Transfusion Therapy (from Harmening [7th ed.] | F) Flashcards
What is transfusion therapy (in general)?
It is a broad term that encompasses all aspects of the transfusion of pts
True or False
Each blood component has sp. indications for use, expected outcomes, and other considerations
True
Pts w/ special conditions requires what?
Strategies and decisions to optimize therapy
Are blood and blood products considered as drugs? Why or why not?
Yes, blood and blood products are considered as drugs because of their use of treating diseases
True or False
As w/ drugs, adverse effects may occur, necessitating careful consideration of therapy
True
Is transfusion of blood cells also a transplantation?
Yes
What are the things that must be achieved in transplantation (specifically in transfusion of blood cells)?
1) The cells must survive
2) The cells must fxn after transfusion (to have a therapeutic effect)
What is the best tolerated form of transplantation?
Transfusion of red blood cells (RBCs)
Transfusion of RBCs can cause what?
Rejection (as in a hemolytic transfusion reaction [HTR])
How is rejection of PLTs shown?
It is shown by refractoriness to PLT transfusions
Is rejection of PLTs relatively common in multiply transfused pts?
Yes
Transfusion therapy is used primarily to treat what conditions?
1) Inadequate oxygen-carrying capacity
2) Insufficient coagulation proteins or PLTs
What are the causes of inadequate oxygen-carrying capacity?
1) Anemia
2) Blood loss
Where are coagulation proteins and PLTs are needed?
Providing adequate hemostasis
True or False
Each pt does not require an individualized plan that reflects his/her changing clinical condition, anticipated blood loss, capacity for compensatory mechanisms, and lab results
False, because each pt requires an individualized plan that reflects his/her changing clinical condition, anticipated blood loss, capacity for compensatory mechanisms, and lab results
Is it possible for some pts (w/ anemia or thrombocytopenia) to not require transfusion? How?
Yes, because their clinical conditions are stable and they have little or no risk of adverse outcomes
Provide an ex of a pt (w/ anemia or thrombocytopenia) who does not need transfusion
Pt w/ iron-deficiency anemia (IDA) w/ minor symptoms
What is the principle of appropriate blood therapy?
It is the transfusion of the sp. blood product needed by the pt
How can selection of blood products be done?
Several pts can be treated w/ the blood from 1 donor, giving optimal use of every blood donation
*What are the different blood products used in transfusion therapy?
1) Whole blood
2) Red blood cells
3) Leukocyte-reduced RBCs
4) Washed RBCs and Frozen / Deglycerolized RBCs
5) Rejuvenated red blood cells
6) Platelets and plateletpheresis
7) Granulocyte pheresis
8) Plasma
9) Cryoprecipitate
10) Thawed plasma, cryoprecipitate reduced
11) Factor VIII
12) Factor IX
13) Antithrombin and other concentrates
14) Albumin
15) Immune globulin
Special products:
16) Leukocyte-reduced cellular blood components
17) CMV-negative cellular blood components
18) Irradiated cellular blood components
When compared w/ the circulating blood in the donor’s blood vessels, what is done to the product of whole blood?
The product of whole blood is diluted in a proportion of 8 parts circulating blood to 1 part anticoagulant
What is present in the anticoagulant (for whole blood)?
Citrate
What is the action of citrate?
It chelates ionized Ca
What is the result of the action of citrate?
The activation of the coagulation system is prevented
If present, what serve as substrates for RBC metabolism during storage?
1) Glucose
2) Adenine
3) Phosphate
True or False
The transfusion of whole blood is not limited to a few clinical conditions
False, because the transfusion of whole blood is limited to a few clinical conditions
What is the requirement for whole blood (that will be transfused)?
It must be ABO identical w/ the recipient
What is the purpose of transfusing whole blood?
To replace the loss of both RBC mass and plasma volume
Who are the pts who can receive whole blood (in connection to the purpose of transfusion of whole blood)?
Rapidly bleeding pts
What are the 2 components of the whole blood that are more commonly used and are equally effective clinically?
1) RBCs
2) Plasma
What is the definite contraindication to the use of whole blood?
Severe chronic anemia
What is the principle of whole blood transfusion for pts w/ severe chronic anemia?
Pts w/ chronic anemia have a reduced # of RBCs but have compensated by increasing their plasma volume to restore their total blood volume. Hence, these pts do not need plasma in the whole blood and may adversely respond by developing pulmonary edema and heart failure due to volume overload. This most likely occur in pts w/ kidney failure or preexisting heart failure
Pts w/ chronic anemia (have reduced # of RBCs) -> compensated (via increasing plasma volume: to restore blood volume) -> may adversely respond (via developing pulmonary edema and heart failure)
For a 70 kg (154 lbs) adult, what are the effects brought by each unit of whole blood?
Increased:
1) Hct (3%)
2) Hgb (1 g/dL)
After transfusion of whole blood, is the increase brought by it apparent already? If no, when is the increase apparent?
No, the increase may not be apparent until 48 - 72 hrs when the pt’s blood volume adjusts to normal
Provide an ex of the increase brought by whole blood transfusion
A pt w/ a 5,000 mL blood volume and 20% hct lvl has 1,000 mL RBCs. After transfusion of 500 mL whole blood (containing 200 mL RBCs), the pt’s blood volume will be 5,500 mL and will result in 21.8% hct. When the pt’s blood volume readjusts to 5,000 mL, the hct lvl will be 24% (1,200 mL divided by 5,000 mL)
What is the principle of increase brought by whole blood transfusion for pts w/ different sizes?
The increase is greater in a smaller person and less in a larger one
> in smaller person; < in larger person
How are RBCs (for transfusion) preped?
These are preped from whole blood collected into any of the anticoagulant-preservative solutions (approved by the FDA) and separated from the plasma by centrifugation and sedimentation
Whole blood (collected from any anticoagulant-preservative solutions) -> separated from plasma (via centrifugation and sedimentation)
What are the indications of RBC transfusions?
Indicated for increasing the RBC mass in pts who require increased oxygen-carrying capacity
What are the clinical manifestations of pts who require increased oxygen-carrying capacity?
These pts typically have:
1) Increased pulse rates (100 beats/min >)
2) Increased respiration rates (30 breaths/min >)
These pts may experience:
3) Dizziness
4) Weakness
5) Angina (chest pain)
6) Difficulty thinking
What may be the causes of decreased RBC mass?
1) Decreased bone marrow production
a. Leukemia
b. Aplastic anemia
2) Decreased RBC survival
a. Hemolytic anemia
3) Surgical or traumatic bleeding
How does the human body compensate for anemia?
By increasing:
1) Plasma volume
2) Heart rate
3) Respiratory rate
4) Oxygen extraction from the RBCs
In terms of oxygen extraction from RBCs, how many % of the oxygen is normally extracted?
About 25%
In terms of oxygen extraction from RBCs, if there is an increased demand at the organ and tissue lvl, how many % of the O2 can be extracted?
Up to 50%
What happens when the demand exceeds 50% of the O2 content?
1) The compensatory mechanisms fail
2) Pt requires transfusion
Are there set hgb lvls that indicates a need for transfusion?
None
What is the critical lvl of hgb?
< or equal to 6 g/dL
What are the trigger values (of hgb) suggested by consensus committees?
1) For most pts: < 7 g/dL
2) For pts w/ heart disease: < or equal to 8 g/dL
Most pts can tolerate 7 g/dL (of hgb lvls) in what circumstances?
1) If pt is on bedrest
2) If pt is at decreased lvls of activity
3) It pt is given w/ supplemental O2
True or False
Healthy individuals can tolerate hgb lvls as low as 6 g/dL w/ minimal effects
False, because healthy individuals can tolerate hgb lvls as low as 5 g/dL w/ minimal effects
What is the contraindication of transfusion of RBCs?
Transfusion of RBCs is contraindicated in pts who are well compensated for the anemia
RBCs (blood product) should not be used to treat what condition?
Nutritional anemia (such as iron deficiency anemia [IDA])
Transfusion of RBCs should not be done to treat nutritional anemia unless what?
Unless the pt shows signs of decompensation (need for increased oxygen-carrying capacity)
Transfusion of RBCs is not to be used for what?
1) To enhance general well-being
2) Promote wound healing
3) Prevent infection
4) Expand blood volume (when oxygen-carrying capacity is adequate)
5) Prevent future anemia
What are the expected results brought by each unit of transfused RBCs (same as whole blood) (in a typical 70 kg [154 lbs] human)?
1) Increased hgb lvl (1 g/dL)
2) Increased hct lvl (3%)
What are the results of transfusing a dose of 10 - 15 mL/kg of RBCs in pediatric pts?
1) Increased hgb (about 2 - 3 g/dL)
2) Increased hct (6 - 9%)
The results of transfusing a dose of 10 - 15 mL/kg of RBCs in pediatric pts varies dependent upon what?
Varies dependent upon the child’s:
1) Age
2) Body mass
True or False
The increase in hgb and hct is evident more quickly > w/ 1 unit of whole blood
True
Why is the increase in hgb and hct evident more quickly > w/ 1 unit of whole blood?
Because the adjustment in blood volume is less
Provide an ex of increase of hgb and hct being evident more quickly > w/ 1 unit of whole blood
The RBC volume is increased to the same amt (1,200 mL), but the blood volume is increased only (330 mL - 5,330 mL). The hct lvl is increased immediately to 22.5%
What is the meaning of CPD?
Citrate phosphate dextrose
What is the meaning of CPDA-1?
Citrate phosphate dextrose adenine
True or False
RBCs preped w/ additive solutions (such as Adsol) have lesser volume < CPD / CPDA-1
False, because RBCs preped w/ additive solutions (such as Adsol) have greater volume < CPD / CPDA-1
What is the value of RBCs preped w/ additive solutions then w/ CPD / CPDA-1?
300 - 400 mL vs. 160 - 275 mL
What are the effects to plasma and RBC mass if RBCs are preped via the use of additive solution?
1) Less plasma
2) RBC mass is the same
Since RBCs preped w/ additive solutions have greater volume > w/ CPD / CPDA-1, what is the difference of hct lvls?
Hct differs from 65 - 80% for CPDA-1 RBCs to 55 - 65% for additive solution RBCs
The ave unit of leukocyte-reduced RBCs contains what?
< 5 x 10^6 leukocytes
Donor leukocytes may cause what?
1) Febrile hemolytic transfusion rxns
2) Transfusion-associated graft-versus-host disease (TA-GVHD)
3) Transfusion-related immune suppression (also known as transfusion-induced immunomodulation [TRIM])
Human leukocyte antigens (HLA) are responsible for what?
HLA alloimmunization
True or False
Leukocytes may harbor cytomegalovirus (CMV)
True
What should be done to reduce the risk of HLA immunization and CMV transmission?
The leukocyte content must be reduced to < 5 x 10^6
How can the reduction of leukocyte content to < 5 x 10^6 be achieved?
By using 1 of several leukocyte-reduction filters
After leukoreduction via the use of leukocyte-reduction filters, what is the value of most leukocyte cts?
< 1 x 10^6
In the U.S., what is the std leukocyte content?
It must be < 5 x 10^6
True or False
The effect of leukocyte-reduced blood on length of hospital stay and postsurgical wound infection is controversial
True
What are the conditions that are decreased if leukocyte-reduced RBCs and PLTs are used?
1) Febrile nonhemolytic transfusion rxns
2) CMV transmission
3) HLA alloimmunization
Does leukoreduction reduce the risk of TA-GVHD?
No
Who are the pts that may benefit from receiving washed RBCs?
1) Pts who have severe allergic (anaphylactic) transfusion rxns to ordinary units of RBCs
2) Rare pts who has had moderate to severe allergic transfusion rxns
3) Pts who has anti-IgA or anti-haptoglobin Abs
What is the effect of washing process?
It removes plasma proteins
What are the cause of most allergic rxns?
Plasma proteins
Freezing RBCs allows what?
It allows the long-term storage of rare blood donor units, autologous units, and units for special purposes (such as intrauterine transfusion [IUT])
What is the process that is needed to be done in terms of freezing RBCs?
The process needed to deglycerolized the RBCs w/c removes nearly all the plasma
What is the characteristic of deglycerolized RBCs?
These units are more expensive
What is the use of deglycerolized RBCs?
These can be used interchangeably w/ washed RBCs
True or False
The shortened outdate of washed or deglycerolized RBCs severely limits the use of these components
True
What should be done if the units were deglycerolized and washed using an open system?
The RBCs must be transfused within 24 hrs after thawing
If a closed system was used, the units may be used for up to how many wks after thawing?
Up to 2 wks
What does deglycerolized RBCs contain?
80% or more of the erythrocytes present in the original unit of blood
What is the characteristic of deglycerolized RBCs?
It have approx the same expected post-transfusion survival as RBCs
True or False
The expected hct increase for washed / deglycerolized RBCs is the same as that for regular RBC units
True
How are rejuvenated red blood cells (blood product) preped?
It may be preped from RBCs stored in CPD, CPDA-1, and AS-1 storage solutions up to 3 days after expiration
What are the actions of FDA-approved solutions of inosine, phosphate, and adenine?
It rejuvenates and restores 2,3-diphosphoglycerate (2,3-DPG) and ATP lvls to approx freshly drawn RBCs
What must be done to FDA-approved solution of inosine, phosphate, and adenine?
These products must be washed before infusion
Why must FDA-approved inosine, phosphate, and adenine be washed before infusion?
To remove the inosine (because it may have toxicity)
What must be done to rejuvenated RBCs after preparation?
1) These must be transfused within 24 hrs
2) Or these must be frozen for long-term storage
What are the importance of PLTs?
These are essential for:
1) Formation of primary hemostatic plug
2) Maintenance of normal hemostasis
What is thrombocytopenia?
It is a condition whereas the pt has a decreased # of PLTs
What may be the clinical manifestations of a pt w/ severe thrombocytopenia or abnormal PLT fxn?
1) Petechiae
2) Ecchymoses
3) Mucosal or spontaneous hemorrhage
What may be the causes of thrombocytopenia?
1) Decreased PLT production
a. After chemotherapy (for pts w/ malignancy)
2) Increased destruction
a. Disseminated intravascular coagulation (DIC)
True or False
Massive transfusion may also cause thrombocytopenia
True
Why does massive transfusion may also cause thrombocytopenia?
Due to:
1) Rapid consumption of PLTs for hemostasis
2) Dilution of the PLTs
How are PLTs diluted?
By resuscitation fluids and RBC transfusion
PLT transfusions are indicated for whom?
1) For pts who are bleeding
2) Indicated as prophylaxis for pts (who have PLT cts under 5,000 - 10,000/uL even if the pt is clinically stable w/ an intact vascular system and normal PLT fxn)
What are the causes of the bleeding of the pt (whom PLT transfusions are indicated)?
1) Thrombocytopenia
2) Abnormally fxning PLTs
True or False
American association of blood banks (AABB) published additional guidelines in 2014 as a part of a clinical practice guideline and address indications in a variety of settings
False, because AABB published additional guidelines in 2015 as a part of a clinical practice guideline and address indications in a variety of settings
What is required to be done for each PLT product?
Bacterial testing
What is done to plateletpheresis products and pooled PLTs?
These are cultured
Who cultures plateletpheresis products and pooled PLTs?
Blood center
What is the characteristic of individual PLT products from whole blood?
These are difficult to culture
Why are individual PLT products from whole blood difficult to be cultured?
Because of their small volume, hence, they are less commonly used for transfusion
How is a plateletpheresis component preped?
It is preped from 1 donor
What must a plateletpheresis component contain?
It must contain a min. of 3 x 10^11 PLTs
What should be the action of 1 plateletpheresis unit?
It should increase the adult pt’s PLT ct to 20,000 - 60,000/uL
What must each unit of PLTs from whole blood contain?
It must contain at least 5.5 x 10^10 PLTs
What should be the action of each unit of PLTs from whole blood (in a 70 kg pt)?
It should increase the PLT ct by 5,000 - 10,000/uL
What does a pool of 4 - 6 units contain?
Roughly 3 x 10^11 PLTs
What should be the action of a pool of 4 - 6 units?
It should give a PLT ct increase similar to plateletpheresis
What may also be done to PLT components (for the same reasons as for RBCs)?
It may also be:
1) Leukocyte-reduced
2) Or washed
What are the results of washing PLT components?
It removes some:
1) PLTs
2) Plasma proteins
What is required if an open method is used in terms of washing PLT components?
It requires a 4 hr expiration time
PLT fxn may also be negatively impacted due to what?
1) PLT adhesion
2) Activation during wash cycles
Since PLT fxn may also be negatively impacted due to activation during wash cycles, what should be done to PLT components?
PLT components should be washed only to prevent severe allergic rxns / to remove alloAbs (in cases of neonatal alloimmune thrombocytopenia)
What may pts (who have received intensive chemotherapy [for leukemia] or bone marrow transplant or both) develop (in connection to granulocyte pheresis [w/c is a blood component])?
These pts may develop:
1) Severe neutropenia
2) Serious bacterial or fungal infection
What may a pt (w/out neutrophils [granulocytes]) experience?
The pt may have difficulty in controlling an infection even w/ appropriate antibiotic treatment
What is the purpose of developing a criteria?
To identify pts who are most likely to benefit from granulocyte transfusions
Who are the pts (who are most likely to benefit from granulocyte transfusions) who are suited in the criteria developed?
1) Pts w/ fever
2) Pts w/ neutrophil ct of < 500/uL
3) Pts w/ septicemia or bacterial infection (who are unresponsive to antibiotics)
4) Pts w/ reversible bone marrow hypoplasia
5) Pts w/ a reasonable chance of survival
True or False
Prophylactic use of granulocyte transfusions is of doubtful value for those pts who have neutropenia but no demonstrable infection
True
True or False
Newborn infants may develop overwhelming infection w/ neutropenia
True
Why does newborn infants may develop overwhelming infection w/ neutropenia?
1) Due to their limited bone marrow reserve for neutrophil production
2) Neonatal neutrophils have impaired fxn
Who are the pts who can benefit w/ granulocyte transfusions?
Newborn infants who have overwhelming infection w/ neutropenia
What is the usual dose (of granulocyte transfusion) for an adult or child pt and when should this/these dose/s be taken (/ scheduled to be taken)?
1 granulocyte pheresis product (daily for 4 or more days)
What is the dose of granulocyte transfusion for neonates?
A portion of a granulocyte pheresis unit (usually given once or twice)
What are the usual components contained in granulocyte components?
1) 1.0 X 10^10 granulocytes >
2) PLTs
3) Erythrocytes (20 - 50 mL)
Because most pts receiving granulocytes are immunocompromised, what should be done to granulocyte products?
These are often irradiated
Why are granulocyte products often irradiated?
To prevent TA-GVHD
What may be done to granulocytes if they cannot be transfused immediately?
They may be stored at 20 - 24 DC w/out agitation
What should be done to granulocyte pheresis?
These needs to be crossmatched
Why are granulocyte pheresis needed to be crossmatched?
Because of the significant content of RBCs
What must be done to the pt (after transfusion of granulocytes)?
The pt must be monitored for:
1) Resolution of symptoms
2) Clinical evidence of efficacy
What must be done to the pt (after transfusion of granulocytes)?
The pt must be monitored for:
1) Resolution of symptoms
2) Clinical evidence of efficacy
What must be done to the pt (after transfusion of granulocytes)?
The pt must be monitored for:
1) Resolution of symptoms
2) Clinical evidence of efficacy
What is the effect of granulocyte transfusion to the pt?
Neutrophil ct will increase to 1,000/uL or more
Why is the pt’s neutrophil ct increased to 1,000/uL or more after granulocyte transfusion?
Pt’s neutrophil ct increased in response to infusion of granulocyte colony-stimulating factor (GCSF)-mobilized granulocyte pheresis
What are included in plasma (blood product)?
1) Fresh-frozen plasma (FFP)
2) Plasma frozen within 24 hrs after phlebotomy (PF24)
3) Thawed plasma
What does FFP and PF24 contain?
Nonlabile coagulation factors
What does FFP contain?
Normal lvls of labile coagulation factors
What are the labile coagulation factors contained in FFP?
1) Factor V
2) Factor VIII
What does PF24 contain?
1) Reduced lvls of factor VIII and protein C
2) Lvls of factor V and other labile plasma proteins (variable compared w/ FFP)
What should be done to FFP and PF24 after being thawed?
1) They should be infused immediately
2) Or stored at 1 - 6 DC
What must be done to FFP and PF24 after 24 hrs?
These must be discarded
2) Or may be relabeled as “thawed plasma” (if collected in a fxnally closed system)
What is PF24RT24?
This is plasma frozen within 24 hrs and held at room temp up to 24 hrs after phlebotomy
PF: plasma frozen
24: 24 hrs
RT: room temp
24: 24 hrs
How is PF24RT24 preped?
This is preped from apheresis collections
What can be done to PF24RT24?
1) It can be held at room temp (for up to 24 hrs) after collection
2) Then frozen (at -18 DC or colder)
What should be done to PF24RT24 (w/c is similar w/ FFP and PF24) after thawing?
1) It should be infused immediately
2) Or stored (at 1 - 6 DC)
What must be done to PF24RT24 after 24 hrs?
1) This cmpt must be discarded
2) Or may be relabeled as “thawed plasma” (if collected in a fxnally closed system)
What should be done to thawed plasma w/c is derived from FFP, PF24, or PF24RT24 (preped in a closed system)?
1) It should be thawed (at 30 - 37 DC)
2) Then it should be stored (at 1 - 6 DC for up to 4 days [after the initial 24-hr post-thaw period])
What does thawed plasma contain?
Stable coagulation factors (w/c are similar clinically to the lvls found in FFP)
What are the stable coagulation factors that thawed plasma contain?
1) Factor II
2) Fibrinogen
Does thawed plasma contain other factors (aside from factor II and fibrinogen)?
Other factors are variable, being reduced in lvls that change over time
What are the indications of plasma (blood product)?
1) It can be used to treat multiple coagulation deficiencies occurring in pts w/:
a. Liver failure
b. DIC
c. Vit K deficiency
d. Warfarin overdose
e. Massive transfusion
2) To treat pts w/ single factor deficiencies (sometimes)
a. Factor XI deficiency
How can pts w/ vit K deficiency / warfarin overdose be treated?
The pt can be treated w/ vit K
How can vit K be administered (/ what are the methods of administration) for pts w/ vit K deficiency / warfarin overdose?
1) Orally
2) Intravenously
3) Intramuscularly
When is intramuscular administration of vit K (for pts w/ vit K deficiency / warfarin overdose) done?
If pt’s liver fxn is adequate and w/ an adequate interval (4 - 24 hrs) before a major / minor hemostatic challenge (such as surgery)
Pts w/ liver disease / liver failure frequently develop what condition / disorder?
Clinical coagulopathy
Why are pts w/ liver disease / liver failure frequently develop clinical coagulopathy?
Due to impaired hepatic synthesis of all coagulation factors and antithrombotic factors
What is the product (/ blood product) of choice for pts w/ multiple-factor deficiencies and hemorrhage or impeding surgery?
Plasma
What are the indications of plasma (blood product)?
1) For pts w/ multiple-factor deficiencies
2) For pts w/ hemorrhage
3) For pts w/ impending surgery
How many units of plasma (blood product) will effectively control hemostasis?
4 - 6 units (usual)
If the pt is transfused w/ 4 - 6 units of plasma (to effectively control hemostasis), can plasma correct the coagulation tests to normal range?
No, it may not correct the coagulation tests to normal range
Why is 4 - 6 units of plasma may not correct coagulation tests to normal range?
Due to dysfibrinogenemia
Is the correction (brought by plasma transfusion) indicated for minor procedures (such as liver biopsy)? Why or why not?
No, because mild hemostatic abnormalities do not predict bleeding
Is plasma (blood product) a concentrate?
No
Since plasma (blood product) is not a concentrate, volume overload may be a what?
It may be a serious complication of transfusion
Can plasma transfusion treat congenital coagulation factor deficiencies?
Yes, rarely
Why are congenital coagulation factor deficiencies rarely treated w/ plasma (blood product)?
Because the dose requirement for surgical procedures and serious bleeding is so great as to cause pulmonary edema as a result of volume overload, even in a young individual w/ a healthy cardiovascular system
What are the exs of factor concentrates?
1) Factor VIII
2) Factor IX
True or False
Factor concentrates offer more effective methods of therapy > plasma (blood product)
True
Does a pt w/ factor XI deficiency still treated by plasma infusion?
Yes
If a pt has factor XI deficiency, what is the required percentage of factor XI lvls for adequate hemostasis?
20 - 30%
What disease is considered as milder > hemophilia A?
Factor XI deficiency
What is hemophilia A?
Factor VIII deficiency
What is hemophilia B?
Factor IX deficiency
What is the characteristic of factor XI?
It also has a long half-life
Since factor XI also has a long half-life, is treatment needed on a daily basis?
No, treatment is not needed in a daily basis
What is a coagulation factor unit?
It is the activity in 1 mL of pooled normal plasma
Accdg to the definition of coagulation factor unit, how many unit/mL or units/dL are equaled to 100% activity?
100% activity = 1 unit/mL or 100 units/dL
How many percent activity of each of the coagulation factor is required for adequate hemostasis?
About 30%
Since about 30% activity of each of the coagulation factor is required for adequate hemostasis, how many plasma volume or plasma units are required to correct a coagulopathy (such as in liver disease or DIC)?
< half of the plasma volume; about 4 - 6 plasma units
True or False
Additional units (of plasma) are usually not needed w/ continued hemorrhage
False, because additional units (of plasma) are usually needed w/ continued hemorrhage
Additional doses (of plasma units) are usually needed w/ continued hemorrhage in what cases?
1) If prothrombin time (PT) is 1.5 times normal >
2) If the international normalized ratio (INR) is 1.5 >
What is the half-life of factor VII, VIII, or IX?
< 24 hrs
Since factors VII, VIII, and IX have half-lives of < 24 hrs, what are required to be done?
Repeated transfusions
Why are repeated transfusions required to be done w/ regards to factors VII, VIII, and IX?
1) To control postoperative bleeding
2) Or to maintain hemostasis
Provide an ex of the application of a clotting factor w/ < 24 hrs of half-life
Factor IX has a half-life of 18 - 24 hrs, requiring daily transfusions
Plasma is sometimes used as what?
It is sometimes used as a replacement fluid during plasma exchange (therapeutic plasmapheresis)
What are the actions of plasma in cases of thrombotic thrombocytopenic purpura (TTP)?
1) It provides a metalloprotease (ADAMTS13)
2) It removes inhibitors (thus, reversing the symptoms)
Plasma should not be used for what?
It should not be used for:
1) Blood volume expansion
2) Or protein replacement
Why is plasma should not be used for blood volume expansion or protein replacement?
Because safer products are available for these purposes
What are the safer products that are available for blood volume expansion or protein replacement?
1) Serum albumin
2) Synthetic colloids
3) Balanced salt solutions
True or False
None among serum albumin, synthetic colloids, and balanced salt solutions transmit disease or cause severe allergic rxns or transfusion-associated acute lung injury
True
Plasma should be what to the recipient’s RBCs?
It should be ABO compatible w/ the recipient’s RBCs
Can the Rh type be disregarded, since plasma should be ABO compatible w/ the recipient’s RBCs?
Yes
What does cryoprecipitate (blood product) contain?
1) Fibrinogen
2) Factor VIII
3) Factor XIII
4) Von Willebrand factor (vWF)
5) Fibronectin
Cryoprecipitate is used primarily for what?
Fibrinogen replacement
What does American Association of Blood Banks (AABB) require to be in each unit of cryoprecipitate?
AABB requires 150 mg > of fibrinogen be in each unit of cryoprecipitate
What are often the quality control lvls for cryoprecipitate?
Often over 250 mg
What is the meaning of AHF?
Cryoprecipitated antihemophilic factor
What should AHF contain?
It should contain > or equal to 80 IU of factor VIII in each unit
Generally, how many cryoprecipitate units are pooled at the blood center and are labeled “pooled cryoprecipitated AHF”?
5 cryoprecipitate units
What is done to each unit of AHF?
Each of the units is rinsed w/ 10 - 15 mL of saline diluent
Why is each unit of AHF rinsed w/ 10 - 15 mL of saline diluent?
To ensure complete removal of all material
What are done in pooled cryoprecipitate AHF?
These are frozen -> and shipped to transfusion services
What is done to pooled cryoprecipitate AHF in transfusion services (where they are shipped)?
These pools can be:
1) Thawed
2) Issued
How many mg of fibrinogen does each pool (of pooled cryoprecipitate AHF) contain?
Each pool contains 750 - 1,250 mg of fibrinogen
Fibrinogen replacement may be required to whom?
To pts w/:
1) Liver failure
2) DIC
3) Massive transfusion
4) Congenital fibrinogen deficiency (in rare pts)
What is the recommended fibrinogen plasma lvl for adequate hemostasis w/ surgery / trauma?
A fibrinogen plasma lvl of about 100 mg/dL
Provide an ex of the application of a fibrinogen plasma lvl of 100 mg/dL w/c is recommended for adequate hemostasis w/ surgery / trauma
A pt’s fibrinogen must be increased from 30 to 100 mg/dL, or an increment of 70 mg/dL (100 - 30 mg/dL)
Cryoprecipitated AHF may be dosed at what when used to correct hypofibrinogenemia?
It may be dosed at 1 bag per 7- to 10-kg body weight
Why is cryoprecipitated AHF dosed at 1 bag per 7- to 10- kg body weight when used to correct hypofibrinogenemia?
To raise plasma fibrinogen by approx 50 - 75 mg/dL
Cryoprecipitate was used as a source for what?
It was used as a source for fibrin sealant
Fibrin sealant uses what as the source of fibrinogen?
Cryoprecipitate
What type of fibrin sealants are preferred?
FDA-approved fibrin sealants (w/c have been treated to reduce viral transmission) are preferred
Each unit of cryoprecipitate (blood product) must contain at least what?
Must contain at least 80 units of factor VIII
What are used now to treat mild / moderate factor VIII deficiency (hemophilia A)?
1) Desmopressin acetate (1-deamino-[8-D-arginine]-vasopressin [DDAVP])
2) Or factor VIII
3) Or both
What is now used to treat severe factor VIII deficiency?
Factor VIII
Cryoprecipitate was used to treat pts w/ what disease / condition?
Pts w/ von Willebrand disease (vWD)
What is vWD?
It is a condition whereas there is a deficiency of vWF
Is cryoprecipitate still considered as the product of choice for factor VIII deficiency or vWD?
It is no longer considered as the product of choice for these conditions / disorders
True or False
Virus-safe factor VIII w/ assayed amts of factor VIII and vWF is not available
False, because virus-safe factor VIII w/ assayed amts of factor VIII and vWF is available
What is done to thawed plasma, cryoprecipitate reduced (blood product)?
1) This is thawed (at 30 - 37 DC)
2) Then maintained (at 1 - 6 DC for up to 4 days after the initial 24-hour post-thaw period has elapsed)
What are the components contained by thawed plasma, cryoprecipitate reduced (blood product)?
1) Variable lvls of albumin
2) ADAMTS13
3) Factors
a. Factor II
b. Factor V
c. Factor VII
d. Factor IX
e. Factor X
f. Factor XI
Thawed plasma, cryoprecipitate reduced (blood product) is deficient in what factors (and components)?
1) Fibrinogen (factor I)
2) Factor VIII
3) Factor XIII
4) vWF
5) Cryoglobulin
6) Fibronectin
What is used to treat pts w/ hemophilia A (factor VIII deficiency) who experiences spontaneous hemorrhages?
Recombinant or human plasma-derived factor VIII replacement (blood product)
What are the 2 types of factor VIII (blood product)?
1) Recombinant (factor VIII)
2) Human plasma-derived factor VIII replacement
How is plasma-derived factor VIII preped?
1) It is preped from plasma obtained from paid donors by plasmapheresis
2) Or from volunteer whole blood donors
What are the different methods that treats factor VIII (blood product)?
1) Pasteurization
2) Nanofiltration
3) Solvent detergent
What are the purposes of treating factor VIII (blood product) (done via different methods)?
To ensure sterility for:
1) Human immunodeficiency virus (HIV)
2) Hepatitis B virus (HBV)
3) Hepatitis C virus (HCV)
What is the characteristic of recombinant human product (of factor VIII: blood product)?
It is virus-safe
What are done to both the plasma derived and recombinant factor VIII (blood product)?
1) These are stored (at ref temp)
2) These are reconstituted w/ saline (at time of infusion)
True or False
It is easy to handle both plasma derived and recombinant factor VIII (blood product), hence, this ease of handling allows self-therapy for individuals w/ hemophilia
True
Provide an ex of how to calculate factor VIII (blood product) dose and solve the problem
A 70-kg hemophiliac pt w/ a hct lvl of 30% has an initial factor VIII lvl of 4% (4 units/dL, 0.04 units/mL). How many units of factor VIII concentrate should be given to raise his factor VIII lvl to 50%?
Points:
1) 70-kg hemophiliac pt
2) Hct lvl: 30%
3) Factor VIII lvl (initial): 4% (/ 4 units/dL or 0.04 units/mL)
Formula:
{desired factor VIII (units/mL) - initial factor VIII (units/mL) } x plasma volume (mL) = units of factor VIII required
Blood volume = weight (kg) x 70 mL/kg
70 kg x 70 mL/kg = 4,900 mL
Plasma volume = blood volume (mL) x (1.0 - Hct)
4,900 mL x (1.0 - 0.30) = 3,430 mL
Solution:
3,430 mL x (0.50 - 0.04) = 1,578 units
The assayed value on the label can be divided into the number of units required to obtain the number of vials to be infused
Only factor VIII products labeled as containing vWF should be used for pts w/ vWD
What are the indications of recombinant human products (of different factors [in relation to factor VIII]: blood product)?
Product:Indications
1) Factor VIIIl: hemophilia A, vWD
2) Factor IX: hemophilia B
3) Factor VIIa: inhibitors in hemophilia A or B, factor VII deficiency, acquired factor VII deficiency (liver disease, warfarin overdose | randomized controlled trials needed), massive hemorrhage
Is factor VIII (blood product) a concentrate?
Yes
What is the other term for factor IX complex (blood product)?
Prothrombin complex
How is factor IX complex preped?
It is preped from pooled plasma (via the use of various methods of separation and viral inactivation)
What are the components that PT complex contain?
1) Factor II
2) Factor VII
3) Factor IX
4) Factor X
PT complex is recommended for whom pts?
It is recommended for:
1) Pts w/ factor IX deficiency (hemophilia B)
2) Pts w/ factor VII or X deficiency (rare)
3) Selected pts w/ factor VIII inhibitors
4) Selected pts w/ reversal of warfarin overdose
Activated coagulation factors present in the PT complex may cause what?
Thrombosis
Activated coagulation factors (w/c are present in the PT complex) may cause thrombosis to whom?
It may cause thrombosis especially to pts w/ liver disease
Recombinant human factor IX is effective only in what?
It is effective only in the management of factor IX deficiency (hemophilia B)
How is the dose for factor IX calculated?
Its dose is calculated in the same manner as that for factor VIII concentrate, using the assayed value of factor IX on the label, w/ the caveat that half the dose of factor IX rapidly diffuses into tissues and half remains within the intravascular space, so the initial dose must be doubled
What is antithrombin (blood product)?
It is a protease inhibitor
What is the action of antithrombin?
It has an activity towards thrombin
What are the actions of heparin?
It accelerates the:
1) Binding
2) Inactivation of thrombin (by antithrombin)
What are the 2 ways (or principles) of antithrombin deficiency?
1) Hereditary
2) Acquired
The hereditary deficiency of antithrombin is associated w/ what condition?
Venous thromboses
Acquired antithrombin deficiency is seen most frequently in whom?
To pts w/ DIC
True or False
Antithrombin concentrates are not licensed for use in the U.S.
False, because antithrombin concentrates are licensed for use in the U.S.
To whom are antithrombin concentrates licensed to be used in the U.S.?
To pts w/ hereditary antithrombin deficiency
What is done to antithrombin concentrates?
These are pasteurized
Why are antithrombin concentrates pasteurized?
To eliminate the risk of:
1) HIV infections
2) HCV infections
Does antithrombin (blood product) shown to provide significant clinical benefit in acquired antithrombin deficiency?
No, because antithrombin (blood product) has been shown to provide no significant clinical benefit in acquired antithrombin deficiency
Aside from antithrombin concentrates, what is the alternative source of antithrombin?
Thawed plasma
What is the characteristic of protein C and protein S?
These are vitamin K-dependent proteins
Where are protein C and protein S synthesized?
Liver
What is the fxn of protein S in relation to protein C?
Protein S fxns as a cofactor for activated protein C
What is the action of activated protein C?
It inactivates factors V and VIII
What is the result of the action done by activated protein C?
The formation of thrombus is prevented
Antithrombin deficiency (hereditary or acquired) leads to what condition?
Hypercoagulable state (i.e., the tendency for thrombosis)
What is approved for use in hereditary deficiency states?
Human plasma-derived protein C concentrates
What are the uses of recombinant human activated protein C?
It has been used for:
1) DIC
2) Sepsis
What is the meaning of rFVIIa?
Recombinant human activated factor VII
What are the uses of rFVIIa?
1) It has been used to control bleeding episodes in pts w/:
a. Hemophilia A
b. Hemophilia B
2) It has been used in pts w/ a wide variety of bleeding disorders
True or False
Large randomized controlled trials are not needed to define dose, indications, and adverse effects (in relation to rFVIIa)
False, because large randomized controlled trials are needed to define dose, indications, and adverse effects (in relation to rFVIIa)
True or False
Reports of use for liver disease, massive transfusion, and other bleeding disorders (of rFVIIa) have not been promising
False, because reports of use for liver disease, massive transfusion, and other bleeding disorders (of rFVIIa) have been promising
How is albumin (blood product) preped?
It is preped by chemical and physical fractionation of pooled plasma
What are the solutions (/ types) that are available for albumin (blood product)?
1) 5% solution
2) 25% solution
What is the percentage of the protein content (specifically albumin) in the 25% solution (of albumin)?
96%
What is the action done to 25% solution (of albumin)?
It is heat-treated
True or False
25% solution (of albumin) has been proved to be virus-safe over many yrs of use
True
What are the uses of albumin (blood product)?
1) It may be used to treat pts who requires volume replacement
2) It can also be used in the treatment of burn pts (to replace colloid pressure)
True or False
Whether albumin or colloids other than crystalloid (i.e., saline or electrolyte) solutions are better for treating hypovolemia w/ shock is controversial
True
In many plasmapheresis procedures, what is routinely used as the replacement fluid for the colloid that is removed during the procedures?
Albumin (blood product)
What is the action of albumin (w/ diuretics)?
It can induce diuresis in pts who have low total protein
What are the causes of low total protein to pts who are induced of diuresis (due to the action of albumin w/ diuretics)?
Severe liver / protein-losing disease
What is the action of 25% solution (of albumin)?
It brings about 5 times its volume from extravascular H2O into the vascular space
Due to the action brought by 25% solution (of albumin), pts receiving 25% albumin need to have what?
They need to have adequate extravascular H2O and compensatory mechanisms (to deal w/ the expansion of the blood volume)
How is immune globulin (blood product) preped?
It is preped from pooled plasma
What is the primary type of Ig for immune globulin (blood product) w/c is preped from pooled plasma?
IgG
What are the other types of Ig that may be present in some preparations of immune globulin (blood product)?
1) IgM
2) IgA
What is the characteristic of other preparations of immune globulin (blood product)?
Others are free of the contaminating proteins
What are the contaminating proteins that are not present in other preparations of immune globulin (blood product)?
1) IgM
2) IgA
What are the methods of administration of immune globulin (blood product)?
1) Intramuscular administration
2) Intravenous administration
Can the intramuscular product (of immune globulin [blood product]) be given / administered intravenously?
No
Why is the intramuscular product (of immune globulin [blood product]) cannot be given / administered intravenously?
Because severe anaphylactic rxns may occur
What must be done to intravenous product (of immune globulin [blood product]) in terms of its administration?
It must be given / administered slowly
Why must intravenous product (of immune globulin [blood product]) be given / administered slowly?
To lessen the risk of rxn
What are the uses / indications of immune globulin (blood product)?
1) It is used for pts w/ congenital hypogammaglobulinemia
2) It is used for pts who are exposed to diseases
a. Hepatitis A
b. Measles
What should be the frequency of administration of immune globulin (blood product) for pts w/ hypogammaglobulinemia?
Monthly injections (intramuscular administration) / infusions (intravenous administration) (usual)
Why are monthly injections / infusions usually given to pts w/ hypogammaglobulinemia?
Because of the 22-day half-life of IgG
What is the recommended dose for intramuscular administration of immune globulin (blood product)?
0.7 mL/kg intramuscularly
What is the recommended dose for intravenous administration of immune globulin (blood product)?
100 mg/kg intravenously
What is the method of administration of immune globulin (blood product) that is recommended to be done for hepatitis A prophylaxis?
Intramuscular administration
What is the recommended dose for intramuscular administration of immune globulin (blood product) for hepatitis A prophylaxis?
0.02 - 0.04 mL/kg
What is the use / indication of intravenous preparation of immune globulin (blood product)?
It is used increasingly in the therapy of autoimmune diseases
What are the autoimmune diseases whereas intravenous preparation of immune globulin (blood product) is used increasingly for therapy?
1) Immune thrombocytopenia
2) Myasthenia gravis
True or False
Various mechanisms of action (regarding intravenous preparation of immune globulin [blood product]) have been postulated
True
Conceivably, what are the actions of infused immune globulin (blood product)?
It blocks the:
1) Reticuloendothelial system (RES)
2) Or mononuclear phagocytic system
True or False
Various hyperimmune globulins are not available to treat such viruses
False, because various hyperimmune globulins are available to treat such viruses
What are the viruses that can be treated by various hyperimmune globulins?
1) Hepatitis B
2) Varicella zoster
3) Rabies
4) Mumps
How are various hyperimmune globulins preped?
These are preped from the plasma of donors (who have high Ab titers to the sp. virus w/c causes the disease)
The dose of various hyperimmune globulins is recommended to be present where?
It is recommended to be in the package insert
True or False
It should be noted that preparations such as hepatitis B hyperimmune globulin provide only passive immunity after an exposure
True
True or False
Preparations such as hepatitis B hyperimmune globulin does confer permanent immunity and so must be accompanied by active immunization
False, because preparations such as hepatitis B hyperimmune globulin does not confer permanent immunity and so must be accompanied by active immunization
What is the meaning of RhIG?
Rh-immune globulin
RhIG was developed to protect whom?
1) Rh-(-) female who is pregnant
2) Or who delivers an Rh-(+) infant
Much of the IgG in the preparation of RhIG is directed against what?
D Ag (within the Rh system)
Administration of the preparation of RhIG allows what?
It allows attachment of anti-D to any Rh-positive cells of the infant that have entered the maternal circulation
What happens to Ab-bound cells?
These are subsequently removed by the mother’s macrophages (preventing active immunization or sensitization)
What are the methods of administration of Rh-immune globulin products?
1) Intravenously
2) Intramuscularly
Rh-immune globulin products (w/c can be administered intravenously or intramuscularly) are approved for use in pts w/ what condition / disorder?
These are approved for use in idiopathic thrombocytopenic purpura pts (who are Rh-[+])
What is the proposed mechanism of action (of Rh-immune globulin products)?
Blockage of the RES by anti-D coated RBCs (thereby reducing the destruction of autoAb-coated PLTs)
How is the number of standard-dose RhIG vials (for RBC transfusion accidents) calculated?
It is calculated by dividing the volume of Rh-(+) PRBCs transfused by 15 mL, the amt of RBCs covered by 1 vial
The number of vials can be large, so the entire dose is often divided and administered in several injections at separate sites and over 3 days
Can the intravenous preparation (of RhIG) may also be used?
Yes
*What is another approach that can be done / performed?
Perform an exchange transfusion w/ Rh-(-) blood and then calculate the dose based on the number of Rh-(+) RBCs remaining in the circulation
How many vial/s is/are sufficient (for plateletpheresis) for 30 or more products?
1 vial
Why is 1 vial (for plateletpheresis) sufficient for 30 or more products?
Because each unit contains fewer than 0.5 mL RBCs
How can the dose for leukocyte concentrates can be calculated?
It can be calculated by obtaining the hct and volume of the product from the supplier
Immune globulins may cause what conditions / disorders?
Anaphylactic rxns
a. Flushing b. Hypotension c. Dyspnea d. Nausea e. Vomiting f. Diarrhea g. Back pain
True or False
Caution should be used in pts w/ known IgA deficiency and previous anaphylactic rxns to blood components
True
Certain categories of pts require what?
Require the selection of blood products that are:
1) Leukocyte-reduced
2) CMV-negative
3) Irradiated
What is the action of leukocyte-reduction filters (in relation w/ leukocyte-reduced cellular blood components [special product])?
These are designed to remove 99.9% > of leukocytes from RBCs and PLT products
What is the use of leukocyte-reduction filters (in relation w/ leukocyte-reduced cellular blood components)?
1) They can be used in the lab (prestorage)
2) Or can be used at the bedside during blood transfusion
What is the goal that can be achieved via the use of leukocyte-reduction filters?
Fewer than 5 x 10^6 leukocytes remaining in the RBC or apheresed PLT unit
When is prestorage filtration more reliable for leukocyte reduction?
Prestorage filtration in the lab or at the time of collection rather > at the bedside
Why is prestorage filtration in the lab or at the time of collection more reliable for leukocyte reduction > prestorage filtration at the bedside?
Because leukocytes degranulate, fragment, or die during storage, releasing their contents (that could result in febrile and allergic transfusion rxns)
What is the sp. cytokine that accumulate during storage w/c have been implicated for some failures of bedside filtration to prevention febrile rxn?
IL-8
What are the uses of leukocyte-reduced RBCs and PLTs?
1) These can be used to prevent febrile nonhemolytic transfusion rxns
2) To prevent or delay the development of HLA Abs
3) To reduce the risk of CMV transmission
What are the controversial effects of leukocyte reduction?
1) Decreased mortality
2) Decreased of length of hospital stay
True or False
CMV is carried, in a latent or infectious form, in neutrophils and lymphocytes
False, because CMV is carried, in a latent or infectious form, in neutrophils and monocytes
If transfusion of virus-infected cell (CMV) in a cellular product (such as RBCs / PLTs) is done, can it transmit infection?
Yes
What can be used to reduce the CMV infection of the pts?
1) Leukocyte-reduction filters
2) Or by providing CMV Ab-(-) blood
What are the indications of CMV-negative or leukocyte-reduced components?
These are indicated for:
1) Recipients who are CMV-(-)
2) Pts who are at risk for severe sequelae of CMV infections
*Who are the pts who are at greatest risk for CMV infections?
1) CMV-(-) women (mainly for the benefit of the fetus)
2) Allogeneic CMV-(-) bone marrow
3) Hematopoietic progenitor cell transplant recipients
4) Premature infants (weighing < 1,200 g)
What is done to blood components?
These are irradiated w/ gamma radiation (irradiated cellular blood components [special product])
Why are blood components irradiated w/ gamma radiation?
To prevent GVHD
What are the 3 conditions that are required to occur for GVHD to occur?
1) Transfusion or transplantation of immunocompetent T lymphocytes
2) Histocompatibility differences between graft and recipient (major or minor HLA or other histocompatibility Ags)
3) Usually, an immunocompromised recipient
What condition / disorder is common after allogeneic bone marrow or hematopoietic progenitor cell transplantation?
GVHD
What are affected by GVHD?
It is a syndrome affecting mainly:
1) Skin
2) Liver
3) Gut
*W/c occurs less frequently, GVHD or TA-GVHD?
TA-GVHD
What is the cause of TA-GVHD?
It is caused by viable T lymphocytes in cellular blood components (ex. RBCs and PLTs)
What is the mortality rate in TA-GVHD?
The mortality rate is high
Since the mortality rate in TA-GVHD is high, what should be done?
Prevention is the key
What is the focus of prevention for TA-GVHD?
Prevention focuses on irradiating cellular components before administration to significantly immunocompromised individuals
True or False
Irradiation doses does not vary
False, because irradiation doses can vary
What are the characteristics of high irradiation doses?
1) These are more effective
2) But these are more damaging to RBCs
What is the std dose of gamma radiation?
2,500 cGy (centigray)
The std dose of gamma irradiation is targeted to what?
It is targeted to the central portion of the container w/ a min. dose of 1,500 cGy delivered to any part of the component
What are the actions of irradiation (in relation to TA-GVHD)?
It decreases or eliminates the mitogenic (blastogenic) capacity of the transfused T cells, rendering the donor T cells immunoincompetent
Who are the pts that are at risk for TA-GVHD (or pts w/ severe immunosuppressive conditions who are most at risk for TA-GVHD)?
1) Transfusion recipients w/ congenital immunodeficiencies
a. Severe combined immunodeficiency
b. DiGeorge syndrome
c. Wiskott-Aldrich syndrome
2) Hodgkin lymphoma
3) Bone marrow transplants
a. Allogeneic
b. Autologous
4) Pts who had received intrauterine transfusion (IUT) of fetuses
5) Exchange transfusion of neonates
6) Donations from blood relatives
7) HLA-matched PLTs
What is the condition that immunocompetent recipients have experienced after receiving nonirradiated directed donations primarily from first-degree relatives?
TA-GVHD
What will happen if the related donor is homozygous for 1 of the pt’s (host’s) HLA haplotypes (in relation to TA-GVHD)?
The pt is incapable of rejecting the donor’s (graft’s) T lymphocytes
Since the related donor is homozygous for 1 of the pt’s HLA haplotypes and hence the pt is incapable of rejecting the donor’s T lymphocytes, what is the action of the donor’s T lymphocytes?
These then can act against the HLA Ags encoded by the pt’s other haplotype
After the donor’s T lymphocytes acted against the HLA Ags encoded by the pt’s other haplotype (since the related donor is homozygous for 1 of the pt’s HLA haplotypes), what will happen next?
The donor lymphocytes then reject the host
True or False
The lvl of immunosuppression a recipient must have to develop TA-GVHD is unknown
True
True or False
The dose of lymphocytes needed for TA-GVHD to occur is unknown
True
Since the dose of lymphocytes needed for TA-GVHD to occur is unknown, what should be done / observed?
Prevention (w/c depends on irradiation and not on reduction of lymphocytes by filtration) should be done / observed
True or False
All pts require policies and procedures that address particular clinical situations
False, because some pts require policies and procedures that address particular clinical situations
True or False
All surgical procedures do not require blood transfusion
False, because most surgical procedures do not require blood transfusion
What are the results of crossmatching for procedures w/ a low likelihood of transfusion?
1) It increases the number of crossmatches performed
2) It increases the amt of blood inventory in reserve
3) It increases the amt of blood inventory w/c are unavailable for transfusion (if electronic crossmatch is not available)
4) It contributes to the aging and possible outdating of blood components
What are the procedures that are prudent to be performed prior to surgery?
1) Type
2) Screen (/ Ab screen)
What must be done if Ab screen is (+)?
Ab identification must be completed and compatible units found
What may be done if Ab screen is (-)?
ABO- and Rh-type-specific blood may be released after an immediate spin or electronic crossmatch in those rare instances when transfusion is required
What is the requirement of number of crossmatched units for a pt who is likely to require blood transfusion?
The number of crossmatched units should be no more than twice those usually required for that surgical procedure
What is the meaning of C/T ratio?
Crossmatch-to-transfusion ratio
Since the # of crossmatched units should be no more than twice those usually required for that surgical procedure, what will be the C/T ratio?
It will be between 2:1 and 3:1 (w/c has been shown to be optimal practice)
Do some transfusion services extend the practice of C/T ratio between 2:1 and 3:1 to non-surgical pts?
Yes
When is crossmatching done to non-surgical pts?
It is done only when the RBCs are requested for issue to the pt
What is the result of doing the practice of crossmatching only when the RBCs are requested for issue to the pt (w/c is done by some transfusion services)?
It increased the inventory of uncrossmatched units that can be used for immediate needs
*What are different types of transfusion therapy in special conditions?
1) Autologous transfusion
2) Emergency transfusion
3) Massive transfusion
4) Neonatal transfusion
5) Transfusion in oncology
What is autologous (self) transfusion?
It is the donation of blood by the intended recipient
What is allogeneic transfusion?
It is the infusion of blood from another donor
What are the benefits of autologous transfusion?
The pt’s own blood:
1) Reduces the possibility of transfusion rxn
2) Reduces the transmission of infectious disease
What are the types of autologous transfusion?
1) Predeposit of blood by the pt
2) Intraoperative hemodilution
How is predeposit of blood (by the pt) collected?
It is collected by / via regular blood donation procedure
What are the ways that can be done to store predeposit of blood (by the pt)?
1) The blood can be stored as liquid
2) The blood can be frozen (for longer storage)
True or False
Pts may donate several units of blood over a period of wks
True
Pts may donate several units of blood over a period of wks, but what should they do?
They should take iron supplements
Why should pts who may donate several units of blood over a period of wks intake iron supplements?
To stimulate erythropoiesis
To whom are predeposit autologous donation usually reserved?
For pts anticipating a need for transfusion (such as for a scheduled surgery)
What is the characteristic of predeposit autologous transfusion?
It is expensive
Why are predeposit autologous transfusion expensive?
Because about half of the donated units are not used
What are units given to pts present for surgery w/ lower hcts?
Increased transfusion of allogeneic units in addition to autologous units
What can pts w/ multiple RBC Abs or Abs to high-incidence Ags may do?
They may store frozen units for use by themselves or others
What is intraoperative hemodilution?
It is the collection of 1 / 2 units of blood from the pt just before a surgical procedure
What should be done if intraoperative hemodilution is done?
The removed blood volume should be replaced w/ crystalloid or colloid solution
At the end of surgery, what is done to the blood units (w/c are obtained via intraoperative hemodilution)?
These are infused into the pt
True or False
Care must be taken to label and store the blood units properly and to identify the blood units w/ the pt before infusion
True
What are the concepts that has allowed surgical procedures that once required many units of blood to be performed w/out the need for allogeneic blood?
1) Meticulous attention to hemostasis
2) Meticulous attention to salvage of shed blood
Several types of equipment (in relation to salvage of shed blood) are available for what purposes?
1) Collecting, 2) washing, and 3) filtering shed blood before reinfusion
What is recommended to be done (in relation to salvage of shed blood)?
Washing of intraoperative or postoperative salvaged blood
Why is washing of intraoperative or postoperative salvaged blood recommended to be done?
To remove the:
1) Cellular debris
2) Fat
3) Other contaminants
What anticoagulants may be used for the anticoagulation of the shed blood?
1) Heparin
2) Or citrate solutions
Who are the pts who require immediate transfusion?
Pts who are rapidly / uncontrollably bleeding
What is the ABO type of the RBCs w/c is selected for pts whom transfusion cannot wait until their ABO and Rh type can be determined?
Grp O RBCs
What is the ABO and Rh type of the RBC units that should be used if the pt is a female of childbearing potential?
Grp O-negative RBC units
What can be done if few O-(-) units are available or if massive transfusion is required for an Rh-(-) male pt or an older postmenopausal female pt?
They can be switched from Rh-(-) to Rh-(+) RBCs
What may be more dangerous, delaying blood transfusion in emergency situations or transfusing incompatible blood before the Ab screen and crossmatch are completed?
Delaying blood transfusion in emergency situations may be more dangerous > small risk of transfusing incompatible blood before the Ab screen and crossmatch are completed
What can be done after issuing O blood or type-specific blood?
1) Ab screen can be completed
2) Decisions can then be made for the selection of additional units of blood
What can be done if the pt has been typed and screened for a surgical procedure and his/her Ab screen is (-)?
ABO- and Rh-type-specific blood can be given after an immediate spin crossmatch
Transfusions should be reserved to whom?
To / for those pts losing 20% > of their blood volume
True or False
The condition of most pts allows determination of ABO and Rh type and selection of ABO- and Rh-type-specific blood for transfusion
True
What is massive transfusion?
It is defined as the replacement of 1 or more blood volumes within 24 hrs, or about 10 units of blood in an adult
True or False
The strategy for treating massive hemorrhage has changed in recent yrs, as experience in the military has promoted preventive treatment to avoid coagulopathy
True
True or False
Most medical centers w/ high-level trauma services have adopted a massive transfusion protocol
True
What are essential for guiding appropriate transfusion therapy?
Analysis of the pt’s:
1) Clinical status
2) Lab tests
Can the massive transfusion pack be adjusted for low hgb or PLTs or prolonged coagulation tests?
Yes
Provide exs of application where massive transfusion pack can be adjusted for low hgb or PLTs or prolonged coagulation tests
1) PLTs are required if the PLT ct is < 50,000/uL
2) Plasma is needed if:
a. PT ratio is 1.5 >
b. INR is 1.5 >
c. Activated partial thromboplastin time (aPTT) exceeds 60 secs
Should fibrinogen lvls be monitored (in massive transfusion)?
Yes
Why should fibrinogen lvls be monitored?
Because replacement by cryoprecipitate may be indicated when the fibrinogen lvl is < 100 mg/dL
A pt in critical condition and a limited supply of type-specific blood may require what?
May require a change in ABO or Rh types
Why is an Rh-(-) male or a postmenopausal female pt being switched from Rh-(-) to Rh-(+) blood?
To avoid depleting the inventory of Rh-(-) blood
Can an Rh-(-) potentially childbearing woman be switched from Rh-(-) to Rh-(+) blood?
No, because she should receive Rh-(-) RBC products for as long as possible
Premature infants frequently require what (in relation to neonatal transfusion)?
Transfusion of small amts of RBCs
Why are premature infants frequently require transfusion of small amts of RBCs?
1) To replace blood drawn for lab tests
2) To treat the anemia of prematurity
What is the effect of a dose of 10 mL/kg (of RBCs)?
The hgb is increased by approx 3 g/dL
True or False
There are no methods available for preping small aliquots for transfusion
False, because various methods are available for preping small aliquots for transfusion
What can be done to small aliquots of donor blood?
1) These can be transferred from the collection bag to a satellite bag or transfer bag
2) Or blood can be withdrawn from the collection bag or transfer bag (using an injection site coupler and needle and syringe or a sterile docking device and syringe)
Can RBCs in CPD, CPDA-1, or additive solution be used safely?
Yes
What must be done to the preped aliquots of donor blood?
1) These must be labeled clearly w/:
a. Name
b. Identifying numbers (of pt and donor)
2) The blood must be fully tested (the same as for adult transfusion)
What is the blood preferred to reduce the risk of hyperkalemia and to maximize the 2,3-diphosphoglycerate (2,3-DPG) lvls?
Blood units that are < 7 days old
In some institutions, what is the blood used?
CPDA-1 RBCs (14 - 21 days old)
What should be the blood (/ requirements | that will be transfused) for very-low-birth-weight infants?
1) CMV-seronegative
2) Leukocyte-reduced
Why should the blood (for transfusion) for very-low-birth-weight infants be CMV-seronegative or leukocyte-reduced?
To prevent CMV infection (w/c can be serious in premature infants)
What blood (/ requirements | for transfusion) should be given for pregnant women (if they test [-] for CMV)?
1) CMV-negative
2) Leukocyte-reduced cellular components
What is recommended to be done to the blood (for transfusion) to prevent possible TA-GVHD (when blood is used for IUT, for an exchange transfusion)?
Irradiation of the blood is recommended
Are transfusions in a full-term newborn infant require routine irradiation?
No, transfusions in a full-term newborn infant do not require routine irradiation
What should be done to infants who are hypoxic or acidotic?
They should receive blood (tested and [-] for hgb S)
What are the effects that can be experienced by the bone marrow of oncology pts (in connection to transfusion in oncology)?
It may be suppressed due to:
1) Chemotherapy 2) Radiation therapy 3) Infiltration 4) Replacement of bone marrow w/ malignant cells
Repeated RBC and PLT transfusions may lead to what?
These may lead to the need for rare RBC units or HLA-matched plateletpheresis components (because of incompatibility problems)
PLT transfusion requirements may also necessitate what?
It may also necessitate a change from Rh-(-) to Rh-(+) products
Can RhIG may be given to a woman w/ childbearing potential?
Yes
What is the purpose of giving RhIG to a woman w/ childbearing potential?
To protect against immunization
What is the volume / amt of Rh-(+) RBCs present in each Rh-(+) plateletpheresis component?
< 0.5 mL
What is the volume / amt of RBCs that a pool of PLTs may contain?
As much as 4 mL of RBCs
What is the action of one 300-ug dose of RhIG?
It can neutralize the effects up to 15 mL of Rh-(+) cells
Since one 300-ug dose of RhIG can neutralize the effects of up to 15 mL of Rh-(+) cells, 1 dose could be used for what?
It could be used for 30 plateletpheresis or 4 PLT pools
What are the conditions / disorders that are frequently complicating some malignancies (such as chronic lymphocytic leukemia [CLL] and lymphoma)?
1) Autoimmune hemolytic anemia (AIHA)
2) Increased destruction of RBCs
3) Pretransfusion testing problems
Who are the pts that are at increased risk of TA-GVHD?
Oncology pts w/ hematologic malignancies (such as Hodgkin’s disease and lymphoma)
Why are oncology pts w/ hematologic malignancies (such as Hodgkin’s disease and lymphoma) at increased risk of TA-GVHD?
Because of the chemotherapy drugs used for treatment
Since oncology pts w/ hematologic malignancies (such as Hodgkin’s disease and lymphoma) are at increased risk of TA-GVHD, these pts should receive what?
Irradiated cellular components
*What are the exs of coagulation factor deficiencies?
1) Hemophilia A (/ classic hemophilia | factor VIII deficiency)
2) Hemophilia B (factor IX deficiency)
3) DIC
What are the characteristics of factor VIII?
It is normally complexed w/ another plasma protein (w/c is vWF)
What are the proteins that are both necessary for normal hemostasis?
1) Factor VIII
2) vWF
Pts w/ hemophilia A (/ classic hemophilia) have what?
They have factor VIII deficiency (factor VIII lvls < 50%)
Is the clinical disease (hemophilia A) generally apparent if the pt’s factor VIII lvls are < 50%?
No
When is the clinical disease (hemophilia A) generally apparent?
If the pt’s factor VIII lvl is < 10%
What is the normal lvl of factor VIII?
50 - 150%
In accordance to the normal lvl of factor VIII, if a pt has a factor VIII lvl of < 1%, what are the conditions that the pt have?
Severe and spontaneous bleeding
The severe and spontaneous bleeding that are present if a pt has a factor VIII lvl of < 1% typically occurs where?
Typically into the:
1) Muscles
2) Joints
Is the vWF lvl usually normal in pts w/ hemophilia A?
Yes
What is vWD?
It is defined by a deficiency of vWF
What are the different types of vWD?
1) Type I
2) Type IIA
3) Type IIB
4) Type III
What are the characteristics of type I vWD?
1) It is characterized by a reduced amt of all sizes of vWF multimers
2) It is milder > type III
What is type III vWD?
There is little or no vWF produced
What is type IIA vWD?
It is distinguished by a deficiency of high MW multimers (that have an increased avidity for binding to PLTs)
What is the ability that pts w/ type I vWD have?
They have the ability to make the full spectrum of vWF multimers (but do not produce them in normal amts)
What is the meaning of DDAVP?
Desmopressin (1-deamino-8-D-arginine vasopressin)
What is DDAVP?
It is a synthetic vasopressin analog
What is the action of DDAVP?
It can stimulate release of the vWF from the vascular endothelium in type I pts
In connection to the action by DDAVP, it is however contraindicated to what type of vWD?
Type IIB vWD
What can be used for type III vWD or in type I or IIA disease when DDAVP treatment has failed?
Many factor VIII products (w/c are assayed for vWF)
What is hemophilia B?
It is the congenital deficiency of factor IX
What are the factors that activated factor IX?
1) Factor XIa
2) Factor VIIa
What are the factors (and components) that activates factor X to Xa?
1) Factor IXa
2) Factor VIII
3) Ionized Ca
4) Phospholipid
What are the components that should be used to treat factor IX deficiency?
1) Recombinant factor IX
2) PT complex concentrates
What is the characteristic of factor IX concentrates?
These are made virus-safe
How are factor IX concentrates made virus-safe?
These are made virus-safe by / via sterilization techniques
Are all coagulation factors made in the liver?
No, because all coagulation factors (except vWF) are made in the liver
What conditions can occur (/ what are the effects that can occur) if pt has severe liver failure?
1) Multiple coagulation factor deficiencies
2) Some of the coagulation factors produced may be abnormal
Can the liver also produce many of the thrombolytic proteins?
Yes
Since the liver also produces many of the thrombolytic proteins, what is its effect?
Imbalance between the coagulation process and the control mechanism
What are the components of plasma?
Normal amts of proteins (coagulation factors and thrombolytic proteins)
What can be used to treat pts w/ severe liver failure w/c leads to multiple coagulation factor deficiencies, presence of abnormally produced coagulation factors, also, production of many of the thrombolytic proteins (by the liver)?
Plasma (w/ normal amts of these proteins [coagulation factors and thrombolytic proteins])
What are the actions of vit K?
It aids in the carboxylation of factors:
1) II
2) VII
3) IX
4) X
What is the effect if vit K is not present, or the use of drugs (such as warfarin) that interfere w/ vit K metabolism is taken?
The inactive coagulation proteins cannot be carboxylated to active forms
What is recommended to correct vitamin K deficiency or warfarin overdose, vit K administration or plasma transfusion?
Vit K administration rather > plasma transfusion is recommended
True or False
Several hrs are required for vit K effectiveness, depending on the route of administration
True
Because several hrs are required for vit K effectiveness (depending on route of administration), signs of hemorrhage or impeding surgery may require what?
May require transfusion of plasma
What is DIC?
It is the uncontrolled activation and consumption of coagulation proteins, causing small thrombi within the vascular system throughout the body
What is the treatment for DIC?
The treatment is aimed at correcting the cause of the DIC w/c are / can be:
1) Sepsis
2) Disseminated malignancy
3) Certain acute leukemias
4) Obstetric complications
5) Shock
In some cases of DIC, what may be required to be done?
Transfusion of plasma, PLTs, and/or cryoprecipitate
Monitoring of the PT, aPTT, PLT ct, fibrinogen, hgb, and hct lvls direct what?
Direct the choice of the next component to be used
What may be the causes of PLT fxnal disorders?
1) Drugs
2) Uremia
3) Congenital abnormalities
What should be reserved for pts w/ PLT fxnal disorders?
PLT transfusions
What are the roles (/ purposes) of reserving PLT transfusions (for pts w/ PLT fxnal disorders)?
For treating hemorrhage or the impending need for adequate hemostasis (such as a surgical procedure) to decrease development of PLT refractoriness
Provide a drug that can interfere w/ PLT fxn
Clopidogrel (Plavix)
What is the common use of clopidogrel?
It is commonly used in cardiovascular disease
What is the action of clopidogrel?
It is reversible for the life of the PLTs
What should be done (in relation to clopidogrel) to minimize hemorrhage and lessen the need for massive transfusion?
The drug should be discontinued (for 5 - 7 days before surgery)
What are the things that may be beneficial for pts w/ uremia?
1) DDAVP
2) Dialysis
3) RBC transfusions
What is the action of DDAVP?
It releases fresh, fxnal vWF from endothelial cells
What is the action of dialysis?
It removes by-products of protein metabolism that degrade vWF and coat PLTs, making both nonfxnal
What is the action of RBC transfusion?
It increases viscosity
Are blood administration and the hospital transfusion committee responsibility of the transfusion service, nurses, physicians, and administrators look to the transfusion specialists to guide policies and practices?
No
True or False
Blood must be administered carefully for pt safety
True
What are essential to be done (in terms of blood administration)?
(+) identification of:
1) The pt
2) Pt’s blood sx
3) Blood unit (for transfusion)
What should be done to prevent transfusion-related deaths of ABO incompatibility?
Careful identification procedures
The identification process (in terms of blood administration) begins w/ what?
(+) identification of the pt
How is (+) identification of the pt done (in terms of blood administration)?
By asking pts to state or spell their name (while you read their armband)
What should be done to the pt identification label?
It should be compared at the bedside to the pt’s hospital armband
Comparing the pt identification label at the bedside to the pt’s hospital armband prevents what?
It prevents a sx tube labeled w/ 1 pt’s name being used for the collection of a sx from another pt
What should be done to the labels (in terms of blood administration)?
These should be applied to the sx tubes before leaving the bedside
Why should the labels be applied to the sx tubes before leaving the bedside?
To avoid labeling the wrong tube
True or False
In terms of labeling, electronic systems for pt and label identification are available but these should not be adopted because it promotes the occurrence of clerical errors
False, because in terms of labeling, electronic systems for pt and label identification are available and should be adopted to reduce clerical errors
Where should (+) identification (in terms of blood administration) be carried out?
In the lab
How many times should clerical check be performed?
3 times
When is clerical check performed?
1st: as results are generated and compared to historical results
2nd: when blood is issued from the BB
3rd: performed at the pt bedside (as the nurse compares the pt armband w/ the BB tag attached to the component to be transfused)
In combined fiscal yrs (2011 through 2015), what is the order of conditions that caused # of reported fatalities? Provide their corresponding percentages
1) Transfusion-related acute lung injury (TRALI) (highest): 38%
2) Transfusion-associated circulatory overload (TACO): 24%
3) Hemolytic transfusion reactions (HTR)
a. Due to non-ABO incompatibility: 14%
b. Due to ABO incompatibility: 7.5%
4) Microbial contamination: 10%
5) Anaphylactic rxns: 5%
6) Hypotensive rxns: 1%
What is the condition that continues to be 1 of the leading causes of transfusion-associated fatalities reported to the FDA?
TRALI
What are taken by the transfusion community to reduce the risk of TRALI have coincided w/ a reduction in the # of TRALI deaths?
Voluntary measures
What should be done if pt has difficult veins (in terms of blood administration)?
The intravenous infusion device should be in place before the blood is issued from the transfusion service
What must be done to all blood components (in terms of blood transfusion)?
These must be filtered
Why are all blood components must be filtered (in terms of blood administration)?
Because clots and cellular debris develop during storage
What does the AABB Standards states (in terms of blood administration)?
“Blood and blood components shall be transfused through a sterile, pyrogen-free transfusion set that has a filter designed to retain particles potentially harmful to the recipient”
How are blood components infused (in terms of blood administration)?
1) These are infused slowly (for the first 10 - 15 mins while the pt is observed closely for signs of a transfusion rxn)
2) These should then be infused as quickly as tolerated or, at most, within 4 hrs
What should be monitored periodically during the transfusion?
The pt’s vital signs such as:
1) Pulse
2) Respiration
3) BP
4) Temp
Why should the pt’s vital signs be monitored (in terms of blood transfusion)?
To detect signs of transfusion rxn
What are the signs and symptoms (and their corresponding indication) that can / may be observed during blood transfusion?
1) Fever w/ back pain: acute hemolytic transfusion rxn
2) Anaphylaxis
3) Hives or pruritus: urticarial rxn
4) Congestive heart failure (CHF): volume overload
5) Fever alone: febrile nonhemolytic transfusion rxn
What is the sign and symptom (and its corresponding indication) that may be diagnosed 5 - 10 days after transfusion (hence, it is not considered as an immediate rxn)?
Jaundice, decreasing hct lvl: delayed hemolytic transfusion rxn
What are the actions of the 150- to 260-um filter (in std blood administration)?
It removes:
1) Gross clots
2) Cellular debris
What must be used for transfusion of all blood components (in terms of blood administration)?
A blood administration filter
What should be done to the sp. product manufacturer’s package insert?
It should be reviewed for instructions pertaining to use of transfusion devices
What are the transfusion devices that are used (in terms of blood transfusion)?
1) Filters
2) Blood administration sets
3) Blood warmers
What is required to be done by rapid transfusion, including exchange transfusion?
Blood warming
Why is blood warming required to be done by rapid transfusion (including exchange transfusion)?
Because the cold blood can cause hypothermia in the pt
What are the effects of hypothermia in pt (w/c can be due to cold blood)?
It increases the possibility of:
1) Cardiac arrhythmia
2) Hemorrhage
True or False
A pt w/ paroxysmal cold hemoglobinuria (PCH) or w/ potent cold agglutinins does not require blood warming
False, because a pt w/ paroxysmal cold hemoglobinuria (PCH) or w/ potent cold agglutinins does may also require blood warming
What should be the characteristics of the blood warmer (that will be used for certain contexts for blood transfusion)?
It should have automatic temp control w/ an alarm that will sound if the blood is warmed over 42 DC
Can blood units be warmed by immersion in a H2O bath or by domestic microwave oven? Why or why not?
No, because uneven heating can cause damage to blood cells and denaturation of blood proteins
What should be used to dilute blood cmpts because other intravenous (IV) solutions may damage the RBCs and cause hemolysis (dextrose solutions such as D5W) or initiate coagulation in the infusion set (calcium-containing solutions such as lactated Ringer solution)?
Only isotonic (0.9%) saline
True or False
All drugs may cause hemolysis if injected through the blood infusion set
False, because some drugs may cause hemolysis if injected through the blood infusion set
What may be done after transfusion (blood transfusion)?
The transfusion set may be flushed w/ isotonic saline
What should be done to the empty blood bag (after blood transfusion)?
1) It can be discarded
2) Or it can be returned to the transfusion service
* accdg to hospital policy
True or False
A copy of the blood bag tag is placed in the pt’s chart
True
What does the Joint Commission require?
It requires all blood transfusion to be reviewed for appropriate use
A hospital transfusion committee may serve as what?
It may serve as the peer review grp for transfusions
True or False
Blood usage review should not be performed prospectively
False, because blood usage review may also be performed prospectively if criteria are approved by the transfusion committee and the medical staff
What may be done by the blood bank director?
He/she may interact and correspond directly w/ the chair of individual hospital depts concerning medical staff blood cmpt usage patterns
True or False
Appropriate criteria for blood transfusion have been published, serving as a guide for conducting audits
True
Who can use the results of audits?
The transfusion committee
Why does the transfusion committee can use the results of audits?
To recommend changes in practice by the hospital staff to improve pt care
What are the other actions done by the transfusion committee?
1) The transfusion committee also reviews transfusion rxns
2) The transfusion committee ensures that appropriate procedures (such as for blood administration) are in place and are followed by hospital personnel
3) Optimally ensures that the most appropriate, efficient, and safe use of the blood supply is achieved
Why does the transfusion committee also reviews transfusion rxns?
To ensure that adverse rxns are unavoidable
Who is most effective if the various grps who order and administer blood (such as surgeons, anesthesiologists, oncologists, and nurses) are represented on the committee?
The transfusion committee
The transfusion committee must have what?
Must have a mechanism for reporting activities and recommendations to the medical staff and hospital administration
What must be done to all adverse events related to transfusion?
These must be reported to the transfusion service (accdg to its local protocol)
What are the primary uses of transfusion therapy?
It is used primarily to treat 2 conditions:
1) Inadequate O2-carrying capacity (because of anemia or blood loss)
2) Maintenance of hemostasis (when the pt has insufficient coagulation proteins / PLTs)
What should be the action of a unit of whole blood (WB) / RBCs in an adult?
It should increase the:
1) Hct lvl (3%)
2) Or hgb lvl (1 g/dL)
What is the indication of RBCs (blood product)
Indicated for increasing the RBC mass (in pts who require increased O2-carrying capacity)
To whom are PLT (blood product) transfusions indicated?
1) These are indicated for pts who are bleeding (due to thrombocytopenia)
2) PLTs are indicated prophylactically for pts who have PLT cts under 5,000 - 10,000 /uL
What should be the action of each dose of PLTs?
It should increase the PLT ct 20,000 - 40,000/uL (in a 70-kg pt)
How is a plateletpheresis product collected?
It is collected from 1 donor
A plateletpheresis product must contain how many PLTs?
Min. of 3 X 10^11 PLTs
What is the cmpt that plasma (blood product) contain?
All coagulation factors
To whom is plasma (blood product) indicated?
It is indicated to pts w/:
1) Multiple coagulation deficiencies (w/c occur in liver failure)
2) DIC
3) Vit K deficiency
4) Warfarin overdose
5) Massive transfusion
What are the cmpts that cryoprecipitate (blood product) contain?
1) At least 80 units of factor VIII
2) 150 mg of fibrinogen
3) vWF
4) Factor XIII
What is the indication of factor IX (blood product)?
It is used in the treatment of persons w/ hemophilia B
What are the indications of immunoglobulin (IG; blood product)?
1) It is used in the treatment of congenital hypogammaglobulinemia
2) To provide passive immunity for certain infections (such as hepatitis A and measles)
3) In certain autoimmune conditions (such as immune thrombocytopenic purpura)
What is massive transfusion?
It is the replacement of 1 or more blood volume(s) within 24 hrs, or about 10 units of blood in an adult
What is the ABO type of the RBCs warranted (in cases of emergency transfusions) if / when the pt type is not yet known?
Grp O RBCs
