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CCP Semester 1 > CCP 107 - Transfusion Medicine > Flashcards

CCP 107 - Transfusion Medicine Flashcards

1
Q

What is plasma and what percentage of blood volume is it?

A

55% of blood volume.
Water and proteins. Proteins are: albumin, globulins (alpha, beta, immunoglobulins)

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2
Q

What percentage of blood is cells and what are the different types of cells?

A

45%.
Erythrocytes.
Leukocytes .
Thrombocytes

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3
Q

Name the types of leukocytes

A

Granulocytes (Neutrophils, Eosinophils and Basophils) and Agranulocytes (Lymphocytes (B lymphocytes, T lymphocytes and Natural killer cells) and Monocytes)

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4
Q

What is the universal plasma donor?

A

Type AB because it has no antibodies in the plasma.

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5
Q

What is the universal red blood cell donor?

A

Type O because it has no antigens on the cells.

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6
Q

What type of blood is used as a universal plasma donor as well as Type AB?

A

Type A

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7
Q

What is the reaction that occurs in blood when antigens and antibodies interact?

A

Agglutination

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8
Q

How does blood type compatibility relate to transfusion of platelets?

A

Platelets can be donated from any type to any type because they don’t have antigens or antibodies.

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9
Q

Explain Rh hemolytic disease

A

Rh positive father and a Rh negative mother make a baby who is Rh positive. Rh positive baby’s blood cells enter mother’s bloodstream during childbirth. Mother produces Rh antibodies which remain in bloodstream and attack future Rh+ baby’s blood causing hemolysis.

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10
Q

How much does 1 unit PRBCs increase serum Hgb by?

A

10 g/L

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11
Q

What is the lower threshold Hgb level for transfusing PRBC’s in a symptomatic patient?

A

70 g/L

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12
Q

Why do we base transfusion requirements on clinical exam, not Hgb levels in actively bleeding patients?

A

The Hgb level will lag behind as the remaining Hgb has to redistribute through the body to give an accurate reading.

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13
Q

What is the shelf life of PRBCs?

A

21-42 days

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14
Q

What is the volume/unit of PRBCs?

A

250-350 mL

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15
Q

Define hematocrit

A

the concentration of RBC’s in a unit. High hematocrit = viscous blood with lots of cells. If you bolused saline and diluted the blood = low hematocrit.

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16
Q

What is the initial dose of PRBCs?

A

2 units. (increases the Hgb by 20 g/L)

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17
Q

What are the two ways to collect platelets?

A

Apheresis - 1 donor, blood removed, platelets removed, remaining blood components replaced
Pooled - platelets collected from 4-5 donors pooled together to create a unit. Pooled is a higher risk of infection and increased risk of presence of antibodies.

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18
Q

How much will 1 platelet unit increase the platelet level by?

A

15-25 x10^9/L (this is just the unit, 50 is the answer)

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19
Q

What is a normal platelet count?

A

300-450 x10^9/L

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20
Q

Define thrombocytopenia

A

Low platelet count
<50 x10^9/L

21
Q

What is the shelf life of platelets?

A

5 days. After that, risk of bacterial infection.

22
Q

What is the dose of platelets?

A

5 mL/kg

23
Q

When should platelets be transfused?

A

To facilitate primary hemostasis in patients with platelet deficiency or dysfunction
To prevent or control bleeding
or to raise the platelet count.

24
Q

Who should receive irradiated platelets and why?

A

Immunocompromised or immunoincompetent patients. Irradiation prevents transfusion-associated graft vs host disease.

25
Q

What is the adult dose of plasma for transfusion?

A

15 ml/kg (3-5 units)

26
Q

What are the indications to transfuse plasma? (5)

A
  1. Moderate to severe bleeding
  2. To prevent periprocedural bleeding if patient with acquired factor deficiency
  3. Warfarin reversal ONLY if PCC unavailable.
  4. Factor replacement if factor concentrate unavailable.
  5. Plasmapheresis for thrombotic thrombocytopenic purpura.
27
Q

List 4 situations where plasma is not indicated

A

1.j

28
Q

What is an erythrocyte (origin, role)

A

Bone marrow, carries o2/co2

29
Q

Role of a neutrophil

A

Phagocytosis of bacteria and fungus

30
Q

Role of eosinophil

A

Fights parasites, allergic reaction

31
Q

Role of basophil

A

Releases histamine and other inflammatory mediators

32
Q

Role of lymphocytes

A

(b, t, nk) produce antibodies, cell mediated immunity

33
Q

Role of monocytes

A

Macrophage or dendritic

34
Q

What is human leukocyte antigen (HLA) and relevance in setting of blood product admin

A

Present on the surfaces of cell membranes of circulating platelets, WBCs (buffy coat <1%) and most tissues. Pts receiving from pool of donors may experience febrile transfusion reaction and the ensuing antigen-antibody reaction destroys the platelets. *hla-matched platelet transfusions are best

35
Q

Describe PRBCs

A

Retain all the characteristics of whole blood minus 250mL of platelet rich plasma. Indicated for actively bleeding pts and estimated blood loss (~30%/1500mL loss will produce symptoms). For hospitalized pts, Hgb <70g/L or <80g/L undergoing sx or preexisting cardiovascular disease.

36
Q

Describe platelets

A

Manufactured in bone marrow, necessary for normal clotting response. Indicated for thrombocytopenia (<150x 10^9 and/dysfunctional) AND clinical exam

37
Q

Describe FFP

A

Clotting factors- alpha and beta globulin and fibrinogen/factor I; albumin, immunoglobulin (antibodies).
Indicated in blood loss, coagulation deficiencies, warfarin reversal (if PCC isn’t available) and TTP (thrombotic thrombocytopenia). Must be used in 5 days once thawed. Type AB is universal plasma donor but type A is carried by BCEHS (should be ABO compatible, Rh not required)

38
Q

Describe Cryoprecipitate

A

Aka antihemophilic. Frozen blood product made from plasma. Contains vWF, fibrinogen, factor Viii and Xiii. May be used in bleeding pts with fibrinogen <1g/L due to severe hepatic failure, uremia, or DIC. Not ABO compatibility required, but preferred. Rh not required

39
Q

Describe prothrombin complex concentrate (pcc)

A

Aka octaplex. Contains factors ii, VII, IX, x and antithrombotic proteins c and s. Indicated for urgent reversal of bleeding from Vit K antagonist (warfarin/Coumadin). VitK (long onset ~6hrs) still given to prevent rebound effect and lots of factors in liver ready to go but need VitK as last conversion step.

40
Q

Describe Albumin

A

Prepared by the fractionation of pooled plasma. Used for volume replacement in burns, trauma, surgery, or infections. ABO and Rh comparability not required. 25% solution will produce 5x volume from extravascular

41
Q

Describe plasma protein fractions

A

83% albumin, 17% globulins. Indicated for volume expansion in hypovolemia (shock or burns) or hypoproteinemia

42
Q

Describe anaphylaxis as it pertains to blood transfusion

A

Usual s/s— chills, facial and laryngeal edema, pruritus c’est urticaria, bronchospasm, fever, nause, vomit.
If isolated urticaria or hives, continue transfusion and treat with antihistamine. If the pt has known history of this type of allergic reaction, premeditate before transfusion

43
Q

Describe hemolytic transfusion reactions

A

Caused by ABO or Rh incompatibility, infrasonic incompatability, improper cross matching, or improper blood storage. May occur during transfusion (1-2hrs) or within 3-7days.
Immediate: severe from RBCs quickly destroyed and rbc remnants into bloodstream- hemoglobinuria, abnormal bleeding from open sites, hypotension, CP, facial flush, sob, fever/chills, flank pain.
Delayed: most often in occur in pts who are sensitized by previous transfusions/preg/transplant. Usually mild s/s (fever/chills, jaundice)

44
Q

Describe TRALI

A

transfusion related acute lung injury. Acute onset (0-6hrs) hypoxemia, clear evidence of bilateral pulmonary edema on imaging. S/s dyspnea, hypoxemia, fever, and hypotension. Usually resolves in 24-72hrs

45
Q

Describe TACO

A

transfusion-associated circulatory overload. Circulatory overload from impaired cardiac function and/or excessively rapid rate of transfusion. Evidence of acute pulmonary edema on physical exam and/or imaging.
S/s sob, orthopnea, tachycardia, increased venous pressure, HTN. Possibly fever. Onset 0-12hrs, most common cause of death from transfusion. Risk factors- >70YO, HF, LV dysfunction, MI, renal dysfunction, positive fluid balance.

46
Q

Describe DIC

A

Disseminated intravascular coagulation. Complex coagulopathy that can develop in critically ill patients and causes bleeding and thrombosis.

47
Q

Discuss infection as a transfusion complication

A

Bacterial- contamination from skin commensals from donor (venipuncture skin plug), unrecognized bacteremia from donor, contamination from handling or environment.
S/s- rigors, fever, tachy, hypotn, n/v, sob, DIC. Delayed presentation <24hrs

Virus- risk is donating in the “window period” (between infection and detectable appearance). Exps (in order of likelihood)- west Nile, hepB, HIV, hepC.

48
Q

Can you give blood to a life threatening hemorrhage without their consent?

A

Yes- if they are unable to provide consent. Health Care (Consent) and Care Facility (Admission) Act- Section 12

49
Q

What is an example of a synthetic blood substitute

A

TXA- synthetic antifibrinolytic

CCP Semester 1 (10 decks)

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