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Pathology Exam 3 > Transfusion Medicine > Flashcards

Transfusion Medicine Flashcards

1
Q

Define Screen

A

Basic Check to see if antibodies are present

If present must identify

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2
Q

Define Crossmatch

A

Mixing patient plasma with with donor RBC

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3
Q

Define Emergency Release

A

issue of uncrossmatched blood

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4
Q

Explain Blood Donation

A

First must be donated - voluntarily

No current FDA approved blood substitutes

Only 5% eligible donate

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5
Q

What are the steps in managing a safe transfusion

A

Patient identification and specimen labeling

Good quality specimens

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6
Q

What contribute to a good quality specimen

A

Draw in the right color tube

Send enough specimen for testing

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7
Q

What occurs in the blood bank before units are issued?

A

Specimen is accessioned

Patient history is checked

Specimen is centrifuged to separate RBCs and plasma

Forward and reverse typing

Antibody screen

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8
Q

Front/Forwarding Typing

A

forward typing is performed by mixing a sample of blood with anti-A serum) and with anti-B serum. Whether the blood cells stick together (agglutinate) in the presence of either of these sera determines the blood type,

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9
Q

Reverse Typing

A

The patient’s serum is mixed with blood that is known to be either type A or B to watch for agglutination. A person’s blood type is confirmed by the agreement of these two tests.

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10
Q

Antibody Screen

A

An RBC antibody screen is used to screen an individual’s blood for antibodies directed against red blood cell (RBC) antigens other than the A and B antigens.

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11
Q

What temperature must RBCs and Plasma be issued at?

A

<10º C

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12
Q

What temperature are platelets and cryo maintained at

A

Room temp (20-24º C)

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13
Q

When will Emergency Release of RBCs occur

A

when you can not wait for the laboratory to finish the work up

Universal donor: O-Negative, O-Positive can be used in shortages

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14
Q

What should occur at the patient’s bedside for a transfusion

A 
Confirm informed consent
Verify information on transfusion slip
Hang unit within 20 minutes or return to blood bank
Transfusion must be completed in 4 hours
Document
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15
Q

What occurs when an adverse reaction occurs?

A 
1-5% of all transfusions expected
Stop transfusion and do clerical check
Maintain IV line
Give supportive care
Complete reaction report: Call blood bank
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16
Q

What are the types of adverse reactions?

A 
Febrile - fever
Allergic (anaphylaxis)
Hemolytic (delayed vs. immediate)
Bacterial contamination
Acute lung injury
fluid overload
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17
Q

Creating and storing RBC

A

Made by centrifuging a whole blood unit

250mL of RBCs plus additive

Hematocrit 55-70%

Shelf life of 35-42 days

Stored at 1-6º C (refrigerated)

Keep in a cooler

18
Q

Packed RBC characteristics

A

Avg lifespan of 120 days

Transfused RBC avg half-life of 60 days

Indication: Restore Oxygen Carrying Capacity

19
Q

What is the dosing of RBC

A

Adult: 1 PRBC unit raises hemoglobin by 1g/dL or hematocrit by 3%

Children: 10 mL/kg right hgb by 2.5 g/dL

20
Q

Fresh Frozen Plasma Storage

A

Separated from whole blood must be frozen within 8 hours or aphaeresis frozen within 6 hours

250-300 mL per unit

Long-term storage (-18º C, 1 year)
Short-term storage 1-6º C (expires in 24 hours)

Keep in cooler

21
Q

Fresh Frozen Plasma Characteristic

A

Indication: complex factor deficiencies or factor deficiency for which no concentrate is available

Variable response

10-25% of normal factors levels needed to maintain homeostasis

22
Q

Fresh Frozen Plasma Dosing

A

Adults: Two units at a time is standard

Children: 10-20 mL/kg to raise factors by 20%

Follow Response
Clinical improvement in bleeding
PT, PTT, Fibrinogen

23
Q

FP24 Plasma

A

Plasma originally frozen within 24 hours (rather than 8 hours)

24
Q

Thawed Plasma

A

FFP that has been kept thawed for more than 24 hours

Shelf life of 5 days at 1-6 C

Low labile factors

Same dosing as FFP

25
Q

Liquid Plasma

A

Separated from whole blood but never frozen

26
Q

Platelets

A

All units here currently come from aphaeresis donors

Random donor platelet units are separated from whole blood RBCs

5 or 6 RDPs = 1 SDP

Stored at room temp

NOT put in a cooler

27
Q

Apheresis Platelets

A

3x10^11 platelets in at least 250mL of plasma (FDA)

5 Day shelf life

High risk of bacterial contamination

Transfused platelets can last up to 7 days in circulation

28
Q

Platelet indications

A

Thrombocytopenia

Neuro/ophtho cases (<10,000/uL)

29
Q

Platelet Dysfunction

A

Aspirin or other platelet inhibiting drugs

Uremia

Liver failure

30
Q

Platelet Dosing

A

Adults: One SDP should raise platelet count by 25-50,00/uL

Children: 10 mL/kg should raise platelet count by 75-100,000/uL

Increase in platelet count will be less with active bleeding, fever, coagulopathy

Platelet units already concentrated

31
Q

Cryoprecipitated AHF

A

Cryo derives from precipitate that forms when FFP is allowed to warm to refrigerator temperature

Contains:
80 IU factor VIII
150 mg fibrinogen (3-6 day half-life)
Von Willebrand Factor, Factor XIII, Fibronectin

32
Q

Cryo Storage

A

Long-Term Storage in Freezer (-18 C, 1 year)

Short-Term Storage is room temperature (20-24 C)

Thawed units good for 6 hours

Thawed & pooled good for 4 hours

DO NOT put in cooler

33
Q

Cryo Indications

A

Fibrinogen Deficiency
Fibrin Glue
Factor VIII or vWF replacement only if no concentrates are available
Correction of platelet dysfunction in uremia

34
Q

Cryo Dosing

A

one unit for every 5-10 kg or use weight-based calculation

35
Q

Blood Bank Math

A

Blood volume:
70 mL/kg (older children/adults)
80 mL/kg (newborns)
100 mL/kg (preemies)

Plasma Volume
Blood volume x (1-hematocrit)

36
Q

Dosing Cryo for Fibrinogen math

A

250 mg fibrinogen per bag of cryo

one dL = 100 mL

Need to know:
Pt. Weight in kg
Hematocrit as a decimal
Desired change in fibrinogen level (mg/dL)

37
Q

How much cryo to raise fibrinogen level by 100mg/dL in an 80kg adult with hematocrit of 40%

A

(70mL/kg * 80 kg)(1-.40)(100mg/dL)/(250mg fibrinogen/bag)(100 mL/dL)

33600 mL x 100 mg/dL
250mg/bag x 100mL/dL = 13.4 bags

38
Q

Leukocyte reduction

A

Residual WBC < 5 x 10^6/unit in US

Reduce febrile transfusion reactions

Reduce alloimmunization

Prevention of CMV infection

Reduce transfusion-related immunomodulation

39
Q

Irradiation

A

Indication: Prevention of transfusion-associated Graft-Versus-Host-Disease (ta-GVHD) in susceptible patients

Blood components: RBC, Whole Blood, Platelets, Leukocytes

Not associated with GVHD: Cryoprecipitate, fresh frozen plasma

Dose: 2500 cGy

40
Q

Irradiation: Susceptible Patients

A

Congenital Immune Deficiencies, bone marrow transplants

Infants receiving IU

Patients receiving directed donor blood from relatives, HLA matched

Hodgkin’s disease

Purine analog exposure

Pathology Exam 3 (4 decks)

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