Transfusion Medicine Flashcards
collection process
-blood collection ->
-testing of blood for infectious disease ->
-blood component preparation ->
-identification of appropriate components for treatment ->
-assessment of donor recipient compatibility
-if necessary treatment of component prior to transfusion to minimize adverse effects
-after correct identification of the pt and the product intended for transfusion (2 people must sign off), transfusion of the pt ->
-evaluation of the pt for complications of transfusion and response to transfusion
RBC transfusion decision in adults
-transfuse to anemic pts -> check Hmg
-<7 hmg -> transfuse
->10 hmg and rapidly declining -> transfuse
-7-10 hmg and having an MI, hemodynamically unstable (bp, ABCs abnormal), respiratory or cardiac symptoms -> transfuse
when to transfuse: hmg 7-10 with no MI, hemodynamically unstable, respiratory or cardiac symptoms
-CAD- coronary artery disease
-**chemo pt 7-8
-palliative care setting -> as needed for symptoms, hospice benefits may vary -> increase quality of life
collection
-volunteer only for donation, no payment
-questionnaire- screened for behaviors and medical conditions
-temp, bp, pulse, hmg check (13 for males, 12.5 females)
-cross check for prior disqualification
-disinfected, collection for screening and then 450-500 ml donation
-no more than 15 minutes, 10% of blood volume -> K+ release, sheer force hemolysis, clot
apheresis
-whole blood removed
-object of collection gathered by centrifugation
-remaining components returned to body
-plasma, platelets, WBC, RBC taken out by centrifugation
-gives a lot more platelets than a typical spun down whole blood
preparation of whole blood gives
-packed RBCs- separate these out from platelet and plasma
-platelets- separate these from plasma
-plasma
plasma
-fresh frozen plasma, FFP
-FFP given to pts bleeding out
-contains the following (from least to most spun down):
-Cryoprecipitate:
-Factor 8 and 13
-Von Willebrand factor
-Fibrinogen
-Cryo-poor plasma:
-Albumin
-Immunoglobulins
-you can specifically give these
blood component preparation
routine infectious testing
-Syphilis
-Hiv
-Hepatitis c
-Hepatitis B
-Human t-cell leukemia lymphoma virus (htlv)
-Zika
-West nile
-Trypanosoma cruzi (Chagas disease)
-bacteria
testing of donated blood
-ABO
-Rh Type
-Rbc alloantibodies
ABO/Rh typing
test for A or B antibodies
-A type- antigens to A
-B type- antigens to B
-AB type- antigens to A and B
-O type- no antigens
cross match
-take recipients and puts it with donors
-see if its clots (agglutinates)
-no clumping, no antigen
-determines if anything in blood of pt recipient will hemolyze or agglutinate the RBC from donor
-pt serum mixed with RBC from donor -> centrifugation -> incubation -> addition of other reagents
-sample check for hemolysis or agglutination -> incompatible
-+ for hemolysis or agglutination -> uncompatible
-neg for hemolysis or agglutination -> compatible
forward typing
-to detect antigens on RBCs
-add antibodies to A, B, and Rh antigens in 3 separate tubes (1 for A, 1 for B, 1 for Rh) containing pt RBC
-clumping of RBC indicates presence of antigen on RBC
-failure to clump indicates absence of antigen on RBC
reverse typing
-to detect antibodies in serum which can bind to RBC antigens
-add pt serum with or without anti-A and anti-B antibodies to A+ and to B+ RBC (A cells in 1 tube and B cells in another)
-clumping of RBC indicates presence of antibody to RBC antigen on cells used (either A or B)
-failure to clump indicates absence of antibody to RBC antigen
Rh factor- pregnancy
-rhesus
-lack of D antigen -> -
-D- can receive D+ blood once -> then develops response
-when Rh+ father has baby with Rh- female -> fetus can inherit Rh+ antigen
-during pregnancy or childbirth -> small amount of fetal blood enters mothers circulation
-over next several weeks women develops antibodies and an immune memory against Rh antigen
-when women becomes pregnant with her second Rh+ child -> immune system quickly produces antibodies that attack the fetus’s red blood cells
-Rh- baby and Rh+ mom -> no issue
compatibility testing: antigens, antibodies, can donate to, can receive from
platelet transfusion indications
-prophylactically for <10,000 adult, <50,000 neonate
-<30,000 and bleeding or minor bedside procedure
-<50,000 and intraoperative or postoperative bleeding
-<100,000 and bleeding post cardiopulmonary bypass
-if platelets are low due to excessive clotting -> DO NOT transfuse (purpura, heparin induced thrombocytopenia)
FFP transfusion indications
-normal INR- 1
-bleeding in pts with INR >= 2
-bedside procedure and INR >= 2
-prophylaxis (nonbleeding) with INR >= 10
-FFP NOT indicated for pts with INR <1.5
-thrombotic thrombocytopenic purpura
-pt may have high INR in cases of coagulopathy, warfarin, liver failure -> dont transfuse
cryoprecipitate transfusion indications
-bleeding in setting of:
-dysfibrinogenemia
-fibrinogen <100
-von willebrand disease
indications for amount and type of tranfusions
-whole blood 1 unit=500mL (RBC, platelets, plasma) -> rarely required, massive bleeding
-RBCs in additive solution (RBCs)- anemia and bleeding -> 1 unit = 1 # in hmg
-FFP or other plasma product (plasma proteins and clotting factors) -> emergent bleeding, liver disease, warfarin
-cryoprecipitate (fibrinogen, factors 8,13, VWF) -> bleeding pts with hypofibrinogenemia
-platelets -> 1 unit will bump you up 30,000
RBC transfusions
-Treatment of anemia
-Sickle cell crisis
-Hemolytic disease of the newborn
-Must be ABO and Rh compatible and cross matched!
-Can be leukoreduced for those with febrile reactions or CMV
-a few WBCs that got into the RBCs -> cause fever
platelets
-Whole blood or apheresis
-Patients who are thrombocytopenic (production or loss)
-Given to cease or prevent bleeding
-ABO preferred, not necessary
fresh frozen plasma
-Frozen within 8 hours of collection
-Whole donation or Apheresis
-Significant levels of coagulation factors
-Controls bleeding, restores plasma proteins
-Not for blood volume
-Should be ABO compatible, no crossmatch, no rh type
cryoprecipitate
-Precipitate of FFP
-Used for fibrinogen deficiency (Disseminated intravascular Coagulation) or Factor xiii
-Hemostatis in above deficiency
-ABO preferred, not necessary. No crossmatch. Rh type not considered
granulocytes
-Single donor during apheresis
-Given to patient who is neutopenic and has an infection that is not mounting an immune response
-More effective in infants
-Must crossmatch (rbcs can leak into the product)
-dont really do bc we have injections for this
relation of non-chemo related neutropenia and infection risk
transfusion complications
-3% complication rate
-first complain is commonly- back pain
-REACTION- rash, elevated temp, aches, chills, tachycardia/HTN, inspirations rapid, oliguria, nausea
-blood in urine
-hot around entry point
-Immune: Hemolytic Transfusion reactions- With 24 hr to 21 days
-Allergic: Hypersensitivity
-WBC Reaction
-Febrile nonhemolytic
-Transfusion related Acute Lung
-Platelet reactions
-non hemolytic febrile reaction
-Infectious
what to do in blood reaction
-2 wide bore IVs in separate arms
-if you have rxn in arm your transfusions -> stop that and start the other
-if IV you are using for transfusion only normal saline can be used in that same IV
-fluids going in other arm
-HF- dont volume overload
-flush the tubing
-premedicate if concerned with mild transfusion reaction - Benadryl, tylenol (fever), lasix (volume overload)
-if reaction -> STOP disconnect and rapidly run normal saline
-monitor, vitals every 5 mins
-aggressive steroid therapy
-if acute hemolytic rxn -> respiratory measures
-look for hemolysis- urine, labs
-do not throw out tubing -> goes to lab to find out if blood was mislabeled and what happened
