transfusion and apheresis therapy Flashcards
What is total blood volume based on?
body mass
How many ml/Kg does the average person have?
adult: 70ml/kg. child: 80ml/kg. neonate: 85-90ml/kg
Describe whole blood
Composed of RBC, plasma, WBC, platelets. Obtained through blood donation.
What are indications for whole blood?
cardiac surgery or massive hemorrhage
Describe packed RBCs
Contain hemoglobin. Hct -70% (slow infusion rates).
What are indications for packed RBCs?
Symptomatic anemia. Need to increase red cell mass. Symptomatic deficit of O2 carrying capacity
Describe filtered leukocyte-poor RBCs
WBCs removed leukocyted can cause febrile rxns and CMV transmission.
What are indications for filtered leukocyte-poor RBCs?
H/O previous febrile transfusion reactions and to reduce immunological reactions
Describe washed RBCs
No plasma, minimal plts, 90% WBC removal.
What are indications for washed RBCs?
Need to increase red cell mass -AND- Prevent febrile or allergic reactions
Describe how platelets are obtained
centrifuge separates platelet rich plasma from donated unit of whole blood obtained from donor. Each unit may increase platelet count by 5 -10,000
What are indications for platelets?
Thrombocytopenia not caused by increased destruction (TTP, ITP). Platelet function disorder. Actively bleeding or to prevent spontaneous bleeding
Describe fresh frozen plasma (FFP)
Plasma proteins (e.g. complement). All coagulation factors (except Calcium) centrifuged from whole blood.
What are indications for FFP?
Treatment of stable clotting factor deficiences if no concentrates are available. Warfarin reversal. Immediate therapy for bleeding/surgery if prolonged PT
What are SE of FFP?
DISEASE TRANSMISSION, BACTEREMIA (RARE), TRANSFUSION REACTIONS, VOLUME OVERLOAD
How is cryoprecipitate obtained?
by slowly thawing a unit of FFP at temperatures just above freezing (1-6 °C). Centrifuged to remove the majority of the plasma. Precipitate is re-suspended in the remaining plasma or in sterile saline.
Describe cryoprecipitate
80+ units antihemophilic factor (AHF) VIII per concentrate. 200 mg fibrinogen I per concentrate. von Willebrand’s factor (vWF). Factor XIII and fibronectin. Volume 10-15 mL per concentrate
What are indications for cryoprecipitate?
vWD deficient, Hypofibrinogenemia (DIC), Factor XIII deficiency. don’t use unless lab results indicated a specific hemostatic defect
How long can blood components be stored?
Red cells: 42 days, collected in CP2D/AS-3 or 35 days collected in CPDA-1. Platelets: 5 days with continuous agitation. Cryo: 12 months at -18°C or 4 hours after thawing. Plasma: 12 months at -18°C or 24 hours after thawing
What are some immunological rxns to blood transfusions?
Acute hemolytic. Delayed hemolytic. Febrile
Transfusion Related Acute Lung Injury, Allergic, Anaphylactic, Bacterial
What are some non-immunologic transfusion rxns?
Circulatory overload, Microaggregate infusion, Citrate toxicity, Hyper/Hypokalemia, Iron overload,
Air embolism, Hypothermia, Hypocalcemia
What is massive transfusion quantified as and what are some of its complications?
1-2 X patient’s normal blood volume. 10-20 units. Coagulopathy (dilutional thrombocytopenia). Acid-base disturbances. Hypothermia. hypocalcemia. hyperkalemia
What is citrate toxicity?
Citrate in the transfused blood binds calcium in the patient’s body. hypocalcemia does not usually occur unless the rate of transfusion exceeds one unit every five minutes. hepatic disease or dysfunction can cause this effect to be worse
What are signs and symptoms of a transfusion rxn?
fever, dyspnea, bronchospasm, rash, urticaria, flank pain, hypotension, shock
What is Apheresis/Hemapheresis/Pheresis?
The removal of whole blood from the body, its separation into plasma and cells, one particular component removed and the remaining components re-transfused. Used esp. to remove antibodies if treating autoimmune diseases.
What are indications for plasmapheresis/plasma exchange?
Hyperviscosity syndrome. Myasthenia gravis. Goodpasture’s syndrome. TTP
What are indications for cytapheresis?
Hyperleukemic leukostasis in AML or CML. Thrombocythemia (ET)- Bone marrow problem- cancer. Sickle crisis
Describe granulocyte concentrate
Contain varying numbers of platelets and lymphocytes. Use as soon as possible. Max storage: 24 hours at 20-24 C
Describe apheresis platelets
Equivalent of 6 random donor platelet concentrates. stored at room temperature for 5 days
When is therapeutic phlebotomy used?
Polycythemia vera and Hemochromatosis
What is apheresis/hemapheresis/pheresis?
The removal of whole blood from the body, its separation into plasma and cells, one particular component removed and the remaining components re-transfused. Used esp. to remove antibodies in treating autoimmune diseases.
