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CCHS SBB > Hemotherapy Decisions > Flashcards

Hemotherapy Decisions Flashcards

1
Q

blood products considered to be cellular components

A

whole blood, red blood cells, granulocytes

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2
Q

blood products considered to be plasma components

A

platelet products, cryoprecipitate, fresh frozen plasma, other plasma components

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3
Q

blood products considered to be hematopoietic progenitor cell products

A

bone marrow, peripheral blood stem cells, cord blood preparations

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4
Q

goals of transfusion

A

increase tissue oxygenation and/or restore hemostasis

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5
Q

what product is used to treat inadequate oxygen carrying capacity?

A

red cells

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6
Q

what product is used to treat insufficient coagulation proteins?

A

FFP, cryo

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7
Q

what product is used to treat inadequate hemostasis?

A

[;ate;ets

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8
Q

expected response per dose of red cell transfusion

A

1 g/dl

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9
Q

expected response per dose of FFP

A

25% increase in factor products

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10
Q

expected response per dose of platelets

A

30-50,000 1 hour post transfusion

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11
Q

expected response per dose of cryo

A

fibrinogen increase 50 mg/dl

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12
Q

expected response per dose of granulocytes

A

usually no demonstrable increase in neutrophil count

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13
Q

common transfusion trigger for red cells

A

Hgb <7 g/dl

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14
Q

common transfusion triggers for FFP

A

aPTT and/or PTT increase >1.5 times upper normal limit

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15
Q

common transfusion trigger for platelets

A

plt count <10,000

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16
Q

common transfusion trigger for cryo

A

fibrinogen <100 mg/dl

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17
Q

common transfusion trigger for granulocytes

A

documented sepsis unresponsive to antimicrobial therapy

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18
Q

common adult dose for RBC

A

1 unit

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19
Q

common adult dose for FFP

A

10-20 mg/kg body weight (often 2 units)

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20
Q

common adult dose for platelets

A

1 apheresis or 4-6 pooled whole blood derived units

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21
Q

common adult dose for cryo

A

10 units of 1 unit/kg body weight

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22
Q

common adult dose for granulocytes

A

1 unit

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23
Q

first lab tests used to assess need to transfusion

A

CBC, PTT, PT, INR, fibrinogen

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24
Q

INR value that indicates need for ooagulation factor replacement

A

> 2.0

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25
Q

best treatment of hypovolemia without anemia

A

crystalloid or colloid solutions

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26
Q

crystalloid solutions

A

normal saline, lactated Ringers

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27
Q

what is first line of correction to replenish intravascular volume?

A

crystalloids

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28
Q

disadvantage of crystalloids

A

move outside vascular space rapidly and volume is not sustained

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29
Q

colloids

A

hydroxyethyl starch, dextran, 5% albumin

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30
Q

advantage of colloids

A

maintaining intravascular volume

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31
Q

symptoms of anemia

A 
low Hgb
weakness
headache
dyspnea
angina
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32
Q

symptoms of hypovolemia

A 
cold extremities
hypotension
acidosis
reduced arterial/central venous pressure
decreased urine output
mental status changes
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33
Q

types of anemia: causes

A

blood loss
increased RBC destruction
decreased RBC production

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34
Q

extrinsic causes of hemolytic anemia

A 
alloantibody-mediated
WAIHA
cold agglutinin syndrome
PCH
PNH
drug-related
mechanical
microangiopathic anemia
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35
Q

intrinsic causes of hemolytic anemia

A

hemoglobin disorders
membrane defects
enzyme defects

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36
Q

causes of microcytic anemia

A 
iron deficiency
thalassemia
lead poisoning
anemia of chronic disease
sideroblastic anemia
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37
Q

causes of normocytic anemia

A

myelophthisic anemia
renal/low EPO
anemia of chronic disease
marrow hypo/dys/aplasia

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38
Q

causes of macrocytic anemia

A

megaloblastic

nonmegaloblastic

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39
Q

megaloblastic anemia causes

A

decreased B12, decreased folate, medication

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40
Q

nonmegaloblastic anemia causes

A

marrow hypo/dys/aplasia, alcoholism, liver disease, hypothyroid

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41
Q

anemia caused by shortage of iron in body

A

iron deficiency anemkia

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42
Q

common causes of iron deficiency anemia

A 
heavy menstrual bleeding
ulcer
cancer
polyp
prolonged use of aspirin or NSAIDS
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43
Q

anemia caused by diet lacking in B12 or other key nutrients

A

vitamin deficiency anemia

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44
Q

diseases associated with anemia of chronic disease

A 
cancer
HIV/AIDS
rheumatoid arthritis
Crohn's
chronic inflammatory diseases
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45
Q

rare life-threatening anemia caused by decrease in bone marrow’s ability to product red blood cells

A

aplastic anemia

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46
Q

causes of aplastic anemia

A

infections
drugs
autoimmune diseases

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47
Q

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

A

anemia associated with bone marrow disease

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48
Q

anemia that develops when red cells are destroyed faster than bone marrow can replace them

A

hemolytic anemia

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49
Q

anemia caused by defective form of hemoglobin that forces red blood ells to assume an abnormal crescent shape

A

sickle cell anemia

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50
Q

what causes anemia in sickle cell?

A

irregular-shaped red cells die prematurely, resulting in chronic shortage of blood cells

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51
Q

indications for red cell transfusion

A

symptomatic anemia

increased need for oxygen carrying capacity

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52
Q

contraindications for red cell transfusions

A

pharmacologically treatable anemia
coagulation deficiencies
only volume expansion needed

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53
Q

indications for RBC exchange transfusion

A

sickle cell
severe parasitic infection
severe methemoglobinemia
severe hyperbilirubinemia of newborn

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54
Q

whole blood storage when collected for whole blood

A

CPDA 35 days

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55
Q

whole blood collection to be converted into components

A

CPD or CP2D 21 days (without additive)

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56
Q

final HCT of packed red cells in CPD, CP2D

A

65-80%

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57
Q

red cell shelf life with additive solution

A

42 days

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58
Q

final HCT of red cells with additive solution

A

55-65%

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59
Q

function of adenine in additive soluion

A

provides substrate for ATP synthesis

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60
Q

what additive solutions contain mannitol?

A

AS-1 (Adsol), AS-5 (Optisol)

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61
Q

FDA requirement for completion of red cell transfusion

A

4 hours

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62
Q

advantages of leukoreduced RBCs

A

decreased risk of febrile non-hemolytic trx rxn
decreased risk of CMV transmission
decreased risk of HLA alloimmunization

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63
Q

average unit of whole blood contains how many WBCs?

A

2x10^9 leukocytes

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64
Q

average unit of packed red cells contains how many WBCs?

A

2x10^8 leukocytes

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65
Q

leukocyte reduced packed red cells contain what number of WBCs?

A

<5x10^6 leukocytes

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66
Q

quality control requirements of leukocyte reduced RBCS

A

reduce WBC count to <5x10^6 in at least 95% of units sampled

>85% RBC recovery

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67
Q

purpose of irradiation

A

prevents proliferation of transfused T lymphocytes

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68
Q

3 conditions for GVHD to occur

A

transfusion or transplantation of immunocompetent T lymphs
histocompatibility differences between graft and recipient
immunocompromised patient (usually)

69
Q

shelf life of irradiation red cells

A

28 days, not to exceed original expiration

70
Q

advantages of frozen/deglycerolized RBCs

A

long term storage of rare antigen types
IgA deficient product
reduced risk of allergic and febrile reactions

71
Q

expiration of deglycerolized RBCs

72
Q

RBCs processed for freezing must be placed in freezer within what time frame after removal from refrigeration?

73
Q

red cells in CPD or CPDA must be frozen within ___ from collection

74
Q

red cells in additive solution may be frozen when?

A

anytime before expiration

75
Q

red cells in any preservative can be rejuvenated and frozen when?

A

anytime between 3 days after collection and 3 days after expiration

76
Q

deglycerolization must retain what percent of original red cell volume?

77
Q

average unit of deglycerolized red cells contains how many WBCs?

A

1x10^7 leukocytes

78
Q

oxygen dissociation is based on?

A

affinities of tissues for oxygen and ability of red cells to release oxygen

79
Q

RBC storage changes over time

A

decrease ATP
decrease 2,3-DPG
increased plasma potassium

80
Q

function of 2,3-DPG

A

controls movement of oxygen from red blood cells to body tissues

81
Q

more 2,3-DPG in cells = ___ oxygen delivered to tissues

82
Q

less 2,3-DPG in cells = ___ oxygen delivered to tissues

83
Q

what does oxygen dissociation curve show?

A

percent saturation of hemoglobin at various partial pressures of oxygen

84
Q

factors that influence oxygen binding

A

temperature

2,3-DPG level

85
Q

what happens to hemoglobin at high partial pressures of oxygen?

A

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
Q

influence of increased temperature on oxygen binding

A

SHIFT RIGHT. increases amount of oxygen and hemoglobin, decreases concentration of oxyhemoglobin, tissues receive more oxygen

87
Q

influence of decreased 2,3-DPG on oxygen binding

A

SHIFT LEFT. hgb has increased affinity for oxygen and less release to tissues

88
Q

shift right

A

more oxygen to tissues

89
Q

shift left

A

less oxygen to tissues

90
Q

result of multiple transfusions of 2,3-DPG depleted stored blood

A

shifts O2 curve to left, less oxygen released in tissues and organs, reduced oxygen carrying capacity

91
Q

purpose of rejuvenation solutions

A

biochemically modify RBCs to improve oxygen transport function

92
Q

2,3-DPG levels after rejuvenation

A

1.5x normal

93
Q

when can red cells be rejuvenated?

A

after expiration date

94
Q

how long can rejuvenated red cells be stored?

A

2-4 hours as saline-red blood cell suspension

glycerolized and frozen up to 10 years

95
Q

prophylactic inpatient transfusion threshold for platelets

96
Q

platelet transfusion threshold for patients already bleeding or to undergo surgery

97
Q

platelet transfusion threshold for intracerebral, pulmonary, or ophthalmic hemorrhage

98
Q

determination of response rate to platelet transfusion calculated by?

A

Corrected Count Increment or platelet recovery percentage

99
Q

immune mediated destruction of platelets is evidenced by platelet count obtained when?

A

10 minutes to 1 hour post-transfusion

100
Q

what accounts for more immune mediated platelet refractoriness?

A

class I HLA (A and B loci)

101
Q

what patient population is most likely to be platelet refractory?

A

oncology patients receiving myeloablative chemotherapy

102
Q

immune-mediated platelet refractoriness causes

A

HLA antibodies
ABO antibodies
platelet specific antibodies

103
Q

non-immune mediated platelet refractoriness causes

A

DIC
sepsis
neutropenic fever
splenomegaly

104
Q

non-immune mediated causes of platelet refractoriness are typically associate with?

A

initial increase in platelet count followed by inadequate 24-hour post-transfusion platelet counts

105
Q

DIC is associated with what in regards to platelet refractoriness?

A

platelet consumption

106
Q

sepsis and neutropenic fever are associated with what in regards to platelet refractoriness?

A

platelet activation and utilization

107
Q

splenomegaly is associated with what in regard to platelet refractoriness?

A

platelet sequestration

108
Q

contraindications for platelet transfusion

A 
ITP
TTP
platelet dysfunction caused by extrinsic factors
hemolytic uremic syndrome
heparin-induced thrombocytopenia
109
Q

acquired thrombocytopenia due to immune platelet destruction not caused by an acquired condition

A

ITP (primary immune thrombocytopenia)

110
Q

thrombocytopenia in which patient and donor platelets are rapidly cleared by circulating antibody

111
Q

treatment for children with ITP

A

usually have spontaneous remission; platelet transfusion not necessary

112
Q

treatment goal in adult with ITP

A

reduce risk of bleeding, not to normalize platelet count

113
Q

treatment of ITP in adults

A

glucocorticoids and IVIG, including anti-RH(D) (WinRho) to Rh positive patients

114
Q

rare blood coagulation disorder causing extensive microscopic clots to form in small blood vessels throughout the body

A

TTP (Thrombotic thrombocytopenic purpura)

115
Q

are platelets indicated for patients with TTP?

A

no - can cause increase in platelet aggregates

116
Q

treatment options for TTP

A

plasmapheresis to remove organ-damaging aggregates

117
Q

platelet count in platelet concentrate

A

> 5.5x10^10 platelets in 40-70 ml plasma

118
Q

platelet count in apheresis platelet

A

> 3x10^11 platelets

119
Q

1 apheresis platelet = ___ platelet concentrates

120
Q

platelet transfusion ABO requirements

A

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
Q

indications for plasma transfusion

A

massive transfusion
warfarin anticoagulation reversal
multiple coagulopathy due to liver disease/damage
therapeutic plasma exchance

122
Q

contraindications for plasma transfusion

A

volume replacement
otherwise correctable coagulopathy
normalizing abnormal PT and/or PTT in absence of bleeding
single factor deficiencies when concentrate source is available

123
Q

plasma product with decreased levels of fibrinogen, factor VIII, vWF, fibronectin, and factor XIII

A

plasma cryoprecipitate reduced

124
Q

plasma cryoprecipitate reduced is useful in treatment of what?

A

TTP, hemolytic uremic syndrome

125
Q

cold-insoluble portion of plasma that precipitates when thawed at 1-6C

A

cryoprecipitate AHF

126
Q

cryoprecipitate volume per unit

127
Q

factors found in cryo

A 
fibrinogen
factor VIII:C
factor VIII:vWF
factor XIII
fibronectin
128
Q

only concentrate source of factor I

A

cryoprecipitate

129
Q

standard adult dose of cryo

130
Q

standard child dose of cryo

A

5 units based on 1 unit/7-10 kg body weight

131
Q

standard child dose of cryo

A

5 units based on 1 unit/7-10 kg body weight

132
Q

minimum IU of factor VIII:C in each unit of cryo

133
Q

minimum fibrinogen in each unit cryo

134
Q

indications for cryo

A 
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
Q

contraindications for cryo

A

hemophilia A

vWD when factor concentrates are available

136
Q

hazards of cryo transfusion

A

transfusion-transmitted infectious diseases

allergic reactions to plasma proteins

137
Q

indications for adult granulocyte transfusion

A

transient marrow depression
bacterial or fungal infections unresponsive to antimicrobial therapy for more than 48 hours
congenital neutrophil dysfunction (CGD)

138
Q

indications for neonatal and pediatric granulocyte transfusion

A

neutropenia <3000/ul

bacterial or fungal septicemia not responsive to antimicrobial therapy

139
Q

what is given to increase harvest of granulocytes?

A

oral dexamethasone

subcutaneous G-CSF

140
Q

granulocyte storage

A

room temp, 24 hours

141
Q

contraindications for granulocyte transfusion

A

viral or parasitic infection

142
Q

hormone-like substances naturally made by the body that cause bone marrow to make more blood cells

A

hematopoietic growth factors

143
Q

hematopoietic growth factor that stimulates proliferation, maturation, and differentiation of erythroid precursors

A

erythropoietin

144
Q

alternatives to blood transfusions

A

volume expanders (colloids and crystalloids)
growth factors (EPO)
intraoperative or post-operative blood salvage
blood substitutes
plasma derivatives

145
Q

plasma derivatives derived from?

A

source plasma

recovered plasma

146
Q

plasma collected specifically for the purpose of manufacturing plasma derivatives

A

source plasma (plasma donor centers)

147
Q

plasma separated from whole blood donations

A

recovered plasma

148
Q

how are plasma derivatives prepared?

A

fractionation of plasma

149
Q

plasma derivative used to treat hypovolemic shock and burn patients

A

5% albumin

150
Q

plasma derivative used to treat cerebral edema

A

25% albumin

151
Q

normal serum albumin %

152
Q

salt poor albumin percent

153
Q

high-titer IVIG used to treat ITP for Rh positive patients

154
Q

plasma derivative examples

A 
albumin
RhIg
IVIG
WinRho
antithrombin
activated protein C
alpha-1-antitrypsin
lyophilized clotting factors
155
Q

preparation of plasma derived lyophilized factors

A

treated with solvent and detergent which inactivates lipid-enveloped viruses (HIV, HBV, HPC)

156
Q

preparation of recombinant lyophilized factors

A

genetically engineered

157
Q

what is the risk of viral disease transmission from recombinant lyophilized factors?

158
Q

2 types of plasma derived factor IX

A

complex of factors II, VII, IX, and X

monoclonal factor IX

159
Q

lyophilized factor VIII plasma derived preparation

A

cryoprecipitate purified so that only factor VIII remains

160
Q

pharmacologic alternatives to blood products

A

desmopressin (DDAVP)
recombinant growth factors
fibrinolytic inhibitors

161
Q

purpose of desmopressin (DDAVP)

A

promotes hemostasis

used to mild factor VIII deficiencies

162
Q

recombinant growth factors examples

163
Q

examples of fibrinolytic inhibitors

A

epsilon-aminocaproic acid (EACA)
tranexamic acid
aproptinin

164
Q

widely used hemostatic drug; synthetic analog of natural hormone vasopressin

165
Q

hormone that controls red cell production

166
Q

stimulates bone marrow to produce granulocytes and stem cells and release them into the blood stream

167
Q

synthetic inhibitor of plasmin-plasminogen system

168
Q

only potent anti-fibrinolytic agent commercially available in US

CCHS SBB (40 decks)

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