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Transfusion Medicine Flashcards

1
Q

What is a “universal donor”?

A
  • negative for DEA 1, DEA 3, DEA 5, and DEA 7. Positive for DEA 4 (designated as “DEA 4 positive by commercial blood banks). There is no typing serum for DEA 6, 8.
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2
Q

Which blood typing test is the best to use in an auto-agglutinating patient (IMHA for example?

A

-Immunochromatographic

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3
Q

What does 2,3 DPG stand for?

A
  • 2,3-diphosphoglyceride
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4
Q

What is P50 in a dissociation curve?

A

The PO2 at which the hemoglobin is 50% saturated. A measure of hemoglobin affinity for oxygen

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5
Q

What shift the oxygen-hemoglobin dissociation curve to the right?

A
  • Increases in the PCO2
  • Increases in Body temperature
  • Increases in RBC 2,3 DPG
  • increases in RBC ATP
  • Decreases in pH
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6
Q

What is the p50 of the dog?

A
  • 29-31 mmHg
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7
Q

What is the p50 of the cat?

A

36 mmHg. Cat hemoglobin has a lower affinity for oxygen, dissociation curve is shifted to the right compared to dogs. Rely on chloride (Cl)

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8
Q

How does Oxyhemoglobin (oxyglobin) cause vasoconstriction?

A

By reducing NO + possible release endothelin

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9
Q

What determines the affinity of hemoglobin for oxygen?

A

‘PO2, PCO2, pH, body temperature, 2,3-PDG, chemical structure of HGB

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10
Q

What % is the oxygen extraction rate?

A

25% (leaves 75% in the blood as an oxygen reserve)

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11
Q

What is the definition of a Non-immunologic transfusion reaction according to TRACS?

A

An adverse reaction to transfusion of blood or blood component caused by physical or chemical changes to the blood cells or product, contamination, or secondary to the volume infused

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12
Q

What is the definition of an acute transfusion reaction according to tracs?

A

Adverse reactions to blood, blood components, or plasma derivatives that occur within 24 hours of administration
(late is after 24 h)

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13
Q

What is an adverse event according to tracs?

A

Any undesirable or unintended occurrence associated with transfusion. It includes all adverse reactions, incidents, near misses, errors, deviations from standard operating procedures and accidents

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14
Q

How do you calculate hemolysis %?

A

% hemolysis = (100 − HCT) × (plasmafHb [g∕dL] ∕ tHb [g∕dL]

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15
Q

10 ml/ kg of fresh whole blood increases PLR by (maximum)?

A

10 × 109/L (10,000/μL)

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16
Q

How is platelet rich plasma made?

A

Slow/soft spin of FWB or apheresis.

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17
Q

What % of PLT are lost during processing of platelet rich plasma?

A

22%

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18
Q

What is the PLT count in platelet rich plasma?

A

thrombocytes count 3-10 x1010

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19
Q

How is platelet concentrate made?

A

PRP that has been centrifuged one extra time at a hard spin (PRP made by soft spin), OR by platelet pheresis

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20
Q

1 unit of PRP or PC per 10 kg increases platelet by approx (maximum)?

A

40 × 109/L (40,000/μL).

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21
Q

Name one important drawback with lyophilized platelet

A

Very short effect, only 30% remain after 24 h

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22
Q

What is platelet increment?

A

post-transfusion minus the pre-transfusion platelet count/mL

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23
Q

what are the advantages of platelet concentrate prepared by apheresis (compared to prepared from FWB)?

A
  • greater platelet yield (typically 3–4.5 × 1011 versus <1 x 1011)
    -negligible RBC and WBC contamination
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24
Q

give two definitions of platelet transfusion refractoriness?

A
  • two sequential 1-hour post-transfusion platelet corrected count increments of < 5 x 109/L platelets/m2 body surface area
    OR
  • two sequential 1-hour post-transfusion platelet increments of <11x109/L platelets
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25
Q

how is fresh frozen plasma made?

A

separated from whole blood with hard spin and freezing within 8 h.

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26
Q

What is the “antidote” for heparin?

A

Protamine

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27
Q

What is stored plasma?

A

either separated from whole blood after 8 h, or FFP frozen for more than 1 year (frozen plasma).
contains: albumin, globulin, clotting factors (except factor V, VIII, vWf, X)

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28
Q

what is FP24?

A

plasma prepared from WB and kept in ambient or refrigerator for up to 24 h

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29
Q

what is liquid plasma (LP)?

A

WB hard spin with 8 h. Stored in refrigerator for up to 2 weeks. Minor loss of coag activity in canine plasma (fibrinogen 20% decrease over 14 days although remain within ref range. VIII, X decline over 14 days with maintenance of coag activity)

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30
Q

What does cryoprecipitate contain?

A

vWf, VIII, XIII, fibrinogen, fibronectin

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31
Q

what does cryosupernant (cryopoor plasma) contain?

A

albumin, globulin, coag factors II, VII, IX, X, XI (vit K dependant factors).
EJ till VIII, XIII, vWf, fibrinogen, fibronectin).
Highest COP of plasma products

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32
Q

what does CPDA-1 anticoagulant preservative contain?

A

citrate-phosphate-dextrose-adenine

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33
Q

what % of cats gets FNHR and hemolytic transfusion reactions after xenotransfusions?

A

12% of cats have febrile non-haemolytic reaction (same as when feline blood is used)
64% of cats had haemolytic transfusion reaction. All donor blood gone by 4 days

34
Q

Give 6 functions of albumin in vivo

A

Colloid osmotic pressure
Carrier function
antioxidant properties
Haemostasis
Buffer
Microvascular integrity
Provides amino acids in catabolic states
Wound healing

35
Q

What is Van´t Hoffs law?

A

The COP generated by a particle is indirectly proportional to its molecular weight -> the smaller the particles in a solution, then higher the COP

36
Q

What is the Gibbs-donnan effect?

A

The negative charge of albumin attracts sodium cations, which in turn attracts water, Increased the colloid osmotic effect on albumin

37
Q

Name 3 endogenous or exogenous substrate albumin binds

A

drugs, fatty acids, cations (Ca, Zn), hormones, bilirubin

38
Q

what is the half life of albumin in dogs?

A

8,2 days

39
Q

How is albumin distributed?

A

40% located in intravascular space/serum
60% located in interstitial of skin, muscle, liver, lung, heart, kidneys, spleen

40
Q

Name 10 disease or conditions that can cause hypoalbuminemia

A
  • decreased albumin synthesis
    o hepatic disease
    o cholangiohepatitis
    o cirrhosis
    o hepatic lipidosis
    o histoplasmosis
    o neoplasia
    o phenobarbital toxicosis
    o portosystemic vascular shunts (PSS)
    o other toxicosis
  • endocrinopathies
    o hyperadrenocorticism (increased synthesis but also increased degradation and loss)
    o hypoadrenocorticism
  • albumin loss
    o dirofilaria immitis (caval syndrome)
  • GI disease
    o bacterial enteritis
    o haemorrhagic gastroenteritis
    o histoplasmosis
    o inflammatory bowel disease
    o lymphangiectasia
    o neoplasia
    o parasitism
    o parvoviral enteritis
    o panleukopenia virus
    o toxins
    o heart disease (right sided)
    o heat-induced illness, heat stroke
    o pancreatitis
    o peritonitis
    o portal hypertension
    o pyothorax
    o pulmonary oedema (non-cardiogenic)
  • renal disease
    o diabetes mellitus, dm
    o erlichia canis
    o glomerulonephritis
    o hereditary nephritis
    o renal amyloidosis
    o sepsis
  • any disease causing systemic inflammatory response syndrome, SIRS
41
Q

How is hypoalbuminemia caused in SIRS?

A

decreased production
leakage from vasculature
denaturation of albumin at site of inflammation
degradation of albumin bound to toxins
dilution effects of crystalloid therapy

42
Q

name 3 main effects of hypalbuminaemia

A
  • GI effects
    o delayed gastric emptying time
    o ileus
    o GI oedema
    o enteral feeding intolerance
  • coagulation effects
    o hypercoagulability
    o increased thrombocytes aggregation
    o decreased AT-3 activity
  • oncotic effects
    o decreased COP
    o increased vascular pore size, leads to increased permeability
    o interstitial oedema
    o pulmonary oedema
    o cerebral oedema
    o decreased tissue perfusion
    o tissue ischemia
    o delayed wound healing
    o increased morbidity and mortality
43
Q

how do you calculate the albumin deficit?

A

Albumin deficit (g) = 10 x (serum albumin concentration desired g/dl – px current conc g/dl ) x BW (kg) x 0,3

44
Q

How much albumin is there in cryoprecipitate and FFP?

A

cryoprecipitate 31,7 g/l, (COP 14,5 mmHg)
FFP 28,9 g/l, (COP 12,7 mmHg)

45
Q

What does the surviving sepsis guideline say about albumin transfusions?

A

crystalloids initial choice, but addition of albumin for px who persistently require high volume crystalloids to maintain MAP.

46
Q

What percentage of dogs have naturally occurring alloantibodies against human serum albumin?

A

8-10%

47
Q

Given 4 adverse effects in dogs having HAS transfusion

A

Non-immune anaphylaxis
- Facial oedema, tachypnoea, vomiting, fever, arrythmia, tachycardia, coagulopathy, pulmonary oedema,, bronchospasm

Type III hypersensitivity reaction
- 10 days to 2 months
- Polyarthritis, dermatitis, vasculitis, glomerulonephritis/kidney failure, thrombocytopenia, haemolysis, coagulopathy, death

48
Q

Give 2 different protocols for HAS transfusion

A

2 ml/kg over 2 h of 25% HAS, followed by 0.1-0.3 ml/kg/h . total dose 2.5-5 ml/kg of 25%. Daily dose not exceed 2 g/kg

2 ml/kg/h over 10 h of 5% (median time to reach 2.0 g/dl was 4 days)

Test dos 0,25 ml/kg/h for 15 min, followed by 0,5 ml/kg/h for 24 h (bagis)

Dwr: test dose and then rest over 10 h, not worried about 2 g/kg limit

49
Q

What are the definitions of a massive transfusion?

A

greater than estimated px blood volume (dog 90 ml/kg, cat 66 ml/kg) within 24 h
half the blood volume in 3 h
1,5 ml/kg/min over 20 min
>150% of blood volume ever

50
Q

Give 8 adverse effects of massive blood transfusion

A
  • electrolyte abnormalities:
    o hypoCa, hypoMg, hyperK
    o Hyper K due to changes in stored blood + damaged tissue, extracellular shift, reduced excretion)
    o hypoCa: muscle tremors, excitation, disorientation, hypersensitivity to stimuli, facial rubbing. ECG decreased cardiac output and contractility, arrythmias, prolonged QT interval
    o hypoMg: muscle fasciculations, muscle weakness, seizures
  • haemostatic defects:
    o dilution, consumption of thrombocytes and clotting factors, accelerate fibrinolysis, release of anticoagulation such as protein C. due to blood loss and dilution
  • hypothermia.
    o Due to cold product (affects initiation of intrinsic and extrinsic pathway and enhances fibrinolysis, moves oxygen dissociation curve, rbc more prone to lysis as membranes less flexible. Decreases hepatic metabolism, citrate metabolism, acute-phase production, clotting factor production, and drug clearance)
  • Metabolic acidosis.
    o Due to stored blood gets acidotic due to lactate and pyruvate concentrations from glucose metabolism
    o Worsens if liver disfunction
  • Metabolic alkalosis
    o Citrate metabolises into HCo3
  • immunosuppression.
    o Due to transfused WBC
  • transfused-related acute lung injury.
    o Due to microaggregates and embolism
51
Q

How do you calculate the shock index and what value is 71% accurate for predicting need for transfusion

A

shock index (HR/systolic blood pressure) >1,43 was 71% accurate for predicting need for transfusion

52
Q

what are the formulas for how much whole blood and pRBC to transfuse in dogs?

A

volume (ml) of whole blood = 2 ml x desired % PCV increase x BW (kg)

volume (ml) of pRBC= 1,5 ml x desired % PCV increase x BW

blood volume to transfuse = k x BW (required PCV-recipient PCV) / PCV of donor*
k=90 in dogs, 66 in cats

volume of pRBC to be transfused= (PCV desired-PCV current) / (PCV donor*) x px blood volume (90 ml/kg) x BW

53
Q

erythrocyte life span in dogs and cats?

A

dog 110 days. cat 70 days

54
Q

how do you calculate % hemolysis in a transfusion bag?

A

(100-Hct) x (plasmafHb (g/dl)) / tHb (g/dl)

55
Q

There are naturally occurring ab against which tree blood types?

A

Naturally occurring ab against 3, 5, 7

56
Q

Name a high frequency blood type?

A

DEA 4

57
Q

Which Neu does a type B cat have?

A

NeuAc – ganglioside (type of glycolipid in the red cell membrane)
(type A has NeuGc. Mnemonic type B has Ac)

58
Q

Name three test for blood typing

A

Agglutination cards
Immunochromatographic (ex alvedia)
Gel-based test

59
Q

What is major and minor crossmatching?

A

major: recipient plasma, donor RBC (as ab in recipient is more important). Check for antibodies in recipient blood, that will affect donor blood -> massive haemolysis
minor: recipient RBC, donor plasma

60
Q

what is auto control and back typing in crossmatching?

A

auto-control: recipient plasma + recipient RBC

back typing: modified major crossmatch. Recipient serum with RBC from a donor with a known blood type. Ex donor is A, if reaction recipient is B. If AB compatibility, if mixing recipient serum with donor Mik positive causes agglutination, recipient is Mik negative

61
Q

give 4 examples of techniques for crossmatching

A

standard laboratory (SL) tube agglutination assay (gold standard in vet medicine)

slide assay

saline gel column technique

antiglobulin enhanced gel column test

gel-tube assay

immunochromatographic strip (ICS)

62
Q

what is the recommended blood dose for a cat to donate?

A

12 ml/kg every 6-12 weeks (13 ml/kg in dogs)

63
Q

What is the ratio of anticoagulation to blood?

A

1:7-9

64
Q

Name 3 types of anticoagulation in blood products

A

ACD: acid-citrate-dextrose.

CPD: citrate-phosphate-dextrose.

CPDA-1: citrate-phosphate-dextrose-adenine.

65
Q

What is the definition of shell time in blood products?

A

number of days after collection at which 75% of RBC viability is maintained 24 h after transfusion

66
Q

what transfusion reaction is most common in dogs according to tracs?

A

FNHTR

67
Q

Name three respiratory transfusion reactions

A

Transfusion associated dyspnoea (TAD)

Transfusion associated cardiac overload

Transfusion related acute lung injury (TRALI)

68
Q

How do you characterize a FNHTR according to tracs?

A

temperature > 39◦C AND

increase in temperature of > 1◦C from the pre-transfusion body temperature

during or within 4 hours of the end of a transfusion

external warming, underlying patient infection, AHTR, TRALI, and TTI have been ruled out.

69
Q

What is the inciting cause of a FNHTR?

A

secondary to donor white blood cell or platelet antigen-antibody reactions or due to transfer of proinflammatory mediators in stored blood products

70
Q

what is the definition of transfusion associated dyspnoea according to tracs?

A

development of acute respiratory distress during or within 24 hours of the end of a transfusion

TACO, TRALI, allergic reaction, and underlying pulmonary disease have been ruled out

71
Q

what is the definition of transfusion associated circulatory overload according to tracs?

A

acute, non-immunologic reaction

secondary to an increase in blood volume mediated by blood transfusion

acute respiratory distress and hydrostatic pulmonary edema.

occurs during or within 6 hours of transfusion.

associated with clinical, echocardiographic, radiographic, or laboratory evidence of left atrial hypertension or volume overload. These patients typically have a positive response to diuretic therapy

Definite when clinical signs + echo AND/OR radiographs AND/OR lab + no other explanation

72
Q

what is the definition of transfusion-related acute lung injury according to tracs?

A

acute, immunologic reaction

secondary to antigen-antibody interactions in the lungs

characterized by acute hypoxemia with evidence of non-cardiogenic pulmonary oedema on thoracic radiographs

during or within 6 hours of allogenic blood transfusion

no prior lung injury, no evidence of left atrial hypertension and no temporal relationship to an alternative risk factor for ARDS

73
Q

what it the difference between TRALI 1 and TRALI 2 in humans?

A

TRALI 1
A Acute onset defined by
I. Hypoxemia (P/F ≤ 300 or SPO2 < 90% on room air)
II. Clear evidence of bilateral pulmonary oedema on imaging (chest radiographs, chest CT or ultrasound)
III. No evidence of left atrial hypertension (LAH) on echocardiography or use of pulmonary artery catheter, or if LAH is present, it is judged not to be the main contributor to the hypoxemia*
B Onset of pulmonary signs within 6 hours of transfusion (imaging can be documented up to 24 hours later)
C No temporal relationship to an alternative risk factor for ARDS

TRALI 2 defined as patients who have risk factors for ARDS (but who have not been diagnosed with ARDS) or who have existing mild ARDS (P/F 200–300), but whose respiratory status deteriorates and is judged to be due to a transfusion based on:
A. Findings as described in categories A and B of TRALI type I
B. Stable respiratory status in the 12 hours before the transfusion.

74
Q

Give 4 reasons (groups) for non-immunological transfusion reactions (tracs)

A

thermal, osmotic, mechanical, chemical factors

75
Q

when do delayed haemolytic reactions take place according to tracs?

A

24 h-28 days after transfusion

76
Q

What is the definite definition for delayed haemolytic reaction according to tracs?

A

unexplained decreased in PCV >24 h -28 days

delayed onset of at least two indicators for rbc destruction

evidence of rbc alloantibodies developed between 24 h -28 days

77
Q

what is a delayed serological transfusion reaction according to tracs?

A

delayed, immunological

secondary to development of ab against transfusion product

without evidence of haemolysis.
24 h to 28 days

78
Q

Name three infectious pathogens documented as capable of being transmitted in blood transfusion in vet med

A

dog
Haemobartonella canis
Candidatus mycoplasma haematoparvum
Anaplasma phagocytophilum
Rickettsia conorii
Bartonella henselae
Babesia gibsoni
Leishmania

Cat
Mycoplasma haemofelis
Candidatus mycoplasma haemominutum
Felv
fiv
cytauxzoon

79
Q

what is the definition if citrate toxicity in blood transfusion according to tracs?

A

Acute, non-immunological

Secondary to transfusion of a large volume of blood, with citrate as the anticoagulant, and is characterized by a significant systemic hypocalcemia within hours of initiating transfusion

Patients receiving massive transfusions with impaired hepatic function AND compared to pretransfusion levels, a decrease in ionized calcium to <0.7 mmol/L AND development of seizures, tremors, ptosis, vomiting (nausea), hypotension, QTc prolongation, salivation, tachycardia, salivation, or facial swelling

80
Q

What is the ADCAS score in anaemic dogs?

A

anaemic dog clinical assessment score” (ADCAS): mucous membrane colour, pulse quality, heart rate, respiratory rate, and mentation and exercise tolerance: The higher the score (out of 12), the more likely it is that the dog will benefit from a blood transfusion

81
Q

give two examples each of biomechanical, biochemical and immunological storage lesions

A

biomechanical:
increased lactic acid and protons causing acidosis.
Acidosis inhibits glycolysis, eventually causing decreased levels of ATP

2,3-diphosphoglycerate (2,3 DPG) deficiency, inhibiting oxygen transfer (left shift of o diss curve)

Nitric oxide, Hb moleucles lose their bond to NO and NO becomes depleted ie less vasodilation and tissue oxygen delivery

Oxidative damage. Free hemoglobin and iron due to biomechanical damaged cells being tranfused. Iron can create oxidative damage

Increased potassium, renders NaKAtase pump inactive

Ammonia accumulation

biochemical:
RBC shape change and reduced RBC deformability

Accumulation microparticles: proinflammatory and procoagulant stimuli

Adhesion to endothelial cells: decrased blood flow in capillaries, and increased viscocity

immunological:
transfusion-related immunomodulation

leucocyte contamination and soluble immune response modifiers

82
Q

Name 4 side effects/disadvantages of oxyhemoglobin

A

Can cause peripheral vasoconstriction (due to reduced levels of NO) and compromise tissue perfusion and oxygen delivery).

Concern for volume overload (hypertone).

Increased pulmonary vascular resistance. Pulmonary hypertension and decreased pulmonary compliance

Increased COP (43 mmHg) (whole blood 25 mmHg). Risk for volume overload

Discoloration mucus membranes, urine, serum

Resp sign most common side effects in cats

Interfere with lab test: can’t measure HTC or PCV for approx. 4 days. lactate falsely low

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