intro to blood banking and blood products

Question 1

plasma contents

Answer 1

coagulation factors, albumin, antibodies

Question 2

indications for use of fresh frozen plasma

Answer 2

multiple coagulation deficiencies due to liver failure, diseminated intravascular coagulopathy (DIC), vitamin k deficiency, warfarin toxicity, or massive blood loss

Question 3

indications for use of platelet concentrates

Answer 3

thrombocytopenia (<10,000 if asymptomatic) this may be caused by decreased platelet production or increased destruction (DIC)

Question 4

indications for use of RBCs

Answer 4

increase in oxygen carrying capacity. hemodynamically unstable. transfusion criteria is usually hgb of <7

Question 5

indication for use of albumin

Answer 5

bring osmotic pressure of intra and extra vascular back to normal in situation of hypovolemia and hypoproteinemia

Question 6

type o patients

Answer 6

no abo rbc surface antigen. naturally occurring anti-a and anti-b antibodies

Question 7

type a patients

Answer 7

type a rbc surface antigens. naturally occurring anti-b antibodies

Question 8

type b patients

Answer 8

type b rbc surface antigen. naturally occurring anti-a antibodies

Question 9

type ab patients

Answer 9

type ab rbc surface antigens. no naturally occurring anti-a or anti-b antibodies

Question 10

basic Rh (D) blood group concept

Answer 10

Rh or D antigen is present at birth. However, unlike ABO antibodies, Anti-D antibodies are not present at birth

Question 11

imunologically challenge related to rh blood group

Answer 11

if a patient is rh negative and is given rh positive blood. the patient will develop anti D antibody. Subsequent transfusion with Rh positive blood can be a problem.

Question 12

universal donor for RBC

Answer 12

o negative

Question 13

universal donor for FFP

Answer 13

AB

Question 14

hemolytic transfusion reaction

Answer 14

most likely caused by ABO incompatibility. Rare but most severe. usually human error

Question 15

clinical presentations for hemolytic transfusion reactions

Answer 15

DIC, acute renal failure, acute tubular necrosis, shock. the triads of fever, flank pain and red/brown urine occasionally occur

Question 16

treatment of hemolytic transfusion reactions

Answer 16

this is a medical emergency. stop transfusion immediately. maintain airway. start saline at 100-2– ml/hr. notify the blood bank immediately. obtain blood and urine samples. vasopressors (dopamine) might be indicated for hypotension patients

Question 17

febrile nonhemolytic transfusion reactions

Answer 17

caused by interleukins and TNFalpha substance within the blood products.

Question 18

febrile nonhemolytic transfusion reactions clincal presentation

Answer 18

fever, chills, rigors, mild dyspnea

Question 19

febrile nonhemolytic transfusion reactions treatment

Answer 19

stop transfusion since the symptoms look like more serious events. tylenol and or benadryl and symptomatic treatment are usually effective

Question 20

delayed hemolytic transfusion reactions

Answer 20

this reaction is caused by atypical antibody present in the recipients. Usually occur 2-10 days post transfusion

Question 21

delayed hemolytic transfusion reactions clinical presentation

Answer 21

symptoms are much less severe than acute reactions. slight fever, falling hct, mild increase of unconjugated bilirubinand spherocytes in blood smears. usually this is discovered by the blood bank staffs in patients with new alloantibodies against rbcs

Question 22

delayed hemolytic transfusion reactions treatment

Answer 22

no treatments are necessary. however, antigen negative blood products should be administered in subsequent rbcs transfusion

Question 23

anaphylactic transfusion reactions

Answer 23

just like all other medications transfusion of blood products do post risks of developing anaphylactic reactions

Question 24

anaphylactic transfusion reactions clinical presentations

Answer 24

shock, hypotension, angioedema, and respiratory distress

Question 25

anaphylactic transfusion reactions treatment

Answer 25

stop transfusion immediately. epi IM. prep for possible epi drip. maintain airway. saline. vasopressors if necessary

Question 26

urticarial transfusion reactions

Answer 26

substance in blood products causes histamine release from mast cells and basophils causing hives or urticaria

Question 27

urticarial transfusion reactions clinical presentation

Answer 27

skin lesions with hives or urticaria

Question 28

urticarial transfusion reactions treatment

Answer 28

usually it isn’t necessary to stop transfusion. benadryl po or iv can be given if severe. if no signs of other more severe symptoms and hives are waning, transfusion may be resumed

Question 29

post transfusion purpura (PTP)

Answer 29

very rare. usually associated with sensitization to a foreign antigen from previous platelet containing trasfusion. most common antigen is HPA-1a

Question 30

ptp clincal presentation

Answer 30

severe thrombocytopenia lasting days to weeks 5-10 days post transfusion

Question 31

ptp treatment

Answer 31

high dose corticosteroids or exchange transfusion, but has side effects and takes >2 weeks to be affective. IVIG at high dose X 5days usually is effective and is able to see effect in about 4 days. patients should receive washed cells or HPA-1a negative vells in subsequent transfusions

Question 32

transfusion related acute lung injury

Answer 32

rare acutual cause is unclear. hypotheses: caused by anti-granulocytes antibodies initiating immune inflammatory response within pulmonary microvasculature.

Question 33

transfusion related acute lung injury (TRALI) clinical presentation

Answer 33

sudden onset of respiratory distress during or after transfusion of blood products. fever, tachypnea, tachycardia, and hypotension can occur