Hematology - Transfusions Flashcards
What volume of whole blood is needed to raise the PCV by 1%?
2 mL/kg
What volume of pRBC is needed to raise the PCV by 1%?
1 mL/kg
What factors are present in fresh frozen plasma vs frozen plasma?
Fresh frozen has all coag factors, albumin, and Ig.
Frozen plasma is similar but lacks V and VIII.
How long can frozen plasma be stored?
5 years at 20 C
How is cryoprecipitate made?
Prepared from fresh frozen plasma
What factors are present in cryoprecipitate?
All coag factors if used within 8 hours of thaw.
Concentrated VIII, vWF, and fibrinogen.
What is the main difference between cryoprecipitate and cryopoor plasma?
Cryopoor lacks VIII, vWF, and fibrinogen (but these are concentrated in cryoprecipitate).
How is platelet rich plasma prepared?
Differential centrifugation of fresh whole blood within 2 hours of collection.
How long is platelet rich plasma good for?
24 hours at 20-24 C/
What plasma products can be stored at -20C with a shelf life of 1 year?
Fresh frozen plasma, cryoprecipitate, and cryopoor plasma.
Fresh frozen plasma should not be used as the first line of treatment for what condition? Why?
Hypoalbuminemia.
Albumin is so dilute in this sample that it would take 45 mL/kg to increase serum albumin by 1 g/dL.
What are the main blood types of dogs?
DEA 1.1, 1.2, 7, and 4.
DEA 1.1 is most common - if positive = Type A.
What is Dal?
Dal is present in 93% of dogs, but commonly absent in Dalmatians, shih tzus, and Dobermans. Sensitized Dal negative dogs could have acute and delayed hemolytic reactions.
How are dogs blood typed?
Cards or alvedia quick tests.
What are the different cat blood types?
Type A (most common)
Type B
Mlk Ag
Type A cats have Anti-B antibodies that are _____ compared to the Anti-A antibodies of Type B cats that are _____.
Anti-B antibodies - weak IgG and IgM
Anti-A antibodies - strong hemagglutinins and hemolysis (IgM)
What happens when mlk negative cats receive mlk positive blood?
Ag:Ab –> acute hemolytic conditions.
Do you need to cross match all dogs? What about cats?
Dogs - very unlikely to react to first transfusion, but should cross match if receiving >1.
Cats - ALWAYS cross match!!!
What is the RBC lifespan when A blood –> A cat? B blood –> A cat? A blood –> B cat?
A –> A = 1 month
B –> A = 2 days, risk of hemolytic rxn
A –> B = 1 hr, FATAL in most cases
What type of blood should be given to an AB cat?
AB if possible, otherwise A (since it carries the weaker anti-B-Ab)
What is major cross matching vs minor?
Major: mix donor RBC with recipient serum.
Minor: mix recipient RBC with donor serum.
How is a simple major crossmatch performed?
2 drops recipient blood:1 drop donor blood and check for agglutination/hemolysis
When should a simple major crossmatch be performed?
When a crude match must be made in an emergency.
Acute hemolytic reactions are type __ hypersensitivity against the ____ RBC antigen.
Acute hemolytic reactions are type II hypersensitivity against the donor RBC antigen.
What mediators are involved in type II hypersensitivity?
IgG, IgM, complement
What are the clinical signs associated with acute hemolytic reactions?
Agitation, tachycardia, tachypnea, pyrexia, vomiting, hypotensive sock…
T/F: Death is slow and rare in acute hemolytic reactions.
False - it frequently occurs and does so rapidly.
What is the treatment for acute hemolytic reactions?
Stop the transfusion, provide IVF and supportive care.
What type of hypersensitivity is an acute febrile non-hemolytic reaction?
Type II hypersensitivity
What is the interaction causes acute febrile non-hemolytic reactions?
Ab against donor leukocytes or platelets.
What are the clinical signs of acute febrile non-hemolytic reactions?
Vomiting, tachypnea, fever.
What is the treatment for acute febrile non-hemolytic reactions?
Stop transfusion - see resolution - continue slowly with close monitoring.
How long does an acute febrile non-hemolytic reaction last?
30 minutes to 20 hours
Acute hypersensitivity reactions are type __.
Acute hypersensitivity reactions are type 1.
What mediators are responsible for type I hypersensitivity?
IgE and mast cells
What is the most common blood product associated with type I hypersensitivity? By what mechanism?
Plasma transfusion.
Transfusion –> mast cell stimulation –> vasoactive substances released.
What are the signs of acute hypersensitivity (type I)?
Urticaria, pruritic, facial edema, rarely death
What are the treatments for type I hypersensitivity?
Discontinue transfusion, antihistamines, epinephrine if severe.
What is TRALI? Is it seen in vet med?
Transfusion related acute lung injury - non-cardiogenic pulmonary edema
Only reported in human medicine
What are the treatments for TRALI?
Stop transfusion, supplement oxygen, intermittent positive ventilation.
What are examples of acute non-immunologic reactions to blood transfusions?
Hypocalcemia Embolism Circulatory overload Bacterial infection Hyperammonemia Hypothermia Hemolysis secondary to physical/thermal RBC damage
What are 2 forms of delayed non-immunologic reactions?
Disease transmission
Immunosuppression
How can we prevent complications associated with transfusions?
Blood typing and cross matching Use of components Screening of donors Appropriate storage and delivery of blood Prophylactic diphenhydramine
Should you give steroids to prevent hypersensitivity/complications?
NO! There is no scientific reason to!
What are the key monitoring parameters during a transfusion?
Temperature, HR, RR and effort, BP, vomiting, urticaria, angioedema, pruritus.
What products should be used to treat anemia?
pRBC or whole blood
What products should be used to treat a coagulopathy with concurrent anemia?
Fresh whole blood
What product for vWF disease?
Cryoprecipitate
What product for hemophilia A (VIII deficiency)?
Cryoprecipitate
What product for hemophilia B (IX deficiency)?
Cryopoor plasma
What product for vitamin K antagonism/rodenticide toxicity?
Frozen plasma
What product for liver failure?
Fresh frozen plasma
What product for DIC?
Fresh frozen plasma
What product for sepsis or SIRS?
Fresh frozen plasma
What product for hypoalbuminemia?
PLASMA PRODUCTS SHOULD NOT BE USED AS THE 1st LINE OF TX!
