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Small Animal Medicine > Hematology - Transfusions > Flashcards

Hematology - Transfusions Flashcards

1
Q

True or False: Blood transfusions are used to treat disease.

A

false - they are supportive

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2
Q

What are the indications for transfusion?

A

Temporary replacement of red cells, platelets, and plasma proteins/factors

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3
Q

What are the benefits to blood component therapy?

A

It conserves products, allows for the most specific and safe product to be used for each animal, and minimizes transfusion volume

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4
Q

What are the different forms of whole blood that can be transfused?

A

fresh whole blood and stored whole blood

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5
Q

What are the different forms of blood components that can be transfused?

A

Packed red cells, fresh frozen plasma, frozen plasma, and platelet rich plasma/platelet concentrate

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6
Q

What are the criteria for plasma to be considered fresh frozen plasma?

A

If it is frozen in less than 8 hours and stored for less than a year

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7
Q

What are the criteria for plasma to be considered frozen plasma?

A

If it is frozen in greater than 8 hours or stored for greater than 1 year and less than 4 years

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8
Q

How many units of packed RBCs and fresh frozen plasma do we get from 500 mL of whole blood?

A

2 half units of packed RBC (125 mls each) and 1 unit of fresh frozen plasma (240 mls)

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9
Q

What does fresh whole blood contain?

A

RBCs, all plasma components, platelets, and white cells

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10
Q

How quickly after collection should fresh whole blood be transfused?

A

within 4-6 hours of collection

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11
Q

What is the criteria for whole blood to be stored whole blood?

A

If it is older than 6 hours but less than 1 month old and kept at 4 degrees celcius

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12
Q

What does stored whole blood contain?

A

RBCs and plasma - it does not contain viable platelets or labile clotting factors

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13
Q

What are the indications for whole blood use?

A

patients need multiple blood components or the patients need volume

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14
Q

What does packed red cells contain?

A

Cells and small amounts of plasma and anticoagulant that remains after the plasma is removed from one unit of whole blood

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15
Q

What are the indications for packed red cells?

A

anemia

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16
Q

You have a patient that was hit by their owner’s car. They present collapsed with an open femoral fracture and a significantly swollen rear leg. HCT is 16%, total protein is decreased and the platelet count is normal. The patient is very shocky. What type of transfusion is preferred in this patient?

A

Whole blood because the dog has lost blood volume from bleeding at the site of truama and is very anemic

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17
Q

You have a patient that presented for lethargy and anorexia. This patient had a history of seizures, managed with phenobarbitol. They are anemic with a HCT of 9% and a normal TP. The heartrate was 150, the patient was hypotensive, weak, and 5% dehydrated. Your working diagnosis is bone marrow suppression from phenobarbitol. What type of blood product would you want to give to this patient?

A

Packed red cells because the patient was only missing RBCs. This patient would also be given crystalloids to handle the dehydration

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18
Q

What does fresh frozen plasma contain?

A

Coagulation factors, antithrombin and other anticoagulation factors, von Willebrand factor (vWF), albumin, and globulins

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19
Q

What are the indications for the use of fresh frozen plasma?

A

coagulation disorders resulting in hemorrhage or prophylaxis before surgery in an animal with known clotting factor deficiency

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20
Q

What clotting factor deficiencies would indicate the prophylaxis use of fresh frozen plasma prior to surgery?

A

Von Willebrand disease (congenital), Hemophilia A and B (congenital), Rodenticide toxicity (acquired), Coagulopathy due to liver disease (acquired), and DIC (acquired)

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21
Q

What should fresh frozen plasma not be used as a source of?

A

albumin

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22
Q

When should fresh frozen plasma not be given?

A

Unless you know there is bleeding

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23
Q

What does frozen plasma contain?

A

stable coagulation factors II, VII, IX, X and albumin

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24
Q

What are the indications for use of frozen plasma?

A

Coagulation deficiencies of II, VII, IX, or X resulting in active hemorrhage - this would be perfect for rodenticide cases

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25
Q

Where do blood products come from?

A

Commercial blood banks, in-house blood donors, and client owned pets (non-resident blood donors)

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26
Q

What is the most common indication for a transfusion?

A

anemia

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27
Q

What clinical signs in an anemic patient should indicate a transfusion?

A

Lethargy, tachycardia, and tachypnea

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28
Q

At what PCV level should you consider a transfusion?

A

less than 20%

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29
Q

What are blood groups defined by?

A

inherited antigens on the surface of the RBC

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30
Q

What can RBC antigens trigger in an animal that lacks that antigen?

A

antibody production

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31
Q

What is the blood typing system in the dog?

A

DEA - Dog erythrocyte antigen system

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32
Q

What are the five defined canine blood groups?

A

DEA 1, 3, 4, 5, and 7

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33
Q

What are the allele forms of DEA 1?

A

positive, negative, and weak positive

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34
Q

What are the allele forms of DEA 3, 4, 5, and 7?

A

positive or negative

35
Q

What is the most immunogenic and clinically significant canine blood type?

A

DEA 1

36
Q

True or False: There are preformed antibodies to DEA 1

A

false - there are no preformed antibodies to DEA 1, sensitization post transfusion

37
Q

If you give a transfusion of DEA 1+ blood to a DEA 1- recipient what will happen?

A

The recipient will make anti-DEA antibody within 4-7 days

38
Q

If a dog with DEA 1- blood gets a second transfusion of DEA 1+ blood, what will happen?

A

An acute hemolytic crisis will occur

39
Q

What is the canine universal donor?

A

A dog that is negative for DEA 1, 3, 5, and 7, and positive for DEA 4

40
Q

When should you crossmatch for a dog?

A

In dogs with prior transfusion greater than 3 days prior

41
Q

Why can you give a transfusion to a dog without crossmatching if it is their first transfusion?

A

Because they lack clinically significant alloantibodies

42
Q

How do you crossmatch?

A

Mix washed donor RBCs mixed with recipient plasma

43
Q

What crossmatch result indicates incompatibility?

A

agglutination or hemolysis

44
Q

What amount of pRBCs should increase PCV by 1%?

A

1 ml/kg

45
Q

At what temperature should RBC, whole blood, and platelets be transfused?

A

room temperature

46
Q

At what temperature should you thaw fresh frozen plasma to?

A

37 degrees celcius

47
Q

How should blood be administered?

A

Via a dedicated IV line with no additives, through a filter, no pumps, over 1-4 hours, and start slow

48
Q

What should you monitor and monitor for during blood transfusions?

A

TPR every 30 minutes, and watch for nausea, vomiting, diarrhea, and agitation

49
Q

What blood typing system is used for cats?

A

AB system

50
Q

What blood types do cats have and what is the most common?

A

Type A (most common), type B, and Type AB

51
Q

Can cats receive a blood transfusion without crossmatching?

A

No! They have high levels of naturally occuring antibodies to foreign antigens

52
Q

Type B cats have a ______ reaction to type A blood.

A

Strong; giving 1 mL can kill a type B cat

53
Q

Type A cats have a _____ reaction to type B blood.

A

Mild; there will be shortened RBC survival

54
Q

Is there a universal cat donor?

A

no

55
Q

In what breeds are B blood types more common?

A

Purebreds - Devon rex, British shorthair, Cornish rex, exotic shorthair, and Scottish fold

56
Q

What type of blood should AB cats receive?

A

They should receive either type AB or A blood products - AB is better

57
Q

What type of blood should AB cats not receive?

A

B blood because of the strong anti-A antibodies present in donor B sserum

58
Q

What do anticoagulant rodenticides inhibit?

A

Vitamin K1 epoxide reductase

59
Q

Without active Vitamin K, what coagulation factors cannot be activated?

A

Factors II, VII, IX, and X

60
Q

What products contain factors II, VII, IX, and X?

A

FFP, FP, and whole blood

61
Q

What are the general types of tranfusion reactions?

A

Immune-mediated and Non-immune mediated reactions

62
Q

What is an example of a type II acute, immune transfusion reaction?

A

Type B cats receiving Type A cells

63
Q

What signs are associated with Type II acute, immune transfusion reactions in cats?

A

Occur within minutes - hemolysis, hemoglobinuria, apnea, dyspnea, hypotension, cardiac arrythmias, collapse, and forelimb extension

64
Q

What should you do in a patient with Type II acute, immune transfusion reactions?

A

Stop the transfusion and begin crystalloid infusion to optimize blood pressure and maintain renal perfusion

65
Q

What clinical signs are associated Type I with acute, immune transfusion reactions?

A

Allergic reactions ranging from hives (mild) to severe anaphylaxis

66
Q

What antibodies mediate hypersensitivity reactions against proteins in donor plasma?

A

IgE

67
Q

What do you do in a patient with Type I hypersensitivity reactions?

A

Stop transfusion and give antihistamines +/- glucocorticoids

68
Q

What are febrile, nonhemolytic reactions?

A

When the temperature increases of more than 1 degree celcius associated with a transfusion

69
Q

What causes febrile, nonhemolytic reactions?

A

Cytokines in blood product or anti-WBC or anti-platelet antibodies in recipient against donor WBCs or platelets

70
Q

What do you do in cases of febrile, nonhemolytic reactions?

A

Slow the transfusion, consider stopping, and consider an anti-pyretic drug (steroid)

71
Q

What are some non-immune transfusion reactions?

A

TACO, transfusion-associated sepsis, non-immune mediated hemolysis, and citrate toxicity

72
Q

What is TACO?

A

Transfusion-associated circulatory overload

73
Q

What are some clinical signs of TACO?

A

retching, vomiting, tachypnea, and dyspnea

74
Q

How can TACO be treated?

A

Lasix and oxygen as needed

75
Q

What causes transfusion-associated sepsis?

A

bacterial contamination of the blood products

76
Q

What should you do in a patient with transfusion-associated sepsis?

A

Stop the transfusion and culture the unit

77
Q

What causes nonimmune-mediate hemolysis?

A

Improper temperature exposure or mechanical hemolysis

78
Q

What is citrate toxicity associated with?

A

the anticoagulant - hypocalcemia occurs

79
Q

How are transfusion reactions prevented?

A

Type/crossmatch, filter blood, start slowly, and discard blood products if they have been at room temperature for more than 4 hours

80
Q

What is the first step to managing transfusion reactions?

A

stop the transfusion

81
Q

How do you treat volume overload as a result of a transfusion?

A

diuretics and oxygen

82
Q

How do you treat hemolysis, shock, and anaphylaxis as a result of a transfusion?

A

fluids, ventilation, oxygen, epinephrine, and glucocorticoids

83
Q

How do you treat urticaria, pruritus, and edema as a result of a transfusion?

A

diphenhydramine and dexamethasone

84
Q

How do you treat mild febrile reactions as the result of a transfusion?

A

No specific treatment, but in more severe temperature elevations treat with fluid support and antipyretics

Small Animal Medicine (100 decks)

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