Special Transfusion Situations Flashcards
Exam 3
In the case of an emergent transfusion where no blood type is available what RBC type should be given to the patient?
O neg
In the case of an emergent transfusion where no blood type is available what FFP type should be given to the patient?
AB or A
What blood type should be given for a red cell neonatal transfusion?
ABO: O, Rh: type specific, Even if the baby is A, B, or AB, O should be given since mom’s antibodies are present in the neonate’s circulation and could destroy transfused blood.
What modifications should be performed on the red cells for a neonatal transfusion?
<7 days old, CMV negative or leukoreduced, freshly irradiated, hemoglobin S negative
Why are units used for neonatal transfusion <7 days old?
2,3-DPG levels quickly decline after collection and neonates are less capable of replenishing these levels after transfusion. Also, the fresher the unit the less plasma postassium present which can cause cardiac problems.
What speed of transfusion is considered a massive transfusion?
> 10 RBCs in 24 hours or >4 RBCs in 1 hour
What is the strategy for transfusing blood in a massive transfusion situation?
Transfuse blood products in predetermined ratios to ensure the patient is receiving enough of each component to maintain hemostasis. A common ratio is 4-6 RBCs, 4 FFP and 1 platelet.
What are some common causes of massive transfusion?
Trauma, obstetrics, surgery (especially transplants and heart), GI bleeding, aneurysm, bleeding with a coagulation deficiency
What are complications of massive transfusion?
Citrate toxicity and hypocalcemia, hemostatic abnormalities, hypothermia, hyperkalemia and hypokalemia, air embolism
Why are sickle cell patients often give phenotypically antigen matched RBC units?
They are chronically transfused and have high rates of alloimmunization. If antigen matched RBCs are given we can reduce the amount of antibodies a patient will make.
Why do oncology patients require RBC and platelet transfusions more often?
Bone marrow production of RBCs and platelets can be suppressed due to chemotherapy and radiation.
What is cytapheresis?
The reduction or removal of excessive or abnormal cellular elements in blood
When is leukaphersis used?
To treat patients with hyperleukocytosis to reduce the amount of circulating WBCs (Ex. AML patients)
When is plateletpheresis used?
To treat patients with abnormally elevated platelet counts to reduce the amount of circulating platelets (thrombocythemia), polythycemia vera, chronic myelogenous leukemia)
What is extracorporeal photopheresis and for what patients is used?
Patient leukocytes are collected and exposed to 8-methoxypsoralen and UV light to prevent DNA replication and reinfused. Used to treat cutaneous T-cell lymphoma, sezary syndrome, steroid-resistant chronic GVHD, solid organ transplant rejection.
