Test 2 Blood Component Therapy Flashcards

Question

Complications of PRBC transfusions

Answer 1

Infectious disease Hemolytic reaction Allergic reaction Hypothermia Electrolyte disturbances Citrate intoxication (multiple rounds)

Answer 2

Performed at time of collection Removes 80-95% of WBCs and virtually all plasma Decreased K+ level Esquires a hour for processing Must be transfused w/in 24 hours

Answer 3

Performed within 6 days of collection Can be stored for 10 years Thawing and removal of cryoprotectant eliminates virtually all plasma and 99% of WBC Require 90 minutes for processing Must Must be transfused w/in 24 hours

Answer 4

Prevention of reaction caused by infusion of WBCs and foreign proteins Remove of most leukocytes bay also decrease risk of alloimmunization and transmission of CMV

Answer 5

Hemolytic reaction Hypothermia Electrolyte disturbances Citrate intoxication Infectious disease

Answer 6

Exposed to a measured amount of radiation Donor lymphocytes incapable of replication Performed prior to release Labeled “irradiated” Carries NO radiation risk

Answer 7

Hodgkin’s or non-Hodgkin’s lymphoma Acute leukemia Congenital immunodeficiency disorders Low birth weight neonates Intrauterine transfusions Bone marrow transplants

Answer 8

Prevention of GVHD

Answer 9

Hemolytic reaction Hypothermia Electrolyte disturbances Citrate intoxication Infectious diseases

Answer 10

200-400 mL in 4-6 pooled or single apheresis unit Removed from 4-6 units of whole bood Contain some RBCs 35-50 mL/unit

Answer 11

5.5x10^10 PLT in 50-70 mL plasma per unit

Answer 12

30x10^10 PLT in 200-400 mL plasma per unit

Answer 13

Random donor Single donor HLA- matched

Answer 14

Thrombocytopenia (chemotherapy) Platelet dysfunction PLT < 10-20,000 or active bleeding and PLT < 50,000 S/S: petechia, gun bleeding, ecchymoses, hematuria, bloody stool NOT FOR: Immune thrombocytopenic purpura Prophylaxis with massive blood loss or CABG

Answer 15

Do NOT refrigerate - max storage 5 days ABO testing not necessary but usually done Infusion rate: - 10 ml/min - infused within 4 hours

Answer 16

Do NOT use RBC filter Use component set with 170-micron filter obtained from blood bank Leukocyte-poor filters also available 19 gauge or larger needle 0.9% NS

Answer 17

Prevention or resolution of bleeding d/t thrombocytopenia or PLT dysfunction 1 unit of platelets > - increase count by 5,000/µL PLT count within one hour of transfusion

Answer 18

Infectious disease Allergic reactions Febrile reactions

Answer 19

200-250 mL/unit Plasma rich in clotting factors with platelets removed 91% water 7% proteins (clotting factors, albumin, globulins, antibodies) 2% carbohydrates Freezing within 6 hours preserves clotting factors

Answer 20

Demonstrated deficiency of clotting factors - DIC (Disseminated Intravascular Coagulation), liver disease, coagulopathies PT or PTT > 1.5 x normal NOT FOR: Volume expansion Nutritional supplement Prophylaxis with massive blood loss of CABG

Answer 21

Contains no RBCS Administer ABO and Rh compatible plasma Transfuse within 24 hours of thawing Infusion rate: 200 mL/hour Slower if risk of circulatory overload

Answer 22

Do NOT use RBC filter Use component set with 170-micron filter from blood bank 19 gauge or larger 0.9% NS NEVER add meds or diluent

Answer 23

Monitor coagulation function (PT and PTT) Specific factor assays

Answer 24

Allergic reaction Febrile reaction Circulatory overload Infectious disease

Answer 25

~ 30 mL Lyophilized concentrate containing Factor VIII 250 mg of fibrinogen 20-30% Factor XIII From large pools or donor plasma Heat a/o solvent-detergent treatment eliminates risk of viral transmission

Answer 26

Factor VIII - factor VIII deficiency (Hemophilia A) - Von Willebrand’s disease - hypofibrinogenemia - factor XIII deficiency Factor IX deficiency (Hemophilia B)

Answer 27

Dose is calculated based on plasma volume 8-10 badges supply 2 g of fibrinogen (Hemostatic dose) Repeat doses may be necessary to attain satisfactory serum levels Rate of infusion: ~ 1-2 mL?min Usually 4 units (60 mL) in 15 minutes

Answer 28

Blood comment admin set with 170-micron filter obtained from bank 19 gauge or larger 0.9% NS NEVER add meds or diluent other than NS

Answer 29

Hemostasis d/t increased level of deficient factor Correction of factor and fibrinogen deficiencies Cessation of bleeding Lab values required to assess effectiveness

Answer 30

Allergic reactions Hepatitis

Answer 31

Prepared from plasma Albumin: - 96% albumin - 4% globulins and other proteins - available as: 5% iso-oncotic or 25% solution Plasma Protein: - 83% albumin - 17% globulins - available as: 5% solution

Answer 32

Volume expansion - plasma exchange - shock - massive hemorrhage Acute liver failure Burns Hemolytic disease in newborn

Answer 33

5%: 1-10 mL/min - faster in shock but associated with hypotension 25%: 0.2-0.4 mL/min - significant increased blood volume and BP ABO NOT a factor

Answer 34

51-10 mL/min ABO NOT a factor

Answer 35

19 gauge or larger Standard IV transfusion set May require specific filter Set and filter may be supplied with solution

Answer 36

Acquire and maintain adequate BP and volume support

Answer 37

Circulatory overload Febrile reaction Compatibility NOT a factor since no ABO blood group antibodies present CANNOT transmit hepatitis or HIV infection since pasteurization process used to prepare destroys virus

Answer 38

Concentrated aqueous solution of gamma globulins containing a higher tiger of antibodies

Answer 39

Obtained from a a large pool of random donors Used to increase game globulin levels and enhance immune response

Answer 40

Prepared from donors with high antibody titers to known antigens Hepatitis B immune globulins (HBIG) Rh (D) Immune Globulin (RhIG) aka RhoGam Varicella-Zoster Immune Globulins (VZIG)

Answer 41

Provide passive immune protected - HBIG - following exposure to HBV - RhIG - following exposure to Rh antigens through transfusion or pregnancy to prevent antibody dev - VZIG - immuno-compromised patient exposed to chicken pox Treat hypogamma-globulinemia

Answer 42

Patients with a history of severe allergic reactions to plasma should NOT receive ISG Neither HIV not Hep-B is transmitted by ISG however some intravenous gamma globulins solutions have been reported to transmit Hep-C

Answer 43

Most given IM but can be IV IM injections may be painful and result in local irritation - use warm compress NEVER give IM preped IV d/t risk of anaphylaxis READ package inserts carefully Give ISG prior to or as soon after exposure as possible RhIG and VZIG MUST be admined within 72 hours of exposure for optimal effect

Answer 44

Admin only using a filter DO NOT admin with other meds Begin infusion within 2 hours after reconstitution

Answer 45

Transient correction of gamma globulins deficiency or prevention of disease through the passive administration of antibodies

Answer 46

1 unit contains: - a minimum of 1.0x10^10 granulocytes - variable amounts of lymphocytes - 30-50 mL of RBCs - 100-400 mL f plasma - 6-10 units of platelets (optional) Volume: With platelets: 200-400 mL Without platelets: 100-200 mL

Answer 47

Acquired neutropenia - chemotherapy - radiation Congenital WBC dysfunction Serious infection unresponsive to conventional antibiotics Long term therapeutic benefits stills questionable

Answer 48

1 unit daily - 1.0x10^10 granulocytes Give slowly over 1-4 hours Have short survival time Infuse ASAP (within 24 hours) To prevent reaction premedication with: - antihistamines - acetaminophen - steroids - meperidine

Answer 49

Standard blood component set with 170-micron filter from bank 19 gauge or larger 0.9% NS NEVER add meds or diluent do NOT use depth type microaggregate or leukocyte depletion filter that could trap WBCs during infusion

Answer 50

Improvement in or resolution of infection No increase in peripheral WBC is seen in adults but may be seen in children Improvement in clinical condition is only measurement of effectiveness

Answer 51

Rash Febrile reaction * Hepatitis Increased incidence of febrile, nonhemolytic reactions with transfusion of granulocytes * - infuse slowly - observe patient closely do NOT admin Amphotericin B w/in 4 hours of granulocytes infusion d/t risk of pulmonary insufficiency

Answer 52

Acute hemolytic Febrile, non-hemolytic (most common) Mild allergic Anaphylactic Circulatory overload Sepsis Transfusion related a true lung injury (TRALI)

Answer 53

Delayed hemolytic Hepatitis B Hepatitis C HIV-1 infection Iron overload GVHD Other: CMV, HTLV-I, malaria

Answer 54

Fever ^ 1-2 degrees C Chills Muscle aches and pains Back pain Chest pain Headache Heat at site of infusion or along vein

Answer 55

Apprehension Sense of impending doom Tingling, numbness

Answer 56

Respiratory rate - tachypnea - apnea Dyspnea Cough Wheezing Rales

Answer 57

N/V Pain, abdominal cramping Diarrhea (may be bloody)

Answer 58

Changes in urine volume - oliguria/anuria - retail failure Change in urine color - dark, concentrated - shades of red, brown or amber - may indicate presence of RBCs or hemoglobin in urine

Answer 59

Heart rate - bradycardia - tachycardia Blood pressure - hypotension, shock - hypertension Peripheral circ - cyanosis, facial flushing - temp: cool/clammy, hot/flushed/dry Bleeding - generalized (DIC) - oozing at surgical site

Answer 60

Rashes/ hives/ swelling Itching Diaphoresis

Answer 61

Weak pulse Fever Hypotension Visible hemoglobunuria Increased operative bleeding Vasomotor instability Oliguria/anuria

Answer 62

Infusion of ABO-incompatible whole blood, RBCs or components containing 10 mL or more RBCs Antibodies in the recipients plasma attach to antigens on transfused RBCs causing destruction

Answer 63

Chills and fever Low back pain Flushing Tachycardia Tachypnea Hypotension Vascular collapse Hemoglobinemia Bleeding Acute renal failure Shock Cardiac arrest Death

Answer 64

STOP TRANSFUSION Treat shock if present Draw blood samples for serologic testing slowly to avoid hemolysis Send urine to specimen lab Maintain BP with IV colloid solutions Give diuretics to maintain output Insert in dwelling catheter or maintain urine output Dialysis if renal failure

Answer 65

Meticulously verify and document patient identification from sample collection to component transfusion

Answer 66

Sensitization to donor WBCs, PLTs or plasma proteins

Answer 67

Sudden chills Fever (above 1 degrees C or 2 F) Headache Flushing Anxiety Muscle pain

Answer 68

Give antipyretics as prescribed AVOID aspirin in thrombocytopenic patients DO NOT restart transfusion

Answer 69

Consider leukocyte poor blood produces

Answer 70

Sensitivity to foreign plasma proteins

Answer 71

Flushing Itching Urticaria (hives)

Answer 72

Give antihistamines as directed If symptoms are mind and transient - transfusion may be restarted slowly DO NOT restart transfusion if fever or pulmonary symptoms develop

Answer 73

If it has happened before treat prophylactically with antihistamines

Answer 74

Infusion of IgA proteins to IgA-deficient recipient who developed IgA antibody Kind of like shock

Answer 75

Anxiety Urticaria Wheezing Progression to: - cyanosis - shock - possible cardiac arrest

Answer 76

Initiate CPR if indicated Have epinephrine ready for injection DO NOT restart transfusions

Answer 77

Transfuse extensively washed RBC products from which all plasma is removed Use blood from IgA deficient donor

Answer 78

Fluid administered faster than circulation can accommodate

Answer 79

Cough Dyspnea Pulmonary congestion (rales) Headache Hypertension Tachycardia Distended neck veins

Answer 80

Place patient upright with feet in dependent position Admin prescribed diuretics O2 and morphine Phlebotomy may be indicated

Answer 81

Adjust transfusion volume and flow rate based on patient size and clinical status Have transfusion service divide unit into smaller aliquots for better spacing of fluid input

Answer 82

Transfusion of contaminated blood components

Answer 83

Rapid onset of chills High fever Vomitting Diarrhea Marked hypotension Shock

Answer 84

Obtain culture of blood and send bag with remaining blood to transfusion services for further studying Treatment septicemia as directed - antibiotics - IV fluids - vasopressors - steroids

Answer 85

Collect process store and transfuse blood products according to blood bank standards and infuse within 4 hours of starting time

Answer 86

Transfused donor WBCs react with recipients WBCs resulting in agglutination and aggregation in lungs and pulmonary damage

Answer 87

Dyspnea Fever Wheezing Chills Bronchospasm Crackles Restlessness Non-productive cough Pulmonary infiltrates Hypo or hypertension

Answer 88

STOP TRANSFUSION Maintain patent IV line Place is supine position Maintain open airway -mechanical ventilation if necessary Obtain VS and record Notify physician Admin fluids and epinephrine, steroids, diuretics per orders Admin O2 Monitor VS and output Document events

Answer 89

Fever Mild jaundice Decreased Hct

Answer 90

D/t destruction of transfused RBCs by alloantibodies not detected during cross match Can be as early as 3 days or as late as serval months after but using 7-14 days after

Answer 91

Generally no acute treatment required Hemolysis may be severe enough to warrant further transfusion

Answer 92

Elevated liver enzymes (AST & ALT) Anorexia Malaise N/V Fever Dark urine Jaundice

Answer 93

Usually resolves spontaneously within 4-6 weeks Chronic Carrier state can develop and result in permanent liver damage Treat symptomatically

Answer 94

Similar to Hepatitis B except symptoms are usually less severe Chronic liver disease and cirrhosis may develop

Answer 95

Before anti-HCV test accounted for 90-95% of all post transfusion hepatitis Treatment symptomatically

Answer 96

May be asymptomatic for us to several years May develop flu like symptoms within 2-4 weeks Later symptoms: - weight loss - diarrhea - fevers - lymphadenopathy - thrush - pneumocystis pneumonia

Answer 97

Very low risk of infection from a single blood transfusion 1:30,000 to 1:1,500,000

Answer 98

Congestive heart failure Arrhythmias Impaired thyroid and gonadal function Diabetes Cirrhosis Commonly occurs in patients receiving > 100 units for chronic anemia

Answer 99

Treat symptomatically Deferoxamine (Desferal) - chelates and removed accumulated iron via the kidneys - may be administered IV or SubQ

Answer 100

Fever Rash Diarrhea Hepatitis

Answer 101

Results of replication of donor lymphocytes (graft) in the transfusion recipient (host) that attack recipients RBCS (esp in immunocompromised patients)

Answer 102

No effective therapy available PREVENTION: Irradiated blood produced intended for immunocompromised patients May also be indicated for first degree family members’ donations