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MOHDIII - Unit 2 > Transfusion Medicine > Flashcards

Transfusion Medicine Flashcards

1
Q

Why transfuse components rather than whole blood

A
  • conserves blood resources: one donation benefits several patients
  • allows storage of components at different temps for optimal function
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2
Q

RBC description

A
  • RBC in various preservative solutions

- STORAGE TEMP: 1-6 C

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3
Q

RBC indications

A
  • anemia w/ compromised clinical status: low hemoglobin

- NOT volume expansion in bleeding patient

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4
Q

RBC usage

A
  • must be compatible with patients ABO blood type
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5
Q

Compatibility of blood types

A

Type A: B antibodies, A & O compatible
Type B: A antibodies, B & O compatible
Type AB: no antibodies, AB/A/B/O compatible
Type O: A/B antibodies, O compatible

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6
Q

Platelet description

A
  • platelets suspended in plasma
  • single donor (apheresis) or pooled (whole blood donor): **6-8 pooled platelets=1 apheresis platelet unit
  • STORAGE TEMP: 20-24 C
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7
Q

Platelet indications

A
  • quantitative: bleeding w/ low platelet count, prevent bleeding w/ low platelet count (
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8
Q

Platelet dosage

A
  • 1 apheresis unit or 6-8 pooled units (pediatrics 10mL/kg)

- compatibility w/ patients blood type NOT essential

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9
Q

Plasma description

A
  • frozen w/in 8-24 hrs of collection

- STORAGE TEMP:

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10
Q

Plasma indications

A
  • multiple coagulation deficiency (INR>1.8) AND bleeding or invasive procedure
  • congenital coagulation factor deficiency
  • NOT volume expansion
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11
Q

Plasma dose

A
  • 4-6 units (pediatrics 15 mL/kg)
  • advisable to be blood type compatible
  • give as BOLUS
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12
Q

Plasma & INR

A
  • easy to decrease very high INR

- hard to normalize slightly elevated INR

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13
Q

Cryoprecipitate description

A
  • large MW proteins: factor XIII, fibrinogen, vWF+factor VIII
  • STORAGE TEMP:
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14
Q

Cryoprecipitate indications

A
  • fibrinogen deficiency & bleeding or invasive procedure: quantitative (
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15
Q

Blood Components

A
  • RBCs, platelets, plasma, cryoprecipitate
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16
Q

Elements of safe transfusion practice

A
  • high quality blood products: healthy donors, sterile collection, storage
  • good clinical practice: appropriate indications, avoid errors, monitor for reactions
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17
Q

Hazards of transfusion

A
  • 15% incorrect blood component
  • 19% handling & storage errors
  • 9% avoidable/delayed/undertrasfusion
  • 19% anti-D formed due to no/incorrect amount of Rh immune globulin given
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18
Q

Alternatives to allogenic blood transfusion: rationale

A
  • conserves limited blood supply
  • avoids some of risks w/ transfusion
  • treatment of patients w/ contraindications
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19
Q

Alternative to allogenic blood transfusion

A
  • hematopoetic growth factors
  • pharmacologic agents of hemostasis
  • volume expanders
  • autologous blood collection
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20
Q

Hematopoetic growth factors

A
  • EPO to limit chronic RBC transfusions

- Romiplostim (thrombopoietin analogue) to avoid prolonged thrombocytopenia & risk of platelet transfusion

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21
Q

Pharmacologic agents of hemostasis

A
  • procoagulants: desmopressin, recombinant factor VIIa, prothrombin complex, factor VIII/iX concentrates, fibrin sealants (topical)
  • antifibrinolytics: aprotinin, tranexamic acid, aminocaproic acid
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22
Q

Volume Expanders

A
  • crystalloid: saline/hypertonic saline–add volume, pull fluid from inside cells (SHORT term) & distribute in intravascular/extravascular spaces
  • colloid: albumin, dextran, hydroxyethyl starch–pull fluid from interstitial space (LONG acting) & distribute in intravascular ONLY
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23
Q

Autologous blood collection

A
  • preoperative donation: elective procedures likely to require transfusion, patient must have adequate hematocrit & time to replace RBC
  • intra/post operative blood recovery: shed blood recovered from surgical field or drain–washed, filtered, reinfused w/in 24 hours
24
Q

Steps in blood administration

A
  • decision made to transfuse
  • pre transfusion blood same testing
  • appropriate unit selected
  • blood transported to clinical unit
  • blood transfused
25
Q

Testing prior to blood product issue (compatibility testing)

A
  • blood type
  • antibody screen
  • crossmatch
26
Q

Blood type testing

A
  • determination of blood type and Rh (D) Ag
  • required before any products issued for nonemergent transfusion
  • if RBC required emergently, young females receive O Rh negative & everyone else receives O Rh positive units*
27
Q

Antibody screen

A
  • test for Ab specific for clinically relevant RBC Ag other than ABO
  • Ex: if anti-kell detected, patient shouldn’t receive kell+ RBC transfusions
  • **required before RBCs are issued for nonemergent transfusion
28
Q

Crossmatch: positive antibody screen

A
  • test plasma w/ cells from RBC units to be transfused
29
Q

Crossmatch: negative antibody screen

A
  • computer determine compatibility of unit for patient based on ABO & Rh D type only
30
Q

Immediate transfusion reactions

A
  • occur during transfusion or w/in 6 hrs

- categories: hemolytic, febrile, allergic, fluid overload, TRALI, septic

31
Q

First treatment of suspected transfusion reaction

A
  • STOP THE TRANSFUSION
32
Q

Acute hemolytic transfusion reaction: cause

A
  • preformed Ab in patient’s plasma causes INTRAVASCULAR lysis
  • complement activation causes symptoms
  • usually due to anti A or anti B, CLERICAL error
  • may be due to other Ab vs RBC Ag (anti-Kell)
33
Q

Acute hemolytic transfusion reaction presentation

A
  • signs: fever, chills, hypotension, chest/back pain
  • lab findings: hemoflobinemia, hemoglobinuria, persistent anemia, INCREASED LDH & bilirubin (indirect), low or undetectable haptoglobin, spherocytes
34
Q

Key lab finding in acute hemolytic transfusion reaction

A
  • positive direct antiglobulin test (DAT): identifies Ab on the transfused cells in the patients circulation
35
Q

Acute hemolytic transfusion reaction prevention

A
  • ensure accurate patient identification: pretransfusion sample, blood product administration
36
Q

Febrile transfusion: cause

A
  • release of inflammatory mediators (IL-1/8) from WBC or platelets–PGE2 production–hypothalamic drive to increase body temp (WBC or platelets release mediators in vitro (storage) & patient Ab to WBC releases mediators in vivo
37
Q

Febrile transfusion reaction: presentation, prevention

A
  • presentation: ISOLATED fever/chills

- prevention: antipyretics, leukocyte reduction of RBC or platelets at collection

38
Q

Allergic transfusion reaction: cause

A
  • patient Ab to plasma protein: ex. anti IgA in IgA deficient patient
39
Q

Allergic transfusion reaction: presentation, prevention, treatment

A
  • presentation: hives, rarely dyspnea, hypotension
  • prevention: washed RBC to remove allergen, product from IgA negative donor (rarely)
  • treatment: antihistamine, epinephrine
40
Q

Transfusion associated circulatory overload: cause

A
  • too much volume infused rapidly

- at risk: renal insufficiency, chronic anemia

41
Q

Transfusion associated circulatory overload: presentation, prevention

A
  • presentation: dyspnea, hypertension, pulmonary edema–lab evidence = elevated B-natriuretic peptide
  • prevention: transfuse slower, concurrent diuretic administration
42
Q

TRALI: transfusion related acute lung injury

A
  • transfusion associated noncardiogenic pulmonary edema
43
Q

TRALI: cause

A
  • donor anti HLA or anti leukocyte Ab reacting with patient WBC: risk highest with plasma/platelet transfusion
44
Q

TRALI: presentation & prevention

A
  • presentation: HYPOXIA w/ in 6 hrs of transfusion, may require transient ventilator support
  • prevention: minimize collection of products from donors with these Ab, eliminate donors whose previous donations have resulted in TRALI
45
Q

Septic transfusion reaction: cause & presentation

A
  • cause: bacterial contamination of RBC or platelet product

- presentation: fever, chills, hypotension

46
Q

Septic transfusion reaction: lab evidence & prevention

A
  • labs: positive blood culture from patient matches blood culture from blood product
  • prevention: careful screening of blood donors for infection, sterile collection and storage techniques
47
Q

Delayed transfusion reations

A
  • occur days-weeks after transfusion (or longer)

- categories: hemolytic, graft vs host disease (GVHD), iron overload, transfusion transmitted viruses/parasites/prions

48
Q

Delayed hemolytic transfusion reaction: causes

A
  • primary or anamnestic (memory) Ab response to RBC Ag results in EXTRAVASCULAR hemolysis of transfused RBC
  • Ab results from pregnancy or previous transfusion
49
Q

Delayed hemolytic transfusion reaction: presentation & prevention

A
  • presentation: malaise–labs: decreased Hb days to wks after, positive DAT, appearance of new RBC Ab, increased conjugated (direct) bilirubin
  • prevention: educate patient about any anti RBC Ab detected during pretransfusion testing so they can inform future health care providers
50
Q

Transfusion associated GVHD: cause & presentation

A
  • cause: infusion of T cells that recognize patient cells as foreign, while patient T cells don’t recognize donor cells as foreign
  • presentation: fever, skin rash, diarrhea, hepatitis, AND marrow aplasia (10-12 days after transfusion)
51
Q

Transfusion associated GVHD: treatment & prevention

A
  • treatment: nothing effective, >95% lethal due to BM failure
  • prevention: irradiate cellular blood products (at least 2500 cGY) for: immunocompromised patients (not HIV), recipients of blood products from 1st degree relatives
52
Q

Iron overload transfusion reaction: cause & presentation

A
  • cause: numerous chronic RBC transfusions w/ out blood loss: aplastic anemia, sickle cell, thalassemias
  • presentation: high ferritin, eventual hemosiderosis in heart, liver, pancreas
53
Q

Iron overload transfusion reaction: prevention/treatment

A
  • RBC exchange rather than simple transfusion for qualitative defects (sickle cell), chelation therapy (deferocamine, deferasirox)
54
Q

Transfusion transmitted viruses: blood screened

A
  • HCV, HIV, HBV, HTLV I/II, west nile
55
Q

Leukocyte testing for transmitted infections

A
  • cytomegalovirus (CMV)

MOHDIII - Unit 2 (23 decks)

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