Transfusion Medicine

Question 1

What is the difference between activated PCC, 4-factor PCC and 3-factors PCC?

Answer 1

PCC contains the vitamin K dependent factors (II, VII, IX. X) as well as protein C, protein S and heparin.

4-Factor PCC contains FVII
3-Factor PCC DOES NOT contain FVII

Activated PCC contains mostly activated factor VII and is used in the reversal of dabigatran.

Question 2

What is a contraindication for PCC?

Answer 2

History of HIT because PCC contains heparin

Question 3

What is the indication for PCC?

Answer 3

Warfarin reversal or vitamin K deficiency with life threatening bleeding and INR > 1.5 or emergency surgery within 6 hours. Also indicated in reversal of DOACs

Question 4

What does fresh frozen plasma contain?

Answer 4

All clotting factors + fibrinogen.

Question 5

What are the indications for use of fresh frozen plasma?

Answer 5

Warfarin reversal with a previous history of HIT.

Bleeding/procedure with INR > 1.8

Question 6

What is protamine used for?

Answer 6

The reversal of unfractionated heparin. Can also be used to reverse LMWH if andexanet not available.

Question 7

In which patients are irradiated red blood cells required (7)?

Answer 7

Prevents transfusion associated GvHD in:

(1) History of transfusion associated GvHD
(2) Hodgkin’s Lymphoma (even cured)
(3) Congenital T-cell Immunodeficiency
(4) Stem Cell Transplant Recipient
(5) Intrauterine Transfusions
(7) Treatment with a purine analog (fludrabine)

Question 8

In which patients are CMV negative blood products potentially required (3)?

Answer 8

(1) Intrauterine Transfusions
(2) CMV Seronegative Pregnant Women
(3) CMV Seronegative recipients of allo-BMT

Question 9

Which patients require washed blood products (3)?

Answer 9

(1) Hx of anaphylaxis to blood products
(2) Recurrent allergic reactions
(3) IgA deficiency with + IgA antibodies with a history of reaction