Blood transfusions wk7th10 Flashcards
ABO blood groups
- ABH proteins mostly ocated on transport proteins of red blood cell membrane
- antigens differ with respect to one terminal sugar
- O: lack both A and B terminal sugars “H antigen”
- O: non-functioning enzyme
ABO blood type
erythrocytes
plasma
compatible RBCs
compatible plasma
Orderable transfusion tests
1. type and screen
- RBC need possible but too low to justify setting aside crossmatched unit
- Blood type (ABO-rh) and antibody screan (IAT) performed
2. Type and crossmatch
- RBC need likely of definite
- Requested # of RBCs crossmatched and reserved
Indication for transfusion of RBCs
restore O2 carrying capacity in symptomatic anemia
symptomatic anemia:
- exertional dysphnea
- dyspnea at rest
- fatigue
- hyperdynamic state (bounding pulses, palpitations, roaring in ears”
more severe:
- lathargy and confusion
- congestive failure, angina, arrhythmia, MI
Transfusion triggers
high risk patients
- acuteMI, unstable angina, HgB<10
low risk
- young adults with out co-morbid illnesses
- consider transfusing when Hb falls below 7
Acute hemolytic transfusion reactions
Occurs with minutes to hrs after transfusion
- intravascular
- extravascular
Signs and symtoms
- chills
- fever
- hemoglobinuria
- hypotension
- renal failure with oliguria
- DIC (oozing from IV sites)
- back pain
- pain at infusion site
- anxiety
Acute hemolytic transfusion reactions
- managment
- maintain urine output
- analgesics
- pressors for hypotension
- hemostatic components for bleeding/coagulopathy
- follow-up labs
Hemolytics disase of fetus/newborn
- immune- mediated hemolytic disease caused by blood-type incompatibility between mother and child
- Maternal igG antibodies can cross placenta and coat fetl RBCs-> hemolysis
- Tx- transfuse group O and D negative blood- goal is to suppress fetal RBC production
Platelets products
1 PP (platelets phresis) should raise count by 30K
shelf life- 5 days, 4 hours if pooled
PP= single donor, majority plasma
Platelet concentrates (PCs)=pooled
Allergic transfusion reactions
Antibody (igE) to donor plasma proteins
signs and symptoms
- urticaria
- pruritis
- flushing
Therapeutic/prophylactic approach
- antihistamine
- many restart transfusion
Febrile non-hemolytic transfusion reaction
etiology:
signs and symptoms:
Tx:
etiology
- antibody to donor WBCs
- accumulated biologic response midifier (proinflammatory cytokines)
signs and symtoms:
- fever (increase 1 degree C)
- chills//rigors
- headache
- may have changes in BP and HR, dyspnea, nausea or vomiting
Tx:
- antipyretic premedication
- leukocyte reduced blood products
Transfusion- related acute lung injury
(TRALI)
mech
signs and symptoms
consequences
tx
lab testing
Transfusion reaction most frequently associated with transfusion related death
Mech:
- leakage of fluid into alveolar space due to diffuse alveolar capillary damage
signs and symptoms
- acute respiratory distress–severe bilateral pulmonary edema, severe hypoxia
- tachycardia
- fever
- hypotension/hypertension
- cyanosis
consequences
- mild to mod= lung injury and prolonged ventilator time, predispose to pulm infection
- severe= fatal
TX:
- supportive care
- provision of high-volume plasma products from low-risk donors
LAb testing:
- WBC antibody (HLA, granulocyte) screen in donor and recipient
Transfusion associated circulatory overload (TACO)
mech:
- volume overload temporally associated with transfusion
signs and symptoms:
- shortness of breath
- increased resp rate
- hypoxemia
- cough
- tachycardia
- elevted SBP
- jugular venous distension
- headache
TX:
- upright posture
- O2
- IV diuretic
- Transfuse split units
Transfusion of fresh frozen plasma
indications
contraindications
indications:
- correction of clotting factor deficiencies where concentrates not available or when multiple clotting deficiencies are present (ex. liver disease, coumadin reversal, DIC)
Therapy guided by coah studies (PT, PTT)
Contraindications:
- patients with igA anitbodies or selective igA deficiency
- volume expansion
Adverse effects of transfusion
- RBC
- WBC
- Plasma
RBC
- acute hemolytic
- delayed hemolytic
WBC
- febrile non-hemolytic
- graft vs. host disease
plasma
allergic
transfusion associated circulatory overload
transfusion related acute lung injury
infectious
- septic/bacterial
- viral and parasitic
