Lecture 9: Blood Component Therapy Flashcards
When is whole blood used?
actively bleeding patients
lost at least 25% of their blood volume
patients requiring exchange transfusion
What happens when whole blood is run out?
reconstituted whole blood may be used
(RBCs mixed with thawed type AB FFP from a different donor)
When are RBCs used?
oncology patients undergoing chemotherapy or radiation therapy
trauma patients
surgery patients
dialysis patients
premature infants
patients with sickle cell anemia
How does RBC transfusion affect the patient?
increases the patient’s hemoglobin approximately 1 g/dl and the hematocrit by 3 %
When are Leukocyte-Reduced RBCs used?
chronically transfused patients
patients having known febrile transfusion reactions
When is Leukoreduction (filtration) done?
72 hours from collection time
AABB Standards for Leukocyte-Reduced RBCs
85% of RBCs must remain
leukocytes must be reduced to less than 5x106 WBC/unit
What is added to Frozen RBCs
frozen by adding glycerol to prevent cell hydration and the formation of ice crystals that can cause cell lysis
What is done for frozen RBCs to be used?
Thawed
Glycerol Removed by washing the RBCs with a series of saline solutions
Must be used within 24 hours
What are washed RBCs used for?
Used for patients who have a reaction to plasma proteins
Used in infant or intrauterine transfusions
For washed RBCs, how much RBCs are lost?
10-20%
What are Irradiated RBCs used for?
prevents T cells proliferation using gamma radiation
What do T cells cause
caused graft-versus-host disease, with 90% of cases being fatal
What are platelets used for?
Use to control or prevent bleeding
When is the need for platelets indicated?
Indicated in patients with chemotherapy
post-bone marrow transplant patients
patients experiencing postoperative bleeding
Platelet concentrates
Contain approximately 5.5 x 1010 platelets/unit
Pooled platelets
choose one platelet bag of those to be pooled and empty content of other bags into it
What is the usual platelet order?
6-10 units
Plateletpheresis
HLA matched patients who receive numerous platelet transfusions can develop antibodies to the class I
What happens when HLA antigens are not matched?
platelets will not last for 5 days in the patient’s circulation
Purpose of FFP?
replace coagulation factors in the patient
When is the need for FFP indicated?
Bleeding patients who require factors II, V, VII, IX, and X
Abnormal coagulation due to massive transfusion
DIC when fibrinogen is > 100 mg/dL
Antithrombin III deficiencies
Patients on anticoagulants who are bleeding or require surgery
Thawing process for FFP
in water bath at 30-37oC for 30-45 minutes in watertight container
agitators are preferred because the unit thaws faster
Cryoprecipitated Antihemophilic Factor
It contains factor VIII, fibrinogen, Factor XIII, and von Willebrand factor
When is Cryoprecipitated Antihemophilic Factor used?
with factor XIII deficiency
as a fibrin sealant
Pooled cryoprecipitate
pooled into one bag before transfusion
thawed in a similar fashion to FFP before pooling
Fibrin glue
1-2 units of cryoprecipitate are mixed with thrombin and applied topically to the bleeding area
Granulocyte transfusions are considered?
rare and limited to septic infants
What is in a pheresis bag for Granulocyte Pheresis?
> 1.0 x 1010 granulocytes, platelets, and 20-50 ml of RBCs
How long does it take for cells to deteriorate in Granulocyte Pheresis?
2 hours
Labeling Current labeling requirements include
proper name
unique number
amount of blood collected
amount and type of anticoagulant
volume of component
expiration date
storage temperature
ABO/D type
reference to the “Circular of Information for the Use of Human Blood and Blood Components,”
warning regarding infectious agents
prescription requirements
donor classification
FDA license number if applicable
What are some additional labels that are needed?
Irradiated components- with facility name
Autologous unit
Circular of Information for the Ue of Human Blood and Blood Components”
Pooled components: labels
Emergency Transfusions
Rapid loss of blood can result in hemorrhagic shock
Rapid blood loss symptoms
Hypotension, tachycardia, pallor, cyanosis, cold clammy skin, oliguria, decreased hematocrit, decreased (CVP), CNS depression, and metabolic shock
What is are the priority of acute blood loss?
Replace and maintain blood volume
Make sure oxygen carrying capacity is adequate
Maintain coagulation system integrity
Correct metabolic colloid osmotic pressure
Massive transfusion
Replacement if a person’s entire blood volume (approximately 10 units) within 24 hours)
If time is not available to type the patient
type O, D negative blood is transfused into women of childbearing age
Type O, D positive blood is transfused into me
What is one main difference with transfusing infants vs adults?
Smaller blood volume
Transfusions are given in small volumes in multiple packs
Premature infants need transfusion to do what?
offset the effect of hemoglobin F in their system
Since HbF doesn’t give up O2 easily
Iatrogenic blood loss
blood taken from the neonate or infant for laboratory tests
cause the neonate or infant to develop an anemia that may be severe enough to transfuse
Why use warmer bloods on infants?
Neonates and infants do not tolerate hypothermia
liver’s inability to metabolite citrate anticoagulants and potassium
Liver transplant patients require large amounts of blood products because?
the liver produced many coagulation factors and cholesterol for RBC membranes
What type of transplants need ABO compatibility?
kidney, liver, and heart transplants
Progenitor cell transplants
Derived from bone marrow or umbilical cord blood
Wiskott–Aldrich syndrome (WAS
rare X-linked recessive disease
Wiskott–Aldrich syndrome (WAS) symtpoms
Eczema
thrombocytopenia (low platelet count)
immune deficiency
bloody diarrhea
Fanconi Anemia
the result of a genetic defect in a cluster of proteins responsible for DNA repair
Fanconi Anemia symptoms
acute myelogenous leukemia (Most common)
Bone marrow failure- about 90%
60-75% have congenital defects
75% have some form of endocrine problem
Therapeutic Hemapheresis
Replacement of blood from a patient to improve a patient’s health
Oncology
Chemotherapy drugs kill all cells that are undergoing mitosis
Action of chemotherapist drugs
Stopping DNA replication
Interfering with mRNA production
Sickle Cell Anemia
abnormal hemoglobin (e.g., Hgb S) causes cells to be removed from circulation, resulting in a lowered hematocrit
Thalassemia
Decreased synthesis of the alpha and beta globin chains
Hemolytic anemia results
Transfusion support necessary
Aplastic Anemia
Blood transfusion support is usually needed until bone marrow transplant can occur
