Intro to Blood Components and Transfuion - Mo Flashcards
What are the steps of blood component preparation
centrifuge and separate into red cells and platelet rich plasma
- take PRP and push it into separate bag
- hard spin which produces platelets that are separated out of the plasma
apheresis blood componenets
- selective collection of individual components using specialized equipment
- blood is separated by a centrifuge and unused components are returned to the donor
- can get everything you need from one donor
What are the components of a red cell product
200 - 400 mL
- 200 mL of RBC
- 30 mL of plasma
- 100 mL storage solution
What is RBC dosing for adults?
1 unit
What is RBC pediatric dosing?
5-15 mL/kG
What temperature should platelets be stored at?
room temperature
- at higher risk for allowing bacterial growth
- extremely limited resource because not that good for that long
What will 1 apherisis unit increase your platelet dose by?
30,000-60,000
What is the platelet count target for neurosurgery
80-100,000
What percent of blood is plasma?
55%
45% hematocrit
What is plasma used for?
correct coagulopathy
- liver disease
- DIC
- warfarin reversal - replace vitamin K
- massive transfusion
What should you be given if you need to replace a specific factor?
give factor concentrate
- don’t need to give plasma
What are the indications for plasma
documented factor deficiency and active bleeding or about to have a procedure
What is the best way to store plasma?
can be frozen
- but will expire quickly after defrosting
What is the adult dosing for plasma
10-20 mL/kG to increase factor level by 20%
What are the components of cryoprecipitate
- factor VIII, XIII, vWF, fibrinogen
- small volume - need to pool 6-10 units from diff adults to make one adult dose
what are the indications for cryoprecipitate
hypofibrinogemia, DIC, obstetrical bleeding, massive transfusion
How is cryoprecipitate stored
frozen
- need to use right away after defrosting
What temp are RBC stored at
fridge
What is the usual dose of RBC
1 unit
What temp are platelets stored at
room temp
What is the usual dose of platelets
1 apheresis
- 1-6 WBP pool
What temp is plasma stored at
frozen
What is the usual dose of plasma
1-4 units
What temp is cryoprecipitate stored at
frozen
What is the usual dose of cryoprecipitate
6-10 units in a pool
leukoreduction
- filtration to remove WBC because they can contain infections
irradiation
gamma or xray irradiation of cellular blood products
- prevent transfusion associated graft vs host disease in immunosuppressed patients
washing
removal of plasma from cellular blood products
- prevent hyperkalemia in pediatric patients
- recurrent allergic reactions or igA deficiency
- removal of incompatible antibodies
volume reduction
- centrifuge and removal of plasma
- get rid of extra volume
- prevent volume overload
- remove incompatible antibodies
What antibodies do you have in your plasma if you’re type A blood
anti-B antibody plasma
What antibodies do you have in your plasma if you’re type B blood
anti-A antibody plasma
What antibodies do you have in your plasma if you’re type AB blood
neither antibody
What antibodies do you have in your plasma if you’re type O blood
you don’t have A or B antigen on your surface and you have both A and B antibodies
How are the anti-ABO antibodies formed?
naturally occurring in the first 6 months of life
Which group is the universal donor for RBC?
Group O - no antigens on the surface
What type of red cells do group O people have to get?
Can only get O because they have both AB antibodies in their plasma
Which group is the universal donor for plasma?
no antibodies in plasma
- AB
What type of plasma can AB people get?
only from an AB person
Which type of blood is the universal recipient
AB
What can happen to Women that are Rh- and have an Rh+ fetus
can develop hemolytic disease of the newborn
- first time women are exposed to the Rh they form antibodies
- next time they are exposed the antibodies will bind and cause hemolysis
D+ fetus inside of a D- mother
- she forms antibodies
- fetal maternal hemmorhage
- certain antibodies across the placenta can cause fetal death
- hemolytic disease of newborn
How can you avoid hemolytic disease of the newborn
Rhogam pre and post birth
- anti-D antibodies
What is the most severe type of transfusion rxn
transfusion related acute lung injury and TACO (cardiac)
- very severe
- ventilator
leukoreduction
decreased WBC to improve safety profile
CMV infection
- stays in WBC for life
- infection can be asymptomatic to tissue invasive
- most donors have CMV
how can you deal with CMV post-transfusion
- remove WBC to remove CMV = CMV safe
- test some donors - to see if they have CMV and leukoreduction
- leukoreduction and CMV negative have a similar safety profile
What are the most common transfusion rxns
allergic and febrile non-hemolytic
What are the most serious transfusion rxns
TRALI: acute lung injury due to neutrophil activation by donor antibodies
- TACO: cardiac overload due to rapid transfusions
- sepsis due to bacterial overgrowth
What do you do for a septic rxn?
stop the transfusion
- keep the IV line open
- clerical check of product and patient
- note type od product
- notify and send patient tube and product to blood bank
What are the signs and symptoms that need to be monitored for a transfusion rxn
vital signs, supportive treatment, anti-pyretics, anti-histamines, anti-inflammatories, send pertinent labs to assess hemolysis and bacterial contamination
lower severity allergic rxn
- donor proteins cause histamine release in patient
- flushing, urticaria
- treat with anti-histamines
- ok to re-start transfusion at slower rate if symptoms are mild
higher severity allergic rxn
- hypotension, airway edema, larger rash
- emergent care
- anti-histamines, vasopressors, corticosteroids
- can consider volume reducing platelets to reduce plasma exposure
Which part of the transfusion leads to the allergic rxn that patients experience
plasma is where the proteins are found
What causes a febrile non-hemolytic transfusion rxn
donor WBC that secrete cytokines
- febrile
- chills
- N/V
What is the treatment for a febrile non-hemolytic transfusion rxn
- discontinue transfusions
- if no hemolysis, can give another transfusion
GVHD
graft vs host disease
- due to donor lymphocytes start proliferating within the host
- attack everything = everything is foreign
