Hemotherapy Decisions Flashcards
1
Q
blood products considered to be cellular components
A
whole blood, red blood cells, granulocytes
2
Q
blood products considered to be plasma components
A
platelet products, cryoprecipitate, fresh frozen plasma, other plasma components
3
Q
blood products considered to be hematopoietic progenitor cell products
A
bone marrow, peripheral blood stem cells, cord blood preparations
4
Q
goals of transfusion
A
increase tissue oxygenation and/or restore hemostasis
5
Q
what product is used to treat inadequate oxygen carrying capacity?
A
red cells
6
Q
what product is used to treat insufficient coagulation proteins?
A
FFP, cryo
7
Q
what product is used to treat inadequate hemostasis?
A
[;ate;ets
8
Q
expected response per dose of red cell transfusion
A
1 g/dl
9
Q
expected response per dose of FFP
A
25% increase in factor products
10
Q
expected response per dose of platelets
A
30-50,000 1 hour post transfusion
11
Q
expected response per dose of cryo
A
fibrinogen increase 50 mg/dl
12
Q
expected response per dose of granulocytes
A
usually no demonstrable increase in neutrophil count
13
Q
common transfusion trigger for red cells
A
Hgb <7 g/dl
14
Q
common transfusion triggers for FFP
A
aPTT and/or PTT increase >1.5 times upper normal limit
15
Q
common transfusion trigger for platelets
A
plt count <10,000
16
Q
common transfusion trigger for cryo
A
fibrinogen <100 mg/dl
17
Q
common transfusion trigger for granulocytes
A
documented sepsis unresponsive to antimicrobial therapy
18
Q
common adult dose for RBC
A
1 unit
19
Q
common adult dose for FFP
A
10-20 mg/kg body weight (often 2 units)
20
Q
common adult dose for platelets
A
1 apheresis or 4-6 pooled whole blood derived units
21
Q
common adult dose for cryo
A
10 units of 1 unit/kg body weight
22
Q
common adult dose for granulocytes
A
1 unit
23
Q
first lab tests used to assess need to transfusion
A
CBC, PTT, PT, INR, fibrinogen
24
Q
INR value that indicates need for ooagulation factor replacement
A
> 2.0
25
best treatment of hypovolemia without anemia
crystalloid or colloid solutions
26
crystalloid solutions
normal saline, lactated Ringers
27
what is first line of correction to replenish intravascular volume?
crystalloids
28
disadvantage of crystalloids
move outside vascular space rapidly and volume is not sustained
29
colloids
hydroxyethyl starch, dextran, 5% albumin
30
advantage of colloids
maintaining intravascular volume
31
symptoms of anemia
```
low Hgb
weakness
headache
dyspnea
angina
```
32
symptoms of hypovolemia
```
cold extremities
hypotension
acidosis
reduced arterial/central venous pressure
decreased urine output
mental status changes
```
33
types of anemia: causes
blood loss
increased RBC destruction
decreased RBC production
34
extrinsic causes of hemolytic anemia
```
alloantibody-mediated
WAIHA
cold agglutinin syndrome
PCH
PNH
drug-related
mechanical
microangiopathic anemia
```
35
intrinsic causes of hemolytic anemia
hemoglobin disorders
membrane defects
enzyme defects
36
causes of microcytic anemia
```
iron deficiency
thalassemia
lead poisoning
anemia of chronic disease
sideroblastic anemia
```
37
causes of normocytic anemia
myelophthisic anemia
renal/low EPO
anemia of chronic disease
marrow hypo/dys/aplasia
38
causes of macrocytic anemia
megaloblastic
| nonmegaloblastic
39
megaloblastic anemia causes
decreased B12, decreased folate, medication
40
nonmegaloblastic anemia causes
marrow hypo/dys/aplasia, alcoholism, liver disease, hypothyroid
41
anemia caused by shortage of iron in body
iron deficiency anemkia
42
common causes of iron deficiency anemia
```
heavy menstrual bleeding
ulcer
cancer
polyp
prolonged use of aspirin or NSAIDS
```
43
anemia caused by diet lacking in B12 or other key nutrients
vitamin deficiency anemia
44
diseases associated with anemia of chronic disease
```
cancer
HIV/AIDS
rheumatoid arthritis
Crohn's
chronic inflammatory diseases
```
45
rare life-threatening anemia caused by decrease in bone marrow's ability to product red blood cells
aplastic anemia
46
causes of aplastic anemia
infections
drugs
autoimmune diseases
47
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
48
anemia that develops when red cells are destroyed faster than bone marrow can replace them
hemolytic anemia
49
anemia caused by defective form of hemoglobin that forces red blood ells to assume an abnormal crescent shape
sickle cell anemia
50
what causes anemia in sickle cell?
irregular-shaped red cells die prematurely, resulting in chronic shortage of blood cells
51
indications for red cell transfusion
symptomatic anemia
| increased need for oxygen carrying capacity
52
contraindications for red cell transfusions
pharmacologically treatable anemia
coagulation deficiencies
only volume expansion needed
53
indications for RBC exchange transfusion
sickle cell
severe parasitic infection
severe methemoglobinemia
severe hyperbilirubinemia of newborn
54
whole blood storage when collected for whole blood
CPDA 35 days
55
whole blood collection to be converted into components
CPD or CP2D 21 days (without additive)
56
final HCT of packed red cells in CPD, CP2D
65-80%
57
red cell shelf life with additive solution
42 days
58
final HCT of red cells with additive solution
55-65%
59
function of adenine in additive soluion
provides substrate for ATP synthesis
60
what additive solutions contain mannitol?
AS-1 (Adsol), AS-5 (Optisol)
61
FDA requirement for completion of red cell transfusion
4 hours
62
advantages of leukoreduced RBCs
decreased risk of febrile non-hemolytic trx rxn
decreased risk of CMV transmission
decreased risk of HLA alloimmunization
63
average unit of whole blood contains how many WBCs?
2x10^9 leukocytes
64
average unit of packed red cells contains how many WBCs?
2x10^8 leukocytes
65
leukocyte reduced packed red cells contain what number of WBCs?
<5x10^6 leukocytes
66
quality control requirements of leukocyte reduced RBCS
reduce WBC count to <5x10^6 in at least 95% of units sampled
| >85% RBC recovery
67
purpose of irradiation
prevents proliferation of transfused T lymphocytes
68
3 conditions for GVHD to occur
transfusion or transplantation of immunocompetent T lymphs
histocompatibility differences between graft and recipient
immunocompromised patient (usually)
69
shelf life of irradiation red cells
28 days, not to exceed original expiration
70
advantages of frozen/deglycerolized RBCs
long term storage of rare antigen types
IgA deficient product
reduced risk of allergic and febrile reactions
71
expiration of deglycerolized RBCs
24 hours
72
RBCs processed for freezing must be placed in freezer within what time frame after removal from refrigeration?
4 hours
73
red cells in CPD or CPDA must be frozen within ___ from collection
6 days
74
red cells in additive solution may be frozen when?
anytime before expiration
75
red cells in any preservative can be rejuvenated and frozen when?
anytime between 3 days after collection and 3 days after expiration
76
deglycerolization must retain what percent of original red cell volume?
80%
77
average unit of deglycerolized red cells contains how many WBCs?
1x10^7 leukocytes
78
oxygen dissociation is based on?
affinities of tissues for oxygen and ability of red cells to release oxygen
79
RBC storage changes over time
decrease ATP
decrease 2,3-DPG
increased plasma potassium
80
function of 2,3-DPG
controls movement of oxygen from red blood cells to body tissues
81
more 2,3-DPG in cells = ___ oxygen delivered to tissues
more
82
less 2,3-DPG in cells = ___ oxygen delivered to tissues
less
83
what does oxygen dissociation curve show?
percent saturation of hemoglobin at various partial pressures of oxygen
84
factors that influence oxygen binding
temperature
| 2,3-DPG level
85
what happens to hemoglobin at high partial pressures of oxygen?
binds to oxygen to form oxyhemoglobin --> travel to tissues deprived of oxygen and producing CO2 --> partial pressure of oxygen decreases --> oxyhemoglobin releases oxygen to tissues
86
influence of increased temperature on oxygen binding
SHIFT RIGHT. increases amount of oxygen and hemoglobin, decreases concentration of oxyhemoglobin, tissues receive more oxygen
87
influence of decreased 2,3-DPG on oxygen binding
SHIFT LEFT. hgb has increased affinity for oxygen and less release to tissues
88
shift right
more oxygen to tissues
89
shift left
less oxygen to tissues
90
result of multiple transfusions of 2,3-DPG depleted stored blood
shifts O2 curve to left, less oxygen released in tissues and organs, reduced oxygen carrying capacity
91
purpose of rejuvenation solutions
biochemically modify RBCs to improve oxygen transport function
92
2,3-DPG levels after rejuvenation
1.5x normal
93
when can red cells be rejuvenated?
after expiration date
94
how long can rejuvenated red cells be stored?
2-4 hours as saline-red blood cell suspension
| glycerolized and frozen up to 10 years
95
prophylactic inpatient transfusion threshold for platelets
10,000
96
platelet transfusion threshold for patients already bleeding or to undergo surgery
50,000
97
platelet transfusion threshold for intracerebral, pulmonary, or ophthalmic hemorrhage
100,000
98
determination of response rate to platelet transfusion calculated by?
Corrected Count Increment or platelet recovery percentage
99
immune mediated destruction of platelets is evidenced by platelet count obtained when?
10 minutes to 1 hour post-transfusion
100
what accounts for more immune mediated platelet refractoriness?
class I HLA (A and B loci)
101
what patient population is most likely to be platelet refractory?
oncology patients receiving myeloablative chemotherapy
102
immune-mediated platelet refractoriness causes
HLA antibodies
ABO antibodies
platelet specific antibodies
103
non-immune mediated platelet refractoriness causes
DIC
sepsis
neutropenic fever
splenomegaly
104
non-immune mediated causes of platelet refractoriness are typically associate with?
initial increase in platelet count followed by inadequate 24-hour post-transfusion platelet counts
105
DIC is associated with what in regards to platelet refractoriness?
platelet consumption
106
sepsis and neutropenic fever are associated with what in regards to platelet refractoriness?
platelet activation and utilization
107
splenomegaly is associated with what in regard to platelet refractoriness?
platelet sequestration
108
contraindications for platelet transfusion
```
ITP
TTP
platelet dysfunction caused by extrinsic factors
hemolytic uremic syndrome
heparin-induced thrombocytopenia
```
109
acquired thrombocytopenia due to immune platelet destruction not caused by an acquired condition
ITP (primary immune thrombocytopenia)
110
thrombocytopenia in which patient and donor platelets are rapidly cleared by circulating antibody
ITP
111
treatment for children with ITP
usually have spontaneous remission; platelet transfusion not necessary
112
treatment goal in adult with ITP
reduce risk of bleeding, not to normalize platelet count
113
treatment of ITP in adults
glucocorticoids and IVIG, including anti-RH(D) (WinRho) to Rh positive patients
114
rare blood coagulation disorder causing extensive microscopic clots to form in small blood vessels throughout the body
TTP (Thrombotic thrombocytopenic purpura)
115
are platelets indicated for patients with TTP?
no - can cause increase in platelet aggregates
116
treatment options for TTP
plasmapheresis to remove organ-damaging aggregates
117
platelet count in platelet concentrate
>5.5x10^10 platelets in 40-70 ml plasma
118
platelet count in apheresis platelet
>3x10^11 platelets
119
1 apheresis platelet = ___ platelet concentrates
4-6
120
platelet transfusion ABO requirements
no requirement, donor plasma ABO-compatible to recipients red cells when transfusing infants or large volumes to adults
Rh negative to Rh negative when possible, especially women of childbearing age
121
indications for plasma transfusion
massive transfusion
warfarin anticoagulation reversal
multiple coagulopathy due to liver disease/damage
therapeutic plasma exchance
122
contraindications for plasma transfusion
volume replacement
otherwise correctable coagulopathy
normalizing abnormal PT and/or PTT in absence of bleeding
single factor deficiencies when concentrate source is available
123
plasma product with decreased levels of fibrinogen, factor VIII, vWF, fibronectin, and factor XIII
plasma cryoprecipitate reduced
124
plasma cryoprecipitate reduced is useful in treatment of what?
TTP, hemolytic uremic syndrome
125
cold-insoluble portion of plasma that precipitates when thawed at 1-6C
cryoprecipitate AHF
126
cryoprecipitate volume per unit
10-15 mL
127
factors found in cryo
```
fibrinogen
factor VIII:C
factor VIII:vWF
factor XIII
fibronectin
```
128
only concentrate source of factor I
cryoprecipitate
129
standard adult dose of cryo
10 units
130
standard child dose of cryo
5 units based on 1 unit/7-10 kg body weight
131
standard child dose of cryo
5 units based on 1 unit/7-10 kg body weight
132
minimum IU of factor VIII:C in each unit of cryo
80
133
minimum fibrinogen in each unit cryo
150 mg
134
indications for cryo
```
hypofibrinogenemia/dysfibrinogenemia
bleeding associated with fibrinogen deficiencies
intracranial hemorrhage
vWD unresponsive to DDAVP
uremic bleeding unresponsive to DDAVP
factor XIII deficiency
fibrin sealant (topical use)
```
135
contraindications for cryo
hemophilia A
| vWD when factor concentrates are available
136
hazards of cryo transfusion
transfusion-transmitted infectious diseases
| allergic reactions to plasma proteins
137
indications for adult granulocyte transfusion
transient marrow depression
bacterial or fungal infections unresponsive to antimicrobial therapy for more than 48 hours
congenital neutrophil dysfunction (CGD)
138
indications for neonatal and pediatric granulocyte transfusion
neutropenia <3000/ul
| bacterial or fungal septicemia not responsive to antimicrobial therapy
139
what is given to increase harvest of granulocytes?
oral dexamethasone
| subcutaneous G-CSF
140
granulocyte storage
room temp, 24 hours
141
contraindications for granulocyte transfusion
viral or parasitic infection
142
hormone-like substances naturally made by the body that cause bone marrow to make more blood cells
hematopoietic growth factors
143
hematopoietic growth factor that stimulates proliferation, maturation, and differentiation of erythroid precursors
erythropoietin
144
alternatives to blood transfusions
volume expanders (colloids and crystalloids)
growth factors (EPO)
intraoperative or post-operative blood salvage
blood substitutes
plasma derivatives
145
plasma derivatives derived from?
source plasma
| recovered plasma
146
plasma collected specifically for the purpose of manufacturing plasma derivatives
source plasma (plasma donor centers)
147
plasma separated from whole blood donations
recovered plasma
148
how are plasma derivatives prepared?
fractionation of plasma
149
plasma derivative used to treat hypovolemic shock and burn patients
5% albumin
150
plasma derivative used to treat cerebral edema
25% albumin
151
normal serum albumin %
5%
152
salt poor albumin percent
25%
153
high-titer IVIG used to treat ITP for Rh positive patients
WinRho
154
plasma derivative examples
```
albumin
RhIg
IVIG
WinRho
antithrombin
activated protein C
alpha-1-antitrypsin
lyophilized clotting factors
```
155
preparation of plasma derived lyophilized factors
treated with solvent and detergent which inactivates lipid-enveloped viruses (HIV, HBV, HPC)
156
preparation of recombinant lyophilized factors
genetically engineered
157
what is the risk of viral disease transmission from recombinant lyophilized factors?
none
158
2 types of plasma derived factor IX
complex of factors II, VII, IX, and X
| monoclonal factor IX
159
lyophilized factor VIII plasma derived preparation
cryoprecipitate purified so that only factor VIII remains
160
pharmacologic alternatives to blood products
desmopressin (DDAVP)
recombinant growth factors
fibrinolytic inhibitors
161
purpose of desmopressin (DDAVP)
promotes hemostasis
| used to mild factor VIII deficiencies
162
recombinant growth factors examples
EPO
| G-CSF
163
examples of fibrinolytic inhibitors
epsilon-aminocaproic acid (EACA)
tranexamic acid
aproptinin
164
widely used hemostatic drug; synthetic analog of natural hormone vasopressin
DDAVP
165
hormone that controls red cell production
EPO
166
stimulates bone marrow to produce granulocytes and stem cells and release them into the blood stream
G-CSF
167
synthetic inhibitor of plasmin-plasminogen system
EACA
168
only potent anti-fibrinolytic agent commercially available in US
EACA
