transfusion and apheresis therapy

Question 1

What is total blood volume based on?

Answer 1

body mass

Question 2

How many ml/Kg does the average person have?

Answer 2

adult: 70ml/kg. child: 80ml/kg. neonate: 85-90ml/kg

Question 3

Describe whole blood

Answer 3

Composed of RBC, plasma, WBC, platelets. Obtained through blood donation.

Question 4

What are indications for whole blood?

Answer 4

cardiac surgery or massive hemorrhage

Question 5

Describe packed RBCs

Answer 5

Contain hemoglobin. Hct -70% (slow infusion rates).

Question 6

What are indications for packed RBCs?

Answer 6

Symptomatic anemia. Need to increase red cell mass. Symptomatic deficit of O2 carrying capacity

Question 7

Describe filtered leukocyte-poor RBCs

Answer 7

WBCs removed leukocyted can cause febrile rxns and CMV transmission.

Question 8

What are indications for filtered leukocyte-poor RBCs?

Answer 8

H/O previous febrile transfusion reactions and to reduce immunological reactions

Question 9

Describe washed RBCs

Answer 9

No plasma, minimal plts, 90% WBC removal.

Question 10

What are indications for washed RBCs?

Answer 10

Need to increase red cell mass -AND- Prevent febrile or allergic reactions

Question 11

Describe how platelets are obtained

Answer 11

centrifuge separates platelet rich plasma from donated unit of whole blood obtained from donor. Each unit may increase platelet count by 5 -10,000

Question 12

What are indications for platelets?

Answer 12

Thrombocytopenia not caused by increased destruction (TTP, ITP). Platelet function disorder. Actively bleeding or to prevent spontaneous bleeding

Question 13

Describe fresh frozen plasma (FFP)

Answer 13

Plasma proteins (e.g. complement). All coagulation factors (except Calcium) centrifuged from whole blood.

Question 14

What are indications for FFP?

Answer 14

Treatment of stable clotting factor deficiences if no concentrates are available. Warfarin reversal. Immediate therapy for bleeding/surgery if prolonged PT

Question 15

What are SE of FFP?

Answer 15

DISEASE TRANSMISSION, BACTEREMIA (RARE), TRANSFUSION REACTIONS, VOLUME OVERLOAD

Question 16

How is cryoprecipitate obtained?

Answer 16

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.

Question 17

Describe cryoprecipitate

Answer 17

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

Question 18

What are indications for cryoprecipitate?

Answer 18

vWD deficient, Hypofibrinogenemia (DIC), Factor XIII deficiency. don’t use unless lab results indicated a specific hemostatic defect

Question 19

How long can blood components be stored?

Answer 19

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

Question 20

What are some immunological rxns to blood transfusions?

Answer 20

Acute hemolytic. Delayed hemolytic. Febrile

Transfusion Related Acute Lung Injury, Allergic, Anaphylactic, Bacterial

Question 21

What are some non-immunologic transfusion rxns?

Answer 21

Circulatory overload, Microaggregate infusion, Citrate toxicity, Hyper/Hypokalemia, Iron overload,
Air embolism, Hypothermia, Hypocalcemia

Question 22

What is massive transfusion quantified as and what are some of its complications?

Answer 22

1-2 X patient’s normal blood volume. 10-20 units. Coagulopathy (dilutional thrombocytopenia). Acid-base disturbances. Hypothermia. hypocalcemia. hyperkalemia

Question 23

What is citrate toxicity?

Answer 23

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

Question 24

What are signs and symptoms of a transfusion rxn?

Answer 24

fever, dyspnea, bronchospasm, rash, urticaria, flank pain, hypotension, shock

Question 25

What is Apheresis/Hemapheresis/Pheresis?

Answer 25

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.

Question 26

What are indications for plasmapheresis/plasma exchange?

Answer 26

Hyperviscosity syndrome. Myasthenia gravis. Goodpasture’s syndrome. TTP

Question 27

What are indications for cytapheresis?

Answer 27

Hyperleukemic leukostasis in AML or CML. Thrombocythemia (ET)- Bone marrow problem- cancer. Sickle crisis

Question 28

Describe granulocyte concentrate

Answer 28

Contain varying numbers of platelets and lymphocytes. Use as soon as possible. Max storage: 24 hours at 20-24 C

Question 29

Describe apheresis platelets

Answer 29

Equivalent of 6 random donor platelet concentrates. stored at room temperature for 5 days

Question 30

When is therapeutic phlebotomy used?

Answer 30

Polycythemia vera and Hemochromatosis

Question 31

What is apheresis/hemapheresis/pheresis?

Answer 31

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.