ISBB Finals Flashcards
Pretransfusion, Blood Components, Adverse Reactions
- Is diagnosed when dyspnea occurs within 24 hours post transfusion
- caused by increased intravascular volume due to excessive transfused fluid and/or too rapid of an infusion rate and the inability of the patient to accommodate the volume of transfused products due to impaired pulmonary, cardiac, or renal function.
Transfusion-Associated Dyspnea (TAD)
- a nonspecific sign that could be seen in a variety of other transfusion reactions or as part of the patient’s underlying condition
- when hypotension is seen alone during or within 1 hour after the transfusion is finished.
Adult: BP systolic drop of** ≥30 mm Hg** and systolic BP ≤80 mm Hg
Children: 25% drop in the baseline systolic BP
Hypotensive Transfusion Reaction
- Are one of the most common adverse TR
- Fever is greater than 100.4 F (38C)
- Or 1.8F (1.0C) from the pretransfusion level occurring during or **within 4 hours **after the end of the transfusion
- or** chills and/or rigors** are present
**Febrile Nonhemolytic Transfusion Reaction (FNHTR)
**
- The most common reactions seen with platelet and plasma transfusion
-* IgA deficiency* is defined as undetectable serum IgA (less than 0.5 mg/dL). Most IgA-related anaphylactic reactions occur in IgA-deficient persons with detectable class-specific anti-IgA antibodies. - However, reactions do not occur in the majority of patients, and anaphylaxis is rare.
Allergic Transfusion Reaction (ATRs)
- Headache is the most commonly reported symptom
- Fever, chills, nausea, vomiting, abdominal pain, diarrhea, facial flushing, urticaria, itching, muscular cramps, and back pain are other common symptoms
- albumin, intravenous immune globulin (IVIG), and human-derived factor concentrates, can be associated with adverse events other than viral transmission.
Adverse Reactions to Infusion of Plasma-Derived Products
- A clinical syndrome developing from 2 days to 6 weeks after transfusion characterized by the typical skin rash seen and other forms of GVHD, diarrhea, fever, enlarged liver, elevated liver enzymes, marrow aplasia, and/or pancytopenia.
- Definitive Diagnosis: skin biopsy (occasionally liver)
Transfusion-Associated Graft-vs- Host Disease
- is a rare transfusion reaction in which there is a severe and sudden drop in the platelet count, usually occurring 5 to 10 days after transfusion due to alloimmunization to platelet-specific antibodies from prior transfusion or pregnancy
- Diagnosis: Thrombocytopenia
Post-Transfusion Purpura
**Adverse Metabolic Effects of Transfusion
**
- excessive amounts of citrate can enter the circulation in massive transfusion or in patients with severe liver disease.
- can cause hypocalcemia and hypomagnesemia. In addition, metabolic alkalosis can de velop from bicarbonate produced from citrate metabolism.
Citrate toxicity
**Adverse Metabolic Effects of Transfusion
**
- During RBC storage, intracellular potassium slowly leaks from aging RBCs causing increased potassium in the super natant.
- is very uncommon in massive trans fusion in adults, but it is of special concern in neonatal transfusions, especially in premature infants.
- The signs and symptoms of increased potassium are due to neuromuscular and cardiac effects
Hyperkalemia
- causes:
Viruses, bacteria, non-infectious agents such as chemicals (drugs and alcohol), ionizing radiation, and autoimmune processes - As complication:
EBV, CMV, parvovirus, and HSV (these are not considered as hepatitis viruses)
Transfusion-Associated Hepatitis
- It is a single-stranded RNA lipid-enveloped virion that is common in Africa, West Asia, and the Middle East.
- The infection in humans has an incubation period of approximately 3 to 14 days following the mosquito bite, with symptoms lasting 3 to 6 days
West Nile Virus
WNV detection method
ELISA
- symptoms include fever, headache, rash, and muscle and joint pain.
- It is estimated that less than 20% of infected individuals experience symptoms.
- has been associated with severe neurological complications including increased rates of microcephaly and fetal brain anomalies during pregnancy and Guillain-Barre syndrome.
Zika Virus
Primary disease symptoms include high fever, severe joint pain, headache, muscle pain, rash, and leukopenia
Chikungunya Virus (CHIKV)
is the most common risk of infection due to transfusion of blood
Bacterial contamination
are the most common bacterial contaminants of blood
Staphylococcus epidermidis or S. aureus
According to the CDC, –––– is the most common isolate found in RBC units, followed by the Pseudomonas species.
Yersinia enterolitica
strongly indicates contamination. COLOR.
dark purple or black
clots in the unit and hemolysis may also indicate contamination.
Red Cells Shelf Life
a. ACD-A, CPD, CP2D: 21 days
CPDA-1: 35 days
a. ACD-A, CPD, CP2D: 35 days
CPDA-1: 21 days
a. ACD-A, CPD, CP2D: 21 days
CPDA-1: 35 days
a. ACD-A, CPD, CP2D: 35 days
CPDA-1: 21 days
Platelets shelf life
a. 24 hours
b. 1-6 days
c. 5 days
Platelets shelf life
a. 24 hours
b. 1-6 days
c. 5 days
The tubing that connects blood bags is usually made of
polyvinyl chloride (PVC)
Mechanical devices that apply pressure to the blood bag, which allows blood components to flow from one bag to another by way of the integrated tubing system
Plasma Expressors
RBCs + plasma
a. 5,000 x g, 5 minutes
b. 2,000 x g, 3 minutes
c. 5,000 x g, 7 minutes
RBCs + plasma
a. 5,000 x g, 5 minutes
b. 2,000 x g, 3 minutes
c. 5,000 x g, 7 minutes
Collecting whole blood and transforming into components
centrifugation
Collecting targeted components
Apheresis
Plasma concentrated, sterile specific proteins, obtained
from large pools of donor t**hrough plasma fractionation. **
Ex: albumin, RHIG, HBIG, freeze dried factor VIII and IX.
** Plasma derivative**
Rejuvenation solutions: PIPA
Phosphate, Inositol, Pyruvate, Adenine
is the only FDA-approved rejuvenation solution sold in the US
Rejuvesol (enCyte Systems)
- invaluable for preserving selected autologous and rare units of blood for later use
- The process by which ATP and 2,3 DPG levels are restored or enhanced by metabolic alterations.
Rejuvenation of RBCs
- an RBC membrane stabilizing reagent
- protects against storage- related hemolysis
Mannitol
Benefits of RBC Additive Solutions
- Extends the shelf-life of RBCs to 42 days by adding nutrients
- Allows for the harvesting of more plasma and platelets from the unit
- Produces a packed RBC of** lower viscosity **that is easier to infuse. Reduces hematocrit from 65% to 80% to around 55% to 65% (300 to 400 mL)
- added to the RBCs after removal of the plasma with or without platelets
- Removal of the plasma component during the preparation of packed RBCs removed much of the nutrients needed to maintain RBCs during storage
Additive Solutions
Additive solution volume
Volume: 100 mL to RBC conc from 450 mL blood collection
must be added within 72 hours
Random Donor Platelet (RDP)
storage temperature
a. 1-6 C
b. 37 C
c. 20-24 C
Random Donor Platelet (RDP)
storage temperature
a. 1-6 C
b. 37 C
c. 20-24 C
Random Donor Platelet (RDP)
must be processed within
a. 6-8 hrs
b. 24 hrs
c. 4 hours
with constant agitation
Random Donor Platelet (RDP)
must be processed within
a. 6-8 hrs
b. 24 hrs
c. 4 hours
Platelets obtained from an apheresis donation
- Higher yield, contain 4 to 6 times as many platelets as RDP
- Minimal RBC contamination
Single Donor Platelet (SDP)
Indications:
- Patients who are unresponsive to RDPs due to HLA alloimmunization
- Or to limit the platelet exposure from multiple donors (must be divided into aliquots if small-volume transfusion are required)
a. SDP
b. RDP
c. Platelets, irradiated
d. Platelets, leukoreduced
Indications:
- Patients who are unresponsive to RDPs due to HLA alloimmunization
- Or to limit the platelet exposure from multiple donors (must be divided into aliquots if small-volume transfusion are required)
**a. SDP
**b. RDP
c. Platelets, irradiated
d. Platelets, leukoreduced
One unit of plasma contains:
Approx. 300 mg fibrinogen per 100 mL
And 1 unit of activity per mL of each of the stable clotting factors
Indications:
1. Multiple coagulation factor deficiencies (Liver disease, DIC)
2. For isolated factor deficiencies when no component is available 3. Antithrombin III deficiency
4. Patients on anticoagulants who are bleeding or require surgery; reversal of warfarin/coumadin overdose
a. plasma
b. SDP
c. RDP
d. RBC
Indications:
1. Multiple coagulation factor deficiencies (Liver disease, DIC)
2. For isolated factor deficiencies when no component is available 3. Antithrombin III deficiency
4. Patients on anticoagulants who are bleeding or require surgery; reversal of warfarin/coumadin overdose
**a. plasma **
b. SDP
c. RDP
d. RBC
- Is the cold-precipitated concentration of FVIII (AKA-antihemophilc factor)
- The process of isolating FVIII also harvests fibrinogen, FXIII, von Willebrand factor, cryoglobulin, and fibronectin
Cryoprecipitated AHF
INDICATIONS
Treatment of FXIII deficiency, as a source of fibrinogen for hypofibrinogenemia, and as a secondary line of treatment for classic hemophilia (hemophilia A) and vWD.
Has also been used to make fibrin glue, a substance composed of cryoprecipitate (fibrinogen) and topical thrombin.
Cryoprecipitated Antihemophilic Factor
- Is the plasma from which the cryoprecipitate concentrate has been harvested.
- Contains the residual albumin; factors II, V, VII, IX, X, XI; and ADAMTS13
-Cannot be used as substitute for FFP, PF24, or thawed plasma.
a. Cryoprecipitated Antihemophilic Factor
b. Cryo-Poor Plasma (CPP)
c. AKA: Granulocyte pheresis
d. Platelets
- Is the plasma from which the cryoprecipitate concentrate has been harvested.
- Contains the residual albumin; factors II, V, VII, IX, X, XI; and ADAMTS13
-Cannot be used as substitute for FFP, PF24, or thawed plasma.
a. Cryoprecipitated Antihemophilic Factor
b. Cryo-Poor Plasma (CPP)
c. AKA: Granulocyte pheresis
d. Platelets
he process of removing the extracellular solution and replacing with normal saline
washing
Indications:
Neonates whose platelet counts fall below 50,000/mL and who are experiencing bleeding.
Platelet Aliquots
- Allow for multiple blood components to be transfused at a single event
- The components pooled may be all the same or a combination of components depending on the patient’s need.
pooling
Frozen, Deglycerolized RBC
shelf life
a. 24 hours
b. 1 year
c. 5 days
d. 10 years
Frozen, Deglycerolized RBC
shelf life
a. 24 hours
b. 1 year
c. 5 days
d. 10 years
Made of large molecules that form a shell around the cell, preventing loss of water and subsequent dehydration
* Ex: Hydroxyethyl starch (HES) and dimethylsulfoxide
a. penetrating
b. nonpenetrating
Made of large molecules that form a shell around the cell, preventing loss of water and subsequent dehydration
* Ex: Hydroxyethyl starch (HES) and dimethylsulfoxide
a. penetrating
b. nonpenetrating
- Involves small molecules that cross the cell membrane into the cytoplasm
- The osmotic force of the agent prevents water from migrating outward as
extracellular ice is formed, preventing intracellular dehydration * Ex: Glycerol
a. penetrating
b. nonpenetrating
- Involves small molecules that cross the cell membrane into the cytoplasm
- The osmotic force of the agent prevents water from migrating outward as
extracellular ice is formed, preventing intracellular dehydration * Ex: Glycerol
a. penetrating
b. nonpenetrating
Indications:
- Patients with **hemophilia A or B **who have circulating antibodies or inhibitors
- In patients with** congenital factor VII deficiency**
- Patients with Glanzmann thrombasthenia
a. Activated FVII (Factor VIIa)
b. Factor VIII Concentrates (FVIII)
c. Factor IX Concentrates
Indications:
- Patients with **hemophilia A or B **who have circulating antibodies or inhibitors
- In patients with** congenital factor VII deficiency**
- Patients with Glanzmann thrombasthenia
a. Activated FVII (Factor VIIa)
b. Factor VIII Concentrates (FVIII)
c. Factor IX Concentrates
contains significant levels of vit. K-dependent factors II, VII, IX, and X)
a. Prothrombin complex concentrates
b. Factor IX
c. rFIX
contains significant levels of vit. K-dependent factors II, VII, IX, and X)
a. Prothrombin complex concentrates
b. Factor IX
c. rFIX
Prepared from:
Pooled plasma by cold ethanol fractionation
Indications:
* Patients with** immunodeficiency diseases** (i.e. severe combined immunodeficiency and Wiskott-Aldrich syndrome)
* Provides passive antibody prophylaxis against hepatitis and herpes
a. Normal Serum Albumin
b. Immune Serum Globulin
c. PPF or Plasma Protein Fraction
Prepared from:
Pooled plasma by cold ethanol fractionation
Indications:
* Patients with** immunodeficiency diseases** (i.e. severe combined immunodeficiency and Wiskott-Aldrich syndrome)
* Provides passive antibody prophylaxis against hepatitis and herpes
a. Normal Serum Albumin
b. Immune Serum Globulin
c. PPF or Plasma Protein Fraction
Indications:
- Patients who are hypovolemic and hypoproteinemic - In clinical settings for shock and burn patients
Plasma Protein Fraction
*Indication:
Treatment of** ITP** and immunization against the D antigen
a. Rho (D) Immune Globulin
b. Immune Serum Globulin
c. Normal Serum albumin
*Indication:
Treatment of** ITP** and immunization against the D antigen
a. Rho (D) Immune Globulin
b. Immune Serum Globulin
c. Normal Serum albumin
