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Heme 2 > Transfusion medicine > Flashcards

Transfusion medicine Flashcards

1
Q

Blood should be treated like a _____ ; there are indications, contraindications and benefits

A

drug or translpant

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2
Q 
Process of donation
\_\_ years of age
Limited\_\_\_\_ and physical*
– Donation interval for Whole Blood = 
– Approx \_\_\_\_ml of blood taken
A

16
history
8 weeks
500 (+/-50)

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3
Q

What is looked at in the donor physical and exam

A

• Exam: vital signs, general appearance,
venipuncture site
• Donor medical history
• Hemoglobin level

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4
Q

What three products do we get from blood

A

Plats
RBCs
Plasma

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5
Q

Preservative Solutions to Maintain Function and
Viability of Cells:
Anticoagulant that binds Calcium =
Maintiains 2,3 DPG levles =

A

Citrate

Phosphate

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6
Q

What is for cell metablosin when storing blood

what about for ADP, ATP production

A

Dextrose

Adenine

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7
Q

What happens to cell when stored for long time

A

becomes distorted, eventually sphere like

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8
Q

Key biological effects seen in RBC storage

A

Decrease in ATP, 2,3 DPG and pH
• Extracellular plasma changes (potassium increases)
• Increased free hemoglobin (iron) and NTBI
• Increased oxidative stress (ROS)

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9
Q

What is processed or tested for in blood

A
  • Infectious Disease Testing
  • ABO and Rh type
  • Antibody Screen
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10
Q

The one infectious disease we still have issues with

A

Hep B~ has a chronic carrier state in people

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11
Q 
• Most important red cell blood group
system
• Antibodies are naturally occurring,
very potent, and can activate
complement
– Responsible for many acute and fatal
hemolytic transfusion reactions
A

ABO group system

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12
Q

Group A blood has antibodies against:

What type of blood can pt receive?

A

Anti-B

type: A, O

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13
Q

Group B has antiB against:

what type of blood can it recieve?

A

AntiA

recieve: B and O

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14
Q

Group AB blood has antiB against:

Can receive what type of blood:

A

NONE

all types

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15
Q

Group O blood has antiB vs:

can receive:

A

antiA, AntiB, anit AB

O

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16
Q

What are the major antiGs associated with Rh blood group:
MOst important?
most immunogenic?

A
  • Major Antigens are D, C, c, E, e
  • Most important Antigen is D
  • D is highly immunogenic- 80% sensitization risk
  • Rh antibodies develop through pregnancy or transfusion
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17
Q

Implicated in Hemolytic Disease of the Newborn and

hemolytic transfusion reactions

A

Rh antibodies

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18
Q

In Antibody screens what do they detect?

A 
• Antibody screens detect most clinically
relevant antibodies (~30 antigens)
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19
Q

How does Indirect Antiglobin Test work?

A

Take patients plasma that has antiB in it and add it to tube with RBC (either known or donor). If RBC has lots of antiB on it like in plasma, they will link up and RBC aggregate
***Detects antibody in patients serum

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20
Q

Use of IAT

A

Antibody detection/ID, Red

Cell Typing, Compatibility Testing

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21
Q 
• ABO and Rh (D) type patient and donor
• Antibody Screen (IAT): Test Cells of
known phenotype + patient serum
• Crossmatch: Donor cells + patient serum
   – Electronic
   – Serologic
All above are examples of
A

Compatibility testing of RBCs

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22
Q

What is the DAT and it’s purpose?

A

Direct Antiglobulin Test
The DAT detects antibody attached to red cells in vivo
(take pts RBC, add antiB and antiB binds if its present on RBCs)

23
Q

Causes of (+) DAT

A
  • Autoimmune Hemolytic Anemia
  • Drug Induced Hemolytic Anemia
  • Hemolytic Transfusion Reaction
  • Hemolytic Disease of the Newborn
24
Q

What happens in pre-transfusion testing?

A

Pt blood sample, ABO typing/ antiB screen/ identify antiBs and select ABO/D compatible donor

25
Q

What are the total Blood Products used?

A
  • Whole Blood
  • Packed RBCs
  • Fresh Frozen Plasma
  • Platelets
  • Cryoprecipitate
26
Q

What is key in Whole Blood transfusion, when is it used?

A

must have same ABO type only!

not really used, hard to come by and hard to get very close match

27
Q

How are RBC prep/stored and what do they have?

A

Cells separated by centrifugation, plasma removed. 4C, 42 days.
Contains 300 ml, HCT 55-60%, No viable platelets or WBC’s

28
Q

What is the outcome of pt given RBC

A

raise Hgb 1g/dL in adult

29
Q 
RBC transfusion
\_\_\_ cells to A, AB patient
\_\_ cells to B, AB patient
\_\_\_ cells to A, B, AB, O patient
\_\_ cells to AB patient only
A

A
B
O
AB

30
Q

In a critical care setting, which is better, lots of RBC to get HgB to 10 or restrictive to get HgB to 7

A

Restrictive to 7~ only give when pts are symptotic, not to boost HgB

31
Q

Factors in Transfusion\Decision

A

• Patients symptoms, signs, baseline functional
capabilities
• Etiology and anticipated course of anemia
• Alternative Therapies
• Underlying cardiovascular or respiratory disease
• Risk/benefit analysis

32
Q 
HgB guidelines:
HgB:          Probablity of impairment       Strategy
>10
8-10
6-8
<6
A

> 10 Very low Avoid
8-10 Low Avoid, consider transfusion “trial”
6-8 Moderate Transfusion if symptomatic
<6 High Frequently requiresTransfusion

33
Q

Fresh Frozen plasma: plasma seperated from whole blood via centrifugation, RBC removed; contains

A

all plasma proteins

34
Q

Outcome of FFP transfustion

A

10-15 mL/kg raises all clotting factors by 20-30%

in average size adult (run into issue if try to correct competely d/t volume overload)

35
Q

A plasma to
B plasma to
AB plasma to
O plasma to

A

A plasma to
B plasma to
AB plasma to anyone
O plasma to O patient only

36
Q

– Multiple factor deficiency
• Liver Disease
• Vitamin K deficiency/reversal of warfarin
• DIC
• Isolated factor deficiency if no factor concentrate available (factor XI)
These guys can receive:

A

FFP!

37
Q

Use FFP in Replacement of Plasma Proteins for hemostasis: (2 examples)

A

– Abnormal bleeding with documented coagulopathy
– Multiple factor deficiency
– Prophylaxis for surgery /procedure with coagulopathy

38
Q

What do we use for replacement fluid in therapeutic plasma exchange like TTP?

A

FFP

39
Q

FFP is not indicated for:

A

– Volume expansion

– Reversal of Heparin

40
Q

• FFP not usually needed to correct:

FFP never completely corrects the:

A

minor prolongation of PT (3 Sec or INR<1.5)

PT in patients with severe liver disease

41
Q

FFP
• Usual Dose=10 ml/kg or ____units in average adult. 1
unit is homeopathic

A

3-4

42
Q

In INR graph, when do we see FFP having biggest effect?

A

When INR is REALY high, FFP helps lower that fast, but the closer INR gets to normal, the more FFP units you need

43
Q

How is Cryprecipiate made?

A

Thaw out FFP and store at -18

44
Q

What factors does Cryoprecipitate contain?

What is is most useful for?

A

F-VIII, Fibrinogen, vWF, F-XIII, Fibronectin
most useful for fibrinogen, not for vWF
**Goal = Fibrinogen level >150 mg/dl

45
Q

Outcomes of giving pt Cryoprecipitate

A

1 unit/ 10 kg will raise fibrinogen by 50 mg/dL

in an average size adult.

46
Q

Contains: 15 ml/ unit, enriched for Fibrinogen.

No viable platelets, RBCs or WBC’s

A

Cryoprecipitate

47
Q

Indications for Cyroprecipitate:

A 
• Hypofibrinogenemia
– DIC
– Severe liver disease
– Congenital
– Trauma with massive transfusion
• Dysfibrinogenemia
– Acquired (liver disease)
– Congenital
48
Q

_____units WB-derived Platelet or Platelet Concentrate= ___ units Apheresis Platelet

A

6-8

1

49
Q

Prep/Storage of Plats

A

-Cells separated by centrifugation of whole blood
or apheresis.
-Stored at room temperature for 5 days.

50
Q

Outcomes in Plat transfustion

A

-Raise plt count 30,000 – 60,000 in an average
size adult.
-Can trigger anti-D formation

51
Q

Plats considered as Prophylaxsis in Marrow failure pts:
<10k:
10-20 K:

A

– <10K: Transfusion indicated
– 10-20K: Transfusion reasonable
• Concurrent risks: fever, mucositis, bleeding history

52
Q

Prophylaxis of Plats before surgery
____: General Surgery, Procedures
____: Eye, CNS, high risk surgery

A

– <100K

53
Q

At what point of Plat count do we really see pts run into bleeding issues when in hospital?

A

below 10K

54
Q

How long does it take to consume Plats in health person?
Ill person?
Antibody mediated destruction?

A

healthy: last over a day
Disease: see drop very quickly
AntiB: never really rises

Heme 2 (14 decks)

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