Chapter 16 Transfusion Therapy in Selected Patients Flashcards
What is a massive transfusion?
Replacing total blood volume in 24hrs
What symptoms are present with hypovolemia?
Symptoms of hypovolemia: hypotension, cooling of extremities, oliguria, acidosis, increased respiration
What are the priorities to correct during a massitive transfusion?
- Correct hypovolemia with crystalloids. Normal saline or Ringer’s Lactate to prevent shock
- Optimize the oxygen-carrying capacity
- Maintain hemostasis: platelets and coagulation factors
- Correct or avoid metabolic disturbances
- Maintain intravascular volume with colloids (ie. Albumin)
What are the complications in a massive transfusion that can occur?
- Microvascular hemorrhage due to either a) dilution of coag. factors & platelets
b) hypotension
c) consumption of coag. factors
d) consumption of platelets - Citrate toxicity due to decrease in ionized calcium from anticoagulants in blood products.
- Hypothermia due to rapid infusion of blood products.
What is done to counteract microvascular hemorrhage caused by a massive transfusion?
Platelets
Fresh Frozen Plasma
or
Control hypotension
What is done to correct citrate toxicity?
Slower infusion or calcium replacement if severe.
What is done to counteract hypothermia from a massive transfusion?
Use of high-flow blood warmers.
What happens in cardiac surgery that puts them at risk for bleeding? How does the Dr. typically counteract that?
Patient’s blood circulates through an oxygenating pump outside the patient’s body. Results in decrease in platelet number and function, decrease in coagulation factors, hypothermia, increase in residual heparin.
Usually put on warfarin following surgery.
What are risk factors for bleeding during cardiac surgery?
- Time on pump
- Patient’s age
- Previous cardiac surgery
- Surgical procedure: valve replacement, CABG or both.
- Preoperative medications: aspirin and anticoagulant.
- Heparin effects.
- Decreased platelet function from hypothermia.
What causes physiologic anemia in infants receiving a transfusion?
Changing from fetal Hgb to adult Hgb, can cause physiologic anemia of infancy. More of a concern in low weight, pre-mature babies
Besides physiologic anemia, what other issues does the Dr. need to be aware of with neonates when giving them a transfusion?
- Iatrogenic blood loss in hospitals
- Decreased response in production of erythropoietin
- Low tolerance to hypothermia
- Greater risk of cytomegalovirus infection
- Decreased ability to metabolize citrate and potassium
- Decreased ability to restore 2,3-DPG in older units
What is type of blood should be given and how should it be given to neonates for a transfusion?
- Try to give blood less than 7 days old. Always give CMV negative units. Irradiate and wash red cells first.
- Give small amounts of blood as slow as possible through a blood warmer or can administer with a syringe.
What is the type of bleeding risk to the patient getting a liver transplant?
Liver
Transplantation is associated with massive hemorrhage due to hypocoagulability
How does giving erythropoietin help the person receiving a kidney transplant?
Kidney - Erythropoietin has reduced need for transfusion
See slide 8 for a table of avg blood components transfused during transplant surgery.
What actions are taken to enhance graft survival?
Graft survival is enhanced with;
1. HLA-matched donor–recipient combinations,
2. Leuko-reduction,
3. Live donor for kidney transplant,
4. ABO compatibility for vascularized grafts such as livers, kidneys and heart (not as important for bone, heart valves, skin or cornea).
What is Hematopoietic Progenitor Cell (HPC) Transplantation used for?
- Hematopoietic cells contain stem cells and progenitor cells
- Used for aplastic anemia, thalassemia, sickle cell disease, acute leukemia, lymphomas, multiple myeloma, PNH, multiple sclerosis, etc.
What are the different types of HPC transplants are there?
Transplants can be:
1. Allogeneic
2. Syngeneic*
3. Autologous
*Means genetically identical or sufficiently identical & immunologically compatible to donate for transplant purposes.
What are sources for HPC transplants from the donor’s body?
Sources:
1. Bone marrow
2. Peripheral blood stem cells (apheresis)
3. Umbilical cord blood
How does the quality of the HLA match in a HPC transplant matter?
HLA matched - closer the better.
What are the purposes of therapeutic apheresis?
Therapeutic apheresis removes abnormal cells, plasma, or plasma constituents to:
1. Supply an essential substance that is absent
2. Reduce the quantity of a particular antibody
3. Modify mediators of inflammation
4. Clear immune complexes
5. Replace cellular elements
See slide 12 for details on indications for therapeutic apheresis.
What are the risks that chemotherapy brings to a patient?
- Chemotherapy can result in a decrease of platelets, leukocytes, hemoglobin, and hematocrit.
- Side effects include bleeding, anemia, and infection.
What alternatives are there for chemotherapy patients instead of transfusion?
Alternatives to transfusion include:
1. Erythropoietin
2. Colony-stimulating factors (CSFs)
3. DDAVP (desmopressin)
See slide 14 for details on alternatives to transfusion.
What can result in transfusion needs in patients that have chronic renal disease?
Patients that undergo dialysis will have many hematologic complications that require attention.
1. Elevated urea levels (uremia) leads to altered rbc shapes and often are removed by the spleen.
2. The equipment used for dialysis can also harm the patient’s red cells, leaving them anemic.
3. These individuals are not able to produce erythropoietin since they have kidney damage
What are the similar symptoms between Hemolytic uremic syndrome (HUS) and Thrombocytopenic Purpura (TTP)?
- Thrombocytopenia
- Microangiopathic hemolytic anemia
- Renal dysfunction
- Central nervous system involvement
