Oncology Therapies and blood transfusions Flashcards

Question

Answer 1

Whole blood Used for cardiac surgery or massive hemorrhage (>10 units of blood are needed in 24-hours) Packed red blood cells Most commonly used Recommended transfusion “trigger” - hemoglobin is 7-8 g/dL Autologous red blood cells Donate own blood for an elective procedure

Answer 2

Risk of spontaneous bleeding Platelet count < 80,000/mcL Risk of life-threatening bleeding Platelet count < 5,000/mcL 6 pack or 1 unit pheresed platelets 1 pheresed unit will increase count by 50,000-60,000/mcL Lasts 2-3 days

Answer 3

200-250 ml of plasma containing All clotting factors (1 unit/mL of each) AT-III Protein C & S Indications: Correct factor deficiencies Thrombotic microangiopathies- TTP Correct/prevent coagulopathy with massive transfusions- 1:2 FFP:PRBC

Answer 4

Cryoprecipitated antihemophilic factor (AHF) Thaw FFP and precipitate refrozen 15-20 ml per unit (bag) Fibrinogen >150 mg Factor VIII > 80 IU Factor XIII at least 50-75 IU Von Willebrand Factor at least 100-150 IU Indications Acute DIC Low fibrinogen with bleeding/risk 1 unit INCREASE fibrinogen 8mg/dL

Answer 5

Volume overload Transfusion reactions Iron overload Infections Hyperkalemia Massive transfusions CKD

Answer 6

Complication that occurs during or after a blood product is given Range from clinically benign to life-threatening Minor Urticarial (simple allergic) transfusion reaction Febrile non-hemolytic transfusion reaction Critical Transfusion-associated circulatory overload (TACO) Transfusion-related acute lung injury (TRALI) Acute hemolytic transfusion reaction (AHTR) Transfusion-associated sepsis Anaphylactic transfusion reaction q

Answer 7

Common reaction Occurs during or up to 2 hours after the transfusion Commonly due to an antigen-antibody interaction that occurs between the patient and the product given Clinical features: Hives or pruritus Management: Mild reaction – continue the transfusion Antihistamines (H1 and H2 blockers)

Answer 8

Febrile non-hemolytic transfusion reaction (FNHTR) Occurs during and up to 4 hours after transfusion Accumulation of cytokines in the donor blood → immune reaction Type II hypersensitivity reaction in which the host antibodies target donor leukocytes Prevention by giving leukoreduced blood products Clinical features: Low-grade fever with chills Headache Malaise Management: Hold the transfusion for 30 minutes (often can restart) Acetaminophen for fever Check CBC and bilirubin to rule out hemolytic reaction

Answer 9

Transfusion-associated circulatory overload (TACO) Occurs during or within 6 hours after transfusion Patient develops pulmonary edema due to volume overload or circulatory overload < 1% of patients At risk patients: Receive a large volume of a transfused product over a short period of time H/O renal or cardiovascular disease Clinical features: Sudden tachycardia Hypertension Overload symptoms: increased jugular venous pressure CXR: bilateral infiltrates (pulmonary edema) Management: Stop the transfusion Diuresis – furosemide (Lasix) Supplemental oxygen or assisted ventilation

Answer 10

Transfusion-related acute lung injury Occurs during or up to 6 hours after transfusion Patients develop acute lung injury HLA antibodies in the donor blood triggers the neutrophils and pulmonary endothelial cells of the recipient Neutrophils secrete proteolytic enzymes that lead to tissue damage → hypoxemia 1 in 5,000 transfusions Clinical features: Fever and/or chills Respiratory distress (tachypnea, frothy pink sputum) Hypotension CXR: bilateral infiltrates (pulmonary edema) Management: Stop the infusion Assisted ventilation or oxygen administration IV steroids to aid with inflammation No diuresis

Answer 11

Acute hemolytic transfusion reaction (AHTR) True EMERGENCY Occurs during or within 1 hour after transfusion Acute intravascular hemolysis of transfused RBCs Usually due to ABO incompatibility Mislabeling and administering to wrong person 1:76,000 transfusions

Answer 12

High grade fever Flank pain, hematuria Tachycardia, Tachypnea, Hypotension Oozing from the IV site (DIC) Chills Headache Anxiety Cardiovascular collapse

Answer 13

Stop Transfusion Aggressive intravenous hydration urine output to be 100-200 cc/hr Prevent acute tubular necrosis Confirm correct transfusion was initiated Return blood, bag, tubing, labels, transfusion record to the blood bank Retype and crossmatch **Check Coombs test** → should be positive Coagulation studies (PT, PTT, Fibrinogen)- Risk of DIC DIC: Administer FFP and platelets

Answer 14

Rare reaction Usually occurs within 1 hour of transfusion Bacterial infection from a transfusion product that contains a microorganism Clinical features: Fever and/or chills Hypotension Management: Stop the infusion Culture the recipient’s blood and the donor’s blood Broad-spectrum antibiotics

Answer 15

Usually occurs right after the start of the transfusion; can be delayed up to 4 hours Clinical features: Angioedema Wheezing, respiratory distress (bronchospasm) Hypotension Nausea and/or vomiting Cardiac arrest or shock Management: Stop the transfusion Hemodynamic stabilization (IV fluids, vasopressors) Airway management Epinephrine, steroids, antihistamines