Kruse 2

Question 1

Leukocyte reduction

Answer 1

• performed by filtration
• vast majority of US blood supply is leukoreduced
• reduces risk of CMV transmission in bone marrow transplant patients*******************
• does NOT prevent transfusion assocaited graft versus host disease

Question 2

Washing (special processing of RBCs

Answer 2

• washed in normal saline
• removes extra plasma and associated antibodies
• DECREASE RISK OF ANAPHYLACTOID REACTION, PARTICULARLY IN IgA deficient patients******
  
  • IgA deficient patients have anti-IgA antibodies

Question 3

Describe Tranfusion triggers

Answer 3

• Hemodynamically stable medical, surgical or ICU patients
  
  • Hgb < 7.0 should be transfused
• In patients with active bleeding
  
  • Hgb < 8.0 should be transfused
• in patients with active cardiovascular disease
  
  • Hgb < 8.0 is generally accepted
• GENERAL GOAL IN MOST PATIENTS IS TO KEEP HEMOGLOBIN 7.0-9.0
  
  • PUSHING HIGHER MAY INCREASE MORTALITY

SPECIAL CASE: bleeding esophageal varices

• keep the patient as close to Hgb 8.0 as posible (less may impair oxygen delivery!!!!)
  
  • more may lead to high intravascular pressure and worsen the bleed!!!

Question 4

tYPE and screen versus type and cross

Answer 4

• Type and screen
  
  • screens patient blood
  • does NOT prepare DONOR BLOOD
• Type and cross
  
  • screens patients blood
  • cross matches donor blood for patient use

Question 5

contraindications to platelet transfusion

Answer 5

• heparin induced thrombocytopenia
  
  • increased rate of thrombosis
• thrombotic thombocytopenic purpura/hemolytic uremic syndrome
  
  • accelerates the dsiease process

Question 6

Transfusion releated infections

Answer 6

BACTERIAL INFECTIONS in 1/2,000 to 1/3,000 (mostly platelets)

Question 7

transfusion related reactions

Answer 7

• allergic reaction (preformed antibodies to donor plasma proteins)
• anaphylactoid/anaphylactic reaction (antibody to donor plasma proteins)
  
  • hypotension, urticarial, bronchospams, angioedema (epi IM)
• febrile non-hemolytic transfusion reactions (febrile non-HTR)
  
  • due to preformed anti-WBC antibodies in pts (brief fever)
• delayed hemolytic transfusion reaction (DHTR)
  
  • occurs 1-2 weeks after transfusion (fever, jaundice, falling hgb)
• Acute hemolytic transfuison reactions (AHTR)
  
  • preformed antibodies incompatible attack donor product antigen
    
    • chills, fever, hypotension, back pain, DIC
• Tranfusion assocaited circulatory overload (TACO)
  
  • hydrostatic fluid overload
• Transfusion related acute lung injury (TRALI)
  
  • massive capillary leak in pulmonary vasculature
    
    • hypoxemia, transient leucopenia, bilateral pulmonary edema