ISBB Finals Flashcards
Pretransfusion, Blood Components, Adverse Reactions (55 cards)
1
Q
- 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.
A
Transfusion-Associated Dyspnea (TAD)
2
Q
- 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
A
Hypotensive Transfusion Reaction
3
Q
- 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
A
**Febrile Nonhemolytic Transfusion Reaction (FNHTR)
**
4
Q
- 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.
A
Allergic Transfusion Reaction (ATRs)
5
Q
- 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.
A
Adverse Reactions to Infusion of Plasma-Derived Products
6
Q
- 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)
A
Transfusion-Associated Graft-vs- Host Disease
7
Q
- 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
A
Post-Transfusion Purpura
8
Q
**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.
A
Citrate toxicity
9
Q
**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
A
Hyperkalemia
10
Q
- 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)
A
Transfusion-Associated Hepatitis
11
Q
- 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
A
West Nile Virus
12
Q
WNV detection method
A
ELISA
13
Q
- 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.
A
Zika Virus
14
Q
Primary disease symptoms include high fever, severe joint pain, headache, muscle pain, rash, and leukopenia
A
Chikungunya Virus (CHIKV)
15
Q
is the most common risk of infection due to transfusion of blood
A
Bacterial contamination
16
Q
are the most common bacterial contaminants of blood
A
Staphylococcus epidermidis or S. aureus
17
Q
According to the CDC, –––– is the most common isolate found in RBC units, followed by the Pseudomonas species.
A
Yersinia enterolitica
18
Q
strongly indicates contamination. COLOR.
A
dark purple or black
clots in the unit and hemolysis may also indicate contamination.
19
Q
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
a. ACD-A, CPD, CP2D: 21 days
CPDA-1: 35 days
a. ACD-A, CPD, CP2D: 35 days
CPDA-1: 21 days
20
Q
Platelets shelf life
a. 24 hours
b. 1-6 days
c. 5 days
A
Platelets shelf life
a. 24 hours
b. 1-6 days
c. 5 days
21
Q
The tubing that connects blood bags is usually made of
A
polyvinyl chloride (PVC)
22
Q
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
A
Plasma Expressors
23
Q
RBCs + plasma
a. 5,000 x g, 5 minutes
b. 2,000 x g, 3 minutes
c. 5,000 x g, 7 minutes
A
RBCs + plasma
a. 5,000 x g, 5 minutes
b. 2,000 x g, 3 minutes
c. 5,000 x g, 7 minutes
24
Q
Collecting whole blood and transforming into components
A
centrifugation
25
Collecting targeted components
**Apheresis**
26
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**
27
Rejuvenation solutions: PIPA
Phosphate, Inositol, Pyruvate, Adenine
28
is the only FDA-approved rejuvenation solution sold in the US
Rejuvesol (enCyte Systems)
29
- 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
30
- an RBC membrane stabilizing reagent
- protects against storage- related hemolysis
Mannitol
31
Benefits of RBC Additive Solutions
1. **Extends the shelf-life of RBCs to 42 days** by adding nutrients
2. Allows for the **harvesting of more plasma and platelets** from the unit
3. 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)
32
- 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
33
Additive solution volume
Volume: **100 mL** to RBC conc from 450 mL blood collection
| must be added within 72 hours
34
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**
35
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
36
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)
37
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
38
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
39
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
40
- 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
41
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
42
- 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
43
he process of removing the extracellular solution and replacing with normal saline
washing
44
Indications:
Neonates whose platelet counts **fall below 50,000/mL** and who are experiencing bleeding.
Platelet Aliquots
45
46
47
- 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
48
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**
49
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**
50
- 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
51
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
52
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
53
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
54
Indications:
- Patients who are **hypovolemic and hypoproteinemic** - In clinical settings for **shock and burn patients**
Plasma Protein Fraction
55
*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
