Transfusion Medicine Flashcards
Define Screen
Basic Check to see if antibodies are present
If present must identify
Define Crossmatch
Mixing patient plasma with with donor RBC
Define Emergency Release
issue of uncrossmatched blood
Explain Blood Donation
First must be donated - voluntarily
No current FDA approved blood substitutes
Only 5% eligible donate
What are the steps in managing a safe transfusion
Patient identification and specimen labeling
Good quality specimens
What contribute to a good quality specimen
Draw in the right color tube
Send enough specimen for testing
What occurs in the blood bank before units are issued?
Specimen is accessioned
Patient history is checked
Specimen is centrifuged to separate RBCs and plasma
Forward and reverse typing
Antibody screen
Front/Forwarding Typing
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,
Reverse Typing
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.
Antibody Screen
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.
What temperature must RBCs and Plasma be issued at?
<10º C
What temperature are platelets and cryo maintained at
Room temp (20-24º C)
When will Emergency Release of RBCs occur
when you can not wait for the laboratory to finish the work up
Universal donor: O-Negative, O-Positive can be used in shortages
What should occur at the patient’s bedside for a transfusion
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
What occurs when an adverse reaction occurs?
1-5% of all transfusions expected Stop transfusion and do clerical check Maintain IV line Give supportive care Complete reaction report: Call blood bank
What are the types of adverse reactions?
Febrile - fever Allergic (anaphylaxis) Hemolytic (delayed vs. immediate) Bacterial contamination Acute lung injury fluid overload
Creating and storing RBC
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
Packed RBC characteristics
Avg lifespan of 120 days
Transfused RBC avg half-life of 60 days
Indication: Restore Oxygen Carrying Capacity
What is the dosing of RBC
Adult: 1 PRBC unit raises hemoglobin by 1g/dL or hematocrit by 3%
Children: 10 mL/kg right hgb by 2.5 g/dL
Fresh Frozen Plasma Storage
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
Fresh Frozen Plasma Characteristic
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
Fresh Frozen Plasma Dosing
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
FP24 Plasma
Plasma originally frozen within 24 hours (rather than 8 hours)
Thawed Plasma
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
