Transfusion Therapy Flashcards
Serological crossmatch
no previous type on record, mix rbcs from donor w plasma of recipient
IS/Extended
Electronic Crossmatch
2 determinations of recipient blood type match
must validate at seach site and anually after
Abnormal crossmatch
Incompatible cross match
exceptions
all incompatibilites must be resolved before transfusion
except if mom has Ab, crossmatch.screen moms plasma
uncrossmatched blood rewuires signed physicians order
Abnormal cross match <4mos
risk? g/v
vol
tox
risk graft vs host, viral transmission, volume overload toxicity
Neonate crossmatch
small volume blood type
no fully functional immune syst until 4 mos
O neg, CMV neg, sickle cell neg
<7 days
irradiated
aliquoted
Emergency release
O blood unit retyped
rh negative to females of child bearing age
Rh pos to males and females over age
segments saved for crossmatch after unit is issued
should be tagged uncrossmatched
Massive transfusion
what replacement
how many in 24hr? 1hr?
what is not required?
Considerations?
whole blood replacement
10 rbcs in 24hr
5rbs 1 hr
sero crossmatch of additional units not required
considerations: toxicity, overload, coag
maybe emergency release
Massive transfusion risks
what causes shock?
c
hypo
acid
hypo - car
acidosis = shock
coagulopathy
hypocalcemia - excess citrate, admin calcium
Acid base imbalace - monitor sodium/choride
Hypothermia - cardiac arrythmias
Citrate/lactate levels
K+ levels
Hgb/oxy affinity levels
decreased
increased
increased
Presurgical regulations
3 day rule doesnt apply for the most part
Transfusion decisions
scheduled
prework- type/screen
have product on hand
pt may qualify for crossmatch beyond 72 hrs if
no transfusion/preganancies within 3 mos and no alloabs
Heart surgery
reduced what in circulation
blood loss?
sensitive to?
reduces plt in circulation
blood loss 1000ml
sensitive to K+ in system
Liver surgery
SEVERE
prepare for?
what should be considered?
severe coagulopathy
great blood loss
prepare for massive surgery
intraoperative cell salvage should be considered
Kidney surgery
end…
difficulty?
blood loss
end stg renal and anemia
difficulty clearing anticoags and medicines
<1000ml blood loss
Spinal surgery
fully functional organs
transfusions may make it worse
Pre surgical transfusion tools
selected
preor
pos
MSBOS
selected panel cells
preorder expected delivery
pos ID pt
MSBOS - maximum surgical blood order schedule
Bloodless medicine
religious/safety concerns
diff surgical practice
micro sampling
monitored but NOT acted on
DO NOT COLLECT BB samples
Jahovahs witnesses
Transfusion decisions
Oncology
pt treated for?
needs more?
removal is?
what kind of difficulites?
what kind of products?
pt treated for cancer
needs more transfusions
tumor removal bloody
serological difficulites w immunocompromised
Irradiated products
Urgent warfarin reversal
what kind of pts
what for intracranial hemorrhage
what if not at risk of volume loss
mentally compromised
plasma for intracranial hemorrhage
Vit. K/PCC if not at risk of volume loss
Brain injury
increase plasma
TTP
recommend plasma over plts
AIDS
may increase chronic anemia
irradiated products
