Transfusion Medicine Flashcards by Reena Pabari

what factor has the shortest half life?

factor VII

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half life of factor VII?

6 hrs

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how to reverse warfarin

PCC (FEIBA)
vitamin K (IV faster than PO)
plasma can be given if other options are not available

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what is in PCCs

human-derived coagulation factor concentrates - contains factor 2, 7, 9 and 10, protein C and S

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volume of one unit of cryo

10-15 mL

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infusion time of cryo

15-30mins for total dose

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sepsis occurs most frequently with which blood product and why

platelets, because they are stored at RT

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what is TRALI

acute respiratory distress with hypoxia and bilateral chest infiltrates on x-ray - occurs within 6 hrs of transfusion

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when can transfusion associated GVHD occur?

immunocompromised recipient

- immunocompetent recipient transfused a haplo identical product

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who should receive irradiated blood?

Congenital immunodeficiency states
Intrauterine and neonatal exchange transfusions
Pre-term infants
Patients with lymphoma
Post-transplant (bone marrow or stem cell)
Treatment with purine analogues (e.g. fludarabine)
Directed donations from family members
HLA-matched platelets

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most common antigen causing anti-platelet antibodies post transfusion?

HPA-1a

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most common viral infection transmitted by blood product in canada

west nile virus (< 1 in 1 million)
hepatitis B (1 in 1.7 million)
chagas (1 in 4 million)

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components of cryoprecipitate

fibrinogen
factor 8
factor 13
vWF

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what is the correlation between ABO antigen expression and VWF

people with blood type O have approx 25% less factor 8 and VWF

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dosing of pRBCs and how much hemoglobin should increase

10-20 cc/kg (15 cc/kg) should increase hemoglobin by 10

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dosing of platelets and how much count should increase

10 cc/kg should increase platelets by 50-100

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FFP dosing and how much coagulation factors should increase

10-15 cc/kg should increase coagulation factors 15-20%

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dosing of cryo and how much fibrinogen should increase

1 unit/10kg should increase fibrinogen by 0.5

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which viruses are destroyed by viral inactivation?

encapsulated viruses (inactivation affects lipid membrane) such as HIV, hep B/C, HTLV, EBV, CMV

at what age do isohemagglutinins develop?

usually between 4-8 months

altho small amounts can be detected at birth

what is a type and screen

determines the person’s ABO blood group, Rh status and screens for antibodies against minor antigens

what is a cross match

mixing of the person’s serum with the washed RBCs that they were matched with to ensure they do not agglutinate

most common blood type?

O (approx 46% in canada)

least common blood type?

bombay (no AB or H antigen, <1%)

followed by AB (approx 3%)

common clinical scenarios that can have a positive DAT (name 3)

delayed hemolytic transfusion reaction AIHA HDFN

what is the indirect antiglobulin test?

the patient's serum is incubated with RBCs that are known to express a certain antigen on their cell surface, then incubated with anti-human globulin - observed to see if they agglutinate (used to screen pregnant women for antibodies that can cause HDFN)

patient has anaphylaxis to blood products. how do you investigate IgA deficiency?

IgA level | anti-IgA antibodies

special prep for platelets in patient with anaphylaxis related to IgA deficiency

apheresis platelets from IgA deficient donor

special prep for RBCs in patient with anaphylaxis related to IgA deficiency

wash to reduce IgA levels significantly

two uses of PCC

- to reverse warfarin-related bleeding | - to treat bleeding in hemophilia B if purified factor is not available

when would you use activated PCC (FEIBA)

in patient with hemophilia A and inhibitor who is bleeding

how common is selective IgA deficiency?

range from 1/100 to 1/1000 (in canada, less common in asians)

components of whole blood

RBC plasma buffy coat (which contains platelets)

storage limit of platelets

5 days

which antigens are important in SCD population

Rh and Kell

what is the formula used to identify patients who are refractory to platelet transfusions

Correct count increments = platelet count increase x BSA x 10^11 / total platelet transfused

how can you prevent platelet refractoriness?

use ABO compatible platelets

treatment of platelet refractoriness

try using HLA matched platelets, crossmatch the platelets, give fresh platelets, ABO matched platelets

cause of febrile transfusion reaction

cytokines that are generated / accumulated during storage of blood products

three benefits of leukoreduction

1. transmission of CMV 2. alloimmunization of HLA antigens 3. prevent febrile transfusion reactions

what products are leukoreduced?

RBC and platelets

why is blood irradiated?

to prevent transfusion associated GVHD

what products are irradiated?

RBCs platelets granulocytes non-frozen fresh plasma

indication for CMV negative blood

patients receiving intrauterine transfusion

indications for cryopreservation of RBCs

rare blood types (ie bombay phenotype)

when evaluating an antibody panel, which antibodies have a dosage effect? (ie, if the antigen is heterozygous, it may be a false negative)

``` Rh (other than D) Kidd Duffy MNS ("R you KidDing Me?") ```