Transfusion Therapy and Adverse Effects Exam 7 Flashcards
Define transfusion therapy
A broad term that encompasses all aspects of transfusion of patients
________ have specific indications for use, expected outcomes, and other considerations.
Blood components
What is considered when using blood products?
Drugs patient is on, adverse effects that may occur, and the chance of rejection of blood cells because transfusion is a form of transplantation.
Transfusion therapy is used for what two conditions?
Mainly anemia and hemostasis. It can be used to prevent stroke or recurrent pain episodes.
Anemia occurs because…
Inadequate oxygen-carrying capacity because of anemia or blood loss
Hemostasis occurs because…
Insufficient coagulation proteins or platelets to provide adequate hemostasis
True or false, transfusion therapy is the same for all patients.
False, transfusion therapy is unique for each individual depending on their needs. They will need certain blood components to meet their needs.
Why would whole blood be used for transfusion:?
Used to replace loss of both RBC mass and plasma volume
What kind of patients can use whole blood or RBC + plasma?
Rapidly bleeding patients
What are the anticipated effects of using whole blood in a transfusion?
Increases in hemoglobin and hematocrit
What is the indicated effect of using RBCs for transfusion?
Increase RBC mass in patients who require increased oxygen-carrying capacity
What are the anticipated increases using an RBC transfusion?
Increase in hemoglobin 1 g/dL and hematocrit 3%
Why would a clinician transfuse leukocyte reduced RBCs?
To reduce HLA alloimmunization, CMV transmission, FNHTR, TA-GVHD, and transfusion related immune suppression
What is the threshold for an RBC to be considered leukocyte reduced?
< 5x10^6 WBCs
Washed RBCs are used when?
When a patient has an anaphylactic transfusion reactions to ordinary units of RBCs.
RBC washing process removes…?
Plasma proteins because it is the cause of most allergic reactions.
What causes an allergic reaction in patients in RBC transfusion?
Plasma proteins
An IgA deficient patient requires what kind of RBC transfusion?
Washed RBC
What is required before freezing an RBC for long term storage?
The addition of glycerol
What should be done to a frozen RBC before transfusion?
Wash so glycerol levels are gone
Platelet transfusion are for what kind of patients?
Patients with thrombocytopenia or abnormally functioning platelets.
What is plateletpheresis?
Component prepared from one donor and must contain a minimum of 3 x 10^11 platelets
What is the anticipated increase from platelet transfusion?
30k to 60k platelet count increase
When would a patient be considered refractory?
If the 10 minute increment platelet count increase is less than 50% of that expected on two occasions. The rational behind the lack of increase is because the HLA of the platelet does not match or an antibody is behind the destruction of the platelet. The common antibody behind platelet destruction is PA1.
What is the criteria for identifying patients who are likely to benefit from granulocyte transfusion?
1 Fever, neutrophil counts less than 500/uL, septicemia or bacterial infection unreponsive to antibiotics, reversible bone marrow hypo plasma, and a reasonable chance for survival
2. Requirement or crossmatch
What are the different products that can be made from plasma?
Fresh frozen plasma, Plasma 24, and thawed plasma
What are some situations to use plasma on a patient?
- Treatment of single and multiple coagulation deficiencies
- In Vitamin K deficiency or warfarin overdose
- Use in liver disease or liver failure
- Use in treatment of DIC
What is the purpose of cryoprecipitate transfusion?
Used for fibrinogen replacement. Useful in mild or moderate Factor VIII deficiency
What is AABB requirements for fibrinogen content?
150 mg fibrinogen and 80 units of Factor VIII per unit
Today, mild or moderate factor VIII deficiency is treated with…
Desmopressin acetate
What product is an alternative to CMV negative RBC?
Leuko reduced RBC
What is the goal WBC count for an RBC product to be considered leuko reduced?
5x 10^ 6 leukocytes
What products can be used to prevent febrile non hemolytic transfusion reactions, prevent or delay development of HLA antibodies, and reduce the risk of transmission of CMV?
Leukocyte - reduced RBCs or platelets
What must a blood component undergo for the transfusion into a transplant patient?
Irradiation with gamma radiation to prevent GVHD
What is GVHD?
Stands for graft versus host disease. It’s commonly seen after allogenic bone marrow or hematopoietic progenitor cell transplantation. The syndrome affects mainly skin, liver, and gut.
What would need to be ordered for a transfusion not to be considered emergent?
A type and screen would need to be ordered and completed to not require paperwork for emergent transfusion.
When are emergent transfusions done?
A signature from doctor is required. It’s used for patients who are rapidly or uncontrollably bleeding losing more than 20% of their blood volume
What blood product is used for emergent transfusion?
Group O Rh negative and Rh positive RBCs
What must be done for emergent transfusion cases besides a signature from the doctor?
Completion of antibody screen
Define. Massive transfusion
Replacement of one or more blood volumes within 24 hours (about 10 units)
What blood product old a Rh-negative woman of potential childbearing age receive?
Rh-negative RBC products as long as possible
What are the risk factors for bleeding during cardiac surgery?
1 Time on pump
2. Age of patient
3. Previous cardiac surgery
4. Type of surgery valve replacement, CABG, or both
5. Pre operative medications (aspirin and anticoagulant)
6. Heparin effect
7. Hypothermia decreases platelet function
What information is required for the aliquot for an infant?
Name and identifying numbers of patient and donor
What kind of blood unit are preferred for infants?
Blood units less than 7 days old to reduce the risk of hyerkalemia and to maximize the 2,3-diphosphoglycerate levels.
What kind of RBC product do infants get to prevent CMV infection?
CMV negative RBC or leukoreduced RBC
If an infant is hypoxic or acidosis, what would they receive?
Blood test and negative for hemoglobin S
What is associated with liver transplant?
Massive hemorrhage due to hypocoagulability
If you are working during heart and lung surgery what kind of components should you have ready?
Leukoreduced components
Graft survival is enhanced with…?
HLA-matched donor - recipient combinations
Hematopoietic cells contain…?
Stem cells and progenitor cells
What are the three types if transplant?
Allogeneic, syngeneic, and autologous
Sources of transplants can be…?
Bone marrow, peripheral blood (spheres is), and umbilical cord blood
What are some congenital immune deficiencies that can benefit from therapeutic use of hematopoietic progenitor cell transplants?
Severe combined immunodeficiency disease
2. Wiskott - Aldrich syndrome
3. Aplastic anemia
4. Fanconi anemia
5. Hemoglobinopathies
6. Thalassemia
7. Sickle Cell. Disease
What malignancies can benefit from hematopoietic progenitor cell transplantation?
- Acute leukemia
- Non-Hodgkin and Hodgkin lymphoma
- Myelodysplastic/myeloproliferative disorders
- Multiple myeloma
What other conditions can benefit from cell transplantation?
- Paroxysmal nocturnal hemoglobinuria
- Multiple sclerosis
True or false, ABO compatibility is essential for HPC transplants.
False, it is not essential. Why? I don’t have a reason please refer to the textbook.
What could happen if a Group O recipient received a group A donor?
Delayed engraftment may occur following a major ABO-incompatible transplant.
What may occur if a group A recipient received group O?
Hemolysis after a minor ABO-incompatible transplant
What is essential for an ABO mismatch cell transplant?
RBCs and plasma must be. Compatible with donor and recipient!
In Oncology, what could result in a decrease of platelets, leukocytes, hemoglobin, and hematocrit?
Chemotherapy
What are the side effects of chemotherapy?
Bleeding, anemia, infection, and increased risk of TA-GVHD
What alternatives are there to transfusion in oncology?
- Erythropoietin
- Colony-stimulating factors (CSFs)
- DDAVP (desmopressin)
In chronic renal disease, elevated uremia would have what effects on the RBCs?
Altering RBC shape, and premature RBC removal
In chronic renal disease, dialysis procedure would have what effect on RBCs?
Shearing RBCs
In chronic renal disease, low erythropoietin levels would have what effect on the body?
Low RBC production
HUS and TTP have what similar symptoms?
- Thrombocytopenia
- Microngiopathic hemolytic anemia
- Renal dysfunction
- Central nervous system involvement
What is the treatment of HUS and TTP?
- Therapeutic plasma exchange daily for 1 - 2 weeks.
- Platelet transfusions are contraindicated or not recommended
About 25% - 30% of patients with what disease will develop alloantibodies?
Sickle Cell disease patients. Some patients are phenotypically matched to prevent alloimmunization (D,C,E,K1)
Whats a complication of transfusion for sickle cell anemia patient?
Iron overload from repeated transfusion and thalassemia.
True or false, RBCs are not removed from circulation sooner than 120 days in immune hemolytic anemias.
False, they are removed from circulation sooner or can be.
What are the three groups of immune hemolytic anemia?
- Autoimmune hemolytic anemia that can be cold or warm
- Drug induced hemolytic anemia
- Alloimmune hemolytic anemia
What are the different forms of drug induced hemolytic anemia
Drug adsorbs on RBC membrane
Drug-antibody complex adsorbs on RBC membrane
Drug causes autoantibody to be produced
What are the two ways alloimmune hemolytic anemia can be caused?
Transfusion or HDFN
How are hemostatic disorders characterized?
- One or more coagulation proteins are decreased or missing
- Protein has normal production but abnormal structure.
- Symptoms include prolonged bleeding, bleeding in joints, and subcutaneous bleeding
What are common hemostatic disorders?
Von willebrand’s disease, hemophilia A, and hemophilia B.
Whats the most common treatment for hemostatic disorders?
Missing factors or DDAVP
What is required before administration and during administration of blood?
Positive identification during lab testing where the nurse asks the patient to say or spell their full name while they read it off the armband.
What is done to reduce clerical errors in blood transfusion?
Electronic systems check patient and label identification to make sure things match. Lab checks past patient test results to make sure the results are not abnormal. The last check is done by nurses that compare patient armband to blood bank tag attached to blood components that will be transfused.
What is used to prevent blood products from causing hypothermia in patients while transfusion is done?
Blood warmers. Hypothermia in the patient increases the possibility of cardiac arrhythmia and hemorrhage.
What are alternatives to transfusion?
- Growth factors - Stimulates bone marrow to produce RBCs, white blood cells, and platelets
- Blood derivatives - Factors 7A, 8, or 9, antithrombin, and protein C
- Volume expanders - crystalloids or colloids
What does the joint commission do?
- Require all blood transfusion be reviewed for appropriate use, publishes guides, and audits the transfusion process.
2.
