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Senior - Heme-Onc > Lecture 5 - tranfusion > Flashcards

Lecture 5 - tranfusion Flashcards

1
Q

Why are RBC transfusions given?

A

To raise H/H levels

  • anemia pts
  • replace after bleeding

Simple answer: to increase OT carrying capacity

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2
Q

Give a transfusion if?

A

Hb is <7g/dL
Or
Significant hemorrhage

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3
Q

Transfusion reaction?

A

STOP the transfusion

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4
Q

Blood products list?

A
  • Fresh Whole blood (<24hrs)
  • PRBC
  • filtered RBC
  • frozen RBC
  • irradiated RBC
  • platelets
  • FFP
  • Cryoprecipate
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5
Q

What makes fresh whole blood better?

A

Nothing really, we can get all the components seperately

We do use them a lot when we anticipate a lot of blood loss

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6
Q

MC use for PRBC?

A

To raise HCT

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7
Q

Volume of PRBC?

A

Approx 300mL

- (200mL of RBC)

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8
Q

PRBC expect what lab changes per unit?

A

HCT: 3-4%
Hb: 1g/dL increase

(Test Q)

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9
Q

What are CMV neg leukocyte-reduced filtered RBCs?

A

Aka “leukocyte-poor”

They have the donor WBC’s filtered out

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10
Q

Why give CMV neg filtered RBCs?

A

Reduces risk of febrile nonhemolytic reaction

Prevents CMV transmission

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11
Q

Who gets CMV neg RBC’s?

A
  • previous transfusion reaction
  • cardiovascular surgery
  • potential transplant
  • chronically transfused pt
  • hx of sever leukoagglutinization reaction to PRBC
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12
Q

How long can frozen RBC’s keep?

A

Up to 10 yrs

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13
Q

Who gets irritated RBCs?

A

Immunocompromsied pts at risk for transfusion-associated graft vs host disease
(TA-GVHD)

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14
Q

Will leukoreduced blood products prevent TA-GVHD?

A

Nope

They need irradiated RBCs

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15
Q

5types of lympohcytes?

A

B Cells
T Cells
NK Cells

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16
Q

Autologous PRBC?

A

Pts own blood given back to them

- good for elective surgeries

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17
Q

Only way to completely (almost) eliminate infection with blood products

A

Autologous blood

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18
Q

1 unit of apheresis platelets =?

A

“6 pack”

- 6 units of whole blood derived platelets

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19
Q

apheresis definition?

A

Fancy medical speak for:

Selective collection of specific component of blood and return of the remainder of circulation

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20
Q

What will one 6 pack provide?

A

Increase platelet count by 5,000 to 10,000 in 1 hr

Lasts 2-3 days

If you dont see the rise it is “refractoriness”

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21
Q

Causes for refractoriness to platelets

A

Common

  • fever
  • sepsis
  • bleeding
  • splenomegaly
  • alloimmunization
  • ABO mismatch

Less common
- hematopoietic cell transplant
—> autolgous or allogenic
- disseminated intravascular coagulation

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22
Q

What is FFP used for?

A

It contains all coagulation factors

Used to replace depleted coag factors in pts with active bleeding or high-risk for bleeding

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23
Q

Volume of FFP

A

200-250mL

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24
Q

What is cryoprecipate?

A

Three seperate remains from thawing FFP?

Contains

  • factor VII
  • factor VIII
  • vWF
  • fibrinogen
  • fibronectin

Can be refrozen

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25
Q

When do you give cryoprecipate?

A

When the pt needs only clotting factors

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26
Q

What is done w a type and screen?

A

ABO and RH type of pt

Antibody screen of pts serum

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27
Q

If the recipients antibody screen is neg?

A

No further type and screening is needed

28
Q

Type and cross?

A

Matches the pt serum with donors RBC 45-60 min

Used to avoid hemolytic transfusion reactions

29
Q

Universal recipient?

A

AB pos

30
Q

Universal donor?

A

O neg

31
Q

Compatibility explanation?

A

Slide 27

32
Q

Types of transfusion complications?

A

Non hemolytic
Hemolytic
Blood product contamination
Transfusion-associated infection

33
Q

Non-hemolytic complications?

A

Febrile non-hemolytic transfusion reaction

34
Q

Hemolytic transfusion complications?

A

Acute and Delayed hemolytic transfusion reaction

35
Q

Leukoagglutination reaction is aka?

A

Febrile, non-hemolytic transfusion reaction

36
Q

MC transfusion reactions are?

A

Not hemolytic

37
Q

What causes febrile, non-hemolytic transfusion reaction?

A

Small amount of transfused donor WBC found in PRBC that gets to pts with prior sensitization

38
Q

MC leukoagglutination reaction?

A

Mild fever and chills w/in 12 hrs of transfusion

39
Q

Sever leukoagglutination reaction?

A

Dypsnea and cough
Pulmonary infiltrates

1% of all PRBC transfusions (MC)

40
Q

Tx for leukoagglutination reaction?

A

Diphenhydramine
Tylenol
Corticosteroids

41
Q

When does acute hemolytic transfusion reaction (AHTR) occur?

A

With mismatched ABO/Rh blood is give -> massive intravascualr hemolysis

42
Q

MC reason for AHTR reaction?

A

Clerical error

43
Q

Severity of AHTR is dependent on?

A

Amount transfused

- usually its surgery pts that get it

44
Q

Classic signs fo AHTR

A 
Fever
Rigors
HOTN
Subjective pain at infusion site
HA
Back pain

Not seen in pts under gen anesthesia

45
Q

Severe AHTR symptoms?

A 
Acute renal failure
- acute tubular necrosis
Circulatory shock 
DIC
Death
46
Q

Delayed hemolytic transfusion reaction occurs?

A

5-10 days later

47
Q

Why is delayed hemolytic transfusion reaction delayed?

A

Less antigen-antibody burden (recipient has low alloantibody levels)

  • results in less of a hemolytic response that may not occur for up to several days after the transfusion “amnestic response”
48
Q

Where does hemolysis occur with the DHTR?

A

Extravascularly (in spleen)

49
Q

How common is delayed hemolytic transfusion reaction ?

A

1 in 260,000 transfusions

- greater incidence in high-risk groups (SCD, rare blood types etc)

50
Q

Blood product contamination is usually?

A

Gram neg organisms

  • yersinia enterocolitica MC
51
Q

How common is contamination?

A

1 of ever 2000 - 5000 platelet donations (cannot be refrigerated so its worse)

52
Q

Reaction to gram neg contamination?

A

Septic shock
Acute DIC
Acute kidney injury
- transfused endotoxin

Usually fatal

53
Q

Gram pos contamination leads to?

A

Fever/bacteremia

Rarely proceeds to sepsis

54
Q

Common viral contamination for blood products?

A

Hep B
Hep C
HTLF (human T-lymphotrypic virus)
HIV

55
Q

Viral transmission is common?

A

Not really

Hep B - 1 in 290,000

The rest are 1 in 2 million ish

56
Q

TRALI’?

A

Transfusion associated lung injury

Noncardiogenic pulmonary edema after blood product transfusion without other explanation

57
Q

What happens with TRALI?

A

allogenic antibodies in donor plasma component that bind to recipient leukocyte antigen

58
Q

Who usually gets TRALI?

A

Surgical and critically ill pts

59
Q

Warning signs for TRALI?

A

Hypoxemia and Pulmonary edema followed by ARDS w/in hrs of transfusion

60
Q

What is considered a “massive” transfusion?

A

50% of pts blood volume in 12-24hrs

Approx 10 units of PRBC in 24hrs

61
Q

What type of complications come from massive transfusion?

A
  • Coagulopathy
  • Dilution thrombocytopenia
  • Metabolic acidosis
  • Hypocalcemia
  • Hypothermia
  • Hyperkalemia
62
Q

Massive transfusion recommendation?

A

Strive for 1:1:1
FFP: PRBC:Platelets
Mortality = 20%

If
FFP:PRBC ratio of 1:4 or less
mortality = 65%

63
Q

Chronic anemia and transfusions?

A

Last resort

64
Q

When giving PRBC you can expect what lab changes?

A

HCT increase 3-4%

Hb increase 1g/dL

300mL impact on blood volume

65
Q

Yo mama so dumb

A

She studied for the blood test

Senior - Heme-Onc (6 decks)

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