Transfusion Therapy and The role of the medical director in blood banking Flashcards
- True or false? A liberal transfusion policy for red blood
cells, utilizing a transfusion trigger of 10 g/dL should be
utilized for all patients.
False.
There is no single transfusion trigger applied to all patients. The decision to transfuse
must be based on assessment of clinical factors as
well as laboratory values. The TRICC trial demonstrated a restrictive transfusion policy which is at
least as and possibly superior to a liberal policy in
critically ill patients.
- True or false? Transfusion of two units of packed red
blood cells would be expected to raise a patient’s
hemoglobin from 7 to 9 g/dL
True.
Transfusion of one unit of packed red blood
cells is expected to raise the hemoglobin concentration by 1 g/dL and the hematocrit by 3%
- True or false? Transfusion of HLA-matched platelets is
indicated in a thrombocytopenic patient with refractoriness due to nonimmune causes.
False.
HLA-matched platelets are indicated for
the immune cause of refractoriness due to presence of patient HLA antibodies. For nonimmune
causes, there would be no benefit over transfusion
of randomly selected platelets
- True or false? The term “least incompatible” as applied
to red blood cells assures the clinician that all of the
units in the blood bank have been screened and the
unit issued shows the lowest amount of reactivity on
crossmatch with the patient’s sample
False.
“Least incompatible” red blood cell units
are provided in the case of the presence of autoantibodies when all alloantibodies are ruled out.
Because of the broad specificity of the autoantibodies, some reactivity on crossmatch is expected
with all units, since the autoantibody reacts even
with the patient’s own cells.
- True or false? Leukocyte reduction reduces the risk of
transfusion of Cytomegalovirus, and such products are
considered “CMV safe.”
True.
Leukocyte reduction may reduce the risk of
febrile nonhemolytic reactions, CMV transmission, and HLA alloimmunization.
- True or false? Irradiation of blood products is performed to
prevent transfusion-associated graft-versus-host disease.
True.
Lymphocytes are inactivated by irradiation at 2,500 cGy. It is indicated in directed donor components from blood relatives of the patient, bone
marrow transplant recipients, immunodeficient
patients, and intrauterine and neonatal transfusions as well as other conditions.
- True or false? Refractoriness to platelet transfusion is
suggested when a patient’s 1-hour posttransfusion CCI
or PPR is below adequate response levels on two consecutive transfusions.
True.
An adequate PPR is >20% when measured
10 to 60 minutes post transfusion. A CCI of 7,500 platelets X m2 BSA per microliter is considered adequate
- True or false? Granulocytes must be ABO and crossmatch compatible, irradiated, and transfused within 24
hours of collection
True.
Irradiation prevents graft-versus-host
disease by inactivating lymphocytes, but does
not affect neutrophil function. The component
must be ABO and crossmatch-compatible due
to the presence of contaminating red blood
cells. Granulocytes must be transfused within
24 hours of collection because they undergo
rapid apoptosis
- True or false? A leukocyte reduction filter should be
used when transfusing granulocytes.
False.
A leukocyte reduction filter would remove
granulocytes from the component before transfusion to the patient.
- True or false? Preoperative autologous blood donors
must meet all of the same criteria as volunteer allogeneic blood donors.
False.
Autologous donors may donate at a lower
hemoglobin level and are not necessarily prevented from donation by various disease states that render allogeneic donors ineligible
- Platelet transfusions are absolutely or relatively contraindicated in all of the following except:
a. thrombotic thrombocytopenic purpura (TTP)
b. idiopathic thrombocytopenic purpura (ITP)
c. heparin-induced thrombocytopenia (HIT)
d. a bleeding patient with a platelet count of
50 X 10_3 /mm3
d. a bleeding patient with a platelet count of
50 X 10_3 /mm3
Platelet transfusion in TTP or HIT may fuel
thrombosis. It is not indicated in ITP because it is ineffective
- Which of the following is the least-favored alternative to
allogeneic transfusion?
a. preoperative autologous donation
b. intraoperative blood salvage
c. postoperative blood salvage
d. acute normovolemic hemodilution
c. postoperative blood salvage
Postoperative blood salvage has limited utility,
and the product obtained is hemodilute, partially hemolyzed, defibrinated, and cytokine-rich.
Match
Column A
- Replacement fluid for plasma exchange in a patient with TTP
- A 3-year-old profoundly neutropenic patient with leukemia and a bacterial infection unresponsive to antibiotics
- A stable patient with a hemoglobin of 9 g/dL and asymptomatic
- Patient with thrombocytopenia and active bleeding
- Hypofibrinogenemia
- Replacement fluid for plasma exchange for Guillan–Barré syndrome
- Bleeding in hemophilia A patient
- Exchange transfusion in patient with sickle cell disease
Column B
A. apheresis platelets
B. albumin
C. granulocytes
D. cryoprecipitate
E. packed red blood cells
F. plasma frozen within 24 hours (FP24)
G. no transfusion
H. recombinant factor VIII (rFVIII)
- Replacement fluid for plasma exchange in a patient with TTP
=> F. plasma frozen within 24 hours (FP24) - A 3-year-old profoundly neutropenic patient with leukemia and a bacterial infection unresponsive to antibiotics
=>C. granulocytes - A stable patient with a hemoglobin of 9 g/dL and asymptomatic
=>G. no transfusion - Patient with thrombocytopenia and active bleeding
=>A. apheresis platelets - Hypofibrinogenemia
=>D. cryoprecipitate - Replacement fluid for plasma exchange for Guillan–Barré syndrome
=>B. albumin - Bleeding in hemophilia A patient
=>H. recombinant factor VIII (rFVIII) - Exchange transfusion in patient with sickle cell disease
=>E. packed red blood cells
