Exam 4 - Complications of Transfusions

Question 1

why are transfusion rates started slow?

Answer 1

hemolytic reactions are most likely to occur early on in the transfusion

Question 2

T/F: non-hemolytic reactions are most likely to occur at the beginning of a transfusion

Answer 2

false - most likely to occur at the end

Question 3

what monitoring should be done during a blood transfusion?

Answer 3

obtain baseline numbers before starting

HH, RR, temperature every 10 minutes for the first 30 minutes & then every hour until the transfusion is done

Question 4

T/F: refrigerated blood products that have been open for more than 24 hours are at an increased risk of bacterial contamination

Answer 4

true

Question 5

T/F: room temperature blood products that have been open for more than 6 hours are at an increased risk of bacterial contamination

Answer 5

true

Question 6

what is the mortality of blood transfusions in patients receiving them?

Answer 6

39-53% - usually due to underlying disease

Question 7

what are the general clinical signs associated with transfusion reactions?

Answer 7

non-specific, tachycardia, tachypnea, evaluate serum & urine for hemolysis, & rapid resolution of signs typically indicate less severe reactions

Question 8

what is the most common transfusion reaction?

Answer 8

febrile, non-hemolytic reaction - increase in 1 C from baseline temperature

Question 9

what is a febrile, non-hemolytic reaction associated with?

Answer 9

response to protein, leukocytes, or platelets in plasma protein

plasma products!!!!

Question 10

T/F: a febrile, non-hemolytic reaction is possible with any transfusion product

Answer 10

true

Question 11

what is the treatment for a febrile, non-hemolytic transfusion reaction?

Answer 11

stop the transfusion immediately - restart it in 20-30 minutes at a slower rate

Question 12

what is an allergic, type I hypersensitivity reaction?

Answer 12

uncommon reaction - animal has urticaria, wheals, flares, & facial swelling

Question 13

what is the treatment for an allergic, type I hypersensitivity reaction?

Answer 13

diphenhydramine at 1-4mg/kg SQ or IM - stop the transfusion, but you can typically resume at a slower rate with resolution of signs

Question 14

what is an anaphylactic, type I hypersensitivity reaction?

Answer 14

acute onset of integumentary, gi, or respiratory signs without hypotension following exposure to an antigen

Question 15

what is the treatment for an anaphylactic, type I hypersensitivity reaction?

Answer 15

epinephrine 0.01 mg/kg IV or IM - stop transfusion & DO NOT RESUME

Question 16

what is the second most common transfusion reaction?

Answer 16

type II hypersensitivity

Question 17

T/F: type II hypersensitivity reactions can be hard to identify in patients with IMHA

Question 18

what causes acute hemolysis from a type II hypersensitivity reaction? what is the treatment recommended?

Answer 18

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

Question 19

what causes delayed hemolysis from a type II hypersensitivity reaction? what is the treatment recommended?

Answer 19

induction of antibody production typically to other blood groups in which the patient may or may not have clinical signs - supportive care

Question 20

what is TRALI?

Answer 20

transfusion associated acute lung injury

Question 21

what is the treatment for TRALI?

Answer 21

largely supportive care - supplemental O2

single dose of furosemide may be beneficial - issue with widespread inflammation & leaky capillaries, not a hydrostatic problem

Question 22

what patients are at a greater risk for TACO?

Answer 22

patients with pre-existing cardiac disease, cats

also greater risk with plasma products due to colloid effects

Question 23

what is the treatment for TACO?

Answer 23

furosemide trial & oxygen therapy

Question 24

what is TACO?

Answer 24

transfusion associated circulatory overload

Question 25

T/F: TACO is a common reaction in transfusion patients

Answer 25

false - uncommon

Question 26

what is the mechanism of citrate toxicity in transfusion patients?

Answer 26

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

Question 27

what is the treatment for citrate toxicity?

Answer 27

calcium gluconate 0.5mL/kg IV slowly over 5-10 minutes & evaluated ECG during administration for bradycardia

Question 28

T/F: administration of diphenhydramine and/or corticosteroids prior to a transfusion showed a decreased occurrence of hemolytic/febrile reactions

Answer 28

false - no decreased occurrence showed

Question 29

what is a massive transfusion?

Answer 29

• 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

Question 30

when should the massive transfusion protocol be used?

Answer 30

meets one of the massive transfusion definitions & required when using component therapy

Question 31

why is the massive transfusion protocol used for component therapy?

Answer 31

component therapy has an increased risk for reactions - prevents dilutional coagulopathy

Question 32

what is the protocol for component therapy?

Answer 32

1:1:1 ratio - 20 kg patient receives 240 mL of pRBCs in 5 minutes - administer 1 unit FFP & 1 platelet transfusion

Question 33

what are the mortality & complication rates associated with massive transfusions?

Answer 33

high mortality & high rates of complications

Question 34

what products are included in CPDA solutions used to preserve blood products?

Answer 34

citrate, phosphorus, dextrose, adenine

Question 35

what is a storage lesion?

Answer 35

refers to morphologic, biochemical, & immunological changes that occur secondary to prolonged storage or blood products

Question 36

what are some examples storage lesions demonstrating immunologic changes?

Answer 36

• progressive increases in IL-8
• progressive increases in microparticle concentration

Question 37

what are some examples storage lesions demonstrating morphoologic changes?

Answer 37

• progression to spheroechinocyte formation
• progressive hemolysis

Question 38

what are some examples storage lesions demonstrating biochemical changes?

Answer 38

• progressive increases in ammonia & lactate
• progressive decreases in glucose, adenine, & pH

Question 39

what are some examples of clinical signs & lab results supportive of performing a blood transfuion?

Answer 39

anemia with signs of decreased oxygen delivery

coagulopathy with signs of active bleeding

Question 40

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?

Answer 40

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!!!

Question 41

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

Answer 41

true