Exam 4 - Complications of Transfusions Flashcards
why are transfusion rates started slow?
hemolytic reactions are most likely to occur early on in the transfusion
T/F: non-hemolytic reactions are most likely to occur at the beginning of a transfusion
false - most likely to occur at the end
what monitoring should be done during a blood transfusion?
obtain baseline numbers before starting
HH, RR, temperature every 10 minutes for the first 30 minutes & then every hour until the transfusion is done
T/F: refrigerated blood products that have been open for more than 24 hours are at an increased risk of bacterial contamination
true
T/F: room temperature blood products that have been open for more than 6 hours are at an increased risk of bacterial contamination
true
what is the mortality of blood transfusions in patients receiving them?
39-53% - usually due to underlying disease
what are the general clinical signs associated with transfusion reactions?
non-specific, tachycardia, tachypnea, evaluate serum & urine for hemolysis, & rapid resolution of signs typically indicate less severe reactions
what is the most common transfusion reaction?
febrile, non-hemolytic reaction - increase in 1 C from baseline temperature
what is a febrile, non-hemolytic reaction associated with?
response to protein, leukocytes, or platelets in plasma protein
plasma products!!!!
T/F: a febrile, non-hemolytic reaction is possible with any transfusion product
true
what is the treatment for a febrile, non-hemolytic transfusion reaction?
stop the transfusion immediately - restart it in 20-30 minutes at a slower rate
what is an allergic, type I hypersensitivity reaction?
uncommon reaction - animal has urticaria, wheals, flares, & facial swelling
what is the treatment for an allergic, type I hypersensitivity reaction?
diphenhydramine at 1-4mg/kg SQ or IM - stop the transfusion, but you can typically resume at a slower rate with resolution of signs
what is an anaphylactic, type I hypersensitivity reaction?
acute onset of integumentary, gi, or respiratory signs without hypotension following exposure to an antigen
what is the treatment for an anaphylactic, type I hypersensitivity reaction?
epinephrine 0.01 mg/kg IV or IM - stop transfusion & DO NOT RESUME
what is the second most common transfusion reaction?
type II hypersensitivity
T/F: type II hypersensitivity reactions can be hard to identify in patients with IMHA
what causes acute hemolysis from a type II hypersensitivity reaction? what is the treatment recommended?
happens due to preformed antibodies to RBC surface antigens - most commonly DEA 1.1
immediately life threatening - stop transfusion & cross match before the next transfusion
what causes delayed hemolysis from a type II hypersensitivity reaction? what is the treatment recommended?
induction of antibody production typically to other blood groups in which the patient may or may not have clinical signs - supportive care
what is TRALI?
transfusion associated acute lung injury
what is the treatment for TRALI?
largely supportive care - supplemental O2
single dose of furosemide may be beneficial - issue with widespread inflammation & leaky capillaries, not a hydrostatic problem
what patients are at a greater risk for TACO?
patients with pre-existing cardiac disease, cats
also greater risk with plasma products due to colloid effects
what is the treatment for TACO?
furosemide trial & oxygen therapy
what is TACO?
transfusion associated circulatory overload
T/F: TACO is a common reaction in transfusion patients
false - uncommon
what is the mechanism of citrate toxicity in transfusion patients?
sodium citrate is used for anticoagulation in transfusion medicine - citrate will bind to calcium
increased risk with number of transfusions but unlikely in single unit cases
what is the treatment for citrate toxicity?
calcium gluconate 0.5mL/kg IV slowly over 5-10 minutes & evaluated ECG during administration for bradycardia
T/F: administration of diphenhydramine and/or corticosteroids prior to a transfusion showed a decreased occurrence of hemolytic/febrile reactions
false - no decreased occurrence showed
what is a massive transfusion?
- transfusion of a volume equal to or greater than a whole blood volume within a 24 hour period
- replacement of half of the patient’s estimated blood volume within 3 hours
- administration of blood products at a rate of 1.5ml/kg/min over 20 minutes
- replacement of 150% of a patient’s blood volume irrespective of time
when should the massive transfusion protocol be used?
meets one of the massive transfusion definitions & required when using component therapy
why is the massive transfusion protocol used for component therapy?
component therapy has an increased risk for reactions - prevents dilutional coagulopathy
what is the protocol for component therapy?
1:1:1 ratio - 20 kg patient receives 240 mL of pRBCs in 5 minutes - administer 1 unit FFP & 1 platelet transfusion
what are the mortality & complication rates associated with massive transfusions?
high mortality & high rates of complications
what products are included in CPDA solutions used to preserve blood products?
citrate, phosphorus, dextrose, adenine
what is a storage lesion?
refers to morphologic, biochemical, & immunological changes that occur secondary to prolonged storage or blood products
what are some examples storage lesions demonstrating immunologic changes?
- progressive increases in IL-8
- progressive increases in microparticle concentration
what are some examples storage lesions demonstrating morphoologic changes?
- progression to spheroechinocyte formation
- progressive hemolysis
what are some examples storage lesions demonstrating biochemical changes?
- progressive increases in ammonia & lactate
- progressive decreases in glucose, adenine, & pH
what are some examples of clinical signs & lab results supportive of performing a blood transfuion?
anemia with signs of decreased oxygen delivery
coagulopathy with signs of active bleeding
what happens if you have a puppy or a kitten that is severely anemic from intestinal parasites & you don’t have any commercial blood products for a transfusion?
bitch or queen are usually excellent donors - make sure to type the queen & kittens prior
coat the syringe in heparin & waste it
FWD = 2ml/kg * BW (kg) * desired increase in PCV
don’t exceed 10% of the donor’s blood volume!!!
T/F: in storage of blood products, there is a significant increase in ammonia concentration, but in healthy patients transfused with it, there were no significant elevations in ammonia in their blood
true
