Hematology indications CC Flashcards
1
Q
Exchange transfusion in sickle cell
A
- Severe chest crisis
- Suspected CNS event
- Multiorgan failure—when the proportion of HbS should be reduced to <30%
3
Q
Platelet transfusion
A
- Clinically stable patients with chemotherapy-induced thrombocytopenia who are not bleeding do not benefit from platelet transfusion when the platelet count is 10,000/µL (10 × 109/L) or greater
AABB Guideline:
- transfuse below 10,000/mm3
- May increase threshold for:
- Fever and infection
- Combined coagulopathy
- Acute promyelocytic leukemia
4
Q
Platelet transfusion contraindications
A
- TTP/HUS
- HELLP
- HIT
6
Q
Recommend prophylactic platelet transfusions
A
- Single apheresis unit or equivalent in pt at risk of bleeding, for platelet count ≤10 × 109/l
- Therapeutic platelet transfusions are required in hemorrhage to keep platelet count >100 × 109/l required to create stable clot & minimize rebleeding
- Suggest platelet transfusion for pt having elective central venous catheter placement with platelet count <20 × 109/l
- Suggest platelet transfusion for pt having elective diagnostic lumbar puncture with platelet count <50 × 109/l
- Suggest platelet transfusion for pt having major elective nonneuraxial surgery with platelet count <50 × 109/l
7
Q
Transfusion of red blood cells
A
- Current guidelines recommend transfusing red blood cells if a patient has symptoms attributable to anemia or a hemoglobin level less than 7 to 8 g/dL (70-80 g/L)
- For patients with cardiovascular disease and postoperative anemia, transfusion of red blood cells is recommended if the patient has symptoms attributable to anemia or a hemoglobin level less than 7 to 8 g/dL (70-80 g/L)
- Symptomatic anemia should be treated with transfusion in patients with hemoglobin <10 g/dL, regardless of the hemoglobin level, provided that the symptoms are severe enough and are clearly related to the anemia rather than the underlying condition
- Acute coronary syndrome: transfuse when hemoglobin is <8 g/dL and to consider transfusion when the hemoglobin is between 8 and 10 g/dL. If the patient has ongoing ischemia or other symptoms, we maintain the hemoglobin ≥10 g/dL
9
Q
Cryoprecipitate transfusion
A
- hypofibrinogenemia,
- tPA-related life-threatening bleeding,
- von Willebrand’s disease,
- uremic bleeding,
- massive transfusion
- hemophilia A
10
Q
Stem cell transplant (Malignant)
A
- Acute lymphoblastic leukemia
- Acute myelogenous leukemia
- Myelodysplastic syndrome
- Non–Hodgkin’s lymphoma
- Hodgkin’s lymphoma
- Chronic myelogenous leukemia
- Chronic myelomonocytic leukemia
- Neuroblastoma
11
Q
Stem cell transplant (Nonmalignant)
A
- Bone marrow failure syndromes
- Hemoglobinopathies
- Immunodeficiencies
12
Q
Extended indications for prophylactic vena cava filter placement in a pt with established DVT or PE
A
- Large free-floating thrombus in the iliac vein or IVC
- Following massive PE in which recurrent emboli may prove fatal
- During/after surgical embolectomy
14
Q
Indications to choose warfarin over a DOAC
A
- Valvular atrial fibrillation
- Mechanical heart valves
- Severe hepatic impairment
- BMI > 40 or Weight > 120 kg
- Anti-phospholipid syndrome
15
Q
Fresh Frozen Plasma (FFP) transfusion indications
A
- Bleeding due to Deficiency of Multiple Coagulation Factors
- Disseminated Intravascular Coagulation (DIC)
- Thrombotic Thrombocytopenic Purpura (TTP) or Hemolytic Uremic Syndrome (HUS) when plasmapheresis is not available
- Liver disease with active bleeding
- Over-anticoagulation with warfarin and active bleeding
- Dilutional coagulopathy in massive transfusion scenarios
- Prothrombin Time (PT)/International Normalized Ratio (INR) > 1.5 times the upper limit of normal with active bleeding
- Massive Transfusions: A balanced transfusion strategy with a plasma to RBC ratio of 1:1 is recommended in cases of massive transfusion
- Warfarin Overdose: FFP can be used to reverse warfarin effects in patients with bleeding or those with warfarin-related intracranial hemorrhage. If available, Prothrombin Complex Concentrate (PCC) is preferred
- Prolonged Prothrombin Time (PT) or Partial Thromboplastin Time (PTT): PT/PTT > 1.5 times the upper limit of normal with active bleeding
16
Q
Non-recommended situations for FFP transfusion
A
- Routine use in patients undergoing surgery without massive transfusion
- Stable patients with liver disease, hemophilia A or B, or other factor deficiencies without active bleeding
- Antithrombin deficiency in situations requiring anticoagulation with heparin
17
Q
Indications for IVC filters
A
- Acute venous thromboembolism (VTE), including deep vein thrombosis (DVT) or pulmonary embolism (PE), when anticoagulation is contraindicated (e.g., due to active bleeding or high risk for bleeding) [Strong Recommendation]
- Recurrent VTE despite adequate anticoagulation therapy [Strong Recommendation]
18
Q
Indications to choose irradiated red cells and platelets for transfusion
A
- Hodgkin lymphoma
- Severe T-lymphocyte immunodeficiency syndromes
- Recipients of allogeneic stem cell transplants during conditioning chemotherapy, throughout the 6 month posttransplant prophylaxis and as long as immunosuppression is required
- Recipients of autologous stem cell transplant during conditioning chemotherapy and throughout 3 to 6 months of posttransplant prophylaxis
- Patients undergoing bone marrow harvest during and 7 days before the procedure
- Patients treated with purine analogue immunosuppressive agents
- All intrauterine fetal transfusions
It is not typically necessary to use irradiated products for patients with human immunodeficiency virus (HIV), solid tumors, autoimmune disease, or after solid organ transplantation
19
Q
Hemodialysis indications in patient with tumor lysis syndrome
A
- patients who are oliguric or anuric,
- have persistent hyperkalemia, or
- have hyperphosphatemia-induced symptomatic hypocalcemia.
