Transfusion

Question 1

What are the guidelines for RBC use?

Answer 1

• RBC transfusions should not be dictated by a hemoglobin trigger → should be based on patients risk of developing complications of inadequate oxygenation
  
  • RBCs rarely indicated when Hgb >10, usually indicated when <6

Question 2

What are the guidelines for Platelet use?

Answer 2

• Prophylactic platelet transfusions are INEFFECTIVE when thrombocytopenia is due to increased platelet destruction
  
  • Surgical patients usually need platelets when count is <50k, and rarely when >100k

Question 3

What are the guidelines for FFP use?

Answer 3

• FFP indicated for urgent reversal of warfarin

- Usually when PT and pTT are >1.5 times normal

Question 4

What are the guidelines for Cryo use?

Answer 4

Cryo should be considered for patients with von Willebrand’s disease that is unresponsive to desmopression, bleeding vW disease patients and patients with fibrinogen levels <80-100mg/dL.

Question 5

1. What is the shelf life of PRBCs?

2. When do adverse events related to old RBCs start?

Answer 5

1. Up to 42 days

2. >14-21 days

Question 6

What are some of the problems associated with old RBCs?

Answer 6

• Depletion of ATP
• Decreased 2,3 DPG
• → shifts the oxyhemoglobin curve to the left ⇒ increases Hgb’s affinity for O2 → decreased oxygen delivery and increased hemolysis
• Shape changes → increased fragility and may impair microcirculatory flow
• Old RBCs lead to increased risk for TRALI

Question 7

1. What is TRALI?
2. What are the s/sx?
3. Treatment and avoidance?

Answer 7

1. Volume overload is NOT the cause of pulmonary edema (LV six should be normal or low with RV dilation => Activated neutrophils release pro inflammatory substances that lead to damage to endothelial cells, vascular leakage and pulmonary edema.
2. Looks like ARDS: Acute onset (minutes to 6 hours), bilateral pulmonary infiltrates, and hypoxia WITHOUT evidence of HF
   Other symptoms: hypoxemia ratio of Pao2: FiO2 regardless of PEEP or oxygen saturation, pulmonary artery occlusion <18mmHg
3. Stop infusion and treat like ARDS; *Females have increased HNA and MHC antibodies so using male donors is better, or washing RBCs can help.

Question 8

1. What is TACO?

2. What are the s/sx?

Answer 8

1. Simply a volume overload state, where the rate of volume infusion of blood products is in excess of what the patient’s CV status can handle.
2. Acute onset (slower than TRALI), HTN, tachycardia, tachypnea, increased BNP levels
   
   • Other symptoms: dyspnea, elevated jugular venous pressure, Rales
   • Looks like TRALI → echo differentiates, will show hypervolemia, ventricular dysfunction and potential exacerbation of valvular dysfunction -> An exacerbation of HF is seen