Transfusion Flashcards
Organism - RBC antigen associations
Big I = Mycoplasma pneumonia
Little i = EBV
H and Lewis B = H. pylori
P = Parvovirus B19
Duffy = P. vivax
Life span of blood products
pRBCs
FFP
Platelets
Cryoprecipitate
pRBCs - 35 days with CPDA-1, 42 days with Additive Solution
FFP - 1 year at -18C, 7 yearss at -65C with FDA approval, 24 hours after thaw
Platelets - 5-7 days at RT
Cryo - 1 year frozen, 4 hours after thaw
Antibodies in hemolytic disease of newborn
anti-AB
anti-D
anti-K
anti-Fya
anti-C
anti-c
anti-S
Components of cryoprecipitate
Fibrinogen
vWF
Factor 8
Factor 13
Partial D vs weak D vs Rh null
Partial D - altered antigen, may type as D+ but need D- blood
Weak D - decreased levels, may type as D- on immediate spin but IAT D+, can receive D+ blood
Rh null - chronic hemolytic anemia
Blood type A2 typing
Forward type - A+
Reverse type - anti-A and anti-B (since make anti-A1 that react with commercial cells)
Acquired B typing
Forward type- strong A+, weak B+
(B antigen acquired from bacteria deacetylating A antigen)
Reverse type - anti-B
RhIG - one vial covers how much D+ blood?
One vial RhIG = 30 mL blood
RhIG - Kleihauer-Betke equation
-Get % fetal (microscopy)
-Assume 5L maternal blood
-Fetal volume = % fetal x maternal volume
- Divide fetal volume by 30 mL
If decimal .0 to .4 - add 1 vial
If decimal .5 to .9 - add 2 vials
Bombay vs Para-Bombay phenotype
Bombay: se/se h/h
No H antigens in blood or secretions
Para-Bombay: Se/se or Se/Se h/h
H antigens insecretions only
**Both need anti-H (Bombay) blood
Antigens enhanced by enzyme treatment
Enhanced - “A Rotten Kid LIP”
ABO
Rh
Kidd
Lewis
I
P
Antigens decreased by enzyme treatment
Decreased - “My Dog Lassie”
MNS
Duffy
Lutheran
Lewis A vs Lewis B genetics
Le gene makes Lewis A
Se gene makes H (H + LeA = LeB)
Le Le/le + Se Se/se = Lewis A+ Lewis B+ secretions and Lewis B+ RBCs
Le Le/le + se se = Lewis A+ LewisB- secretions and RBCs
le le + Se Se/se = Lewis A- Lewis B - secretions and RBCs (but still H+ secrtions)
Lewis antibodies - type, significance
anti-Lewis
IgM, clinically insignificant
I/i antibodies - significanc
anti-I/i
Clinically insignificant
Rh antigen nomenclature
R1
R2
R0
Rz
R = D+
R1 = DCe
R2 = DcE
R0 = Dce
Dz = DCE
Rh antigen nomenclature
r
r’
r’’
rgamma
r = D-
r = ce
r’ = Ce
r’’ = cE
rgamma = CE
MNS antibodies - exposure, type, significance
anti-M/N - natural, IgM, rare significance
anti-S - exposure, IgG, significant
Kell antibodies - significance
anti-K and anti-k - both very significant
McLeod Syndrome
McLeod syndrome
X-linked, absence of Kell antigens
Acantholytic hemolytic anemia and late onset neuromuscular
Duffy antibodies - type, significance
anti-Duffy
IgG, significant
Permanent donation deferrals
Dura mater graft
Bovine insulin, HGH or CJD
HBV, HCV, HIV, HTLV
Etretinate
Antiretroviral treatment
3 year donation deferrals
History of malaria, residence in malaria country > 5 y
1 year donation deferrals
Incarceration > 72 h
Sex with HBV
3 mo donation deferrals
Needle stick
HIV risks (MSM, money)
Hx transfusion
Travel to malaria
Syphilis or gonorrhea
Vaccine donation deferrals:
No deferral
2 week referral
4 week deferral
Vaccine deferrals:
- No deferral - toxoids, killed or recombinant vaccines
- 2 week - live attenutated, measles, mumps, polio, typhoid, yellow fever
- 4 week - Rubella, Chicklpox / shingles, unlicensed vaccines
Donation Physical Criteria
Weight
Temp
Pulse
BP
Hgb/Hct
Donation Criteria:
Weight - > 50 kg
Temp - < 99.5 F
Pulse - 50-100 bpm
Bp - 90-180 / 50-100
Hgb/hct- Females 12.5/38%, Males 13.0/39%
Expected change in Hgb from 1u pRBCs
1 g/dL Hgb (3% Hct)
Apheresis platelets - adv vs disadv
Apheresis platelets
Adv
- fewer allergic rxns
- less hemolysis from plasma
- single donor so can HLA match
Disadv - lower increment
Leukoreduction benefits
Leukoreduction:
- Decreased febrile reactions
- Decreased CMV transmission
- Decreased HLA immunization
Irradiation benefits
Irradiation:
- GVHD
RBC Washing Benefits
Washed RBCs (remove plasma and Igs):
- Large volume to K sensitive patients, esp neonates when fresh units not avail
- History of plasma-related reactions (eg IgA defic or anaphylactic rxns)
Indications for plasma transfusion
Plasma indications:
Bleeding with multiple factor defic:
- Liver disease
- DIC
- Dilutional coagulopathy
Congenital factor defic with no concentrates - 5 and 11
Life threatening anti-coagulation reversal
RBC lifespan after irradiatio
Original date or 28 days after irradiation
Acute hemolytic reaction
Sx
Labs
Tx
Acute hemolytic reaction
- Sx: fever, pain. Severe: hypotension, dyspnea
- Labs: positive DAT, indirect hyperbiliubinema, schistocytes or spherocytes
- Tx: volume and BP support, maintain urine
Transfusion related sepsis
Sx
Dx
Prevention
Transfusion related sepsis
- Sx: fever > 38C with > 1 C increase, rigors, hypotension
- Dx: Gram stain, culture matching patient
- Prevention: clean skin, divert first 10-40 mL to container
Febrile non hemolytic reaction
Sx
Dx
Timing
Tx
FNHTR
- Sx: shaking, increase RR, change in BP
- Dx: >38C with > 1 C increase.
- Timing: within 4 hours
- Tx: stop transfusion, check no hemolysis
Allergic Transfusion Reaction
Sx
Timing
Tx
Prevention
Allergic Transfusion Reaction
- Sx: urticaria
- Timing: within 4 hours
- Tx: pause transfusion, give antihstamine, resume once resolves
- Prevention: wash products
TACO
Sx
Dx
Tx
Prevention
TACO
- Sx: tachycardia, hypertension, dyspnea
-Dx:
Three of more of:
- One of - A) acute or worsening resp compromise, B) Evidence of worsening pulmonary edema (clinical or radiographic)
- CV changes (tachy, BP, EKG)
- Fluid overload (resp to diuretics, weight)
- Releveant biomarker (BNP)
- Tx: stop tfn, O2. diuretics
- Prevention: transfuse at risk patients slowly (2-4 mL/min or 1 mL/kg per hour)
Delayed hemolytic reaction
Sx
Labs
DHTR
- Sx: often none but can be fever, anemia, jaundice
- Labs: increased LDH, bilirubin, DAT+, newly positive screen, spherocytes
Transfusion associated GVHD
Sx
Prevention
Transfusion associated GVHD
- Sx: erythroderma, vomiting, diarrhea, hepatitis, pancytiopenia
- Prevention: irradiation at risk patients ( tfn from blood relatives or HLA compatible)
Indications for irradiation of products
Indications for irradiation:
- Intrauterine transfusions
- Prematurity, low birthweight
- Congenital immunodef
- Heme malignancy
- Stem cell transplant
- Crosmatched or family donation
- Fludarabine therapy
Typical cold RBC antibodies
Le a
Le b
M
N
P
