Component Therapy / Test 3/3 Flashcards
1
Q
What is the concept of component administration ?
A
use particular component for specific need
2
Q
What ate the advantages of specific component administration ?
A
conserve blood, facilitate optimum treatment
3
Q
Blood can be separated into what other components?
A
Packed cells
Plasma
Platelets
Cryoprecipitate
4
Q
WHOLE BLOOD
A
- Approximately 400-550 ml plus
- 63 ml of CPD (anticoagulant)
- Hematocrit (HCT) – 36-44%
5
Q
WHOLE BLOOD is stored at 1-6 C.
What beomes non functional ?
What factors decrease during storage?
A
platelets/granulocytes
Factors V and VIII
6
Q
What are 3 Indications for Whole Blood ?
A
- Oxygen-carrying capacity / blood volume expansion
- Stable coagulation factors.
- Actively bleeding with > 25% blood loss
7
Q
What is the best solution of the storage of whole blood ?
A
CPDA – 35 day outdate
8
Q
Dose and administration of whole blood (adult) & (Peds)?
A
1g/dL Hgb or 3% Hct increase (adults)
8mL/kg – 1g/dL Hgb increase (peds)
9
Q
Whole blood must be Administered through a blood filter within ?
A
4 hrs
10
Q
Hematocrit of the donor unit is ?
A
60%
11
Q
Dose and administration of whole blood (neonates?
A
10 – 15 mL/kg will increase the hemoglobin by about 3 g/dL
12
Q
RED BLOOD CELLS Prepared from whole blood: What is the Hct range for (AS red cells) ?
A
(Hct 50-65%)
13
Q
RED BLOOD CELLS Prepared from whole blood: What is the Hct range for (CPDA-1) & (CPD) ?
A
(Hct 65-80%)
14
Q
What is the residual plasma content in RBC units?
A
~20 – 120 mL
15
Q
Why would you transfuse RBCs ??
A
Increase oxygen carrying capacity and red cell mass
16
Q
General guidelines for RBC transfusion for patients that have a Hgb > 10g/ml ?
A
increased oxygen consumption, e.g. sepsis
17
Q
Signs and symptoms supporting need for transfusion
of RBC ?
A
- Syncope
- Angina
- dyspnea
- Tachycardia
- Rapid fall in Hgb (active bleeding)
18
Q
Medical condition influencing need for transfusion of RBCs ?
A
- CHF
- Coagulopathy,
- DIC
- Acquired or congenital anemias
19
Q
You should NEVER hang RBCs with what other infusions ?
A
- D5W,
- LACTATED RINGERS OR
- MEDICATIONS
20
Q
What other infusions CAN you hang RBCs with ?
A
- NS,
- albumin or
- plasmanate
21
Q
In Order to transfuse RBCs ABO and Rh must be compatible, you should transfuse over a period of ?
A
4 hrs with a filter
22
Q
Regular PRBCs contain how many WBC ?
A
1-3x 10^9 WBC/unit
23
Q
Leukoreduced units must retain what percentage of RBCs after filtration?
A
85%
24
Q
3 reasons of why we should use Leukoreduced PRBCs ?
A
- Prevent febrile nonhemolytic reactions
- Reduce HLA alloimmunization
- Prevent TA-CMV infection
25
Some patients may actually produce leukoagglutinins after many transfusions or just a few. The patient produces antibodies that will bind to the transfused leucocytes and the resulting complexes bind to and activate monocytes which release what?
cytokines with pyrogenic properties.
26
RED BLOOD CELLSWASHED with NS ?
```
70-80% Hct
98% plasma free
Reduced leukocytes, platelets
24 hour shelf life
10-20% red cell loss
```
27
Why would we transfuse washed RBCs ?
Prevent recurrent/severe allergic reactions to plasma proteins
28
When RED BLOOD CELLS are Frozen and deglycerolized for Long term preservation
what do we add as a cryoprotectant ?
glycerol
29
When RED BLOOD CELLS are Frozen and deglycerolized they can be stored at -65 c for how long ?
10 yrs
30
When RED BLOOD CELLS have been Frozen and deglycerolized, and now we need to use them, what do we do ?
-Thaw and wash with saline/glucose solution
- Maintain 70-80% Hct
- 24 hour shelf life
31
IRRADIATED Blood Products gamma rays, cobalt-60, or x-rays produced by radiation, renders the T lymphocytes inactive. How many RADS are delivered to the units ?
2500 - 3000
32
What is the shelf life of IRRADIATED Blood Products?
28 days
33
When would you consider it necessary to use IRRADIATED Blood Products ?
- Prevent GVHD
- Intrauterine transfusions
- Neonates
34
What cellular components do
| Irradiated products include ?
Platelets
| Red blood cells
35
Serologically screened negative for CMV antibody is the definition for what word ?
Seronegative
36
What products are CMV safe ?
Leukoreduced
37
What is the risk of CMV transmission from a seropositive unit ?
0.3 %
38
Why would we administer CMV NEGATIVE or CMV SAFE units ?
- Prevent TA-CMV infection
- CMV seronegative mother
- Bone marrow transplant recipients
- Solid organ transplants
39
What is the platelet count that we can generate from concentrating one 50 ml whole blood unit ?
5.5 x 10^10 plts/unit
40
What is the shelf life of platelets stored at RT with constant agitation ?
5 days
41
What platelet count can we achieve from a single donor through APHERESIS ?
~3x10^11 plts/unit (200-400 ml)
42
What 2 things must we consider when administering donor platelets ?
ABO compatible preferred
| Irradiation to prevent GVHD
43
Pool of 5 units or 1 apheresis platelet will raise the platelet count by how much?
25,000 – 50,000 µL
44
Normal adult platelet count =
150,000 – 400,000
45
What is caused by bleeding, fever, sepsis, DIC, medications, or splenomegaly ?
How can we fix this ?
refractoriness
Leukoreduction
46
FRESH FROZEN PLASMA should be Separated and frozen within ?
Volume ?
Stored at ?
8 hours of collection
200-250 ml/unit
-18C for up to 1 yr
47
Plasma frozen within 24 hours of collection (FP24) has
| Reduced levels of what ?
Factor V and VIII
48
Once thawed FFP** and FP24 are good for how long ?
5 days
49
Once thawed FFP** and FP24's
| Factor VIII and Factor V activity are at their highest levels within ?
24 hrs
50
Under what circumstances should we consider administering Thawed Plasma:FFP or FP24 ?
- Bleeding
- Multiple coagulation deficiencies
- Congenital factor deficiency
- No factor concentrate available
51
Thawed Plasma:FFP and FP24 is not indicated for what purposes ?
- hemophilia,
- nutritional support or
- volume expansion
52
Thawed Plasma:FFP and FP24 Dose is calculated to achieve a minimum of ?
30% of plasma factor concentration (~10-20 mL.kg)
53
universal plasma recipient
O
54
universal plasma donor
AB
55
Thawed Plasma ABO compatibility ?
A,B,O, AB
56
What shoulf you monitor for after Plasma administration ?
Pro-time and aPTT (INR)
or
specific factor assay
57
Cryoprecipitate is Separated from frozen – thawed plasma that has been frozen -18 C for up to one year.
What does it contain ?
```
Factor VIII (80 IU)
Fibrinogen (150 mg)
vWF (vonWillibrand’s factor)
Factor XIII
Fibronectin
```
58
For patients that are in need of Fibrinogen, or that suffer from vonWillibrand disease or Hemophilia A (factor VIII), we should treat them with ?
CRYOPRECIPITATE
59
1 unit of CRYOPRECIPITATE increase fibrinogen by how much ?
5 mg/dL (adult)
60
Dose for CRYOPRECIPITATE ?
1 unit per 7 – 10 kg body wt
- ABO compatible preferred but not necessary
- Given in pools of 10 for adult dose
61
Developed for use to bypass antibodies against Factor VIII in hemophilia A patients
Used for Factor VII deficiency
Used in massive transfusion cases for procoagulant deficiency and achievement of hemostasis
Activated Factor VIIa
62
What drug is Used for expanding plasma volume ?
Albumin: 5%
63
What medication Restores plasma volume and
| prevents deep vein thrombosis ?
Dextrans
64
What drug has an equivalent plasma volume expansion to albumin but may increase post-op bleeding ?
Hydroxyethyl starch (HES)
65
Blood components are transfused through a standard filter that measures ?
(170-260-micron filter)
66
Transfusion must be completed within ___ of time it is signed out of the blood bank.
4 hrs
67
No medications or solution other than 0.9% NaCL injection (USP) should be administered with blood components through the same tubing. Solutions containing dextrose alone may cause what ?
red cells to swell and lyse
68
Lactated ringer’s solution or other solutions containing high levels of Ca may overcome the buffering capacity of the citrate anticoagulant in the blood preservative solution and cause what ?
clotting of the component
69
Adverse Reactions to Transfused Blood Components ?
- Allergic (anaphylactic)
- Febrile
- Transfusion associated circulatory overload
- Transfusion Related Acute Lung Injury
- Acute Hemolytic Transfusion Reaction
- Intravascular Hemolysis
70
During an Anaphylactic reaction due to transfused IgA in a recipient that is IgA deficient, we can expect what type of symptoms ?
Severe hypotension, mild hives
1.1 – 3 % occurrence
71
Transfusion-related acute lung injury (TRALI) results from ?
- Transfusion of Donor Human leukocyte antigen (HLA) antibodies
- Recipient reaction
72
Transfusion-related acute lung injury (TRALI) results from ?
- Transfusion of Donor Human leukocyte antigen (HLA) antibodies
- Recipient reaction
73
What signs and symptoms can we expect from Transfusion-related acute lung injury (TRALI) ?
Chills, fever, non-productive cough, hypo- or hypertension within 1-2 hours transfusion
Pulmonary inflammation, accumulation of neutrophils and edema.
74
ABO incompatible transfusion of donor; antigen
| Recipient antibodies destroy RBC Intravascularly. As a result ___ of all fatal acute hemolytic reactions
3/4
75
What happens during an Acute Hemolytic Transfusion reaction ?
- Plasma hemolysis increases
- Urine free hemoglobin increases
- Decrease in circulating haptoglobin
That ultimately leads to . .
Shock
DIC
Renal failure
76
General guidelines for RBC transfusion for patients that have a Hgb
- Symptomatic
- Recent/active bleeding
- Hx of cerebro/cardiovascular -disease
