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Hematology > Transfusion and Apheresis Therapy > Flashcards

Transfusion and Apheresis Therapy Flashcards

1
Q

On average the adult has about how much blood circulating in the body?

A

5 liters

Lower for children ad really low for neonates

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2
Q

What are we doing when we are looking at a type and screen for blood and a type and cross for blood?

A

Type: ABO and Rh typing
Screen: Testing for atypical antibodies

Type and Cross: Looks for harmful interactions b/w donors and recipients (take both and mix them in a lab)

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3
Q

In what situations would we do a type and screen and when would we do a type and cross?

A

Type and Cross you will need the blood and probably going to use it
Type and screen - probably wont use it but need to have it available just in case

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4
Q

In what pts can we give a Rh+ transfusion to someone who is Rh-?

A

give it to people who wont have babies
men, menopausal women can give Rh+ to an Rh negative person for the first time but not again (usually if youre just in a bind)

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5
Q

Blood componenets that we give?

6

A
  1. whole blood
  2. red blood cells (leukocyte poor and washed)
  3. Platelets
  4. Fresh Frozen plasma
  5. Cryoprecipitate
  6. Granulocytes
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6
Q

What do we want to do for pre transfusion?

3

A

verify physican order
Verify that consent was obtained
verify pt and blood unit ID

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7
Q

All blood is filterd through a standard filter except what compnenets?

A

albumin
plasma protein fraction
intravenous Ig

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8
Q

If the blood component cannot be started promptly/within 30 min what should you do?

A

return it to the lab

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9
Q

All blood components should be transfused within how many hours?

A

4

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10
Q

What is the temp limit for warming blood?

A

42 C

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11
Q

What is the composition of whole blood?

4

A

RBC, plasma, WBC, platelets

-nothing has been removed

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12
Q

How is whole blood obtained?

A

blood donation and can be transfused directly

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13
Q

How do we store whole blood and for how long?

A

Refrigeration (1-6 C)

21-35 days

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14
Q

What is whole blood indicated for?

2

A

cardiac surgery or massive hemorrhage

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15
Q

One unit of packed (red blood) cells increases hemoglobin by how much?

A

3%

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16
Q

What do packed cells help improve?

A

oxygen delivery to tissues

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17
Q

How do we store packed cells and for how long?

A

Refrigeration (1-6 C)

35-42 days

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18
Q

Indications for packed cells?

4

A
  1. Symptomatic anemia
  2. Need to increase red cell mass
  3. SYMPTOMATIC DEFICIT OF OXYGEN-CARRYING CAPACITY
  4. WHAT ABOUT A NUMBER….WHAT HG? equal to or less than 7 should start to transfer (right not do it right about if they arent symptamatic)
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19
Q

What are the characteristics for filtered leukocyte poor RBCs?

A

WBC removal

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20
Q

Indications for filtered leukocyte poor RBCs?

2

A

H/O previous febrile transfusion reactions

Reduce immunological reactions

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21
Q

Charcteristics of washed red blood cells?

3

A

No plasma, minimal plts, 90% WBC removal

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22
Q

Indications for washed red blood cells?

2

A

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

Less reactions

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23
Q

Disadvantages of transfusing washed red cells?

3

A

1) considerable cost is added to patient care
2) the shelf-life of the unit of blood is reduced to 24 hours
3) 10— 20% loss of red cells as a result of the washing procedure.

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24
Q

Characteristics of platelets?

2

A
  1. centrifuge platelet rich plasma
    obtained from donor…automation (single donor unit of platelets).
  2. Each unit may increase platelet count by 5 -10,000 in average size adult
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25
Q

Indications of platlets?

4

A

Thrombocytopenia
Platelet function disorder
Actively bleeding or to prevent spontaneous bleeding
Platelet count

26
Q

Chracteristics of fresh frozen plasma?

2

A
  1. Plasma proteins (e.g. complement)

2. All coagulation factors (except Calcium)

27
Q

How do we store FFP?

A

Frozen (

28
Q

Indications for FFP?

2

A
  1. TREATMENT OF STABLE CLOTTING FACTOR DEFICIENCIES FOR WHICH NO CONCENTRATES ARE AVAILABLE (other than I, VIII or vWF)
  2. WARFARIN REVERSAL (EMERGENT/BLEEDING)
29
Q

Side effects of FFP?

4

A

DISEASE TRANSMISSION
BACTEREMIA (RARE)
TRANSFUSION REACTIONS
VOLUME OVERLOAD

30
Q

How is cryoprecipitate manufactured?

2

A
  1. by slowly thawing a unit of FFP at temperatures just above freezing (1-6 °C)
  2. Centrifuged to remove the majority of the plasma, and the remaining precipitate is collected
31
Q

Characteristics of cryoprecipitate?

3

A

Contains concentrated subset of FFP

  • -Fibrinogen
  • -Factor VIII and XIII
  • -vonWillebrand factor
32
Q

Storage of cyroprecipitate?

2

A

Frozen (

33
Q

Indications for cryoprecipitate?

4

A

vWD
Hypofibrinogenemia
Factor XIII deficiency
“Fibrin Glue”

34
Q

contraindications for cryoprecipitate?

A

Should not be transfused to patients with deficiencies of factors other than;
Fibrinogen
Factor XIII
vWF

35
Q 
How long can Blood Components be Stored?
Red cells:
Platelets:
Cryo:
PLasma:
A
  1. 42 days collected in CP2D/AS3 35 days, collected in CPDA-1
  2. 5 days with continuous agitation
  3. 12 months at -18°C or 4 hours after thawing
  4. 12 months at -18°C or 24 hours
    after thawing
36
Q

What are the risks involved in blood transfusion?

3

A

Transfusion transmitted diseases
Immunological reactions
Non-immunological reactions (e.g volume overload, hypocalcemia)

37
Q

What is the most common acute hemolytic immunological reaction?

A

mostly ABO incompatibility

38
Q

What is the most common delayed hemolytic reaction?

A

antibody present- Rh reaction

39
Q

Whats happening in a Transfusion Related Acute Lung Injury (TRALI)?

A

an antibody donor plasma against the patient’s leukocytes

40
Q

What are the kinds of allergic reactions in a transfusion immunologocal reaction?
2

A

Allergic (allergens in donor blood)

Anaphylactic (possibly IgA related)

41
Q

What blood transfusion reaction can happen from poor asceptic technique?

A

Bacterial (contaminated blood or equipment)

42
Q

What are some nonimmuniloical reactions that could happen?

4

A

Circulatory overload
Graft-versus-host disease
Iron overload- on chronic transfusions
Hypocalcemia

43
Q

What are some common signs of symptoms of transfusion reaction and how serious is each one of the following:

  1. Fever
  2. Dyspnea
  3. Bronchospasm
  4. Rash
  5. Urticaria
  6. Flank Pain
  7. Hypotension
  8. Shock
A
  1. Mild if temperature rise ≤ 1°C from baseline temperature and no other symptoms
  2. Serious
  3. Serious
  4. Mild if rash is over
44
Q

What is the protocol for any transfusion reaction that occurs?
6

A
  1. STOP THE TRANSFUSION
  2. Contact provider
  3. Check vital signs every 15 minutes until stable
  4. Check labels, tags, patient identification band
  5. Notify blood bank
  6. Complete forms
45
Q

What are some aleternatives to allogenic blood transfusion?

5

A 
autologous
Intraoperative hemodilation
Cell saver
Blood salvage-intraoperative
Medications
46
Q

What is an autologous transfusion?

A

know theyll have surgery and they go in months/weeks early to donate

47
Q

What is Intraoperative Hemodilution?

A

given crystalloid to help with volume loss

48
Q

What is a cell saver?

Contraindicated in?
2

A

machine suctions blood out washes it and gets rid of unwanted cells and transfuses them back into patient. (dont use it for cancer or blood infection)

49
Q

What medications can be used as an alternative to transfusion?
3

A

amicar/EPO/protamine- stops the bleeding

50
Q

What is Apheresis/Hemapheresis/Pheresis?

When is this used?

A

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.

51
Q

Types of peresises?

A 
Plasma (plasmapheresis)
Platelets (plateletpheresis)
Leukocytes (leukapheresis/leukopheresis)
Lymphocytes (lymphopheresis/lymphapheresis)
Red blood cells (erythropheresis)
cytopheresis
52
Q

What are the indications of phereis?

A
  1. Collection of blood products

2. Treatment of certain medical conditions

53
Q

Plasmapheresis/plasma exchange
or Therapeutic hemapheresis is used for what types of diseases?
4

A

Hyperviscosity syndrome
Myasthenia gravis
Goodpasture’s syndrome
TTP

54
Q

What is therapeutic cytapheresis used for ?

3

A

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

55
Q

What blood components are prepared by hemapheresis?

3

A
  1. Granulocyte concentrate
  2. Single donor apheresis platelets- remove platelets give everything else back. Get all same platelets from one source limit risk of rxns.
  3. Peripheral blood stem cells
56
Q

Characteristics of granulocyte concentrate?

2

A

Up to 1.0 X 1010 granulocytes per concentrate

Contain varying numbers of platelets and lymphocytes

57
Q

Storage of granulocyte concentrate?

A

Use as soon as possible

Maximum storage: 24 hours at 20-24 C

58
Q

Indications for granulocyte concentrate?

A

Febrile neutropenia which is unresponsive to broad-spectrum antimicrobial therapy

59
Q

Characteristics of apheresis platelets?

2

A

Contain at least 3.0 x 1011 platelets in 250 mL plasma

Equivalent of 6 random donor platelet concentrates

60
Q

Storage of apheresis platelets?

A 
Room temperature (20-24 C)
Five days
61
Q

Indications for apheresis platelets?

2

A

Thrombocytopenia not caused by increased destruction (TTP, ITP)
Platelet function disorder

62
Q

What is therapeutic phlebotomy used for?

2

A

Polycythemia vera

Hemochromatosis

Hematology (18 decks)

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