TRANSFUSION MEDICINE Flashcards
HgB threshold to transfuse symptomatic pts
HgB= 10
Hgb threshold- hospitalized pts
- preexisting CAD
- acute Mi
- ICU (hemo stable)
- GI bleed (stable)
- non cardiac surgery
- cardiac surgery
- preexisting CAD= 8
- acute MI <10
- ICU (hemo stable) = 7
- GI bleed (stable) = 7
- non-cardiac surgery= 8
- cardiac surgery = 7.5
ratio of how many units RBC raises HgB
1 UNIT RBC = raise HgB by 1
collection process for blood
collect blood, test for infectious processes (CMV, HIV, AIDS), blood component prep, identify components for the tx, assess donor recipient compatibility, tx blood to minimize adverse effects, tranfuse pt and watch for complications or response to transfusion
FFP
- how much time to freeze after coming out of pts arm
- how much time to then get clotting factors
- how do you get cryo
0-8 hrs must freeze to get FFP
>8 HRS can spin to get clotting factors
spin further to get cryoprecipitate
Donation- what is checked before donating, how long can you take someones blood/blood volume
- check behaviors, med status, BP, temp, and pulse
- can do NO MORE than 15 mins, 10% of blood volume
Apheresis
- how does it work
- purposes
- patient has 2 IV lines, one draws the blood, centrifuge to remove products, and goes back into pt through another IV line of remaining components
purpose- tx for hemachromatosis (remove extra iron), or for donation purposes (bone marrow stem cells)
whole blood breakdown
- packed RBC
- platelets
- plasma
plasma–> FFP–> cryoprecipitate and cryo poor plasma
cryoprecipitate- contains factor VIII, XIII, von willlebrand, and fibrinogen
cryo poor- contains albumin and immunoglobulins
infectious testing
syphillis, HIV, AIDS, CMV, hep B and C, zika, west nile, chagas, bacteria, HTLV
compatiblity testing
ABO, Rh type, and RBC alloantibodies
ABO typing- 2 kinds
forward typing and reverse typing
what indicates a positive test for that blood type when doing ABO/Rh typing? FORWARD TYPING!!!!
if that blood sample agglutinates/clumps with that specific antibody, then it is THAT BLOOD TYPE
ex) anti A antibody clumps with the sample—> pt blood sample is type A
agglutination=matches the antigen on that RBC
positive test for REVERSE TYPING
Pts serum or plasma is mixed with RBCs reagents
If blood clumps with A cells, it indicates presence of anti A antibodies— indicating type is B or O
agglutination with that letter means it is NOT that blood type
ABO types
- what is the antigen and antibody
- to who can they donate
- from who can they receive
A: A antigen, anti B antibody
- can give to A, AB, can receive A, O
B: B antigen, anti A antibody
- can give to B, AB, can receive B, O
AB: AB antigen, no antibody
- can give to AB, can receive ALL— A, B, AB, and O
O: no antigens, anti-AB antibodies
- can give to ALL, can only receive O
Rh types
- who can they donate to
- what can they receive
- issues with mother/child Rh
Rh +: have the antigen
- can give to +, can receive + or -
Rh -: do NOT have the antigen
- can give to + or -, can receive only -
Rh neg mom and Rh pos baby—> mom can attack baby, mom needs RhoGAM
universal donor
universal recipient
donor- O neg
(remember neg can give to pos and neg, but cannot receive both)
recipient- AB pos
how does cross matching work
take samples of donor and recipient blood, mix in a tube, and check for any hemolysis or agglutination
which transfusions require ABO compatibility, RH, and cross match?
just ABO?
only cross match?
ABO preferred?
ABO, Rh, and cross match- RBC
only ABO- FFP
only cross match- granulocytes
ABO preferred- platelets, cryoprecipitate
WHEN TO TRANSFUSE
RBC
- HgB thresholds
types of pts
HgB
- <7 or hematocrit <21% in pts with uncompromised CV function
- <10 or hematocrit <30% in pt with CV ds, sepsis, or hemoglobinopathy
pts with:
- anemia
- sickle cell crisis
- hemolytics ds in newborns
LEUKOREDUCE FOR IMMUNOCOMP PTS ( CMV or other infx can cause low grade fever)
RBC to HgB ratio
Hgb to Hematocrit
1 RBC times 3 = HgB
HgB # just calculated times 3 = hematocrit
so if you inc HgB by 1, you also inc hematocrit by 3
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WHEN TO TRANSFUSE
Platelets
- how do we collect
- platelet thresholds
- for which pts
collection: whole blood donation or apheresis
pts: thrombocytopenic, or to STOP/PREVENT bleeding
platelet count
- <10,000 prophylaxis
- <30,000 and bleeding or minor bedside procedure (central line placed)
- <50,000 and intraop or postop bleeding
- <100,000. and bleeding post CABG
WHEN TO TRANSFUSE
Platelets
- evidence of bleeding
- who are we NOT transfusing
bleeding: ecchymosis and petechiae
DO NOT transfuse–> thrombocytopenic purpura, heparin induced thrombocytopenia
- (both are immune rxns, giving platelets would inc risk of thrombosis)
WHEN TO TRANSFUSE
FFP
- how do we collect
- for what kinds of pts
- INR thresholds
collection: whole blood donation or apheresis
pts: to control bleeding or restore plasma proteins (albumin)
- thrombotic thrombocytopenic purpura (TTP)
INR
- bleeding in pts w/INR >= 2
- bedside procedure and INR >= 2
- prophylaxis (nonbleeding) and INR >= 10
- reverse agent for pts on anticoags and begin bleeding
- VERY high INR
- orthostatic hypotension
WHEN TO TRANSFUSE
FFP
- who do we NOT transfuse
- prophylaxis and nonbleeding w/INR <1.5
remember FFP is NOT FOR BLOOD VOLUME
WHEN TO TRANSFUSE
Cryoprecipitate
- for what kinds of pts
- fibrinogen deficiency (DIC)
- factor XIII defiiency (hemophilia)
- hemostasis caused by these deficiencies
fibrinogen <100
dysfibringonemia
von willebrand ds
WHEN TO TRANSFUSE
Granulocytes
- how do we collect
- what pts do we give to
collection: SINGLE donor w apheresis (we want to reduce chance of giving pt another infection)
pts: neutropenic pts who have an infection and are NOT showing immune response (cancer pts post chemo, BM failure, radiated BM and got an infx post radiation)
- very effective in infants
WHEN TO TRANSFUSE
Whole blood
- which patients
trauma, hemorrhaging pts
if you see whole blood coming OUT, give whole blood
complications (4) general
immune- hemolytic transfusion reaction
- compatibility issue
- happens within 24 hrs-21days
allergic- hypersensitivity rxns
WBC rxn
- febrile non hemolytic (RBC not clumping, but causing fever)
- transfusion related acute lung (pulm edema)
- platelet rxns (thrombocytopenia)
infectious
complications
- systemic, vascular, heart, vein, chest, lumbar, urine
sys- chills, fever
vasc- hypotension, uncontrollable bleeding
heart- INC HR
transfused vein- heat sensation
chest- constricting pain
lumbar- pain
urine- bloody, hyperbilirubinemia
febrile non hemolytic reaction vs. acute hemolytic transfusion reaction
non hemolytic–> pt with have fever, chills, LBP, hypotensive
hemolytic–> pt will have similar SS, but ALSO hemoglobinuria (red or brown urine)
- signs of hemolysis
