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Hematology/Oncology > transfusion > Flashcards

transfusion Flashcards

1
Q

what are the available blood products

A

packed rbc, plasma, cryoprecipitate, platelets

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2
Q

what do you use to increase oxygen carrying capacity

A

packed rbc

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3
Q

what do you use to replace clotting factors

A

plasma

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4
Q

what do you use to stop bleeding when a patient has a low platelet count, or rarely - to prevent bleeding with low platelet count

A

platelets

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5
Q

what is the term for low platelet count

A

thrombocytopenia

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6
Q

what is plasma also called

A

FFP fresh frozen plasma

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7
Q

what is max storage time for packed rbc and why was it chosen

A

42 days bc only up to 25% of stored rbc will lyse within 24 hours of transfusion

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8
Q

how do you prep packed rbc

A

differential centrifugation- spin them down, pull of plasma and platelets

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9
Q

how many mL are in 1 unit of blood (packed rbc)

A

250 mL

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10
Q

how much will 1 unit of packed rbc increase hemoglobin by

A

1 g/dL

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11
Q

do packed rbc have to be abo comp

A

yes

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12
Q

what are leukoreduced prbcs

A

steps were taken to remove MOST leukocytes

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13
Q

what are irradiated prbcs

A

all leukocytes were killed

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14
Q

when do you use cryoprecipitate

A

to replace fibrinogen, factor VIII, factor XIII, and vWF

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15
Q

what is cryoprecipitate

A

proteins that precipitate out of plasma at 4 degrees

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16
Q

cryoprecipitate is used to treat genetic or acquired def of the factors but factor VIII def (hemophilia A) is usually treated with

A

factor VIII concentrate

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17
Q

what is factor VIII def

A

hemophilia A

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18
Q

what is vWF def usually treated with

A

“by other means” other than cryoprecipitate

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19
Q

why is cryoprecipitate’s low risk volume ratio better than plasma sometimes

A

bc it requires only low volumes and thus will not get the volume overload that plasma may cause

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20
Q

how do you prepare plasma

A

differential centrifugation, spin down red cells and pull off the plasma

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21
Q

how much is in 1 unit of plasma

A

200-250 mL

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22
Q

how much will 1 unit of plasma increase clotting factors by

A

20%

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23
Q

what is plasma stored at

A

-20 degrees

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24
Q

does plasma have to be abo comp

A

yes

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25
Q

how much is in one unit of cryoprecipitate

A

15 mL

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26
Q

how much does 1 unit of cryoprecipitate raise factor level by

A

5-10 mg/dL

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27
Q

what can you store cryoprecipitate at

A

-20 deg

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28
Q

does cryoprecipitate have to be abo comp

A

no

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29
Q

when do most people start spon bleeding

A

platelet count below 10 K per microL

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30
Q

when are platelet transfusions ordered

A

low platelet count AND bleeding

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31
Q

how are platelets prepared

A

usually plasmaphoresis but less often diff centrifugation

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32
Q

how does differential centrifugation work with platelet prep

A

get 1 unit of blood per donor (x 5 donors) = about same number of platelets per apheresis unit

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33
Q

do platelet preps contain donor plasma

A

yes

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34
Q

do platelets express abo antigens

A

yes

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35
Q

how is prep done for platelet plasmapheresis

A

Spin down the red cells in a continuous flow centrifuge

Pull off the platelets, reinfuse red cells and plasma

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36
Q

how many mL per apheresis unit of platelets

A

300

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37
Q

how much will 1 unit increase platelet count by

A

25 K/microL

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38
Q

what is normal platelet count

A

150-450 K/microL

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39
Q

can you refrigerate platelets

A

no

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40
Q

how long is room temp storage life for platelets

A

4-5 days

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41
Q

do platelets have to be abo comp

A

no

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42
Q

what is most common reason to transfuse patient

A

severely anemic (cannot transport enough oxygen to stay alive)

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43
Q

what do you transfuse in anemic patients

A

packed rbcs

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44
Q

what do you want to avoid in blood transfusion

A

having patient’s immune system attack and lyse the transfused cells

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45
Q

what kind of antigens are on red cells surface

A

number of proteins; and complex carbs on lipids or proteins

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46
Q

what is the core structure of the complex carbs on red cell surface

A

O antigen

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47
Q

what is the H antigen

A

4 sugar precursor to the O antigen seen in very rare cases - WE NEED TRANSFUSION SPECIALISTS

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48
Q

What is structure of O antigen

A

5 linked hexameric sugars

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49
Q

what are the 5 sugars in O antigen

A

GlcNac, Gal, GlcNac, Gal, Fucose

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50
Q

what does ABO glycosyltrasnferase do

A

attaches 6th sugar to O antigen

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51
Q

for the A allele what does ABO glycosyltrasnferase transfer to O antigen

A

GalNac

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52
Q

for the B allele what does ABO glycosyltransferase transfer to O antigen

A

Gal

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53
Q

for the O allele what happens to the ABO glycosyltransferase

A

inactive

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54
Q

what are individuals terms with two A alleles

A

blood group A

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55
Q

what are individuals termed with two ABO glycosyltransferases that transfer GalNac

A

blood group A

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56
Q

what are individuals terms with two B alleles

A

blood group B

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57
Q

what are individuals termed with two ABO glycosyltransferases that transfer Gal

A

blood group B

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58
Q

individuals with only O alleles are termed

A

blood group O

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59
Q

what are individuals termed with two ABO glycosyltransferases that are inactive termed

A

blood group O

60
Q

what are individuals with one A and one B allele termed

A

blood group AB

61
Q

what are individuals termed with one ABO glycosyltransferase that carries GalNac and one that carries Gal

A

blood group AB

62
Q

what are individuals with one O allele and one A allele termed

A

blood group A

63
Q

what are individuals with one O allele and one B allele termed

A

blood group B

64
Q

what are individuals termed with one ABO glycosyltransferase that is inactive and one that carries GalNac

A

blood group A

65
Q

what are individuals termed with one ABO glycosyltransferase that is inactive and one that carries Gal

A

blood group B

66
Q

what antibodies do most type A individuals produce

A

antibodies to B antigen that are IgM, present in high concentration or titer

67
Q

how do antibodies to blood antigens lyse rbc

A

fix complement

68
Q

who can type O blood be tranfused to

A

anyone

69
Q

what happens if patient is transfused

A

lyse them all very quickly called acute hemolytic transfusion rxn

70
Q

what is antigenicity

A

a measure of how likely it is that a potential antibody binding site will actually induce an antibody response

71
Q

are antibodies always hemolytic for protein antigens on rbc

A

no

72
Q

what are tge two most antigenic proteins on red cells

A

RhD and RhCE

73
Q

what is the mmost common and significant allelic variation in Rhd

A

a complete deletion of the coding sequence

74
Q

The Rhd gene duplicated and formed what

A

RhCE to have C/c and E/e antigenic sites

75
Q

what are individuals with two deleted D alleles called

A

Rh negative or D negative

76
Q

15% of europeans have what type of Rh

A

Rh negative which means they make antibodies to Rh

77
Q

pregnancy can immunize what type of mother to D

A

D-

78
Q

what can anti-d antibodies do in pregnancy

A

lyse fetal red cells, causing spontaneous abortion OR severe anemia (hemolytic disease of the newborn).

79
Q

how can Immunization during pregnancy and/or delivery can be prevented

A

anti-Rh-gamma globulin

80
Q

no women at or below childbearing status must ever be able to develop what type of antibody

A

anti d

81
Q

we need to know what status for donors and recipients of transfusions

A

d antigens and antibodies

82
Q

over 80% of d- inviduas tranfused with d+ blood develop what and who is this acceptable for

A

anti d antibodies; males and OLDER females

83
Q

for d- girls and young women what type of blood must never be transfused

A

d+

84
Q

what type of blood must be transfused if they have anti d antbidoes

A

d-

85
Q

can d+ cells be transfused to d- patients

A

yes

86
Q

does plasma contain abo antigens

A

yes

87
Q

if a recipients lacks an entire class of plasma proteins what can develop after transfusion and what is most common example

A

antibodies; people lacking IgA (if transfused after having dev antibodies, can dev a severe allergic reaction)

88
Q

how long do platelets normally live

A

10 days

89
Q

if ABO incompatible what happens to platelets in transfusion

A

their survival will be shortened, but that is not felt to impair their utility for treating an acute bleeding episode.

90
Q

do platelet preps contain plasma

A

yes , about 1 unit per unit

91
Q

is it ok to transfuse incomp ABO plasma in platelet transfusion

A

yes

92
Q

if a patient has a low blood volume (neonate), risk associated with incomp abo plasma is what compared to normal and is avoided by what

A

higher; abo compatible transfusion or resuspending platelets in low volume plasma

93
Q

Patients tend to become less responsive to platelet transfusion after how many transfusions

A

5-10; platelets stop going up

94
Q

patients who donate plasma are not allowed to have what in their blood

A

anti d antibodies

95
Q

After one or more transfusions, patients can develop antibodies to what

A

other minor red cell antigens

96
Q

blood banks must screen recipients for any what prior to transfusion

A

antibodies to red cell antigens

97
Q

what is process of getting compatible red blood cells from bank?

A

physician provides recipient sample to get tested for ABO type, Rhd status and screened for antibodies for any known red cell antigens; a crossmatch usually performed

98
Q

what is a crossmatch

A

mix donor red cells and recipient plasma - look for agglutination

99
Q

in an emergency you take a chance by transfusing with

A

O negative, type compatible units

100
Q

what happens if the antibody test is positive when testing for compatibility of red blood cells

A

identify antibody/antibodies, obtain pRBCs that do not contain antigen, perform cross match

101
Q

if your patient is going into surgery what do you need ready and why

A

2 units of prbcs ready in case of unexpected bleeding, if you wait until they need it the time it takes to identify compatible units can be the difference between keeping your patient alive and not doing so if antibody test is positive

102
Q

what is the objective of red cell transfusion

A

increases patient’s oxygen carrying capacity

103
Q

what is the stuff in blood that carries oxygen

A

hemoglobin

104
Q

what is hematocrit

A

fraction of blood occupied by cells

105
Q

what is hematocrit usually

A

3 times hemoglobin

106
Q

what is purpose of transfusing red cells in massive blood loss

A

restore blood volume

107
Q

how many lab measurements is hemoglobin

A

1

108
Q

how many lab measurements is hematocrit

A

2 measurements on hematology analyzer

109
Q

what are the indications for red cell transfusion

A
  1. when patient is symptomatic (increased HR, increased RR, confusion, weakness, dizziness)
  2. acute blood loss and/ or rapid volume expansion
  3. during or immediately after acute MI
  4. clear Hgb trend that you cant yet reverse
110
Q

what does acute MI mean

A

the patient has just cut off the blood supply to part of their myocardium, which in turn means that their coronary arteries are, at least in one spot, a bit on the narrow side (or completely occluded). Enhanced oxygen carrying capacity has been shown to improve their clinical outcomes.

111
Q

when is acute MI mortality increased

A

hemoglobin less than 10

112
Q

othrwise healthy patients can tolerate hemoglobin less than

A

7

113
Q

what type of patients are usually adapted to low hemoglobin

A

renal failure

114
Q

what are mythical indication for red cell transfusion

A

old and frail patient, asymptomatic coronary artery disease, expand blood volume, promote wound healing

115
Q

why do cardiologists prefer to transfuse coronary artery disease patients

A

to keep hemoglbin above 10, but not much evidence to support this

116
Q

what can hypotensive patients be treated with

A

expand blood volume with isotonic IV fluids; red cells shoud NOT be used as risks outweigh benefits

117
Q

what to do for acute blood loss

A

o neg blood is immed available, typing takes 20 min, screening and crossmatching adds another 20

118
Q

is anemia a diagnosis

A

NO

119
Q

hgb numbers are strict for transfusion purposes True or false

A

false! some patients functional at hgb=7 some need transfusion at hgb=9

120
Q

when is plasma transfusion indicated

A

replace mission plasma protein or multiple ones

121
Q

what are missing plasma proteins that could need transfusion

A
  • Factor VIII or IX (hemophilias A and B)
    • Antithrombin III (rare pro-thrombotic condition)
    • AdamTS13 deficiency (TTP*)
122
Q

what is you ae missing multiple plasma proteins

A

Coumadin toxicity with bleeding

123
Q

what is antithrombin III

A

rare pro thrombotic condition

124
Q

what is def in hemophilia b

A

factor IX

125
Q

what is def in hemophilia a

A

factor VIII

126
Q

what is adamts13 def

A

TTP

127
Q

what are indications for platelet transfusion

A

treat ongoing hemorrhage in thrombocytopenic patient( less than 50), prevent hemorrhage in severe thrombocytopenic patient (less than 10), treat or prevent hemorrhage in patient with dysfunctional platelets (patients who have undergone cardiopulmonary bypass, patients treated with irrev platelet inhibiting drugs)

128
Q

if a patient has been on nsaids within a few days of a current uncontrolled bleed, they may benefit from….

A

platelet transfusion

129
Q

what are the major categories of bad transfusion outcomes

A

immune response, volume overload, transfusion transmitted infection, graft vs host disease

130
Q

what are the types of immune responses in transfusions

A

acute hemolytic reaction, production of antibody to minor red cell antigen, urticarial reaction to transfused plasma proteins, febrile reaction to transfused leukocytes

131
Q

what is seen in acute hemolytic reaction

A

fever, chills, chest pain, hypotension, nausea, flushing, dyspnea, hemoglobinura (in order from most common to least)

132
Q

what are possible clinical outcomes of acute hemolytic reaction

A

renal failure and death

133
Q

what makes a patient more likely to develop anitbody to minor antigen on rbc

A

already formed antibody, poorly defined antibody former, sickle cell patients (extended crossmatch should be standard of care)

134
Q

what is compatibility standard for most patients

A

ABO, rh

135
Q

what is compatibility standard for sickle cell patients

A

abo, rh, RhCE, K compatible

136
Q

Red cells are mostly plasma free, but not entirely so. what can patients suffer from if develop reaction to plasma proteins

A

urticarial reaction

137
Q

how do you treat febrile reaction to transfused leuokcytes

A

tylenol

138
Q

what do you do if patient dev fever after transfusion

A

EXAMINE to make sure no other symptoms of acute hemolytic reaction are present

139
Q

what is patient’s normal blood volume

A

4.5 to 5 L

140
Q

2 units of red cells can increase patients volume by

A

10% - this can be a problem with heart disease patients - cannot handle extra cardiac load

141
Q

how common are transfusion infected infections

A

1 in 100,000!!!!! RARE

142
Q

how do we minimize transfusion infected infections

A

donor screening: questionnaire, multiple criteria for deferral (travel to malaria places, IV drug use, confidential self exclusion); serum tests for infectious agents (HIV, HCV, HBV)

143
Q

what is graft vs host disease

A

immune response of transfused leukocytes against recipient tissues, rare unless patient is immunocompromised

144
Q

how do you minimize risk of graft vs host

A

always use leukoreduced red cells for immunocompromised patients; can reduce risk to 0 by using irradiated cells

145
Q

what is a consequence of graft vs host

A

sloughing of epithelial cells in GI tract

Hematology/Oncology (4 decks)

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