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Transfusion Therapy Flashcards

1
Q

What % of donor cells die every day?

A

1%
EX) if Blood is transfused 10 day after collection in 30 days what % of donor cells remain? 10+30 = 40% lost; so 60% remain

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2
Q

1 Kg equals how many lbs?

A

2.2 lbs

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3
Q

How much will 1 unit of RBC’s increase the Hgb and Hct in an adult?

A 
Hgb = 1 g/dL
HCT = 3%
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4
Q

What is the formula to calculate how much blood to give to an infant?

A

10 ml/kg will increase HGB by 2-3 g/dL

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5
Q

How do you calculate TBV in females, males, and infants?

A

Females = 60 mL/kg
Males = 66 mL/kg
Preterm infant = 110 mL/kg
Term infant = 85 mL/kg

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6
Q

How do you calculate # of RHIG to give?

A

% fetal cells x TBV (AVG 5000) / 30

plus one vial

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7
Q

How do you calculate total plasma volume?

A

TBV x (1-HCT) = TPV

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8
Q

Calculate how much plasma to give to raise coagulation factors from 0 to 25%.

A

PV x % increase = ml of FFP

  • 1 FFP = 200-250 mL
  • 1 mL FFP = 100% coagulation factors
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9
Q

How much fibrinogen is in cryo?

A

150 mg

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10
Q

How much factor VIII is in cryo?

A

80 IU

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11
Q

How many platelets are in an apheresis unit?

A

3.0 x 10*11

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12
Q

What is average volume and HCT of a unit of RBC’s with additives?

A

250-300 mL with 65% HCT
* CPDA HCT is 80%
+ 20-100 ml of plasma = 300-400 mL total volume

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13
Q

Leukocyte reduced blood must have less than how WBC?

A

less than 5.0 x 10*

and 85% of the original RBC volume

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14
Q

What is FFP vs FP24?

A

FFP is frozen within 8 hrs
FP24 is frozen with 24 hrs
FVIII is reduced in FP24

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15
Q

What is cryo poor plasma?

A

FFP thawed at 1-6C and centrifuge to remove precipitate
Has no F-VIII, F-XIII, vWF, or Fibrinogen
Only indicated in TTP when FFP is unsuccessful to remove vWF and replace ADAMTS-13

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16
Q

What is thawed plasma?

A

FFP thawed and stored at 1-6C for 5 days
F-V and F-VIII is reduced
Normal levels of F-II, F-VII, F-IX, F-X, Fibrinogen, ADAMTS-13

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17
Q

What is liquid plasma?

A 
Plasma that's never been frozen
Expires 5 days after WB unit
Reduced levels of F-V and F-VII
Used for MTP
Contains viable lymphocytes that may cause GVHD
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18
Q

What is the usual dose for FFP?

A

10-20 mL/kg will increase coag factors by 20-30%%

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19
Q

How do you calculate Cryo dose?

A

Fibrinogen increase x PV in dL (3000 mL = 30 dL)

divide by 250 mg = # of units

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20
Q

How much will 1 cryo/ 10 kg of body weight raise fibrinogen levels by?

A

50 mg/dL

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21
Q

What is PCC?

A

Prothrombin complex concentrate
4 factor contains F-II, F-VII, F-IX, F-X PC and PS
3 factor lacks F-VII
Used to reverse Vit K antagonist such as warfarin or to replace Vit K dependent Coag factors when concentrates are not available
Can be used in hemophilia patients w/ inhibitors

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22
Q

What is normal serum albumin?

A

A sterile preparation of serum albumin obtained by fractionating blood plasma proteins from healthy donors

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23
Q

When is normal serum albumin used?

A

Used to maintain plasma colloid osmotic pressure in shock, burns, cardiopulmonary bypass, acute nephrosis, (not chronic nephrosis)
Replaces protein loss

24
Q

What is plasma protein fraction?

A

Volume expander used for replacement of human plasma in the acute treatment of shock

25
What is salvage plasma?
Also called recovered plasma Unlicensed component sold to fractionators to make albumin and immune globulins No expiration date but records must be maintain indefinitely
26
What is IVIG?
Used to treat many autoimmune disorders because it suppresses autoantibody production Made from pooled human plasma
27
How does IVIG work?
Blocks Fc receptors on macrophages and B cells and modulates complement activity Suppresses inflammatory signals such as cytokines and chemokines
28
What are the FDA approved uses of IVIG?
``` Primary immunodeficiency Auto immune thrombocytopenia Kawaskai disease HSCT in patients older that 20 yrs Chronic B cell leukemia Prevention of GVHD Pediatric HIV ```
29
What are common off label use of IVIG?
``` aplastic anemia HDFN AIHA Clotting factor inhibitors Multiple sclerosis ```
30
What are the FDA guidelines for IVIG?
Prepared out of 1000 donors All for IgG subclasses must be present IgG should maintain biological activity for 21 days Does not contain samples that are HIV, HEP C, or HEP B positive Screened and treated in a manor that destroys viruses
31
How much Hgb and Iron is in one unit of RBC's?
50-80 g of hgb | about 250 mg of iron
32
How platelets and plasma is in an apheresis platelet unit?
≥3.0 x 10*11 platelets | 100-500 ml of plasma
33
What are PAS plalelets?
Platelet additive solution that dilutes out the plasma | Studies show a reduce risk of allergic reaction
34
How do you calculate the corrected count increment
Post-Pre PLT Ct x BSA / PLT transfused (10*11) | Platelet refractoriness is defined as a CCI ≤7,500 for at least 2 sequential platelet transfusions.
35
What are causes of platelet refractoriness?
Refractory platelet transfusions can be due to a number of non-immune causes, including fever, infection, bleeding, DIC, extensive surgery, splenomegaly, irradiation, and concurrent amphotericin B therapy
36
When is platelet transfusion not indicated?
Use of platelets in patients with autoimmune thrombocytopenia, thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), idiopathic thrombocytopenic purpura (ITP), or heparin-induced thrombocytopenia with thrombosis (HITT) should be avoided except for life-threatening hemorrhage
37
What is solvent-Detergent Plasma?
Pooled plasma that is treated and filtered to remove HMW vWF. Solvent removes lipid virus such as HIV, HCV, and HBV but not HAV or B19 Product is deficient in VIII, vWF and Protein S Thrombotic complications in liver surgery may be due to lack of Protein S
38
What are not indicators for FFP transfusion?
Volume expansion Nutritional support Bleeding with no evidence of factor deficiency Mildly increased PT/PTT alone Prophylactical TRN to increase INR for surgery (Poor predictor of bleeding risk) Heparin reversal - can used for coumadin reversal if emergency and no time for Vitamin K
39
What are indicators for FFP transfusion
Patients with multiple coagulation factor deficiencies massive transfusion Factor deficiency when specific therapy (recombinant or virally-inactivated) is not available (factors II, V, X, and XI, c1-esterase deficiency, AT-III deficiency) Patients requiring emergency reversal of coumadin (NOT heparin) Patients with TTP Patients with protein C or protein S deficiency associated with a hypercoaguable state
40
How much fibrinogen is 1 unit of FPP?
Approx. 400 mg
41
What are some diseases TPE is indicated for?
Thrombotic thrombocytopenic purpura (TTP) Gullain-Barré syndrome Myasthenia gravis Cryoglobulinaemia (severe) Hyperviscosity (Waldenström’s macroglobulinemia) Antibody-mediated renal rejection
42
What are the common anti-platelet drugs?
``` Aspirin inactivate cyclooxygenase and inhibits platelet thromboxane production. Thienopyridines (e.g., ticlopidine [Ticlid] and clopidogrel [Plavix]) inhibit platelet adenosine diphosphate (ADP) receptor. Glycoprotein inhibitors (e.g., abciximab [ReoPro], eptifibatide [Integrilin], and tirofiban [Aggrastat]) are potent inhibitors of platelet aggregation that block a receptor for fibrinogen and vWF ```
43
What are the "triggers" for platelet transfusion?
* 5000/μL: stable patients * 10,000/μL: patients with fever or recent hemorrhage * 20,000/μL: patients with coagulopathy, on heparin, or with anatomic lesions likely to bleed. * 50,000/μL: bleeding patients, patients about to undergo a hemostatic challenge such as surgery * 100,000/μL: patients with intracerebral, pulmonary, and ophthalmic hemorrhage
44
What diseases are platelet transfusions not indicated in?
ITP, TTP, HIT, HUS, or DIC | Unless the patient has a life-threatening hemorrhage
45
What are the disadvantages to a BMT ABO mismatch?
Delayed engraftment Increased risk of GVHD May have decreased survival
46
What is the advantage and disadvantage of using G-CSF mobilized peripheral SCT?
may engraft quicker but may have increased risk of GVHD | Benefit of donor lymph's causing an anti-tumor effect is unclear
47
What are the transfusion threshold for BMT patients?
Hgb 8-10 g/dL | PLT 10,000-20,000
48
What is passenger lymphocyte syndrome?
Donor lymph produce antibodies that may cause acute hemolysis of recipient RBC's Can be ABO, Kidd, Kel, Duffy, or Rh antibodies. Usually occurs during the 1st or 2nd week after transplant
49
What does a major ABO Mismatched BMT result in?
Donor RBC's are incompatible with recipient Can result in immediate hemolysis Ongoing production of ABO antibodies directed against donor RBC may last for 3-4 months.
50
What does a minor ABO mismatched BMT result in?
Donor plasma is incompatible with recipient | Can result in delayed hemolysis from donor antibodies
51
What can cause pure red cell aplasia in BMT patients?
Occurs if there is a major ABO mismatch and recipients lymphocytes survive the myeloablation and produce antibodies against donor RBC's.
52
What are signs of hemorrhagic shock?
``` Tachycardia Hypotension increased respirations Mental status changes Occurs with blood loss of 20-30% ```
53
What does transexamic acid do?
Anti-fibrinolytic > binds to plasminogen to prevent plasmin from breaking down fibrin Prevents fibrinolysis, promotes clot stability, and may lower inflammation Can lead to thrombosis
54
What is ECMO?
Extracorporeal Membrane Oxygenation Pumps the blood and oxygenates to give the heart and lungs a rest. Requires blood to prime machine. Platelets are consumed so goal of 100,000-150,000 Hgb maintained at 10-12 g/dL
55
What are the complications of Massive transfusion?
``` Coagulopathy Hemodilution of Coag factors and PLT's if colloids used Hypocalcemia (citrate toxicity) Hyperkalcemia Acidemia due to shock and poor perfusion Hypothermia Immune hemolysis ```
56
Why should additives in RBC's be removed in large volume transfusions for neonates?
Adenine - renal toxic Mannitol - potential diuretic Dextrose - high blood glucose > brain injury High potassium - cardiac risk (use fresh blood)

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