allergic Reaction/Anaphylaxis: Mild Reaction - how do you handle it

Answer 13

Temporarily stop transfusion

Administer (diphenhydramine) antihistamine; if patient responds, continue transfusion

Question 14

Allergic Reaction/Anaphylaxis

Severe Reaction - Managment

Answer 14

Immediately stop transfusion

Antihistamine (e.g., diphenhydramine, ranitidine)

Corticosteroids (e.g., methylprednisolone, dexamethasone)

Epinephrine

Intravenous fluid administration

Question 15

Transfusion-Related Acute Lung Injury

Answer 15

Non-cardiogenic pulmonary edema

Develops within 1 to 6 hours after transfusion initiation

Question 16

Transfusion-Related Acute Lung Injury Managment

Answer 16

Immediately stop the transfusion!!

Oxygen administration (try to keep SpO2 > 95%)

May require CPAP/BiPAP or intubation with mechanical ventilation

Question 17

Hypervolemia and TRALI

Answer 17

Can be prevented by transfusing 1 unit over 4 hours and co-administration of diuretic (separate IV line)

Headaches or dyspnea should prompt consideration of too rapid of infusion = slow it down

Question 18

Sepsis Management

Answer 18

Immediately stop the transfusion!

Broad-spectrum antibiotics (remember coverage for both gram-positive and gram-negative!)

Intravenous fluid administration

Vasopressors if severe shock with hypotension

Question 19

Massive Transfusion

Answer 19

Bleeding is most common complication following massive transfusions

Related to platelet and coagulation factor deficiencies (not contained in blood products transfused)

Question 20

Delayed Hemolytic Reaction

Answer 20

Extravascular: delayed extravascular hemolytic transfusion reaction)

May be acute, but more likely to occur delayed

Does not usually manifest as an emergency

Question 21

Disease transmission rate of HIV-1, 2

Answer 21

1:2,300,000

Question 22

Disease transmission rate of Hepatitis C

Answer 22

1:1,800,000

Question 23

Disease transmission rate of Hepatitis B

Answer 23

1:220,000