TM / path Flashcards
PRBC: preparation, storage temp, storage duration
centrifuge whole blood and filter (leukoreduction, remove plt)
2-6C storage
35 d
plt: preparation, storage temp, storage duration
apheresis
pooled: 4 donors; whole blood buffy coat + filter leukoreduction
20-24C (room temp) w constant gentle agitation
5-7d
FFP : preparation, storage temp, storage duration
apheresis
whole blood centrifugation
- FFP means frozen <8h from collection
< -18C, 2-6C once thawed
1y
5d thawed
28d never frozen
Cryo: preparation, storage temp, storage duration
insoluble precipitate on centrifugation of FFP
< -18C
1y
plasma derived product preparation
pooled samples from cold ethanol fractionation
Cryo includes:
Fibrinogen, VIII, XIII, VWF
examples of plasma derived products
IVIG
albumin
PCC
rhogam
coagulation factors
IVIG indications
ITP, NAIT, HDNF
primary immunodeficiency
secondary immunodeficiency (hypogamm, post ritux, post BMT)
Kawasaki
HIV
neuro: GBS, chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, myasthenia gravis
IVIG S/E
common: rash, h/a, flushing, arthralgia, mild temp increase, tachypnea/tachycardia
severe: hypotension, fever/chill/rigor, bronchospasm, allergy/anaphylaxis, rare aseptic meningitis
Post: neutropenia, hemolytic anemia (10%), h/a, fluid overload, thrombus (1%)
Dose and expected rise with PRBC, plt, FFP, cryo
PRBC: 15 cc/kg - 20 point rise
plt: 10 cc/kg - 30-50 point rise
FFP: 10-20 cc/kg - increase of 30-50%
cryo: 1 U/10kg to max 10 U - fibrinogen increase by 0.5 g/L
FFP indications
TTP
INR >1.8, PTT > 1.5x ULN
MTP
PLEX replacement fluid
factor deficiency replacement (no specific product available)
warfarin reversal (if PCC unavailable)
Cryo indications
Riastap preferred!
APL
DIC
MTP
hypofibrinogenemia
leukoreduction benefits
reduced TA-GVHD
reduced FNHTR
reduced HLA alloimmunization
reduced CMV
PRBC irradiation pro/con, indications
Pro: reduces TA-GVHD risk (by removing T cells)
Con: shortens shelf life, may increase K
IUT
immunocompromised
directed donation
post BMT/some chemo, malignancy (HL)
neonates <1yo
when/how to cryopreserve PRBC
rare blood donor program
< -65C in glycerol
lasts 10y
which viruses not destroyed by viral inactivation
parvovirus
hepatitis A
development of RBC Ag/Ab
Glycotransferases add A or B Ag to H Ag (fucose) base chain
lack of H = Bombay
anti-A and -B Ab are formed early in life from exposure to similar appearing Ag
Bombay phenotype is
lack of H (fucose) base chain
Describe forward vs reverse typing
forward: pt RBC + anti_ reagant (testing for pt Ag)
reverse: pt plasma + test RBCs (testing for pt Ab)
blood group incidence (including Rh)
O 45%
A 40%
B 10%
AB 5%
Rh+ 85%
forward/reverse typing inconsistency reasons
lab error
immunosuppression
young infants
ABO-mismatch HSCT
chimerism
extra reverse typing: recent non-matched transfusion, autoAb, Rouleaux
missing reverse: infant, immunosuppression
standard vs extended vs full phenotype matching
Standard: Rh (DCE), K
Extended: Rh, K, Jka, Jkb, Fya, Fyb
Full: Ss
Most immunogenic RBC Ag
D (50%) > K (5%) > c > E > k > e …
risk with directed donations
increased:
- TA-TMA
- infection
- cost/waste
plt refractoriness assessment
CCI = [ (plt increment/u] x BSA ] / #plt transfused x10^11
(use 3x10^11 for standard transfusion)
refractory is CCI <5000 x2
Transfusion infectious risks
HIV 1/ 21.4 M
HCV 1/ 12.6 M
HBV 1/ 7.5 M
HTLV 1/ 7.6 M
plt bacteria 1:10k - death 1:200k
Common transfusion risks
mild allergic 1/100
FNHTR 1/200
TACO 1/700
TRALI 1/5000
DHTR 1/7000
anaphylaxis 1/40k
death 1/1M
transfusion fever DDx
FNHTR
hemolysis
sepsis
TRALI
non-transfusion related
Transfusion reaction mgt
stop transfusion
vitals
symptom mgt
check product
report
investigations
return blood to lab
transfusion major vs minor ABO incompatability
major: recipient anti-donor
minor: donor anti-recipient
when can you do electronic over serologic crossmatch
if 2 previous ABO, no Ab hx, negative Ab screen
review Ab screening (:
(‘:
(See TM/HP Answers document @ bottom)
Fridge-thriving bacteria (PRBC)
yersinia
listeria
serratia
CONS
TRIPICU study results
PRBC threshold of 70 vs 95 had 50% decrease in transfusions, no clinic differences
plasmapheresis indications
TTP
neuro: myasthenia gravis, GBS, transverse myelitis
autoimmune: ANCA vasculitis, FSGS
CAPS
Ab mediated solid organ transplant rejection
Extracorporeal photopheresis method and indications
apheresis with UV light crosslinks DNA to prevent T cell proliferation
GVHD steroid refractory
cellular solid organ transplant rejection
cutaneous T cell leuk/loma
Small round blue cell tumors
LEARN NMR
lymphoma
Ewing
ALL
RMS
NBl
neuroepithelioma
Medullo
Retinoblastoma
