Exam 4 - Complications of Transfusions Flashcards

1
Q

why are transfusion rates started slow?

A

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

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2
Q

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

A

false - most likely to occur at the end

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3
Q

what monitoring should be done during a blood transfusion?

A

obtain baseline numbers before starting

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

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4
Q

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

A

true

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5
Q

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

A

true

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6
Q

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

A

39-53% - usually due to underlying disease

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7
Q

what are the general clinical signs associated with transfusion reactions?

A

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

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8
Q

what is the most common transfusion reaction?

A

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

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9
Q

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

A

response to protein, leukocytes, or platelets in plasma protein

plasma products!!!!

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10
Q

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

A

true

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11
Q

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

A

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

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12
Q

what is an allergic, type I hypersensitivity reaction?

A

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

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13
Q

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

A

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

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14
Q

what is an anaphylactic, type I hypersensitivity reaction?

A

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

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15
Q

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

A

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

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16
Q

what is the second most common transfusion reaction?

A

type II hypersensitivity

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17
Q

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

18
Q

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

A

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

19
Q

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

A

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

20
Q

what is TRALI?

A

transfusion associated acute lung injury

21
Q

what is the treatment for TRALI?

A

largely supportive care - supplemental O2

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

22
Q

what patients are at a greater risk for TACO?

A

patients with pre-existing cardiac disease, cats

also greater risk with plasma products due to colloid effects

23
Q

what is the treatment for TACO?

A

furosemide trial & oxygen therapy

24
Q

what is TACO?

A

transfusion associated circulatory overload

25
T/F: TACO is a common reaction in transfusion patients
false - uncommon
26
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
27
what is the treatment for citrate toxicity?
calcium gluconate 0.5mL/kg IV slowly over 5-10 minutes & evaluated ECG during administration for bradycardia
28
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
29
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
30
when should the massive transfusion protocol be used?
meets one of the massive transfusion definitions & required when using component therapy
31
why is the massive transfusion protocol used for component therapy?
component therapy has an increased risk for reactions - prevents dilutional coagulopathy
32
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
33
what are the mortality & complication rates associated with massive transfusions?
high mortality & high rates of complications
34
what products are included in CPDA solutions used to preserve blood products?
citrate, phosphorus, dextrose, adenine
35
what is a storage lesion?
refers to morphologic, biochemical, & immunological changes that occur secondary to prolonged storage or blood products
36
what are some examples storage lesions demonstrating immunologic changes?
- progressive increases in IL-8 - progressive increases in microparticle concentration
37
what are some examples storage lesions demonstrating morphoologic changes?
- progression to spheroechinocyte formation - progressive hemolysis
38
what are some examples storage lesions demonstrating biochemical changes?
- progressive increases in ammonia & lactate - progressive decreases in glucose, adenine, & pH
39
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
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?
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!!!
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
true