Transfusion Cases Flashcards

1
Q

What are the two main sources of vitamin K?

A

Diet

Production by gut bacteria

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2
Q

Why is the source of vitamin K important clinically?

A

Anything that disturbs dietary or bacterial vitamin K can affect bleeding risk.

Gut infection
Antibiotic use
Gut resection
Disease
Diet
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3
Q

Just a reminder, what factors are vitamin K dependent?

A

2, 7, 9, 10, c, s

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4
Q

What is present in cryoprecipitate?

A

Fibrinogen, von Willebrand Factor, Factor 13

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5
Q

If giving multiple blood products, which should be administered first?

A

Cryoprecipitate

Without replacing fibrinogen, clots will not form.

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6
Q

What should be done on patients taking warfarin with an increased INR?

A

Conservative treatment first

  • Hold/ decrease warfarin
  • replace vitamin K
  • replace coagulation factors
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7
Q

What should be used to temporarily reverse warfarin?

What should be used to reverse warfarin long-term?

A

FFP or PCC

Vitamin K

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8
Q

What is PCC?

A

A combination of vitamin K dependent clotting factors

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9
Q

A patient has petechiae, low platelets, increased INR, and low fibrinogen. What is the most likely diagnosis?

A

DIC

Low fibrinogen is a give-away for this

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10
Q

How is DIC treated?

A

DIC is a reactive disease; you must treat the underlying cause

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11
Q

What is the criteria for massive blood loss?

A

One of the following:

  • loss of 5L in less than 24 hours
  • loss of half blood volume in less than 3 hours
  • loss of more than 150ml/min with hemodynamic instability
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12
Q

What are the criteria for a massive transfusion?

A

One of the following:

  • more than 20 units blood in less than 24 hours
  • more than 10 units RBCs in less than 24 hours
  • more than 50 units blood products in less than 24 hours
  • more than 4 units RBCs in one hour, with ongoing need
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13
Q

When might a massive transfusion be necessary?

A
Trauma
Childbirth
Surgery
GI hemorrhage
Aortic aneurysm rupture
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14
Q

If giving blood products to replace blood volume, what ratio of products should be used?

A

2 RBCs : 1 FFP : 1 platelet

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15
Q

What is the best transfusion?

A

No transfusion

whoa….so deep

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16
Q

What are the three most common reactions to transfusions?

A
  • allergy/hives
  • febrile nonhemolytic reaction
  • TACO
17
Q

What is the ddx for transfusion related fever?

A
  • Febrile non-hemolytic transfusion reaction
  • Hemolytic transfusion reaction
  • Septic transfusion reaction
  • Transfusion related acute lung injury
  • Allergic reaction
18
Q

What are the symptoms of febrile non-hemolytic transfusion reaction?

Who is most likely to get it?

A

Chills, rigors, fever over 100.4 up to 4 hours following transfusion

multiparous women or multi-transfused patients

19
Q

What is believed to cause febrile non-hemolytic transfusion reaction?

How is it treated?

A

Recipient antibodies against donor WBCs
OR
Passive infusion of cytokines

Treat with tylenol

20
Q

What is the universal RBC donor?

What is the universal plasma donor?

A

O negative

AB positive

21
Q

Who should ALWAYS be given Rh negative blood?

The answer is not Rh negative people

A

Rh negatives with Anti-Rh IgG
Rh negative fertile females

All other Rh groups can be given Rh positive blood in an emergency

22
Q

What is the difference between the direct coombs test and the indirect coombs test?

A

Direct tests whether antibodies are binding to the RBCs and indirects tests whether there are anti-RBC antibodies in the serum

23
Q

Following hemolysis, in what order are byproducts cleared?

A
Haptoglobin
Urine hemoglobin
Plasma hemoglobin
Serum Bilirubin
LDH
24
Q

What is important following acute hemolytic transfusion reaction?

A

Keep urine output VERY high to prevent clogging kidneys

25
What is the most common cause of acute hemolytic transfusion reaction?
Human error | -usually patient misidentification
26
What is the ddx for a patient presenting with transfusion related dyspnea?
TACO TRALI Anaphylaxsis
27
Transfusion patient presents with dyspnea, bilateral infiltrates, and large heart. What is the dx?
TACO
28
Transfusion patient presents with dyspnea, bilateral infilatrates, and normal sized heart. What is the dx?
TRALI
29
Transfusion patient presents with dyspnea that improves with diuretics. What is the dx?
TACO
30
What is the treatment for TTP?
plasma transfusion to replace ADAMTS13
31
What are the recommendations for RBC transfusion in: Hgb > 10 Hgb 10-8 Hgb 6-8 Hgb <6
Don't transfuse Don't transfuse; consider trial transfuse if symptomatic transfuse
32
What conditions should RBC transfusion be avoided?
Endocrine/Renal Insufficiency Nutritional deficiency anemia Compensated hemolytic anemias
33
When should a patient receive platelet transfusions?
Marrow failure with counts <100K
34
When should platelet transfusions be avoided?
Heparin induced thrombocytopenia Thrombotic thrombocytopenic purpura Immune thrombocytopenia (w/o bleeding)
35
When should a patient receive a plasma transfusion?
documented coagulopathy multiple factor deficiency -liver disease, vitamin K, DIC, or Factor 11 surgery prophylaxis
36
What is ADAMTS13? What disease is caused by an ADAMTS13 deficiency?
enzyme responsible for cleaving VWF TTP
37
When should a plasma transfusion be avoided?
Volume expansion Single factor defects Vitamin K deficiency Liver disease patient (not bleeding)