S18C233 - Transfusion Therapy Flashcards
Total blood volume:
75cc/kg
5L in 70kg person
1 PRBC unit
-250cc transfused over 1-2h (no longer than 4h)
-will increase Hct by 3% and hemoglobin by 10
-indications: acute blood loss or profound anemia with impaired oxygen delivery
-thresholds:
symptomatic pt
Type and crosmatch:
- type takes 15mins
- cross match takes 1h
Platelet TFN: indications
-
Platelet TFN:
- one transfusion is typically 6 units and will raise platelets by 50
- check platelets at 1h and 24h
- platelets should survive 3-5d unless being actively consumed/destroyed
FFP: indications
- rapid reversal of warfarin
- bleeding and multiple coag defects
- correction of coag defect
- TFN of more than a total of one blood volume with evience of active bleeding/coagulopathy
- liver failure, DIC
- NOT required for paracenthesis, thoracentesis unless PT/INR/aPTT is >2x normal
- hereditary angioedema (FFP contains C1 esterase)
FFP:
- one unit has 200-250cc
- contains one unit each of coagulation factor and 2mg of fibrinogen permL
- monitor efficacy with PT, INR, aPTT
- takes 40mins to thaw, alternatives are PCC or factor VII
- need to administer 4 units to see an effect (will raise coag factors by 20%)
Cryoprecipitate: indications
-bleeding with a fibrinogen level
Cryoprecipitate
- cold insoluble protein fraction of FFP
- volume = 20-50cc
- contains 225mg of fibrinogena and 80 units of Factor VIII and vWF
- primary use: replacement of fibrinogen or vWF
- dose: 1 unit cryo per 5kg which will raise fibrinogen level by 2.2umol/L
- usually given in 10unit doses
IVIG indications
- ITP
- GBS
- pediatric HIV
- kawasaki
Albumin
-transiently increases oncotic pressure but rapidly disperses to extravascular space
Massive Transfusion
-defn: replacement of one blood volume or ~10units PRBC w/in first 24h
-PRBC:FFP: platelets should be given in 1:1:1 for massive TFN protocol
-other indications:
give platelets if 1.5
give cryoprecipitate if fibrinogen
Types of TFN rxn
- acute intravascular hemolytic rxn
- acute extravascular hemolytic rxn (Delayed hemolytic tfn rxn)
- febrile nonhemolytic tfn rxn
- Allergic rxn
Hemolytic TFN rxn (pt’s Abs attack donor cells)
ACUTE (intravascular hemolytic rxn)
- f/c, back pina, flushing dyspnea, tachy, shock, hemogloginuria, pulm edema, h/a
- stop tfn, IV hydration, retype and x-match, direct and indirect Coombs, CBC, cr, PT, PTT, haptoglobin, bili, LDH, u/a
- usually ABO incompatibility, high fatality, leads to DIC
DELAYED (acute extravascular hemolytic rxn)
- asymptomatic, may have low-grade fever
- presents days-weeks after tfn
- more common than acute rxn
- stop TFN, hemolytic w/u, rarely causes instability
- positive Coombs test, increased bili
Febrile TFN Rxns
- fever during or w/in a few hours of TFN
- common
- fever, rigors, h/a, myalgias, tachy, dyspnea, c/p
- occurs from recipient antbiody against donor leukocytes
