Chapter 3 - Blood Products

Question 2

Which blood products do not carry the risk of HIV and hepatitis?

Answer 2

Albumin and serum globulins (because they are heat treated)

Question 3

When do you use CMV-negative blood?

Answer 3

• low-birth-weight infants
• bone marrow transplant patients
• other transplant patients

Question 4

What is the #1 cause of death from transfusion reactions?

Answer 4

Clerical error leading to ABO incompatibility

Question 5

What is an acute hemolysis reaction caused by/what are the symptoms?

Answer 5

ABO incompatibility

• Path: antibody mediated
• Psx: back pain, chills, tachycardia, fever, hemoglobinuria
  
  • ​anesthetized pts may present as diffuse bleeding
  • can lead to ATN, DIC, shock

Question 6

What is the treatment for acute hemolysis reaction?

Answer 6

Emergency:

• stop transfusion, ABCs
• aggressive hydration for dilution: goal 1cc/kg UOP, no hemoglobinemia
• IV lasix

Question 7

What is delayed hemolysis reaction caused by?

Answer 7

Antibody-mediated against minor antigens

Question 8

What is the treatment for delayed hemolysis reaction?

Answer 8

Observation if stable

Question 9

What is nonimmune hemolysis caused by?

Answer 9

Squeezed blood

Incredibly rare…

Question 10

What is the treatment for nonimmune hemolysis?

Answer 10

Fluids and diuretics

Question 11

What is the most common transfusion reaction?

Answer 11

Febrile nonhemolytic transfusion reaction

Question 12

What is febrile nonhemolytic transfusion reaction caused by?

Answer 12

Recipient antibody reaction against WBCs in donor blood

Question 13

What is the treatment for febrile nonhemolytic transfusion reaction?

Answer 13

d/c transfusion

use WBC filters for subsequent transfusions

Question 14

What is anaphylaxis due to transfusion caused by?

Answer 14

Usually IgG against IgA

IgA-deficient recipient

Question 15

What is the treatment for anaphylaxis from transfusion?

Answer 15

• Stop the transfusion
• IV NS
• IM/IV epinephrine: 0.2 - 0.5 ml
• IV loratidine for H1 block and ranitidine for H2 block
• IV lasix
• IV pressors if epi maxed out
• +/- IV methylprednisone 1-2 mg/kg/day x2 days
• W/u: IgA levels

Question 16

What is the cause of urticaria from transfusions?

Answer 16

Nonhemolytic, usually a reaction against plasma proteins or IgA in the transfused blood

Urticaria alone doesn’t warrant IgA level workup

Question 17

What is the treatment for urticaria from transfusions?

Answer 17

Histamine blockers (benadryl), supportive

Question 18

After how many units of PRBCs will you see dilutional throbocytopenia?

Answer 18

10

Question 19

What electrolyte abnormality will you see after massive transfusion?

Answer 19

Hypocalcemia - Ca required for clotting cascade

Question 20

What is the incidence and when will people develop antiplatelet antibodies?

Answer 20

In 20% of patients after 10-20 platelet transfusions

Question 21

What is TRALI caused by?

Answer 21

Antibodies to recipient’s WBCs, clot in pulmonary capillaries

Question 22

What is the most common bacterial contaminate of blood products?

Answer 22

GNR (usually E. coli)

Question 23

What is the most common blood product source of contamination?

Answer 23

Platelets (because they’re not refrigerated)

Question 24

What is the risk of transfer of HIV with transfusion?

Answer 24

1: 1-2 million

Question 25

What is the risk of transfer of Hepatitis B or C with transfusion?

Answer 25

1: 250-500 thousand

Question 26

What are the routinely performed infectious diseases screened for in blood donations?

Answer 26

Treponema pallidum, HBV, HCV, HIV, HTLV, WNV

Question 27

What is the volume per dose of PRBC?

Answer 27

250-325ml

Question 28

What is the volume per dose of FFP and how long is thawed FFP good for?

Answer 28

200ml, 24h

Question 29

What is the volume per dose of 4-6pk platelets and what is the shelf life?

Answer 29

200-250ml, 5d

Question 30

What is the volume per dose of 10pk cryo and what is its thawed shelf life?

Answer 30

100ml, 4h