EXAM #2: BLOOD COMPONENT THERAPY

Question 1

Why blood component therapy preferable to whole blood?

Answer 1

Aside from trauma, specific blood component defects require specific blood component therapy

Question 2

What is the clinical indication for red cell transfusion?

Answer 2

• Symptomatic patient with Hb less than 10

- Anemia w/ Hb less than ~7-8

Question 3

What are the two methods of platelet product preparation?

Answer 3

1) Platelets

2) Cryoprecipitate

Question 4

What is alloimmunization?

Answer 4

This is an immune response to foreign antigen

Question 5

What is the mechanism of alloimmunization in platelet therapy?

Answer 5

Patients that recieve platelets may make antibodies to the transfused platelets b/c:

• Anti HLA (human luekocyte antigen)
• Anti HPA (human platelet antigen)

Question 6

How can alloimmunization in platelet transfusion be prevented?

Answer 6

Find compatible platelets by:

1) Give random platelet units
2) Crossmatch
3) Find platelets without the antigen that causes the reaction

Question 7

What is CMV negative?

Answer 7

• CMV is a virus that is carried in WBCs

- pRBCs that undergo Luekoreduction i.e. removal of WBCs are CMV negative

Question 8

What is the clinical indication of CMV negative blood products?

Answer 8

Transfusion of an immunocompromised patient

Question 9

What does irradiated mean?

Answer 9

pRBC components are exposed to x-ray

Question 10

What is the clinical indication for irradiated blood products?

Answer 10

This is done to prevent TRANSFUSION ASSOCIATED GRAFT VS. HOST DISEASE

This is indicated in patients that are IMMUNOCOMPORMISED

Question 11

What does filtered blood products mean?

Answer 11

• Leukoreduction i.e. whole blood unit is hung and run through a filter
• Filters OUT leukocytes

Question 12

What is the clinical indication for filtered blood products?

Answer 12

Immunosuppression

Question 13

List the two indications for transfusing fresh frozen plasma.

Answer 13

1) Coagulation abnormalities in massive transfusions

2) Hemophilia

Question 14

What is cryoprecipitate? What the specific components of cryoprecipitate?

Answer 14

Precipitate that is formed when fresh frozen plasma is thawed, it contains:

• Factor VIII
• Fibrinogen
• vWF
• Factor XIII

Question 15

What is the clinical indication for cryoprecipitate?

Answer 15

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

Question 16

What is prothrombin complex concentrate? What are the clinical indications for prothrombin complex concentrates?

Answer 16

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

Question 17

What is the clinical indication for albumin?

Answer 17

1) Hypoalbuminemia

2) Volume replacement

Question 18

What is the indications for IVIG?

Answer 18

1) Primary humoral immunodeficiency e.g. SCID
2) Immune thrombocytopenia
3) Chronic inflammatory demyelinating polyneuropathy
4) Hypogammaglobulinemia
5) Post-exposure prophilaxis

Question 19

What are the main coagulation abnormalities that occur after massive transfusion?

Answer 19

• Replacement of blood loss will lead to DILUATION of coagulation factors–>additional bleeding
• Fibrinogen levels can drop

Question 20

Outline how the coagulation abnormalities seen following massive transfusion are treated.

Answer 20

1) FFP transfusions for coagulation factors

2) Cryoprecipitate for fibrinogen

Question 21

Is there a difference in clinical outcomes when old pRBCs are given vs. new?

Answer 21

NO

Question 22

What is pRBC volume reduction?

Answer 22

• 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

Question 23

What are the general indications for plasma transfusion?

Answer 23

1) Coagulation factor replacement
2) Massive transfusion
3) ADAMSTS13

Question 24

What are the platelet thresholds for transfusion?

Answer 24

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

Question 25

What is the definition of platelet refractoriness?

Answer 25

Patient that has an alloimmune response to donor platelets

Question 26

What are the ADVANTAGES of whole blood transfusion?

Answer 26

1) Best for TRAUMA
- Volume
- Hb
- Coagulation factors
- Replace platelets

Question 27

What are the indications for Recombinant Factor VIII?

Answer 27

Patients with Hemophilia A to:

• Control and prevent bleeding
• Perioperative bleeding management

Question 28

What blood component would you give a patient with anemia?

Answer 28

RBCs

Question 29

What blood component would you give a patient with DIC?

Answer 29

Plasma

Question 30

What blood component would you give a patient with thrombocytopenia?

Answer 30

Platelets

Question 31

What blood component would you give a patient with low fibrinogen?

Answer 31

Cryoprecipitate