Lecture 5 - tranfusion Flashcards
Why are RBC transfusions given?
To raise H/H levels
- anemia pts
- replace after bleeding
Simple answer: to increase OT carrying capacity
Give a transfusion if?
Hb is <7g/dL
Or
Significant hemorrhage
Transfusion reaction?
STOP the transfusion
Blood products list?
- Fresh Whole blood (<24hrs)
- PRBC
- filtered RBC
- frozen RBC
- irradiated RBC
- platelets
- FFP
- Cryoprecipate
What makes fresh whole blood better?
Nothing really, we can get all the components seperately
We do use them a lot when we anticipate a lot of blood loss
MC use for PRBC?
To raise HCT
Volume of PRBC?
Approx 300mL
- (200mL of RBC)
PRBC expect what lab changes per unit?
HCT: 3-4%
Hb: 1g/dL increase
(Test Q)
What are CMV neg leukocyte-reduced filtered RBCs?
Aka “leukocyte-poor”
They have the donor WBC’s filtered out
Why give CMV neg filtered RBCs?
Reduces risk of febrile nonhemolytic reaction
Prevents CMV transmission
Who gets CMV neg RBC’s?
- previous transfusion reaction
- cardiovascular surgery
- potential transplant
- chronically transfused pt
- hx of sever leukoagglutinization reaction to PRBC
How long can frozen RBC’s keep?
Up to 10 yrs
Who gets irritated RBCs?
Immunocompromsied pts at risk for transfusion-associated graft vs host disease
(TA-GVHD)
Will leukoreduced blood products prevent TA-GVHD?
Nope
They need irradiated RBCs
5types of lympohcytes?
B Cells
T Cells
NK Cells
Autologous PRBC?
Pts own blood given back to them
- good for elective surgeries
Only way to completely (almost) eliminate infection with blood products
Autologous blood
1 unit of apheresis platelets =?
“6 pack”
- 6 units of whole blood derived platelets
apheresis definition?
Fancy medical speak for:
Selective collection of specific component of blood and return of the remainder of circulation
What will one 6 pack provide?
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”
Causes for refractoriness to platelets
Common
- fever
- sepsis
- bleeding
- splenomegaly
- alloimmunization
- ABO mismatch
Less common
- hematopoietic cell transplant
—> autolgous or allogenic
- disseminated intravascular coagulation
What is FFP used for?
It contains all coagulation factors
Used to replace depleted coag factors in pts with active bleeding or high-risk for bleeding
Volume of FFP
200-250mL
What is cryoprecipate?
Three seperate remains from thawing FFP?
Contains
- factor VII
- factor VIII
- vWF
- fibrinogen
- fibronectin
Can be refrozen
When do you give cryoprecipate?
When the pt needs only clotting factors
What is done w a type and screen?
ABO and RH type of pt
Antibody screen of pts serum
If the recipients antibody screen is neg?
No further type and screening is needed
Type and cross?
Matches the pt serum with donors RBC 45-60 min
Used to avoid hemolytic transfusion reactions
Universal recipient?
AB pos
Universal donor?
O neg
Compatibility explanation?
Slide 27
Types of transfusion complications?
Non hemolytic
Hemolytic
Blood product contamination
Transfusion-associated infection
Non-hemolytic complications?
Febrile non-hemolytic transfusion reaction
Hemolytic transfusion complications?
Acute and Delayed hemolytic transfusion reaction
Leukoagglutination reaction is aka?
Febrile, non-hemolytic transfusion reaction
MC transfusion reactions are?
Not hemolytic
What causes febrile, non-hemolytic transfusion reaction?
Small amount of transfused donor WBC found in PRBC that gets to pts with prior sensitization
MC leukoagglutination reaction?
Mild fever and chills w/in 12 hrs of transfusion
Sever leukoagglutination reaction?
Dypsnea and cough
Pulmonary infiltrates
1% of all PRBC transfusions (MC)
Tx for leukoagglutination reaction?
Diphenhydramine
Tylenol
Corticosteroids
When does acute hemolytic transfusion reaction (AHTR) occur?
With mismatched ABO/Rh blood is give -> massive intravascualr hemolysis
MC reason for AHTR reaction?
Clerical error
Severity of AHTR is dependent on?
Amount transfused
- usually its surgery pts that get it
Classic signs fo AHTR
Fever Rigors HOTN Subjective pain at infusion site HA Back pain
Not seen in pts under gen anesthesia
Severe AHTR symptoms?
Acute renal failure - acute tubular necrosis Circulatory shock DIC Death
Delayed hemolytic transfusion reaction occurs?
5-10 days later
Why is delayed hemolytic transfusion reaction delayed?
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”
Where does hemolysis occur with the DHTR?
Extravascularly (in spleen)
How common is delayed hemolytic transfusion reaction ?
1 in 260,000 transfusions
- greater incidence in high-risk groups (SCD, rare blood types etc)
Blood product contamination is usually?
Gram neg organisms
- yersinia enterocolitica MC
How common is contamination?
1 of ever 2000 - 5000 platelet donations (cannot be refrigerated so its worse)
Reaction to gram neg contamination?
Septic shock
Acute DIC
Acute kidney injury
- transfused endotoxin
Usually fatal
Gram pos contamination leads to?
Fever/bacteremia
Rarely proceeds to sepsis
Common viral contamination for blood products?
Hep B
Hep C
HTLF (human T-lymphotrypic virus)
HIV
Viral transmission is common?
Not really
Hep B - 1 in 290,000
The rest are 1 in 2 million ish
TRALI’?
Transfusion associated lung injury
Noncardiogenic pulmonary edema after blood product transfusion without other explanation
What happens with TRALI?
allogenic antibodies in donor plasma component that bind to recipient leukocyte antigen
Who usually gets TRALI?
Surgical and critically ill pts
Warning signs for TRALI?
Hypoxemia and Pulmonary edema followed by ARDS w/in hrs of transfusion
What is considered a “massive” transfusion?
50% of pts blood volume in 12-24hrs
Approx 10 units of PRBC in 24hrs
What type of complications come from massive transfusion?
- Coagulopathy
- Dilution thrombocytopenia
- Metabolic acidosis
- Hypocalcemia
- Hypothermia
- Hyperkalemia
Massive transfusion recommendation?
Strive for 1:1:1
FFP: PRBC:Platelets
Mortality = 20%
If
FFP:PRBC ratio of 1:4 or less
mortality = 65%
Chronic anemia and transfusions?
Last resort
When giving PRBC you can expect what lab changes?
HCT increase 3-4%
Hb increase 1g/dL
300mL impact on blood volume
Yo mama so dumb
She studied for the blood test
