Transfusion Therapy

Question 1

Most common trigger for blood transfusion

Answer 1

7 g/dL

Question 2

filters for leukocyte- reduced RBCs

Answer 2

pre-storage: performed within 24 hrs of collection by size & other mechanisms
bedside: not effective for leukocyte reduction just clump removal

Question 3

Antigen matched RBCs

Answer 3

patient is antigen typed (by serology or DNA)

Rh group, K, Jk, Fy, Ss are normally matched

Question 4

major white blood cell type that CMV invades?

Answer 4

monocytes

Question 5

populations that need CMV negative blood?

Answer 5

BMT patients, neonates & immunocompromised

Question 6

populations that need irradiated blood components?

Answer 6

immunocompromised (except HIV)
BMT patients
intrauterine transfusions
recipients of directed donations from siblings due to shared HLA genotypes
leukemia/lymphoma patients

Question 7

populations that usually get platelets

Answer 7

patients with current/future thrombocytopenia
CHEMOTHERAPY
planned surgery etc etc

Question 8

platelets can be issued without question if:

Answer 8

plt <30,000 uL & bleeding
pediatrics hematology/oncology
BMT patients
GI bleed on coumadin
any patient 24 hrs post surgery
liver transplants
bleed in brain

Question 9

can plasma be used as a volume expander?

Answer 9

NEVER!! use crystalloid or albumin

Question 10

patients with hypofibrogenemia would get what blood product?

Answer 10

cryoprecipitate or fibrin glue

Question 11

Ringer’s Lactate

Answer 11

Na, K, Cl, lactate & Ca
adds fluids, electrolytes & corrects acidosis
CANNOT BE MIXED WITH PRBCs due to calcium clotting

Question 12

Pre-transfusion testing

Answer 12

crossmatch order:
type & screen
antibody ID
crossmatch antigen neg units if necessary
specimen retained 7 days following transfusion

Question 13

during transfusion what can be in the IV line?

Answer 13

ONLY NORMAL SALINE

no dextrose solutions (aggregates PRBCs) & no solutions with calcium (ringers lactate)

Question 14

neonatal & pediatric transfusion issues

Answer 14

fresh RBCs (<7 days) to maximize the level of 2,3- DPG
CMV negative, irradiated & leukocyte reduced

Question 15

Anemia in premature infants can be due to:

Answer 15

fetal hgb F has a higher o2 affinity & less is delivered to the tissues
iatrogenic blood loss due to lab tests
EPO triggered by liver, less responsive to low o2 levels

Question 16

why are oncology patient’s anemic?

Answer 16

most anti-cancer treatments kill rapidly dividing cells & those include hematopoietic cells
plts, leukocytes, hgb & hct drop with the progression of the treatment

Question 17

why transfuse patients with chronic renal disease

Answer 17

high uremic content in the blood leads to altered RBC shape & they are removed by the spleen
patients fail to produce sufficient EPO

Question 18

what blood component should you NOT give to patients with HUS & TTP

Answer 18

DO NOT GIVE PLATELETS!!

therapeutic plasma exchange is performed daily for 1-2 weeks

Question 19

Transplantation compatibility

Answer 19

ABO compatibility is most important

second is HLA

Question 20

whats the most important system to match in Stem cell transplants

Answer 20

HLA match is most important both class 1 & 2 antigens
siblings are the first choice
ABO types are not considered

Question 21

considerations when selecting RBCs & Plasma for BMT patients

Answer 21

make product compatible with both the recipient & the donor