Transfusion Cases Flashcards
What are the two main sources of vitamin K?
Diet
Production by gut bacteria
Why is the source of vitamin K important clinically?
Anything that disturbs dietary or bacterial vitamin K can affect bleeding risk.
Gut infection Antibiotic use Gut resection Disease Diet
Just a reminder, what factors are vitamin K dependent?
2, 7, 9, 10, c, s
What is present in cryoprecipitate?
Fibrinogen, von Willebrand Factor, Factor 13
If giving multiple blood products, which should be administered first?
Cryoprecipitate
Without replacing fibrinogen, clots will not form.
What should be done on patients taking warfarin with an increased INR?
Conservative treatment first
- Hold/ decrease warfarin
- replace vitamin K
- replace coagulation factors
What should be used to temporarily reverse warfarin?
What should be used to reverse warfarin long-term?
FFP or PCC
Vitamin K
What is PCC?
A combination of vitamin K dependent clotting factors
A patient has petechiae, low platelets, increased INR, and low fibrinogen. What is the most likely diagnosis?
DIC
Low fibrinogen is a give-away for this
How is DIC treated?
DIC is a reactive disease; you must treat the underlying cause
What is the criteria for massive blood loss?
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
What are the criteria for a massive transfusion?
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
When might a massive transfusion be necessary?
Trauma Childbirth Surgery GI hemorrhage Aortic aneurysm rupture
If giving blood products to replace blood volume, what ratio of products should be used?
2 RBCs : 1 FFP : 1 platelet
What is the best transfusion?
No transfusion
whoa….so deep
What are the three most common reactions to transfusions?
- allergy/hives
- febrile nonhemolytic reaction
- TACO
What is the ddx for transfusion related fever?
- Febrile non-hemolytic transfusion reaction
- Hemolytic transfusion reaction
- Septic transfusion reaction
- Transfusion related acute lung injury
- Allergic reaction
What are the symptoms of febrile non-hemolytic transfusion reaction?
Who is most likely to get it?
Chills, rigors, fever over 100.4 up to 4 hours following transfusion
multiparous women or multi-transfused patients
What is believed to cause febrile non-hemolytic transfusion reaction?
How is it treated?
Recipient antibodies against donor WBCs
OR
Passive infusion of cytokines
Treat with tylenol
What is the universal RBC donor?
What is the universal plasma donor?
O negative
AB positive
Who should ALWAYS be given Rh negative blood?
The answer is not Rh negative people
Rh negatives with Anti-Rh IgG
Rh negative fertile females
All other Rh groups can be given Rh positive blood in an emergency
What is the difference between the direct coombs test and the indirect coombs test?
Direct tests whether antibodies are binding to the RBCs and indirects tests whether there are anti-RBC antibodies in the serum
Following hemolysis, in what order are byproducts cleared?
Haptoglobin Urine hemoglobin Plasma hemoglobin Serum Bilirubin LDH
What is important following acute hemolytic transfusion reaction?
Keep urine output VERY high to prevent clogging kidneys
What is the most common cause of acute hemolytic transfusion reaction?
Human error
-usually patient misidentification
What is the ddx for a patient presenting with transfusion related dyspnea?
TACO
TRALI
Anaphylaxsis
Transfusion patient presents with dyspnea, bilateral infiltrates, and large heart. What is the dx?
TACO
Transfusion patient presents with dyspnea, bilateral infilatrates, and normal sized heart. What is the dx?
TRALI
Transfusion patient presents with dyspnea that improves with diuretics. What is the dx?
TACO
What is the treatment for TTP?
plasma transfusion to replace ADAMTS13
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
What conditions should RBC transfusion be avoided?
Endocrine/Renal Insufficiency
Nutritional deficiency anemia
Compensated hemolytic anemias
When should a patient receive platelet transfusions?
Marrow failure with counts <100K
When should platelet transfusions be avoided?
Heparin induced thrombocytopenia
Thrombotic thrombocytopenic purpura
Immune thrombocytopenia (w/o bleeding)
When should a patient receive a plasma transfusion?
documented coagulopathy
multiple factor deficiency
-liver disease, vitamin K, DIC, or Factor 11
surgery prophylaxis
What is ADAMTS13?
What disease is caused by an ADAMTS13 deficiency?
enzyme responsible for cleaving VWF
TTP
When should a plasma transfusion be avoided?
Volume expansion
Single factor defects
Vitamin K deficiency
Liver disease patient (not bleeding)
