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CCP > Transfusion Medicine > Flashcards

Transfusion Medicine Flashcards

1
Q

A type blood (antigens and antibodies)

A
  • A type antigens on RBCs

- B type antibodies in serum (will attack B and AB blood)

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2
Q

O type blood (antigens and antibodies)

A
  • No antigens on RBCs (why it is international donor)

- A and B antibodies in serum (can only receive O blood)

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3
Q

How much will one unit of RBCs increase hemoglobin levels by in a non-actively bleeding patient?

A

10g/L

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4
Q

Vitamin K dependant clotting factors

A

X, IX, VII and II

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5
Q

INR of FFP

A

1.3 to 1.5

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6
Q

Agents used for warfarin reversal

A

Vitamin K
Prothrombin complex concentrates (octaplex, beriplex)
Fresh Frozen Plasma
Cryoprecipitate (Von Wilderbrand factor, fibrinogen, factor VIII)

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7
Q

Main risks of transfusing PRBCs

A
  • TACO (transfusion associated circulatory overload)
  • TRALI (transfusion related acute lung injury)
  • Acute/delayed hemolytic reaction
  • Anaphylaxis
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8
Q

TRALI Pathophysiology

A
  • Anti-leukocyte antibodies (ALA) collected from donor are transfused into recipient and travel to the lungs where they initiated inflammatory cascade.
  • Donor neutrophils are primed/sensitized and then activated unnecessarily. This cause inflammation of the pulmonary capillary endothelium.
  • Occurs within 6 hours of transfusion.
  • No evidence of volume overload.
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9
Q

TRALI Key Features

A

-Diffuse bilateral infiltrates on CXR
-Dyspnea
-Hypoxia
-Hypotension
-Fever
-Transient leukopenia
(So, pretty much ARDS with fever and an infusion Hx)

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10
Q

Key features of TACO

A
  • Dsypnea
  • JVD
  • Pulmonary edema
  • Elevated BP
  • Tachycardia
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11
Q

What is IVIG?

A
  • IV Immunoglobulins
  • 90% IgG
  • Used for Ig deficiency, organ rejection, neuro disorders, RA disorders, necrotizing fasciitis
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12
Q

What is RhiG?

A
  • Rho immune globulin
  • Given to Rh- women of child bearing age to prevent isoimmunization
  • Given to Rh- people receiving Rh+ blood products
  • Single IM injection lasts 2-4 weeks
  • WinRho or RhoGAM
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13
Q

Examples of acute transfusion reactions

A
  • Hemolytic ABO incompatibility
  • BaCon (bacterial contamination)
  • Febrile non-hemolytic reaction (from donor cytokines and antibodies)
  • Anaphylaxis
  • TRALI
  • There are 29 different blood group systems and 346 blood group antigens that can cause incompatibility!
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14
Q

Hgb levels of infusions:

A

Hgb < 70g/L

Hgb < 80g/L (symptomatic ACS)

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15
Q

Risk factors for TACO

A
  • Chronic anemia
  • Fast infusion rate
  • Poor renal function
  • Known CHF
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16
Q

Steps taken for suspected transfusion reaction:

A
  • Stop transfusion
  • Assess V/S and volume status
  • Check patient ID and blood product matching
  • Notify blood bank
  • CXR, ABGs, labs
  • Treat patient (O2, crystaloids, colloids)
17
Q

Transfusion rate for RBCs in 15 minutes

A

50mL/hr

8 gtts/min

18
Q

Signs and symptoms of a transfusion reaction

A
  • Fever greater than 38
  • Temperature increase by more than 1 degree during transfusion
  • Hypo/hypertension
  • N/V
  • Urticaria
  • Dyspnea
  • Hematuria
  • Disseminating intravascular coagulopathy
19
Q

Causes of transfusion related hypotension

A
  • TRALI
  • Continued bleeding
  • bradykinin mediated (ACE inhibitors)
  • BaCon/sepsis
  • Anaphylaxis
20
Q

Is intraosseus an acceptable route for RBCs?

A

No

21
Q

Reasons for transfusing

A
  • Volume replacement
  • Improve or maintain oxygen carrying capacity
  • Restore coagulation ability
  • Correct deficiencies
22
Q

Can RBCs go through a fluid warmer?

A

Yes. Only platelets can’t go through.

23
Q

How many units of blood can go through an infusion set before you need to replace it?

A

2-4. Check with the sending hospital as to how many units they have already run through and how many units can go through the set that you’re taking from them.
…or 4 hours

24
Q

How many units of RBCs before you consider administering a gram of Ca++?

A

4 units

25
Q

Is male or female plasma used for cryoprecipitate and/or supernatant?

A

Male. It is also used for FFP donation.

Female plasma is fractionated to make albumin and IVIG

26
Q

Correctly ID patient pre-transfusion

A
  • Read out loud patient’s name, DOB, sex, blood type and cross check same information out loud on chart and transfusion form.
  • Ask patient to confirm if they are conscious.
  • Should be a two person job.
27
Q

What are the three components of whole blood?

A

Erythrocytes
Plasma
Buffy Coat

28
Q

What’s in plasma?

A 
Water
Protein (albumin, immunoglubins, fibrinogen etc)
Solutes 
Gases
Electrolytes
29
Q

What is the time frame for administering a unit of RBCs?

A

Preferred to be started within 30 minutes of removal from fridge. Must be completed 4 hours after removal from fridge.

30
Q

After you infuse 50ml/hr for the first 15 minutes, what is the transfusion rate for PRBCs?

A

2-3ml/min

31
Q

How do you distinguish between a febrile non-hemolytic reaction and an ABO incompatibility reaction?

A

Both can present with fever, nausea/vomiting and/or chills/rigors but an ABO incompatibility will also be associated with DIC, hypotension, oliguria, hemoglobinurea and tachycardia.

32
Q

Tell me about the DIC…

  • Signs
  • Hx
  • Labs
  • Tx
A

Disseminating Intravascular Coagulopathy
-Signs: Bleeding everywhere!
Hx: Sepsis, trauma, CA; transfusions, pregnancy, snake bites, frost bite, burns
-Labs: Low Plts, low fibrinogen, high INR, high PTT, high D-dimer
-Tx: Treat the underlying cause! Platelets, Cryo, FFP

33
Q

What’s the dose of Vitamin K and when does it start to work?

A

5-10mg over 30 minutes in order to avoid an anaphylactoid reaction.

Starts to work in about 6 hours, right around when the PCC is wearing off.

34
Q

The patient has just received a dose of tPA and now it looks like they’re bleeding badly. What do you do?

A

Fibrinogen
Cryoprecipitate
FFP
TXA

35
Q

Aw shit! Your bleeding patient is on a DOAC. How will you manage them if it shows that blood loss is bad and getting worse.

A

Dabigitran has its own expensive and rare reversal agent that is available in Canada.

For the Xa inhibitors, use PCC

An INR works as a crude assay for Xa DOAC’s effectiveness. Most hospitals have a specific Anti-Xa-inhibitor assay, though.

36
Q

What about platelet function? How can you improve it in bleeding patients that are chronically on platelet inhibitors such as ASA and clopidigrel?

A

DDAVP

Saaaay what?!?!

Platelet transfusion won’t work since the platelet inhibitor is still in the system. At best, it’ll give you some working platelets and some shitty platelets (a little like DIC). Ticagrelor is more responsive to platelet transfusion than the other ones.

37
Q

What’s the difference between a type & screen and a cross match?

A

Type and screen determines the patient’s blood group and antigens. It focuses on the patient’s blood only and usually takes about 15 minutes. This can only test for known antigens.

A cross match tests blood products with a sample of the patient’s blood to make sure there is no transfusion reaction. This usually takes about 45 minutes. Once done, blood products are assigned to that patient and can’t be given to another patient. This tests for unknown antigens.

38
Q

How many units of FFP are in one bag?

A

Depends. It’s usually 1-2. Read the label.

Same thing with platelets. Could be up to 10 units of platelets in one bag.

IE: 1:1:1 does not mean one bag for one bag for one bag.

39
Q

Don’t see albumin used that much anymore. What are some types of patients where it still might be effective?

A
  • Spontaneous peritonitous
  • Hepatorenal syndrome
  • Large volume lung paracentesis

CCP (18 decks)

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