Osler 6

Question 1

Neonate transfusion dose?

Answer 1

Blood: 10-15 mL/kg

FFP: 10-15 mL/kg

Plt: 5-10 mL/kg

Cryo: 1-10 U/10kg

Question 2

Do neonates need 5-7 day old RBCs?

Worry of mannitol?

Are units leukoreduced, radiation needed?

Answer 2

No

Concern for >20 mL/kg it effects cerebral blood blow

Yes leukoreduced; Rads for preemies and immunocompromised

Question 3

What causes HDFN?

Labs?

Most common?

Rh, tx?

Answer 3

Mom’s IgG antibodies that attack RBCs of neonate (Paternal molecules)

Anemia; indirect hyperbilirubinemia; and DAT+

ABO most common: mon O, and Anti-A,B (IgG) crosses placenta; mild hemolysis

Rh: Rare, D- mom, D+ baby; Bilirubin below 20 mg/dL; Phototherapy/echange

Question 4

RhIg Indications?

Contraindications?

Answer 4

D- female @ 28 wks

D- female within 72 hrs of D+ delivery

D- with pregnancy complications

Contra: D- female WITH Anti-D (rule out previous RhIg administration last 6 months)

D+ females (weak D)

Question 5

RhIg Full dose 300 ug protects against how much D+ whole blood?

Mini-dose 50 mL protects against?

Answer 5

30 mL D+ whole blood or 15 mL RBCs

Mini: 5 mL D+ whole blood; 1st trimester Abs

Question 6

Fetal Rosette test?

Confirmatory test?

Answer 6

Mom’s blood look for D+ test: Add Anti-D and add indicator D cells and form Rosette’s

Kleihauer-Betke: Fetal hemoglobin is resistant to acid treatment; Maternal cells are ghosts, fetal cells pink. Count 2000 cells

Question 7

RhIg dose; round up or down?

Dosing:

Answer 7

<0.5 round up; if >0.5 or 0.5 round up one and again!

(%KB positive cells *5)/3

Question 8

How to calculate %compatible units?

Estimate number needed to be screened?

Answer 8

Multiple %negative for each unit

Needed to crossmatch= # units needed/Chance of combination

Question 9

What is corrected count incriment?

How to calculate?
Successful vs unsuccessful?

Answer 9

CCI= (Plt increase *BSA)/ Plt transfused

Successful: >7,500

<5000 on 2 or more refractory

Question 10

What is needed to dose Cryoprecipitate for Dosing?

Answer 10

BV, PV, mg Fibrinogen required (150 assumed)
BV: Body weghtx 70 mL/Kg

PV= BV * (1 -HCT)

Mg fibrinogen needed: PV * (desired level - current)/150

Contrainers of cryo: Mg fibrinogen nedded/150

Question 11

Factor 8 calculation requires?

Targets?

Answer 11

Body weight, HCT, F8 level and target

50% for hemarthrosis and 100% for surgery or major bleed

Units= PV (desired- current level)

Cryoprecipitate needed: Units needed/80 IU/unit

Question 12

Antibody indification check first?

Typical cold antibodies (Frigid five)?

Answer 12

Autocontrol for auto antibodies!!

LeA, LeB, M, N, P: do not react at body temp; clinically insignificant most of the time

Question 13

What is autoadsorption?

Answer 13

If autoantibody detected add Patient’s cells to remove to reveal underlying antibodies

Question 14

Lewis a- b- more common in blacks or whites?

S- s- U-?

Fy a- b-?

K+?

Answer 14

Le a-b-: Black 22%, 6% White

S- s- U-: <1% blacks, NEVER IN WHITES

Fy a- b-: 68% blacks, rare whites; protects against P. Vivax

K antigen: 2% black, 9% white

Question 15

Rule of B’s, exception?

Big 4 R/r white vs black?

Answer 15

B antigen more common unless Kidd

White: R1>r>R2>R0

Black: R0>r>R1>R2