Transfusion and Apheresis Therapy Flashcards
On average the adult has about how much blood circulating in the body?
5 liters
Lower for children ad really low for neonates
What are we doing when we are looking at a type and screen for blood and a type and cross for blood?
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)
In what situations would we do a type and screen and when would we do a type and cross?
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
In what pts can we give a Rh+ transfusion to someone who is Rh-?
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)
Blood componenets that we give?
6
- whole blood
- red blood cells (leukocyte poor and washed)
- Platelets
- Fresh Frozen plasma
- Cryoprecipitate
- Granulocytes
What do we want to do for pre transfusion?
3
verify physican order
Verify that consent was obtained
verify pt and blood unit ID
All blood is filterd through a standard filter except what compnenets?
albumin
plasma protein fraction
intravenous Ig
If the blood component cannot be started promptly/within 30 min what should you do?
return it to the lab
All blood components should be transfused within how many hours?
4
What is the temp limit for warming blood?
42 C
What is the composition of whole blood?
4
RBC, plasma, WBC, platelets
-nothing has been removed
How is whole blood obtained?
blood donation and can be transfused directly
How do we store whole blood and for how long?
Refrigeration (1-6 C)
21-35 days
What is whole blood indicated for?
2
cardiac surgery or massive hemorrhage
One unit of packed (red blood) cells increases hemoglobin by how much?
3%
What do packed cells help improve?
oxygen delivery to tissues
How do we store packed cells and for how long?
Refrigeration (1-6 C)
35-42 days
Indications for packed cells?
4
- Symptomatic anemia
- Need to increase red cell mass
- SYMPTOMATIC DEFICIT OF OXYGEN-CARRYING CAPACITY
- 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)
What are the characteristics for filtered leukocyte poor RBCs?
WBC removal
Indications for filtered leukocyte poor RBCs?
2
H/O previous febrile transfusion reactions
Reduce immunological reactions
Charcteristics of washed red blood cells?
3
No plasma, minimal plts, 90% WBC removal
Indications for washed red blood cells?
2
Need to increase red cell mass -AND-
Prevent febrile or allergic reactions
Less reactions
Disadvantages of transfusing washed red cells?
3
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.
Characteristics of platelets?
2
- centrifuge platelet rich plasma
obtained from donor…automation (single donor unit of platelets). - Each unit may increase platelet count by 5 -10,000 in average size adult
Indications of platlets?
4
Thrombocytopenia
Platelet function disorder
Actively bleeding or to prevent spontaneous bleeding
Platelet count
Chracteristics of fresh frozen plasma?
2
- Plasma proteins (e.g. complement)
2. All coagulation factors (except Calcium)
How do we store FFP?
Frozen (
Indications for FFP?
2
- TREATMENT OF STABLE CLOTTING FACTOR DEFICIENCIES FOR WHICH NO CONCENTRATES ARE AVAILABLE (other than I, VIII or vWF)
- WARFARIN REVERSAL (EMERGENT/BLEEDING)
Side effects of FFP?
4
DISEASE TRANSMISSION
BACTEREMIA (RARE)
TRANSFUSION REACTIONS
VOLUME OVERLOAD
How is cryoprecipitate manufactured?
2
- by slowly thawing a unit of FFP at temperatures just above freezing (1-6 °C)
- Centrifuged to remove the majority of the plasma, and the remaining precipitate is collected
Characteristics of cryoprecipitate?
3
Contains concentrated subset of FFP
- -Fibrinogen
- -Factor VIII and XIII
- -vonWillebrand factor
Storage of cyroprecipitate?
2
Frozen (
Indications for cryoprecipitate?
4
vWD
Hypofibrinogenemia
Factor XIII deficiency
“Fibrin Glue”
contraindications for cryoprecipitate?
Should not be transfused to patients with deficiencies of factors other than;
Fibrinogen
Factor XIII
vWF
How long can Blood Components be Stored? Red cells: Platelets: Cryo: PLasma:
- 42 days collected in CP2D/AS3 35 days, collected in CPDA-1
- 5 days with continuous agitation
- 12 months at -18°C or 4 hours after thawing
- 12 months at -18°C or 24 hours
after thawing
What are the risks involved in blood transfusion?
3
Transfusion transmitted diseases
Immunological reactions
Non-immunological reactions (e.g volume overload, hypocalcemia)
What is the most common acute hemolytic immunological reaction?
mostly ABO incompatibility
What is the most common delayed hemolytic reaction?
antibody present- Rh reaction
Whats happening in a Transfusion Related Acute Lung Injury (TRALI)?
an antibody donor plasma against the patient’s leukocytes
What are the kinds of allergic reactions in a transfusion immunologocal reaction?
2
Allergic (allergens in donor blood)
Anaphylactic (possibly IgA related)
What blood transfusion reaction can happen from poor asceptic technique?
Bacterial (contaminated blood or equipment)
What are some nonimmuniloical reactions that could happen?
4
Circulatory overload
Graft-versus-host disease
Iron overload- on chronic transfusions
Hypocalcemia
What are some common signs of symptoms of transfusion reaction and how serious is each one of the following:
- Fever
- Dyspnea
- Bronchospasm
- Rash
- Urticaria
- Flank Pain
- Hypotension
- Shock
- Mild if temperature rise ≤ 1°C from baseline temperature and no other symptoms
- Serious
- Serious
- Mild if rash is over
What is the protocol for any transfusion reaction that occurs?
6
- STOP THE TRANSFUSION
- Contact provider
- Check vital signs every 15 minutes until stable
- Check labels, tags, patient identification band
- Notify blood bank
- Complete forms
What are some aleternatives to allogenic blood transfusion?
5
autologous Intraoperative hemodilation Cell saver Blood salvage-intraoperative Medications
What is an autologous transfusion?
know theyll have surgery and they go in months/weeks early to donate
What is Intraoperative Hemodilution?
given crystalloid to help with volume loss
What is a cell saver?
Contraindicated in?
2
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)
What medications can be used as an alternative to transfusion?
3
amicar/EPO/protamine- stops the bleeding
What is Apheresis/Hemapheresis/Pheresis?
When is this used?
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.
Types of peresises?
Plasma (plasmapheresis) Platelets (plateletpheresis) Leukocytes (leukapheresis/leukopheresis) Lymphocytes (lymphopheresis/lymphapheresis) Red blood cells (erythropheresis) cytopheresis
What are the indications of phereis?
- Collection of blood products
2. Treatment of certain medical conditions
Plasmapheresis/plasma exchange
or Therapeutic hemapheresis is used for what types of diseases?
4
Hyperviscosity syndrome
Myasthenia gravis
Goodpasture’s syndrome
TTP
What is therapeutic cytapheresis used for ?
3
Hyperleukemic leukostasis in AML or CML
Thrombocythemia (ET)- Bone marrow problem- cancer
Sickle crisis
What blood components are prepared by hemapheresis?
3
- Granulocyte concentrate
- Single donor apheresis platelets- remove platelets give everything else back. Get all same platelets from one source limit risk of rxns.
- Peripheral blood stem cells
Characteristics of granulocyte concentrate?
2
Up to 1.0 X 1010 granulocytes per concentrate
Contain varying numbers of platelets and lymphocytes
Storage of granulocyte concentrate?
Use as soon as possible
Maximum storage: 24 hours at 20-24 C
Indications for granulocyte concentrate?
Febrile neutropenia which is unresponsive to broad-spectrum antimicrobial therapy
Characteristics of apheresis platelets?
2
Contain at least 3.0 x 1011 platelets in 250 mL plasma
Equivalent of 6 random donor platelet concentrates
Storage of apheresis platelets?
Room temperature (20-24 C) Five days
Indications for apheresis platelets?
2
Thrombocytopenia not caused by increased destruction (TTP, ITP)
Platelet function disorder
What is therapeutic phlebotomy used for?
2
Polycythemia vera
Hemochromatosis
