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Medicine I > Transfusion Medicine > Flashcards

Transfusion Medicine Flashcards

1
Q

What underlying diseases cause anemia?

A
  • hemolytic disease
  • Hemorrhagic disease
  • Severe non-regenerative disease
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2
Q

What underlying diseases cause Thrombocytopenia

A
  • ITP
  • DIC
  • Severe bone marrow disease
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3
Q

What are the underlying causes of coagulation factor deficiencies?

A
  • Congenital/hereditary
  • Acquired
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4
Q

What blood products are available for transfusions?

A
  • Fresh Whole blood
  • Packed red blood cells
  • Plasma products
  • Cryoprecipitate/Cryosupernatant
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5
Q

What is Fresh Whole Blood? (contents, storage, uses?)

A
  • RBC, WBC, platelets, and plasma proteins
  • Refrigeration renders WBCs and platelets inactive: stable 28-30 days at 1-6C
  • Indicated for anemic animals, especially if coagulation factors are needed
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6
Q

What is packed red blood cells (pRBC)? (contents, storage, uses?)

A
  • Whole blood - plasma = pRBC
  • Storage 3-4 weeks (refrigerate with RBC preservative)
  • Storage leads to reduced deformability and 2,3-DPG levels within RBC
  • Indications for use: anemia
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7
Q

what plasma products are there?

A
  • Fresh/Fresh frozen plasma (FFP)
  • Frozen Plasma
  • Platelet-rich plasma
  • Cryoprecipitate
  • Cryosupernatant
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8
Q

What is Fresh/Fresh Frozen plasma (FFP)? (contents, storage, uses?)

A
  • Administered immediately or frozen within 6 hours
  • Pro-coagulant and anti-coagulant factors, Ig, albumin
  • Uses: coagulopathy of any cause, DIC
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9
Q

What is Frozen Plasma (FP)? (contents, storage, uses?)

A
  • Factors V, VII, vWF no longer considered viable
  • Source of albumin, Ig, Vit K-dependent factors
  • Uses: rodenticide toxicity, oncotic support
  • ~45ml/kg required to increase albumin 1g/dL
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10
Q

What is Platelet-rich plasma? (contents, storage, uses?)

A
  • Warm, slow centrifugation of fresh whole blood
  • No storage
  • Limited use: intracranial hemorrhage
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11
Q

What is cryoprecipitate? (contents, storage, uses?)

A
  • Precipitate formed by thawing FFP
  • vWf, fibrinogen, VII, XIII
  • Uses: vonWillebrands disease, Hemophilia A
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12
Q

What is cryosupernatant? (contents, storage, uses?)

A
  • Fraction remaining after production of cryoprecipitate
  • Factors II, VII, IX, X
  • Indications: Rodenticide, Hemophilia B
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13
Q

What is a transfusion trigger?

A
  • Point were oxygen delivery has dropped enough to stimulate anaerobic metabolism
  • Packed cell volume, HR, BP, Pulse quality, Alertness
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14
Q

What factors influence transfusion triggers?

A
  • Concurrent disease
  • Rate at which anemia developed
  • Need for interventional procedures (Surgery)
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15
Q

What testing is required for canine blood donors?

A
  • Routine health screening:
    • CBC, Chemistry, UA, Fecal
  • Blood type
  • Heartworm, Babesia, Ehrlichia
  • Anaplasma, Mycoplasma
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16
Q

What testing is needed for feline blood donors?

A
  • Routine health screening:
    • CBC, Chemistry, UA, Fecal
  • Blood type
  • FeLV, FIV, Mycoplasma
  • Bartonella, others (?)
17
Q

What are the canine blood groups? what are some important factors of each?

A
  • Most greyhounds are negative for DEA 1.1 and positive for DEA 3
  • Most Labs are positive for DEA 1.1
  • Dogs negative for DEA 1/1 and ½ do NOT have naturally occurring antibodies and can be transfused one time
  • 60% of dogs are DEA 1 positive
  • DEA 4 also antigenic (~98% of days are DEA4 positive)
18
Q

What are the downsides of blood typing?

A
  • does NOT imply immunologic compatibility
  • Affected by autoagglutination and severe anemia
19
Q

What are the Feline blood groups? Importance of the groups?

A
  • 3 Groups: A, B, AB
  • Naturally occurring antibodies
    • Type B cats have strong alloantibodies vs A blood
    • Type A cats have weak alloantibodies to B blood
  • AB cats (<1% in US) are universal recipients but cannot donate
  • Small % of cats lack the MiK antigen and have antibodies against it
20
Q

What is neonatal isoerythrolysis?

A
  • Type A kittens born of type B queen
  • Kittens nurse during the first 24 hours of life will infest anti-A antibodies from the queen
  • results in life threatening hemolysis
21
Q

What is cross-matching?

A
  • Helps to define immunological compatibility
  • Ideally should always be carried out
  • Not always required in first transfusion if:
    • Donor is DEA-1 negative
    • Recipient is DEA-1 positive
  • questionable value in cats for 1st transfusion
  • Will not predict delayed immune-mediated reactions
  • Recommended if previous transfusion > 7 days prior
22
Q

What is a Major crossmatch?

A
  • Donor erythrocyte + recipient serum
  • Incompatibility predicts immune-mediated hemolytic reaction to donor blood
23
Q

What is minor crossmatch?

A
  • Recipient erythrocyte + donor serum
  • Incompatibility suggests possible reaction against recipient erythrocytes
24
Q

How much blood can a dog give?

A

15-20 ml/kg

25
Q

How much blood can a cat give

A

10-15 ml/kg

26
Q

How is blood collected from dogs/cats?

A
  • Syringe method
    • CPDA-1 or ACD anticoagulant added
      • 1ml per 9ml blood
27
Q

What is the protocol for transfusions?

A
  • Administer blood through an appropriate filter
  • Use largest IV catheter possible
  • No pump with RBC products (syringe pump -ok)
  • No medications through the same IV set-up
  • Only 0.9% saline may be infused simultaneously
    • flush with saline pre and post-transfusion
  • Rate depends upon product and patient
    • slow infusion recommended for first 10-30 mins while monitoring for incompatibilities (0.5-1ml/kg)
    • Parameters monitored every 5-15 minutes for 15-30 minutes then every 15-30 minutes until completion
  • Warm products to body temperature (water bath)
  • complete transfusion w/in 2-4hrs
  • Avoid volume overload
  • Target PCV dependent on patient/disease
  • Recheck PCV 2hrs post-transfusion then as required
  • Keep transfusion record
    • product information
    • transfusion monitoring
28
Q

What are the transfusion totals for the different blood/plasma products?

A
  • Whole blood: 12-20 ml/kg
  • pRBC: 6-15ml/kg
  • FFP: 10-30 ml/kg (repeat if coag times not improved)
  • Cryoprecipitate: 1 unit/10kg until hemorrhage controlled
  • Cryosupernatant: 6-10ml/kg until hemorrhage controlled
  • Platelet-rich plasma: 1unit/10kg
29
Q

How is the WB/pRBC transfusion amount determined?

A

[(PCV desired - PCV actual)/PCV donor] x blood volume x weight

30
Q

Why does a transfusion need to be completed in 2-4hrs

A
  • Product viability
  • risk of contamination
31
Q

What are the different possible Transfusion reactions?

A
32
Q

Why does Immune-mediated hemolysis occur after transfusion? signs? treatment?

A
  • Recipients Ab’s react against donor RBC
    • Type II hypersensitivity
    • PCV drops 3-5 days after transfusion due to production of antibodies
    • Not predicted by cross-matching
  • Signs:
    • Fever, salivation, restlessness, shock, hemoglobinemia, hemoglobinuria
  • Treatment:
    • Antihistamines, glucocorticoids, treatment for shock
33
Q

Why does a non-hemolytic reaction occur following transfusions? how can this be prevented

A
  • WBC-derived cytokines or recipient Ab’s react against donor WBC or plasma proteins
  • Slow administration rate and/or hemolytic reaction, sepsis
  • Minimized with leukoreduction filters during collection
34
Q

Why do allergic reactions occur following transfusions? Signs? Treatment?

A
  • Donor protein binds pre-formed IgE on recipient mast cells
    • Type I hypersensitivity
  • Signs:
    • urticaria, hives, anaphylaxis, bronchoconstriction
  • Treatment:
    • antihistamines, treatment for shock
35
Q

What is a Transfusion related lung injury?

A
  • clinically resembles ARDS (acute respiratory distress)
  • Occurs w/in 24 hrs and no pre-existing lung disease
  • usually self-limitinga
36
Q

What is Post-transfusion purpura?

A
  • Thrombocytopenia develops 1-2 weeks after transfusion
  • Usually self-resolving in 1-4 weeks
37
Q

What is TACO?

A
  • Transfusion associated cardiac overload
  • At risk:
    • normovolemia, cardiac disease, renal disease
38
Q

Why does non-immune-mediated hemolysis occur?

A
  • Incorrect warming
  • incompatible solutions, medications
39
Q

When does citrate toxicity occur?

A
  • Massive transfusion (dogs >90ml/kg/day)
  • Clinical signs reflect hypocalcemia and/or hypomagnesemia

Medicine I (43 decks)

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