Hematology Flashcards
When do consider partial exchange transfusion for polycythemic newborns?
Hct > 70%
Or lower w/ symp.
If you are giving a partial exchange transfusion- what fluid as diluent?
Normal Saline
How much blood do you give to decrease Hct from 0.75 to 0.5 in 2kg BB?
BB Blood vol= 80 mL x kg
Volume exchange (mL)
= Blood vol x (observed-desired Hct)/ Observed Hct
= (80x2) x (0.75-.05)/0.75
= 53 mL
Or generally 10-20 cc/kg.
What are suggested Transfusion level for infants with anemia of prem?
*start at 115 w/ resp support and minus 15 if none= 100
For each wk start w/ last no resp support (100 for wk 2) threshold for resp support and minus 15.
> Wk 1: Resp support= 115; No resp= 100
> Wk 2= 100 w/ resp support; 85 if not
> Wk 3= 85 or 75 no resp
List 3 AE to RBC transfusion:
> AE of leukocyte
- anaphylaxis
- graft vs. host
- TRALI (transfusion related lung injury)
> Acute volume or lyte
- TACO (transfusion related circulatory overload)
> transfusion infection
- virus, bacterial, parasite
> blood group in compatible
- aute hemolytic rxn
Which blood group do you give neo in ED?
Group O Rh (-)
T or F: you try to maintain Hgb of 75 in prem.
True; regardless of age.
T or F: infants with resp or cyanotic heart dx may need higher transfusion threshold.
True
Most common RBC transfusion rxn?
- Febrile non hemolytic rxn
- Allergic rxn
- TACO (circulatory overload)
Most common cause of febrile rxn in blood transfusion?
Sensitization to WBC
> due to presence of cytokine made by passenger leuk
NOT hemolysis.
Child getting blood. Become febrile and chills. Management?
- stop it; run TKVO
- stop it; steroids
- continue at slow rate
- continue w/ methylpred
Stop it and run TKVO
+/- antipyretic if fever bothersome
+/- ensure no other cause (hemolytic rxn, sepsis)
Which infection is most at risk to get from pRBC?
- Hep B
- Hep C
- HIV
- Parvo B19
Parvo B19
HIV: 1 in 8 million
Hep C: 1 in 5 million
Hep B: 1 in 1 million
Parvo: 1 in 20 K
Child with that major thal and recurrent transfusion. On desfuroxime. Most serious complication?
Cardiac hemosiderosis
** transfusion induced
Fe deposited; liver, endo, cardiac after 10 yr
How are thalassemias inherited?
AR
What are Beta thal minor (trait), intermedia, major.
Beta Thal= beta lacking.
Minor/Trait= 1 abN allele
B/B+, B/B0
= Silent; No Tx
Beta Intermedia
B+/B+, B+/B0
= two abnormal allele
may need transfusion
Beta Major= Cooley
= homozygous
B0__/B0__
> CC: 6-12 mon. when HbA replace HbF= anemia, jaundice, DD, HSM
Tx: transfusion, iron chelation, bone marrow transplant
What Hgb do you find in beta thal major patients?
Hb F
0-10% HbA only
What can you expect on beta thal major BW?
- anemia
BUT low retic (unstable erythroid precursor die) - ++ HbF
Which ethnicity is beta thal dominant in?
Mediterranean
Indian
What ethnicity is alpha-thal dominant in?
S.E Asia
Africa
Describe the 4 types of alpha Thal
aa/-a= 1 bad gene= silent
- a/-a= 2 bad gene= trait
- a/–= Hb H= 3 bad gene
–/– = Hb Barts/ hydrops fetalis
What do you see with HbH:
- inclusion body
- heinz body
- howell-jolly body
Inclusion body
(Hgb= beta 4 because three alpha missing= seen in cells)
Heinz Body= G6PD
Howell-Jolly= asplenia (sickle cell), amyloid, hemolytic anemia, prem infant
How do you a dx a Thalassemia?
Hemoglobin electrophoresis
(i.e. HbA2 and HbF up= beta chain missing)
Confirmation: Gene mapping
What type of treatment is required for Hb Barts?
Intrauterine transfusion
as no alpha gene
= fetal hydrops otherwise
What is gold standard for beta thal major?
Transfusion
+ Hydroxyurea (increase Hb F)
+/- hematopoietic stem cell transplant curative