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Heme/Lymph 1 > Transfusion Medicine > Flashcards

Transfusion Medicine Flashcards

1
Q

Concept of blood component therapy

A

Centrifuge bag of donated whole blood and separate into parts…each component cn go to a different patient

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2
Q

Whole blood

A

Contains everything that came from the donor

RBCs, WBCs, platelets, proteins (including coag factors)

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3
Q

Total bag volume and temp

A

slightly greater than 500 mL

4C fridge

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4
Q

Indication for transfusion of whole blood

A

Only one is to treat patients who are experiencing massive bloodloss

This is rarely done

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5
Q

Benefits of whole blood transfusion

A

RBC replaces patients lost RBCs so increases O2 capactiy

Plasma portion replaces lost intravascular blood volume and prevents CV collapse

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6
Q

Limitations of Whole Blood

A

Not a good source for platelets due to fridge
Not a good source for coagulation factors (especially 5 and 8) due to fridge
Capable of transmitting infectious dzs

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7
Q

RBC volume and storage

A

Same number of RBCs as wholeblood
225 to 350 mL
4 C fridge

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8
Q

Indication to transfuse RB

A

Increase RBC mass…and increase O2 carrying capacity in the anemic patient

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9
Q

Decision to transfuse anemic patient with packed cells depends on

A

HgB and Hct of patient - if HgB less than 7 or HcT less than 21% (general)
Clinical situation - more important…symptomatic may need transfusion regardless of count…if not symptomatic, may want to withold, even if counts are low

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10
Q

Hematologic response to packed cells

A

Transfusion of one unit should increase HgB by 1 and HcT by 3%

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11
Q

Limitations of packed cells

A

Not a good source for platelets or coagulation factors

Capable of transmitting infection

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12
Q

LRBC

A

Leukocyte reduced RBCs….99.9% of leukocytes removed by passing blood through special filter

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13
Q

Indication for transfusion and how it is commonly used

A

Same as RBCs (packed cells)
Commonly used in patients prone to febrile non-hemolytic transfusion reactions (FNHTRs)…occur in patients with ABs against foreign antigens present on membranes of leukocytes that are present within donated blood…produces fever and chills

LRBC is BEST blood component to prevent FNHTRs

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14
Q

LRBC limitations and advantage

A

Besides preventing FNHTRs, prevents CMV transmission

Limitations same as packed cells

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15
Q

WRBCs

A

Washed RBCs…removal of all plasma

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16
Q

Indication for transfusion of WRBCs and how commonly used

A

Same as packed cells
Best to use in anemic patient with history of allergic transfusion reactions (ATR) to human plasma proteins…clinical manifestations are anaphylaxis to hives

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17
Q

LImitations of WRBCs

A

Not a good source for platelets or coag factors

Capable of transmitting dz

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18
Q

PC aka RDP including storage and volume

A 
Platelet concentrate (random donor platelet)
Derived form oneunit of WB and is platelets in 50 mL plasma...stored at room temp
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19
Q

Indications for RDP trnasfusion

A

Thrombocytopenic or has throbocytopathy (aspiriin use could cause)

20
Q

Guidelines for transfusing thrombocytopenic patients

A

If bleeding or about to go to surgery AND platelet<50,000 consider PC transfusion

If not bleeding AND platelet count less than 10,000, consider PC transfusion…prophylactic transfusion will prevent hemorrhage in brain

21
Q

DOse and response to RDP

A

1PC/10kg body weight

1 PC shoud increase platelets by 5,000 to 10,000

22
Q

Disadvantage of RDP

A

Infectious dz

23
Q

Apheresis platelet

A

Number of platelets equivalent to 6 units of PC

24
Q

FFP with storage

A

Fresh frozen plasma

Plasma of 1 unit of WB separated and frozen within 8 hours…then thawed in 37 degree water bath when need

25
Q

FFP advantage

A

Quick freeze preserves ALL coag factors…even 5 and 8

26
Q

Indication for FFP transfusion

A

Tx of bleeding patients who have multiple coag factor deficiencies (cirrhosis, DIC)…offers coag factor replacement

27
Q

Effectiveness of FFP therapy

A

Evaluated by comparison of pre and post PT and PTT

28
Q

Disdvantage of FFP

A

Infectious dz

29
Q

Cryo aka AHF

A

Cryoprecipitate aka cryoprecipitated antihemophilic factor

30
Q

AHF formed when

A

FFP thawed at 4C…precipitate removed and then frozen…thawed and pooled before use

31
Q

AHF rich in

A

Clotting factors - Fibronogen (factor 1), von Willebrand (vWF), factor 8, and factor 13

32
Q

Indication for AHF transfusion

A 
Bleeding patient deficient in one of factors it includes 
Von Willebrands dz (vWF)
Hemophilia A (Factor 8 def)
Factor 13 def (rare)
Fibrinogen def
33
Q

Cryo is most appropriate

A

Blood componenet to be used for these dz

34
Q

Cryo disadvantage

A

Infectous dz

35
Q

Blood derivatives

A

Drugs derived from human plasma

Albumin, Immune globulin, Rh immune globulin, Factor 8 concentrate

36
Q

Hemolytic transfusion txns

A

RBC membranes contain carbs and proteins which functon as antigens in transfusion setting

37
Q

Acute hemolytic transfusion reactions

A

AHTR
Within 4 hours of transfusion
uncommon

38
Q

Mech of AHTRs

A

IgM ABs in recipients bloodstream activate complement…donor RBCs hemolyse intravascularly

39
Q

Most common cause of AHTR and almost always due to

A

Human error

IgM Abs directed against donor ABO red cell antigens

40
Q

Signs of AHTRs and tx

A

Fever, pain at IV site, hemoglobinemia and uria, renal failure due to excess plasma hemoglbin in renal tubules, hypotnesion/schock/DIC due to released RBC stroma, hyperkalemia due to release of K from hemolyses donor RBCs, death

STOP transfusion and seek supportive care

41
Q

DHTR

A

Fairly common

5-21 days after

42
Q

DHTR mech

A

IgG antibodies get phagocytosed by liver and spleen (extravascular hemolysis)…positive Coombs test helps diagnose

43
Q

Why do DHTRs occur

A

Offending AB is too low to detect in recipient

44
Q

ABs of DHTRs directed against

A

Non-ABO antigens

Maybe Rh antigen

45
Q

Symptoms and signs of DHTR and tx

A

Mild, possibly asymptomatic
Fever
Jaundice

Possibly none, monitor Hb and Hct

46
Q

How to prevent DHTR in future

A

Blood bank staff can ID antibody in patient’s post trnasfusion blood specimen courtesy of response

47
Q

Infectious agents to be concerned of

A 
HIV 1/2
HTLV 1/2
HBV (highest risk)
HCV
West nile virus (lowest risk)

Heme/Lymph 1 (14 decks)

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