Transfusion/Problems Flashcards
Is a blood transfusion considered an invasive procedure?
YES, still need informed consent!
Current literature for transfusion supports (restrictive/unrestrictive) blood transfusion strategy
Restrictive
Red blood cell transfusions are given to raise the ______ levels in patients with symptomatic/severe anemia or to replace losses after acute blood loss.
Hematocrit
Patients must meet at least one of the following criteria to receive a blood transfusion:
Acute hemorrhage (_____ mL blood loss) / rapid bleeding with ______ instability
Hgb ____g/dL
Hgb ____g/dL AND is a ________ patient, or has _____ dz w/o signs/sx of acute ______
Hgb ____g/dL AND has _____ dz with signs/sx of acute ______, or symptomatic ______, or ______ instability
Acute hemorrhage (>1500 mL blood loss) / rapid bleeding with hemodynamic instability
Hgb <7g/dL
Hgb <8g/dL AND is a post operative patient, or has cardiac disease without signs/symptoms of acute ischemia
Hgb<10g/dL AND has cardiac disease with signs/symptoms of acute ischemia (infuse slowly and with diuretic) or symptomatic anemia (light headedness, chest pain, dyspnea on exertion, severe fatigue preventing work or usual activity) or hemodynamic instability (sustained tachycardia, tachypnea not attributable to other causes, hypotension)
The volume of blood transfused should be just enough to relieve _____ / _____
clinical sx/hypoxia
It (is not/is) necessary to restore the hemoglobin to normal levels
Is not
What are some examples of preparations of RBCs for transfusion?
Fresh Whole Blood Packed Red Blood Cells (PRBC) Leukocyte-Poor Blood Frozen Packed Red Blood Cells Autologous Packed Red Blood Cells
Fresh whole blood contains ____, ____, and ____.
RBCs, plasma, and platelets
T/F Fresh whole blood is never absolutely necessary
True
Major indications for the use of fresh whole blood are for _____ surgery or massive hemorrhage when _____ units of blood is required in a ____-hour period.
Major indications for the use of fresh whole blood are for cardiac surgery or massive hemorrhage when more than 10 units of blood is required in a 24-hour period.
What is PRBC most commonly used for?
To raise the hematocrit (Hct)
Each unit of PRBC has a volume of ____ mL and each unit will raise the patient’s hematocrit by ___%
300 mL
One unit raises Hct 4%
Leukocyte-poor blood is (frequently/rarely) needed, and is used in patients with what type of reaction?
Rarely; severe leukoagglutinin reactions to PRBC’s
T/F Most blood products today are relatively leukocyte-poor
True
PRBC’s can be frozen and stored up to ___ years, and is mainly done for what purpose?
3 years
Maintaining a supply of rare blood types
_______ PRBCs are donated by patients before their elective surgery and may be stored up to___ days before freezing is necessary
Autologous
35 days
Only the ___ and ____ antigen systems on RBCs are specifically tested prior to all transfusions
ABO and Rh
The ____ and ____ systems are the most important and giving blood from a donor lacking either one of these antigens can cause ______ of the incompatible RBCs
A and B
rapid intravascular lysis
In emergencies, when a pt’s blood type is unknown, type _____ blood can be given.
O/Rh-negative
What are the three types of transfusion reactions?
Hemolytic
Leukoagglutinin
Hypersensitivity
(Acute/Delayed) hemolytic transfusion reactions and are the most severe of reactions and are temporally related to the transfusion
Acute
Hemolytic transfusion reactions are due to what? Secondary to what?
Incompatible mismatches in the ABO system
Secondary to clerical errors and mislabeled specimens
(Acute/Delayed) hemolytic transfusion reactions are less severe and are caused by minor RBC antigen discrepancies
Delayed
Delayed hemolytic transfusion reactions may be delayed ____-____ days after transfusion
5-10 days
In a pt with a delayed hemolytic transfusion reaction, in the time since the transfusion, a new______ has formed
alloantibody
What are some signs and sx that may occur in a pt experiencing an acute hemolytic transfusion reaction? What signs/sx may be seen in a more severe case?
Fever, chills with backache and HA
Severe cases with apprehension, dyspnea, hypotension and CV collapse
Acute DIC and kidney failure can occur
Death occurs in ___% of acute hemolytic transfusion reactions
4%
What are some signs and sx that may occur in a pt experiencing an delayed hemolytic transfusion reaction?
Usually, these pts are without sx or signs
How do you tx a pt with a hemolytic transfusion reaction?
Stop the transfusion immediately and provide aggressive supportive care
What laboratory findings will be seen in a pt with an acute hemolytic transfusion reaction? (think: what will happen to Hct?)
Hct will fail to rise
Hemoglobinuria
What laboratory findings will be seen in a pt with a delayed hemolytic transfusion reaction? (think: what will happen to Hct? Bilirubin? Alloantibody?)
Hct will fall
Indirect bilirubin will rise
New alloantibody easily detected
T/F Most transfusion reactions are hemolytic
False; they are not!
_____ transfusion reactions are the the body’s response to antigens in transfused blood leukocytes by a patient who has been previously sensitized to leukocyte antigens from prior transfusions or pregnancy
Leukoagglutinin
In a pt who is experiencing an leukoagglutinin transfusion reaction, what sx can be observed?
Fever, chills w/in 12 hours, cough, dyspnea, transient pulmonary infiltrates
Hypersensitivity reactions are due to exposure to _____ plasma proteins rather than ______
allogenic; leukocytes
Is there a high or a low risk of having a hypersensitivity reaction to a blood transfusion?
Very low risk
What are two sx that may be experienced during a hypersensitivity reaction to a blood transfusion?
Urticaria, bronchospasm
Other miscellaneous reactions to blood transfusions include ….
Contaminated blood
Infectious disease transmission
Transfusion Graft-Versus-Host Disease (GVHD)
Transfusion-Related Acute Lung Injury (TRALI)
When are platelet transfusions indicated?
Indicated for thrombocytopenia due to decreased platelet production
When considering a platelet transfusion for a patient, you start to think about the possible risks of having a low platelet count. As you think about these risks, you remember that when a pt has a platelet count of ______ , they have a risk of spontaneous bleeding. When they have a platelet count of _____ they are at risk of a life-threatening bleed.
Risk of spontaneous bleeding < 80,000
Risk life-threatening bleed <5,000
When a pt has a platelet count of _____, you should give prophylactic platelets
<10,000
When a pt has a Hx of a prior invasive procedures or surgery, you should keep their platelet count at ______
> 50,000
How often are granulocyte transfusion indicated? Explain.
Granulocyte transfusiona re seldom indicated, due to development of myeloid growth factors
When is a granulocyte transfusion useful?
In pts with profound neutropenia (<100/mcL) and acutely ill from infection
Fresh frozen plasma is available in units of ____mL
200 mL
Fresh frozen plasma contains (low/normal/high) levels of all coagulation factors
normal
What is FFP used for?
To correct coagulation factor deficiencies, TTP, or HUS
