EXAM #2: BLOOD COMPONENT THERAPY Flashcards
Why blood component therapy preferable to whole blood?
Aside from trauma, specific blood component defects require specific blood component therapy
What is the clinical indication for red cell transfusion?
- Symptomatic patient with Hb less than 10
- Anemia w/ Hb less than ~7-8
What are the two methods of platelet product preparation?
1) Platelets
2) Cryoprecipitate
What is alloimmunization?
This is an immune response to foreign antigen
What is the mechanism of alloimmunization in platelet therapy?
Patients that recieve platelets may make antibodies to the transfused platelets b/c:
- Anti HLA (human luekocyte antigen)
- Anti HPA (human platelet antigen)
How can alloimmunization in platelet transfusion be prevented?
Find compatible platelets by:
1) Give random platelet units
2) Crossmatch
3) Find platelets without the antigen that causes the reaction
What is CMV negative?
- CMV is a virus that is carried in WBCs
- pRBCs that undergo Luekoreduction i.e. removal of WBCs are CMV negative
What is the clinical indication of CMV negative blood products?
Transfusion of an immunocompromised patient
What does irradiated mean?
pRBC components are exposed to x-ray
What is the clinical indication for irradiated blood products?
This is done to prevent TRANSFUSION ASSOCIATED GRAFT VS. HOST DISEASE
This is indicated in patients that are IMMUNOCOMPORMISED
What does filtered blood products mean?
- Leukoreduction i.e. whole blood unit is hung and run through a filter
- Filters OUT leukocytes
What is the clinical indication for filtered blood products?
Immunosuppression
List the two indications for transfusing fresh frozen plasma.
1) Coagulation abnormalities in massive transfusions
2) Hemophilia
What is cryoprecipitate? What the specific components of cryoprecipitate?
Precipitate that is formed when fresh frozen plasma is thawed, it contains:
- Factor VIII
- Fibrinogen
- vWF
- Factor XIII
What is the clinical indication for cryoprecipitate?
Generally, the treatment of coagulation factor deficiencies involving fibrinogen and Factor VIII i.e.
1) Fibrinogen replacement in bleeding patient
2) Hemophilia A (Factor VIII)
3) vWF Disease
What is prothrombin complex concentrate? What are the clinical indications for prothrombin complex concentrates?
Prothrombin complex concentrate is made via plasma fractionation and contains Vitamin K dependent coagulation factors; thus, it is indicated for patients with Hemophilia in the following situations:
- Hemorrhage
- Perioperative bleeding management
- Prophylaxis of bleeding events
What is the clinical indication for albumin?
1) Hypoalbuminemia
2) Volume replacement
What is the indications for IVIG?
1) Primary humoral immunodeficiency e.g. SCID
2) Immune thrombocytopenia
3) Chronic inflammatory demyelinating polyneuropathy
4) Hypogammaglobulinemia
5) Post-exposure prophilaxis
What are the main coagulation abnormalities that occur after massive transfusion?
- Replacement of blood loss will lead to DILUATION of coagulation factors–>additional bleeding
- Fibrinogen levels can drop
Outline how the coagulation abnormalities seen following massive transfusion are treated.
1) FFP transfusions for coagulation factors
2) Cryoprecipitate for fibrinogen
Is there a difference in clinical outcomes when old pRBCs are given vs. new?
NO
What is pRBC volume reduction?
- Centrifuge pRBC just prior to administration
- Purpose: remove preservative RBCs are stored in
Indicated for patients with circulatory overload e.g. CHF and renal failure
What are the general indications for plasma transfusion?
1) Coagulation factor replacement
2) Massive transfusion
3) ADAMSTS13
What are the platelet thresholds for transfusion?
Generally, less than 100,000, EXCEPT:
- Active bleed and major surgery= less than 50,000
- Central line= less than 20,000
- Prevent spontaneous bleeding= less than 5,000
What is the definition of platelet refractoriness?
Patient that has an alloimmune response to donor platelets
What are the ADVANTAGES of whole blood transfusion?
1) Best for TRAUMA
- Volume
- Hb
- Coagulation factors
- Replace platelets
What are the indications for Recombinant Factor VIII?
Patients with Hemophilia A to:
- Control and prevent bleeding
- Perioperative bleeding management
What blood component would you give a patient with anemia?
RBCs
What blood component would you give a patient with DIC?
Plasma
What blood component would you give a patient with thrombocytopenia?
Platelets
What blood component would you give a patient with low fibrinogen?
Cryoprecipitate
