Lec 16 - Blood Components Therapy Flashcards
Why is blood component therapy preferable to whole blood therapy?
- allows for more compatible options
- more precise
platelet indications
-prophylaxis: stable patients with platelet counts <100K/uL
clinical presentation of TTP
THINK “MNRFT”
- M-microangiopathic hemolytic anemia
- N-neurologic changes
- R-renal impairment
- F-fever
- T-thrombocytopenia
physiology: decreased ADAMTS-13 level
treatment of TTP
-give plasma to replenish ADAMTS-13 enzyme
mechanism of alloimmunization
significance of alloimmunization
-can get hemolytic reaction in patient if they have antibody to something in the blood you are about to give them
how to decrease chances of alloimmunization
need to test and match blood very well before giving it to patient
indications for massive transfusion
-someone is bleeding out - order MTP
factor 8 concentrate
- what is it?
- what is it used for?
plasma derivative: used for hemophelia A patients (DONT USE CRYO if F8 concentrate is available)
CMV negative indications
Uses:
- Fetuses (IUT-intra uterine)
- LBW (low birth weight) preemies bron to CMV neg moms
- solid organ or allogeneic hematopoetic transplant patients from CMV seronegative donors
washed indications
- give to:
- –neonates undergoing large volume transfusion
- –IgA deficient patients with anti IgA IgE
- –history of severe, progressive allergic transfusion reaction
irradiated indications
give to patient with aplastic anemia
ONLY REASON TO GIVE is to prevent TA-GVHD (transplant associated-graft v host disease
-IT INACTIVATES WHITE BLOOD CELLS TO PREVENT GVHD
Why give red blood cells?
Only to increase O2 carrying capacity
NOT to inc plasma osmolality or for anemias that can be corrected wtih B12, folate, etc
two type of platelet products:
1) single donor apheresis platelets (pull out everything from blood except what you want and give the patient the rest back)
2) whole blood derived pooled platelets - typically from 6-units of whole blood
plasma indications
- bleeding patients with INR>1.8
- emergency coumadin reversal
- bleeding with dilutional coagulopathy
- bleeding with severe liver failure
- TTP treatment
What is ADAMTS-13?
enzyme that cleaves vWF multimers so that that they dont accumulate and impede flow of stuff in the vasculature (schistocytes stuff)
usually an antibody interferes with function of ADAMTS-13
apheresis of component important to help treat what problem
- red cells
- leukocytes
- platelets
- plasma
- RBC ==> sickle cell
- leukocytes ==> acute leukemia
- platelets ==> thrombocytosis
- plasma ==> neurologic diseases and TTP
primary use for cryoprecipitate?
someone with low fibrinogen (usually DIC)
mnemonic for which RBC antigens matter?
Kell Kills
Duffy Dies
Lewis Lives
Massive transfusion considerations:
1-potassium toxicity -(K leaks out of cells with storage) esp in infants and cardiac toxicity
2-citrate toxicity - (citrate bind Ca) hypocalcemia, hypomagnesemia, cardiac dysrythmia
3-hypothermia (significantly cool core body temp if give colder blood)- inc Hb-O2 affinity
4-coagulopathy
Do NOT give irradiated products to:
sickle cell
thallasemia patients
-also not required for solid organ transplant; HIV/AIDS; cardiovasc surgery patients
IV albumin:
- what is it?
- what is it used for?
-plasma derivative:
made from pooled plasma. can be used to maintain oncotic pressure of intravascular space in burn and cirrhotic patients
intavenous immune globulin (IVIG):
- what is it?
- what is it used for?
-plasma derivative: from pooled plasma. Uses: maintenance treatment of immune deficiencies and ITP
prothrombin complex concentrate:
- what is it?
- what is it used for?
-plasma derivative:from pooled human plasma
Kcentra:
- what is it?
- what is it used for?
-plasma derivative: for warfarin reversal - contains all the Vit K dependent clotting factors
