Transfusion 2 Flashcards
Match each blood additive with its function.
Dextrose
Phosphate
Citrate
Adenine
Anticoagulant
Substrate for glycolysis
buffer
substrate for ATP synthesis
Dextrose–> substrate for glycolysis
Citrate–> anticoagulant
Phosphate–> buffer
adenine–> substrate for ATP synthesis
One unit of packed red blood cells contains about __________ mLs with a hematocrit of ________
300 mLs; 70%
Transfusion of one unit of PRBCs raises hemoglobin by ___________ g/dL and hematocrit by _____________
1 g/dL; 2-3%
Citrate is an anticoagulant that inhibits
calcium (factor 4)
A large citrate load can cause
hypocalcemia
Phosphate, dextrose, adenine, and other preservatives help to
offset the consequences of blood preservation (RBC storage lesion)
Consequences of the RBC storage lesion include
decreased 2,3- DPG, decreased pH, increased potassium, impaired ability to change shape, hemolysis, and increased production of proinflammatory mediators
_________________ removes WBCs from PRBCs and platelets
Leukoreduction
Leukoreduction reduces the risk of
HLA sensitization
febrile nonhemolytic transfusion reactions
CMV transmission
________________ removes any remaining plasma from donor RBCs
Washing
Washing prevents
anaphylaxis in IgA deficient patients
__________ destroys donor leukocytes
Irradiation
Irradiation reduces the risk of
graft vs. host disease in immunocompromised patients
Phosphate is a __________– that combats ______–
buffer; acidosis
Dextrose is the primary
substrate for glycolysis
Adenine is a substrate that
helps RBCs re-synthesize ATP
Adenine extends storage time from
21 to 35 days
Newer preservatives (Adsol, Nutricel, and Optisol) extend storage time to
42 days
The most common cause of platelet refractoriness is
HLA alloimmunization
Populations that benefit from irradiated cells include
leukemia
lymphoma
hematopoietic stem cell transplants
DiGeorge syndrome
Rank each infectious complication of transfusion from MOST common to LEAST common:
HIV, Hep C, CMV, Hep B
CMV, Hep B, Hep C, HIV
The most common infectious complication of transfusion is
cytomegalovirus
__________ greatly reduces the risk of cytomegalovirus
Leukoreduction
Immunocompromised patients should receive
leukoreduced blood
Risk of sepsis is most common with
platelets
Why is risk of sepsis most common with platelets?
b/c they are stored at room temperature which explains why bacterial contamination is more common
A patient with O blood received AB blood during surgery. Within five minutes, you observe hemoglobinuria, hypotension, and increased surgical bleeding. What actions should you perform at this time? (select 2)
a. slow the rate of transfusion
b. send an AST/ALT to the lab
c. administer sodium bicarbonate
d. give a crystalloid bolus
c. administer sodium bicarbonate
d. give a crystalloid bolus
____________ occurs when a patient receives an incompatible blood product.
A hemolytic transfusion reacton
The most lethal hemolytic transfusion reaction is
ABO incompatibility
Complications of a hemolytic transfusion reaction include
flushing, renal failure (acute tubular necrosis), DIC, & hemodynamic instability
Signs & symptoms of hemolytic transfusion reaction include
hemoglobinuria, hypotension, fever, chills, and flushing
Treatment of hemolytic transfusion reaction includes
stopping the transfusion, promoting renal blood flow, and alkalinizing the urine
Allergic transfusion reactions are rarely
severe
Allergic transfusion reactions present with
urticaria & facial swelling
Treatment for allergic transfusion reactions is
supportive and includes antihistamines
The most common adverse reaction associated with transfusion is
febrile transfusion reactions (non-hemolytic)
Patients with febrile transfusion reactions present with
fever
chills
headache
nausea
malaise
Treatment of febrile transfusion reactions is
supportive and includes acetaminophen
Signs and symptoms of an acute hemolytic reaction that are masked by anesthesia include
fever
chills
chest pain
dyspnea
nausea
flushing
List the 7 steps to treating an acute hemolytic reaction
- stop the transfusion
- maintain UO >75-100 mL/hr with: IV fluids, mannitol (12.5-25 g), furosemide (20-40 mg)
- alkalinize the urine with sodium bicarbonate
- send urine & plasma hemoglobin samples to the blood bank
- check platelets, PT, & fibrinogen
- Send unused blood to the blood bank to double-check the cross match
- Support hemodynamics with IVF and vasopressors as needed
What is the cause of allergic transfusion reactions?
foreign proteins in the donor blood product
Should a transfusion be continued if a patient has an allergic transfusion reaction?
minor rxn= continue transfusion
major reaction (dyspnea, laryngeal edema, or hemodynamic instability)= stop the transfusion and treat it as anaphylaxis
Fresh frozen plasma from which donor population imparts the HIGHEST risk of transfusion-related acute lung injury?
a. Jehovah’s witness
b. organ recipient
c. multiparous female
d. Creutzfeldt jakob
c. multiparous female
___________________ is a form of non-cardiogenic pulmonary edema that occurs following transfusion.
Transfusion related acute lung injury
The most common cause of transfusion-related mortality in the United States is
TRALI
TRALI is caused by
human leukocyte antigens (HLA) and neutrophil antibodies present in the donor plasma
The highest risk of TRALI stems from
FFP & platelets
High-risk donors for TRALI development includes
women with a history of multiple births
people with a prior hx of transfusions
people with a history of organ transplants
Signs and symptoms of TALI include
the onset of symptoms within 6 hours
bilateral infiltrates via CXR & low oxygenation
Management of TRALI is
supportive: maximize PEEP, use LPV techniques and avoid overhydration
_________________ is a state of volume overload caused by expanding the circulatory volume beyond the patient’s compensatory ability
Transfusion associated circulatory overload (TACO)
Signs and symptoms of TACO include
pulmonary edema, hypervolemia, increased PAOP, and left ventricular dysfunction
Treatment of TACO is
supportive
Patients at higher risk of suffering from TRALI include
critically ill (highest risk)
anyone susceptible to acute lung injuries such as sepsis, burns, or post-CPB
