Hemotherapy Decisions Flashcards
blood products considered to be cellular components
whole blood, red blood cells, granulocytes
blood products considered to be plasma components
platelet products, cryoprecipitate, fresh frozen plasma, other plasma components
blood products considered to be hematopoietic progenitor cell products
bone marrow, peripheral blood stem cells, cord blood preparations
goals of transfusion
increase tissue oxygenation and/or restore hemostasis
what product is used to treat inadequate oxygen carrying capacity?
red cells
what product is used to treat insufficient coagulation proteins?
FFP, cryo
what product is used to treat inadequate hemostasis?
[;ate;ets
expected response per dose of red cell transfusion
1 g/dl
expected response per dose of FFP
25% increase in factor products
expected response per dose of platelets
30-50,000 1 hour post transfusion
expected response per dose of cryo
fibrinogen increase 50 mg/dl
expected response per dose of granulocytes
usually no demonstrable increase in neutrophil count
common transfusion trigger for red cells
Hgb <7 g/dl
common transfusion triggers for FFP
aPTT and/or PTT increase >1.5 times upper normal limit
common transfusion trigger for platelets
plt count <10,000
common transfusion trigger for cryo
fibrinogen <100 mg/dl
common transfusion trigger for granulocytes
documented sepsis unresponsive to antimicrobial therapy
common adult dose for RBC
1 unit
common adult dose for FFP
10-20 mg/kg body weight (often 2 units)
common adult dose for platelets
1 apheresis or 4-6 pooled whole blood derived units
common adult dose for cryo
10 units of 1 unit/kg body weight
common adult dose for granulocytes
1 unit
first lab tests used to assess need to transfusion
CBC, PTT, PT, INR, fibrinogen
INR value that indicates need for ooagulation factor replacement
> 2.0
best treatment of hypovolemia without anemia
crystalloid or colloid solutions
crystalloid solutions
normal saline, lactated Ringers
what is first line of correction to replenish intravascular volume?
crystalloids
disadvantage of crystalloids
move outside vascular space rapidly and volume is not sustained
colloids
hydroxyethyl starch, dextran, 5% albumin
advantage of colloids
maintaining intravascular volume
symptoms of anemia
low Hgb weakness headache dyspnea angina
symptoms of hypovolemia
cold extremities hypotension acidosis reduced arterial/central venous pressure decreased urine output mental status changes
types of anemia: causes
blood loss
increased RBC destruction
decreased RBC production
extrinsic causes of hemolytic anemia
alloantibody-mediated WAIHA cold agglutinin syndrome PCH PNH drug-related mechanical microangiopathic anemia
intrinsic causes of hemolytic anemia
hemoglobin disorders
membrane defects
enzyme defects
causes of microcytic anemia
iron deficiency thalassemia lead poisoning anemia of chronic disease sideroblastic anemia
causes of normocytic anemia
myelophthisic anemia
renal/low EPO
anemia of chronic disease
marrow hypo/dys/aplasia
causes of macrocytic anemia
megaloblastic
nonmegaloblastic
megaloblastic anemia causes
decreased B12, decreased folate, medication
nonmegaloblastic anemia causes
marrow hypo/dys/aplasia, alcoholism, liver disease, hypothyroid
anemia caused by shortage of iron in body
iron deficiency anemkia
common causes of iron deficiency anemia
heavy menstrual bleeding ulcer cancer polyp prolonged use of aspirin or NSAIDS
anemia caused by diet lacking in B12 or other key nutrients
vitamin deficiency anemia
diseases associated with anemia of chronic disease
cancer HIV/AIDS rheumatoid arthritis Crohn's chronic inflammatory diseases
rare life-threatening anemia caused by decrease in bone marrow’s ability to product red blood cells
aplastic anemia
causes of aplastic anemia
infections
drugs
autoimmune diseases
anemia caused by affect of disease on production of bone marrow, from mild alteration in blood production to complete life-threatening shutdown of blood-making process
anemia associated with bone marrow disease
anemia that develops when red cells are destroyed faster than bone marrow can replace them
hemolytic anemia
anemia caused by defective form of hemoglobin that forces red blood ells to assume an abnormal crescent shape
sickle cell anemia
what causes anemia in sickle cell?
irregular-shaped red cells die prematurely, resulting in chronic shortage of blood cells
indications for red cell transfusion
symptomatic anemia
increased need for oxygen carrying capacity
contraindications for red cell transfusions
pharmacologically treatable anemia
coagulation deficiencies
only volume expansion needed
indications for RBC exchange transfusion
sickle cell
severe parasitic infection
severe methemoglobinemia
severe hyperbilirubinemia of newborn
whole blood storage when collected for whole blood
CPDA 35 days
whole blood collection to be converted into components
CPD or CP2D 21 days (without additive)
final HCT of packed red cells in CPD, CP2D
65-80%
red cell shelf life with additive solution
42 days
final HCT of red cells with additive solution
55-65%
function of adenine in additive soluion
provides substrate for ATP synthesis
what additive solutions contain mannitol?
AS-1 (Adsol), AS-5 (Optisol)
FDA requirement for completion of red cell transfusion
4 hours
advantages of leukoreduced RBCs
decreased risk of febrile non-hemolytic trx rxn
decreased risk of CMV transmission
decreased risk of HLA alloimmunization
average unit of whole blood contains how many WBCs?
2x10^9 leukocytes
average unit of packed red cells contains how many WBCs?
2x10^8 leukocytes
leukocyte reduced packed red cells contain what number of WBCs?
<5x10^6 leukocytes
quality control requirements of leukocyte reduced RBCS
reduce WBC count to <5x10^6 in at least 95% of units sampled
>85% RBC recovery
purpose of irradiation
prevents proliferation of transfused T lymphocytes