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SADL Haematology > Transfusion Medicine > Flashcards

Transfusion Medicine Flashcards

1
Q

TRIPICU study

A

RCT: Restrictive (<70) vs liberal transfusion (<95) with end point of MODS - no diff in end point - 54% not transfused in restrictive vs 2% for liberal *Note that in adults restrictive had improved mortality!

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2
Q

Plt threshold in HSCT study - Zumberg 2002

A

RCT: Restrictive (<10) vs liberal transfusion (<20) with end point of MODS - no diff in end point

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3
Q

what does cryo contain

A

FVIII, FXIII, vWF, fibrinogen Dosing 2-5 ml/kg

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4
Q

RING RCT of granulocytes vs Abx alone

A

Underpowered but no difference seen Post-hoc analysis shows that those with highest dose had benefit.

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5
Q

Components of cryo

A

Factor VIII FXIII Fibrinogen vWF Dose: 1U/10kg

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6
Q

IVIG indications

A

Hypogam ITP NAIT Humoral immunodeficiency Neuro - GBS, OMA Inflammatory - KD

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7
Q

Typical transfusion amount and expected rise for:

  1. RBC
  2. Plt
  3. FFP
A

PRBC: 15ml/kg/dose given over 2-4 hrs, expect rise of 20 g/L

Platelets: 10ml/kg, or one pool of platelets (usually 300 ml)l IV given over 60 mins, expect rise of 15-25x10^9 at 1 hr

FFP: 10-20ml/kg/dose IV over 30-120 mins. Half life of different coagulation factors: FVII: 3-6 hrs, FVIII: 8-12 hrs, FII: 2-3 days, FIX: 2-3 days. FP contains 400-900mg of fibrinogen per 250ml

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8
Q

IndicatAddions for erythrocytapharesis

A
  • severe babesiosis
  • severe malaria
  • PV
  • SCD: life/organ threatening
  • SCD stroke prevention
  • SCD iron overload prevention
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9
Q

Indications for plasmapharesis

A
  • ABO incompatible HSCT
  • ABO SOT
  • TTP
  • HUS
  • Myasthenia gravis
  • PANDAS
  • Syndenham’s chorea
  • BGS
  • Chronic inflammatory demylinating neuropathy
  • ANCA-associated vasculitis (Wegner’s)
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10
Q

Forward type A but anti-A and anti-B Ab on reverse typing. How is this possible?

A

Patient has A2 alleles so makes A1 antibodies

Strong cold antibodies that agglutinate all cells

Rouleaux

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11
Q

Forward type O but no anti-A or anti-B antibodies present

A

Newborn

Hypogamm

lab error

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12
Q

What is the bombay phenotype?

A

Lack functional H gene.

Forward and reverse type as O

Make anti-A, anti-B and anti-H antibodies.

Can only transfuse with blood from bombay phenotype

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13
Q

List three benefits of leukoreduction

A

Decreased rates of:

  • febrile non hemolytic transfusion reactions
  • HLA alloimmunization
  • CMV associated
  • reperfusion injury
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14
Q

What are the benefits of washing RBCs or Plts

A

Decreases the proteins in the plasma that can cause allergic reactions. Can be done to prevent recurrent anaphylaxis in patients with IgA deficiency and anti-IgA antibodies.

Lose 25% of cell product

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15
Q

List all the clinical indications in Canada for providing irradiated blood

A
  • Indications for irradiation include:
    • Intrauterine transfusion
    • Premature infants
    • Congenital immunodeficiency
    • Those undergoing exchange transfusion for erythroblastosis
    • Hematological malignancy or solid tumor
    • Recipient of peripheral blood stem cells, marrow, cord blood or cytotoxic T lymphocytes
    • Recipient of HLA matched products
    • Lupus or any other condition requiring fludarabine, cyclophosphamide or combination myeloablative therapy
    • Donor is a blood relative (directed donations)
  • Potential indications include:
    • Term infant (up to 4 months)
    • Recipients of solid organ transplants
    • Recipient and donor pair from a genetically homogenous population
    • Other patients with hematological malignancy or solid tumor receiving immunosuppressive agents
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16
Q

What viruses are not destroyed by viral inactivation of blood

A

HepA and parvovirus

17
Q

2 instances when there may be differences between forward and reverse typing

A
  • Recent transfusion (especially massive transfusion)
  • Medical condition that impairs antibody production - hematologic malignancy, B-cell immunodef
  • ABO incompatible transplant
  • Gram neg bacterial infection - removes the N-acetyl from the N-acetyl-galactosamine from group A, leaving only the terminal galactose to make it look like a B antigen on the surface of the cell (only forward typing)
18
Q

List antigens typically involved in PCH, WAIHA, Cold agglutinin, SCDl

A

PCH: Anti-P antibodies

WAIHA: Common antigens: Rh, Kell

Cold agglutinin: anti-I if mycoplasma, anti-i if EBV, antiP also reported

SCD: majority of alloimmunization occurs to Rh and Kell

19
Q

List reasons why patients may be refractory to platelet transfusions

A

Non-immune (2/3): infection/sepsis, fever (T>38.4), bleeding, splenomegaly, DIC, HSCT, hepatic veno-occlusive disease, GVHD, medications (vanco, amphotericin B, heparin)

Immune (1/3): alloimmunization to HLA (human leukocyte antigen) and/or HPA (human platelet-specific antigens), due to prior exposure via transfusion, pregnancy, or transplantation, ABO incompatibility may also play limited role

20
Q

What are ways to prevent platelet refractory state

A
  • Leukoreduction can decrease in the incidence of alloimmunization to HLA Class I antigens and subsequent platelet refractoriness
  • Use of ABO compatible platelets is shown to reduce the frequency of platelet refractoriness
21
Q

treatment for immune platelet refractoriness

A
  • If HLA antibodies against platelets are identified, give:
    • HLA-matched platelets - matched for HLA-A and HLA-B loci, platelets are not routinely matched for HLA-C antigen
    • HLA-antigen negative “compatible” platelets - apheresis platelets that lack HLA antigens reacting specifically with the patient’s antibodies
    • Crossmatch-compatible platelets - crossmatch the units of apheresis platelets with the patient’s plasma
  • If HPA antibodies against platelets (rare) - crossmatching may be beneficial
  • Give fresher platelets or ABO matched platelets
  • Treat active bleeding aggressively
  • Consider antifibrinolytic agents, IVIG +/- plasmapheresis, rituximab, recombinant human factor VIIa (off-label use)
  • Splenectomy is not helpful
  • Steroids are not helpful
22
Q

Canadian donors tested for the following viruses:

A

HIV, HBV, HTLV, syphilis, HCV, WNV, bacteria (platelets cultured); selectively for CMV, trypanosoma cruzi (Chagas’ disease)

23
Q

Directed donations

A

No difference in HIV, higher hepatitis rates

cannot use emergently

Must irradiate b/c TA-GVHD

24
Q

Benefits of leukoreduction

A

Decreased CMV transmission

Decreased risk of alloimmunization

Decreased febrile transfusion reactions

25
Q

How common is transfusion-related sepsis with platelets?

A

1 in 300

SADL Haematology (13 decks)

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