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Immunohematology (Blood Banking) (Lecture) > Transfusion Therapy (from Harmening [7th ed.] | F) > Flashcards

Transfusion Therapy (from Harmening [7th ed.] | F) Flashcards

1
Q

What is transfusion therapy (in general)?

A

It is a broad term that encompasses all aspects of the transfusion of pts

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2
Q

True or False

Each blood component has sp. indications for use, expected outcomes, and other considerations

A

True

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3
Q

Pts w/ special conditions requires what?

A

Strategies and decisions to optimize therapy

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4
Q

Are blood and blood products considered as drugs? Why or why not?

A

Yes, blood and blood products are considered as drugs because of their use of treating diseases

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5
Q

True or False

As w/ drugs, adverse effects may occur, necessitating careful consideration of therapy

A

True

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6
Q

Is transfusion of blood cells also a transplantation?

A

Yes

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7
Q

What are the things that must be achieved in transplantation (specifically in transfusion of blood cells)?

A

1) The cells must survive

2) The cells must fxn after transfusion (to have a therapeutic effect)

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8
Q

What is the best tolerated form of transplantation?

A

Transfusion of red blood cells (RBCs)

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9
Q

Transfusion of RBCs can cause what?

A

Rejection (as in a hemolytic transfusion reaction [HTR])

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10
Q

How is rejection of PLTs shown?

A

It is shown by refractoriness to PLT transfusions

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11
Q

Is rejection of PLTs relatively common in multiply transfused pts?

A

Yes

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12
Q

Transfusion therapy is used primarily to treat what conditions?

A

1) Inadequate oxygen-carrying capacity

2) Insufficient coagulation proteins or PLTs

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13
Q

What are the causes of inadequate oxygen-carrying capacity?

A

1) Anemia

2) Blood loss

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14
Q

Where are coagulation proteins and PLTs are needed?

A

Providing adequate hemostasis

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15
Q

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

A

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

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16
Q

Is it possible for some pts (w/ anemia or thrombocytopenia) to not require transfusion? How?

A

Yes, because their clinical conditions are stable and they have little or no risk of adverse outcomes

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17
Q

Provide an ex of a pt (w/ anemia or thrombocytopenia) who does not need transfusion

A

Pt w/ iron-deficiency anemia (IDA) w/ minor symptoms

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18
Q

What is the principle of appropriate blood therapy?

A

It is the transfusion of the sp. blood product needed by the pt

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19
Q

How can selection of blood products be done?

A

Several pts can be treated w/ the blood from 1 donor, giving optimal use of every blood donation

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20
Q

*What are the different blood products used in transfusion therapy?

A

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

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21
Q

When compared w/ the circulating blood in the donor’s blood vessels, what is done to the product of whole blood?

A

The product of whole blood is diluted in a proportion of 8 parts circulating blood to 1 part anticoagulant

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22
Q

What is present in the anticoagulant (for whole blood)?

A

Citrate

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23
Q

What is the action of citrate?

A

It chelates ionized Ca

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24
Q

What is the result of the action of citrate?

A

The activation of the coagulation system is prevented

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25
Q

If present, what serve as substrates for RBC metabolism during storage?

A

1) Glucose
2) Adenine
3) Phosphate

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26
Q

True or False

The transfusion of whole blood is not limited to a few clinical conditions

A

False, because the transfusion of whole blood is limited to a few clinical conditions

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27
Q

What is the requirement for whole blood (that will be transfused)?

A

It must be ABO identical w/ the recipient

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28
Q

What is the purpose of transfusing whole blood?

A

To replace the loss of both RBC mass and plasma volume

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29
Q

Who are the pts who can receive whole blood (in connection to the purpose of transfusion of whole blood)?

A

Rapidly bleeding pts

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30
Q

What are the 2 components of the whole blood that are more commonly used and are equally effective clinically?

A

1) RBCs

2) Plasma

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31
Q

What is the definite contraindication to the use of whole blood?

A

Severe chronic anemia

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32
Q

What is the principle of whole blood transfusion for pts w/ severe chronic anemia?

A

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)

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33
Q

For a 70 kg (154 lbs) adult, what are the effects brought by each unit of whole blood?

A

Increased:

1) Hct (3%)
2) Hgb (1 g/dL)

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34
Q

After transfusion of whole blood, is the increase brought by it apparent already? If no, when is the increase apparent?

A

No, the increase may not be apparent until 48 - 72 hrs when the pt’s blood volume adjusts to normal

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35
Q

Provide an ex of the increase brought by whole blood transfusion

A

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)

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36
Q

What is the principle of increase brought by whole blood transfusion for pts w/ different sizes?

A

The increase is greater in a smaller person and less in a larger one

> in smaller person; < in larger person

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37
Q

How are RBCs (for transfusion) preped?

A

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)

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38
Q

What are the indications of RBC transfusions?

A

Indicated for increasing the RBC mass in pts who require increased oxygen-carrying capacity

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39
Q

What are the clinical manifestations of pts who require increased oxygen-carrying capacity?

A

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

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40
Q

What may be the causes of decreased RBC mass?

A

1) Decreased bone marrow production
a. Leukemia
b. Aplastic anemia
2) Decreased RBC survival
a. Hemolytic anemia
3) Surgical or traumatic bleeding

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41
Q

How does the human body compensate for anemia?

A

By increasing:

1) Plasma volume
2) Heart rate
3) Respiratory rate
4) Oxygen extraction from the RBCs

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42
Q

In terms of oxygen extraction from RBCs, how many % of the oxygen is normally extracted?

A

About 25%

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43
Q

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?

A

Up to 50%

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44
Q

What happens when the demand exceeds 50% of the O2 content?

A

1) The compensatory mechanisms fail

2) Pt requires transfusion

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45
Q

Are there set hgb lvls that indicates a need for transfusion?

A

None

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46
Q

What is the critical lvl of hgb?

A

< or equal to 6 g/dL

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47
Q

What are the trigger values (of hgb) suggested by consensus committees?

A

1) For most pts: < 7 g/dL

2) For pts w/ heart disease: < or equal to 8 g/dL

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48
Q

Most pts can tolerate 7 g/dL (of hgb lvls) in what circumstances?

A

1) If pt is on bedrest
2) If pt is at decreased lvls of activity
3) It pt is given w/ supplemental O2

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49
Q

True or False

Healthy individuals can tolerate hgb lvls as low as 6 g/dL w/ minimal effects

A

False, because healthy individuals can tolerate hgb lvls as low as 5 g/dL w/ minimal effects

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50
Q

What is the contraindication of transfusion of RBCs?

A

Transfusion of RBCs is contraindicated in pts who are well compensated for the anemia

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51
Q

RBCs (blood product) should not be used to treat what condition?

A

Nutritional anemia (such as iron deficiency anemia [IDA])

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52
Q

Transfusion of RBCs should not be done to treat nutritional anemia unless what?

A

Unless the pt shows signs of decompensation (need for increased oxygen-carrying capacity)

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53
Q

Transfusion of RBCs is not to be used for what?

A

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

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54
Q

What are the expected results brought by each unit of transfused RBCs (same as whole blood) (in a typical 70 kg [154 lbs] human)?

A

1) Increased hgb lvl (1 g/dL)

2) Increased hct lvl (3%)

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55
Q

What are the results of transfusing a dose of 10 - 15 mL/kg of RBCs in pediatric pts?

A

1) Increased hgb (about 2 - 3 g/dL)

2) Increased hct (6 - 9%)

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56
Q

The results of transfusing a dose of 10 - 15 mL/kg of RBCs in pediatric pts varies dependent upon what?

A

Varies dependent upon the child’s:

1) Age
2) Body mass

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57
Q

True or False

The increase in hgb and hct is evident more quickly > w/ 1 unit of whole blood

A

True

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58
Q

Why is the increase in hgb and hct evident more quickly > w/ 1 unit of whole blood?

A

Because the adjustment in blood volume is less

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59
Q

Provide an ex of increase of hgb and hct being evident more quickly > w/ 1 unit of whole blood

A

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%

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60
Q

What is the meaning of CPD?

A

Citrate phosphate dextrose

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61
Q

What is the meaning of CPDA-1?

A

Citrate phosphate dextrose adenine

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62
Q

True or False

RBCs preped w/ additive solutions (such as Adsol) have lesser volume < CPD / CPDA-1

A

False, because RBCs preped w/ additive solutions (such as Adsol) have greater volume < CPD / CPDA-1

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63
Q

What is the value of RBCs preped w/ additive solutions then w/ CPD / CPDA-1?

A

300 - 400 mL vs. 160 - 275 mL

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64
Q

What are the effects to plasma and RBC mass if RBCs are preped via the use of additive solution?

A

1) Less plasma

2) RBC mass is the same

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65
Q

Since RBCs preped w/ additive solutions have greater volume > w/ CPD / CPDA-1, what is the difference of hct lvls?

A

Hct differs from 65 - 80% for CPDA-1 RBCs to 55 - 65% for additive solution RBCs

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66
Q

The ave unit of leukocyte-reduced RBCs contains what?

A

< 5 x 10^6 leukocytes

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67
Q

Donor leukocytes may cause what?

A

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])

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68
Q

Human leukocyte antigens (HLA) are responsible for what?

A

HLA alloimmunization

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69
Q

True or False

Leukocytes may harbor cytomegalovirus (CMV)

A

True

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70
Q

What should be done to reduce the risk of HLA immunization and CMV transmission?

A

The leukocyte content must be reduced to < 5 x 10^6

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71
Q

How can the reduction of leukocyte content to < 5 x 10^6 be achieved?

A

By using 1 of several leukocyte-reduction filters

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72
Q

After leukoreduction via the use of leukocyte-reduction filters, what is the value of most leukocyte cts?

A

< 1 x 10^6

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73
Q

In the U.S., what is the std leukocyte content?

A

It must be < 5 x 10^6

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74
Q

True or False

The effect of leukocyte-reduced blood on length of hospital stay and postsurgical wound infection is controversial

A

True

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75
Q

What are the conditions that are decreased if leukocyte-reduced RBCs and PLTs are used?

A

1) Febrile nonhemolytic transfusion rxns
2) CMV transmission
3) HLA alloimmunization

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76
Q

Does leukoreduction reduce the risk of TA-GVHD?

A

No

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77
Q

Who are the pts that may benefit from receiving washed RBCs?

A

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

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78
Q

What is the effect of washing process?

A

It removes plasma proteins

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79
Q

What are the cause of most allergic rxns?

A

Plasma proteins

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80
Q

Freezing RBCs allows what?

A

It allows the long-term storage of rare blood donor units, autologous units, and units for special purposes (such as intrauterine transfusion [IUT])

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81
Q

What is the process that is needed to be done in terms of freezing RBCs?

A

The process needed to deglycerolized the RBCs w/c removes nearly all the plasma

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82
Q

What is the characteristic of deglycerolized RBCs?

A

These units are more expensive

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83
Q

What is the use of deglycerolized RBCs?

A

These can be used interchangeably w/ washed RBCs

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84
Q

True or False

The shortened outdate of washed or deglycerolized RBCs severely limits the use of these components

A

True

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85
Q

What should be done if the units were deglycerolized and washed using an open system?

A

The RBCs must be transfused within 24 hrs after thawing

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86
Q

If a closed system was used, the units may be used for up to how many wks after thawing?

A

Up to 2 wks

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87
Q

What does deglycerolized RBCs contain?

A

80% or more of the erythrocytes present in the original unit of blood

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88
Q

What is the characteristic of deglycerolized RBCs?

A

It have approx the same expected post-transfusion survival as RBCs

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89
Q

True or False

The expected hct increase for washed / deglycerolized RBCs is the same as that for regular RBC units

A

True

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90
Q

How are rejuvenated red blood cells (blood product) preped?

A

It may be preped from RBCs stored in CPD, CPDA-1, and AS-1 storage solutions up to 3 days after expiration

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91
Q

What are the actions of FDA-approved solutions of inosine, phosphate, and adenine?

A

It rejuvenates and restores 2,3-diphosphoglycerate (2,3-DPG) and ATP lvls to approx freshly drawn RBCs

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92
Q

What must be done to FDA-approved solution of inosine, phosphate, and adenine?

A

These products must be washed before infusion

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93
Q

Why must FDA-approved inosine, phosphate, and adenine be washed before infusion?

A

To remove the inosine (because it may have toxicity)

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94
Q

What must be done to rejuvenated RBCs after preparation?

A

1) These must be transfused within 24 hrs

2) Or these must be frozen for long-term storage

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95
Q

What are the importance of PLTs?

A

These are essential for:

1) Formation of primary hemostatic plug
2) Maintenance of normal hemostasis

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96
Q

What is thrombocytopenia?

A

It is a condition whereas the pt has a decreased # of PLTs

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97
Q

What may be the clinical manifestations of a pt w/ severe thrombocytopenia or abnormal PLT fxn?

A

1) Petechiae
2) Ecchymoses
3) Mucosal or spontaneous hemorrhage

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98
Q

What may be the causes of thrombocytopenia?

A

1) Decreased PLT production
a. After chemotherapy (for pts w/ malignancy)
2) Increased destruction
a. Disseminated intravascular coagulation (DIC)

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99
Q

True or False

Massive transfusion may also cause thrombocytopenia

A

True

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100
Q

Why does massive transfusion may also cause thrombocytopenia?

A

Due to:

1) Rapid consumption of PLTs for hemostasis
2) Dilution of the PLTs

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101
Q

How are PLTs diluted?

A

By resuscitation fluids and RBC transfusion

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102
Q

PLT transfusions are indicated for whom?

A

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)

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103
Q

What are the causes of the bleeding of the pt (whom PLT transfusions are indicated)?

A

1) Thrombocytopenia

2) Abnormally fxning PLTs

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104
Q

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

A

False, because AABB published additional guidelines in 2015 as a part of a clinical practice guideline and address indications in a variety of settings

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105
Q

What is required to be done for each PLT product?

A

Bacterial testing

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106
Q

What is done to plateletpheresis products and pooled PLTs?

A

These are cultured

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107
Q

Who cultures plateletpheresis products and pooled PLTs?

A

Blood center

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108
Q

What is the characteristic of individual PLT products from whole blood?

A

These are difficult to culture

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109
Q

Why are individual PLT products from whole blood difficult to be cultured?

A

Because of their small volume, hence, they are less commonly used for transfusion

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110
Q

How is a plateletpheresis component preped?

A

It is preped from 1 donor

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111
Q

What must a plateletpheresis component contain?

A

It must contain a min. of 3 x 10^11 PLTs

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112
Q

What should be the action of 1 plateletpheresis unit?

A

It should increase the adult pt’s PLT ct to 20,000 - 60,000/uL

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113
Q

What must each unit of PLTs from whole blood contain?

A

It must contain at least 5.5 x 10^10 PLTs

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114
Q

What should be the action of each unit of PLTs from whole blood (in a 70 kg pt)?

A

It should increase the PLT ct by 5,000 - 10,000/uL

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115
Q

What does a pool of 4 - 6 units contain?

A

Roughly 3 x 10^11 PLTs

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116
Q

What should be the action of a pool of 4 - 6 units?

A

It should give a PLT ct increase similar to plateletpheresis

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117
Q

What may also be done to PLT components (for the same reasons as for RBCs)?

A

It may also be:

1) Leukocyte-reduced
2) Or washed

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118
Q

What are the results of washing PLT components?

A

It removes some:

1) PLTs
2) Plasma proteins

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119
Q

What is required if an open method is used in terms of washing PLT components?

A

It requires a 4 hr expiration time

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120
Q

PLT fxn may also be negatively impacted due to what?

A

1) PLT adhesion

2) Activation during wash cycles

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121
Q

Since PLT fxn may also be negatively impacted due to activation during wash cycles, what should be done to PLT components?

A

PLT components should be washed only to prevent severe allergic rxns / to remove alloAbs (in cases of neonatal alloimmune thrombocytopenia)

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122
Q

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])?

A

These pts may develop:

1) Severe neutropenia
2) Serious bacterial or fungal infection

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123
Q

What may a pt (w/out neutrophils [granulocytes]) experience?

A

The pt may have difficulty in controlling an infection even w/ appropriate antibiotic treatment

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124
Q

What is the purpose of developing a criteria?

A

To identify pts who are most likely to benefit from granulocyte transfusions

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125
Q

Who are the pts (who are most likely to benefit from granulocyte transfusions) who are suited in the criteria developed?

A

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

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126
Q

True or False

Prophylactic use of granulocyte transfusions is of doubtful value for those pts who have neutropenia but no demonstrable infection

A

True

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127
Q

True or False

Newborn infants may develop overwhelming infection w/ neutropenia

A

True

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128
Q

Why does newborn infants may develop overwhelming infection w/ neutropenia?

A

1) Due to their limited bone marrow reserve for neutrophil production
2) Neonatal neutrophils have impaired fxn

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129
Q

Who are the pts who can benefit w/ granulocyte transfusions?

A

Newborn infants who have overwhelming infection w/ neutropenia

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130
Q

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)?

A

1 granulocyte pheresis product (daily for 4 or more days)

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131
Q

What is the dose of granulocyte transfusion for neonates?

A

A portion of a granulocyte pheresis unit (usually given once or twice)

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132
Q

What are the usual components contained in granulocyte components?

A

1) 1.0 X 10^10 granulocytes >
2) PLTs
3) Erythrocytes (20 - 50 mL)

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133
Q

Because most pts receiving granulocytes are immunocompromised, what should be done to granulocyte products?

A

These are often irradiated

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134
Q

Why are granulocyte products often irradiated?

A

To prevent TA-GVHD

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135
Q

What may be done to granulocytes if they cannot be transfused immediately?

A

They may be stored at 20 - 24 DC w/out agitation

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136
Q

What should be done to granulocyte pheresis?

A

These needs to be crossmatched

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137
Q

Why are granulocyte pheresis needed to be crossmatched?

A

Because of the significant content of RBCs

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138
Q

What must be done to the pt (after transfusion of granulocytes)?

A

The pt must be monitored for:

1) Resolution of symptoms
2) Clinical evidence of efficacy

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139
Q

What must be done to the pt (after transfusion of granulocytes)?

A

The pt must be monitored for:

1) Resolution of symptoms
2) Clinical evidence of efficacy

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140
Q

What must be done to the pt (after transfusion of granulocytes)?

A

The pt must be monitored for:

1) Resolution of symptoms
2) Clinical evidence of efficacy

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141
Q

What is the effect of granulocyte transfusion to the pt?

A

Neutrophil ct will increase to 1,000/uL or more

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142
Q

Why is the pt’s neutrophil ct increased to 1,000/uL or more after granulocyte transfusion?

A

Pt’s neutrophil ct increased in response to infusion of granulocyte colony-stimulating factor (GCSF)-mobilized granulocyte pheresis

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143
Q

What are included in plasma (blood product)?

A

1) Fresh-frozen plasma (FFP)
2) Plasma frozen within 24 hrs after phlebotomy (PF24)
3) Thawed plasma

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144
Q

What does FFP and PF24 contain?

A

Nonlabile coagulation factors

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145
Q

What does FFP contain?

A

Normal lvls of labile coagulation factors

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146
Q

What are the labile coagulation factors contained in FFP?

A

1) Factor V

2) Factor VIII

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147
Q

What does PF24 contain?

A

1) Reduced lvls of factor VIII and protein C

2) Lvls of factor V and other labile plasma proteins (variable compared w/ FFP)

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148
Q

What should be done to FFP and PF24 after being thawed?

A

1) They should be infused immediately

2) Or stored at 1 - 6 DC

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149
Q

What must be done to FFP and PF24 after 24 hrs?

A

These must be discarded

2) Or may be relabeled as “thawed plasma” (if collected in a fxnally closed system)

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150
Q

What is PF24RT24?

A

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

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151
Q

How is PF24RT24 preped?

A

This is preped from apheresis collections

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152
Q

What can be done to PF24RT24?

A

1) It can be held at room temp (for up to 24 hrs) after collection
2) Then frozen (at -18 DC or colder)

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153
Q

What should be done to PF24RT24 (w/c is similar w/ FFP and PF24) after thawing?

A

1) It should be infused immediately

2) Or stored (at 1 - 6 DC)

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154
Q

What must be done to PF24RT24 after 24 hrs?

A

1) This cmpt must be discarded

2) Or may be relabeled as “thawed plasma” (if collected in a fxnally closed system)

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155
Q

What should be done to thawed plasma w/c is derived from FFP, PF24, or PF24RT24 (preped in a closed system)?

A

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])

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156
Q

What does thawed plasma contain?

A

Stable coagulation factors (w/c are similar clinically to the lvls found in FFP)

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157
Q

What are the stable coagulation factors that thawed plasma contain?

A

1) Factor II

2) Fibrinogen

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158
Q

Does thawed plasma contain other factors (aside from factor II and fibrinogen)?

A

Other factors are variable, being reduced in lvls that change over time

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159
Q

What are the indications of plasma (blood product)?

A

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

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160
Q

How can pts w/ vit K deficiency / warfarin overdose be treated?

A

The pt can be treated w/ vit K

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161
Q

How can vit K be administered (/ what are the methods of administration) for pts w/ vit K deficiency / warfarin overdose?

A

1) Orally
2) Intravenously
3) Intramuscularly

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162
Q

When is intramuscular administration of vit K (for pts w/ vit K deficiency / warfarin overdose) done?

A

If pt’s liver fxn is adequate and w/ an adequate interval (4 - 24 hrs) before a major / minor hemostatic challenge (such as surgery)

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163
Q

Pts w/ liver disease / liver failure frequently develop what condition / disorder?

A

Clinical coagulopathy

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164
Q

Why are pts w/ liver disease / liver failure frequently develop clinical coagulopathy?

A

Due to impaired hepatic synthesis of all coagulation factors and antithrombotic factors

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165
Q

What is the product (/ blood product) of choice for pts w/ multiple-factor deficiencies and hemorrhage or impeding surgery?

A

Plasma

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166
Q

What are the indications of plasma (blood product)?

A

1) For pts w/ multiple-factor deficiencies
2) For pts w/ hemorrhage
3) For pts w/ impending surgery

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167
Q

How many units of plasma (blood product) will effectively control hemostasis?

A

4 - 6 units (usual)

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168
Q

If the pt is transfused w/ 4 - 6 units of plasma (to effectively control hemostasis), can plasma correct the coagulation tests to normal range?

A

No, it may not correct the coagulation tests to normal range

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169
Q

Why is 4 - 6 units of plasma may not correct coagulation tests to normal range?

A

Due to dysfibrinogenemia

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170
Q

Is the correction (brought by plasma transfusion) indicated for minor procedures (such as liver biopsy)? Why or why not?

A

No, because mild hemostatic abnormalities do not predict bleeding

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171
Q

Is plasma (blood product) a concentrate?

A

No

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172
Q

Since plasma (blood product) is not a concentrate, volume overload may be a what?

A

It may be a serious complication of transfusion

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173
Q

Can plasma transfusion treat congenital coagulation factor deficiencies?

A

Yes, rarely

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174
Q

Why are congenital coagulation factor deficiencies rarely treated w/ plasma (blood product)?

A

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

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175
Q

What are the exs of factor concentrates?

A

1) Factor VIII

2) Factor IX

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176
Q

True or False

Factor concentrates offer more effective methods of therapy > plasma (blood product)

A

True

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177
Q

Does a pt w/ factor XI deficiency still treated by plasma infusion?

A

Yes

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178
Q

If a pt has factor XI deficiency, what is the required percentage of factor XI lvls for adequate hemostasis?

A

20 - 30%

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179
Q

What disease is considered as milder > hemophilia A?

A

Factor XI deficiency

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180
Q

What is hemophilia A?

A

Factor VIII deficiency

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181
Q

What is hemophilia B?

A

Factor IX deficiency

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182
Q

What is the characteristic of factor XI?

A

It also has a long half-life

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183
Q

Since factor XI also has a long half-life, is treatment needed on a daily basis?

A

No, treatment is not needed in a daily basis

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184
Q

What is a coagulation factor unit?

A

It is the activity in 1 mL of pooled normal plasma

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185
Q

Accdg to the definition of coagulation factor unit, how many unit/mL or units/dL are equaled to 100% activity?

A

100% activity = 1 unit/mL or 100 units/dL

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186
Q

How many percent activity of each of the coagulation factor is required for adequate hemostasis?

A

About 30%

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187
Q

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)?

A

< half of the plasma volume; about 4 - 6 plasma units

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188
Q

True or False

Additional units (of plasma) are usually not needed w/ continued hemorrhage

A

False, because additional units (of plasma) are usually needed w/ continued hemorrhage

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189
Q

Additional doses (of plasma units) are usually needed w/ continued hemorrhage in what cases?

A

1) If prothrombin time (PT) is 1.5 times normal >

2) If the international normalized ratio (INR) is 1.5 >

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190
Q

What is the half-life of factor VII, VIII, or IX?

A

< 24 hrs

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191
Q

Since factors VII, VIII, and IX have half-lives of < 24 hrs, what are required to be done?

A

Repeated transfusions

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192
Q

Why are repeated transfusions required to be done w/ regards to factors VII, VIII, and IX?

A

1) To control postoperative bleeding

2) Or to maintain hemostasis

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193
Q

Provide an ex of the application of a clotting factor w/ < 24 hrs of half-life

A

Factor IX has a half-life of 18 - 24 hrs, requiring daily transfusions

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194
Q

Plasma is sometimes used as what?

A

It is sometimes used as a replacement fluid during plasma exchange (therapeutic plasmapheresis)

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195
Q

What are the actions of plasma in cases of thrombotic thrombocytopenic purpura (TTP)?

A

1) It provides a metalloprotease (ADAMTS13)

2) It removes inhibitors (thus, reversing the symptoms)

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196
Q

Plasma should not be used for what?

A

It should not be used for:

1) Blood volume expansion
2) Or protein replacement

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197
Q

Why is plasma should not be used for blood volume expansion or protein replacement?

A

Because safer products are available for these purposes

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198
Q

What are the safer products that are available for blood volume expansion or protein replacement?

A

1) Serum albumin
2) Synthetic colloids
3) Balanced salt solutions

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199
Q

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

A

True

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200
Q

Plasma should be what to the recipient’s RBCs?

A

It should be ABO compatible w/ the recipient’s RBCs

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201
Q

Can the Rh type be disregarded, since plasma should be ABO compatible w/ the recipient’s RBCs?

A

Yes

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202
Q

What does cryoprecipitate (blood product) contain?

A

1) Fibrinogen
2) Factor VIII
3) Factor XIII
4) Von Willebrand factor (vWF)
5) Fibronectin

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203
Q

Cryoprecipitate is used primarily for what?

A

Fibrinogen replacement

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204
Q

What does American Association of Blood Banks (AABB) require to be in each unit of cryoprecipitate?

A

AABB requires 150 mg > of fibrinogen be in each unit of cryoprecipitate

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205
Q

What are often the quality control lvls for cryoprecipitate?

A

Often over 250 mg

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206
Q

What is the meaning of AHF?

A

Cryoprecipitated antihemophilic factor

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207
Q

What should AHF contain?

A

It should contain > or equal to 80 IU of factor VIII in each unit

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208
Q

Generally, how many cryoprecipitate units are pooled at the blood center and are labeled “pooled cryoprecipitated AHF”?

A

5 cryoprecipitate units

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209
Q

What is done to each unit of AHF?

A

Each of the units is rinsed w/ 10 - 15 mL of saline diluent

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210
Q

Why is each unit of AHF rinsed w/ 10 - 15 mL of saline diluent?

A

To ensure complete removal of all material

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211
Q

What are done in pooled cryoprecipitate AHF?

A

These are frozen -> and shipped to transfusion services

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212
Q

What is done to pooled cryoprecipitate AHF in transfusion services (where they are shipped)?

A

These pools can be:

1) Thawed
2) Issued

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213
Q

How many mg of fibrinogen does each pool (of pooled cryoprecipitate AHF) contain?

A

Each pool contains 750 - 1,250 mg of fibrinogen

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214
Q

Fibrinogen replacement may be required to whom?

A

To pts w/:

1) Liver failure
2) DIC
3) Massive transfusion
4) Congenital fibrinogen deficiency (in rare pts)

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215
Q

What is the recommended fibrinogen plasma lvl for adequate hemostasis w/ surgery / trauma?

A

A fibrinogen plasma lvl of about 100 mg/dL

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216
Q

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

A pt’s fibrinogen must be increased from 30 to 100 mg/dL, or an increment of 70 mg/dL (100 - 30 mg/dL)

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217
Q

Cryoprecipitated AHF may be dosed at what when used to correct hypofibrinogenemia?

A

It may be dosed at 1 bag per 7- to 10-kg body weight

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218
Q

Why is cryoprecipitated AHF dosed at 1 bag per 7- to 10- kg body weight when used to correct hypofibrinogenemia?

A

To raise plasma fibrinogen by approx 50 - 75 mg/dL

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219
Q

Cryoprecipitate was used as a source for what?

A

It was used as a source for fibrin sealant

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220
Q

Fibrin sealant uses what as the source of fibrinogen?

A

Cryoprecipitate

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221
Q

What type of fibrin sealants are preferred?

A

FDA-approved fibrin sealants (w/c have been treated to reduce viral transmission) are preferred

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222
Q

Each unit of cryoprecipitate (blood product) must contain at least what?

A

Must contain at least 80 units of factor VIII

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223
Q

What are used now to treat mild / moderate factor VIII deficiency (hemophilia A)?

A

1) Desmopressin acetate (1-deamino-[8-D-arginine]-vasopressin [DDAVP])
2) Or factor VIII
3) Or both

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224
Q

What is now used to treat severe factor VIII deficiency?

A

Factor VIII

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225
Q

Cryoprecipitate was used to treat pts w/ what disease / condition?

A

Pts w/ von Willebrand disease (vWD)

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226
Q

What is vWD?

A

It is a condition whereas there is a deficiency of vWF

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227
Q

Is cryoprecipitate still considered as the product of choice for factor VIII deficiency or vWD?

A

It is no longer considered as the product of choice for these conditions / disorders

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228
Q

True or False

Virus-safe factor VIII w/ assayed amts of factor VIII and vWF is not available

A

False, because virus-safe factor VIII w/ assayed amts of factor VIII and vWF is available

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229
Q

What is done to thawed plasma, cryoprecipitate reduced (blood product)?

A

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)

230
Q

What are the components contained by thawed plasma, cryoprecipitate reduced (blood product)?

A

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

231
Q

Thawed plasma, cryoprecipitate reduced (blood product) is deficient in what factors (and components)?

A

1) Fibrinogen (factor I)
2) Factor VIII
3) Factor XIII
4) vWF
5) Cryoglobulin
6) Fibronectin

232
Q

What is used to treat pts w/ hemophilia A (factor VIII deficiency) who experiences spontaneous hemorrhages?

A

Recombinant or human plasma-derived factor VIII replacement (blood product)

233
Q

What are the 2 types of factor VIII (blood product)?

A

1) Recombinant (factor VIII)

2) Human plasma-derived factor VIII replacement

234
Q

How is plasma-derived factor VIII preped?

A

1) It is preped from plasma obtained from paid donors by plasmapheresis
2) Or from volunteer whole blood donors

235
Q

What are the different methods that treats factor VIII (blood product)?

A

1) Pasteurization
2) Nanofiltration
3) Solvent detergent

236
Q

What are the purposes of treating factor VIII (blood product) (done via different methods)?

A

To ensure sterility for:

1) Human immunodeficiency virus (HIV)
2) Hepatitis B virus (HBV)
3) Hepatitis C virus (HCV)

237
Q

What is the characteristic of recombinant human product (of factor VIII: blood product)?

A

It is virus-safe

238
Q

What are done to both the plasma derived and recombinant factor VIII (blood product)?

A

1) These are stored (at ref temp)

2) These are reconstituted w/ saline (at time of infusion)

239
Q

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

A

True

240
Q

Provide an ex of how to calculate factor VIII (blood product) dose and solve the problem

A

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

241
Q

What are the indications of recombinant human products (of different factors [in relation to factor VIII]: blood product)?

A

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

242
Q

Is factor VIII (blood product) a concentrate?

A

Yes

243
Q

What is the other term for factor IX complex (blood product)?

A

Prothrombin complex

244
Q

How is factor IX complex preped?

A

It is preped from pooled plasma (via the use of various methods of separation and viral inactivation)

245
Q

What are the components that PT complex contain?

A

1) Factor II
2) Factor VII
3) Factor IX
4) Factor X

246
Q

PT complex is recommended for whom pts?

A

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

247
Q

Activated coagulation factors present in the PT complex may cause what?

A

Thrombosis

248
Q

Activated coagulation factors (w/c are present in the PT complex) may cause thrombosis to whom?

A

It may cause thrombosis especially to pts w/ liver disease

249
Q

Recombinant human factor IX is effective only in what?

A

It is effective only in the management of factor IX deficiency (hemophilia B)

250
Q

How is the dose for factor IX calculated?

A

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

251
Q

What is antithrombin (blood product)?

A

It is a protease inhibitor

252
Q

What is the action of antithrombin?

A

It has an activity towards thrombin

253
Q

What are the actions of heparin?

A

It accelerates the:

1) Binding
2) Inactivation of thrombin (by antithrombin)

254
Q

What are the 2 ways (or principles) of antithrombin deficiency?

A

1) Hereditary

2) Acquired

255
Q

The hereditary deficiency of antithrombin is associated w/ what condition?

A

Venous thromboses

256
Q

Acquired antithrombin deficiency is seen most frequently in whom?

A

To pts w/ DIC

257
Q

True or False

Antithrombin concentrates are not licensed for use in the U.S.

A

False, because antithrombin concentrates are licensed for use in the U.S.

258
Q

To whom are antithrombin concentrates licensed to be used in the U.S.?

A

To pts w/ hereditary antithrombin deficiency

259
Q

What is done to antithrombin concentrates?

A

These are pasteurized

260
Q

Why are antithrombin concentrates pasteurized?

A

To eliminate the risk of:

1) HIV infections
2) HCV infections

261
Q

Does antithrombin (blood product) shown to provide significant clinical benefit in acquired antithrombin deficiency?

A

No, because antithrombin (blood product) has been shown to provide no significant clinical benefit in acquired antithrombin deficiency

262
Q

Aside from antithrombin concentrates, what is the alternative source of antithrombin?

A

Thawed plasma

263
Q

What is the characteristic of protein C and protein S?

A

These are vitamin K-dependent proteins

264
Q

Where are protein C and protein S synthesized?

A

Liver

265
Q

What is the fxn of protein S in relation to protein C?

A

Protein S fxns as a cofactor for activated protein C

266
Q

What is the action of activated protein C?

A

It inactivates factors V and VIII

267
Q

What is the result of the action done by activated protein C?

A

The formation of thrombus is prevented

268
Q

Antithrombin deficiency (hereditary or acquired) leads to what condition?

A

Hypercoagulable state (i.e., the tendency for thrombosis)

269
Q

What is approved for use in hereditary deficiency states?

A

Human plasma-derived protein C concentrates

270
Q

What are the uses of recombinant human activated protein C?

A

It has been used for:

1) DIC
2) Sepsis

271
Q

What is the meaning of rFVIIa?

A

Recombinant human activated factor VII

272
Q

What are the uses of rFVIIa?

A

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

273
Q

True or False

Large randomized controlled trials are not needed to define dose, indications, and adverse effects (in relation to rFVIIa)

A

False, because large randomized controlled trials are needed to define dose, indications, and adverse effects (in relation to rFVIIa)

274
Q

True or False

Reports of use for liver disease, massive transfusion, and other bleeding disorders (of rFVIIa) have not been promising

A

False, because reports of use for liver disease, massive transfusion, and other bleeding disorders (of rFVIIa) have been promising

275
Q

How is albumin (blood product) preped?

A

It is preped by chemical and physical fractionation of pooled plasma

276
Q

What are the solutions (/ types) that are available for albumin (blood product)?

A

1) 5% solution

2) 25% solution

277
Q

What is the percentage of the protein content (specifically albumin) in the 25% solution (of albumin)?

A

96%

278
Q

What is the action done to 25% solution (of albumin)?

A

It is heat-treated

279
Q

True or False

25% solution (of albumin) has been proved to be virus-safe over many yrs of use

A

True

280
Q

What are the uses of albumin (blood product)?

A

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)

281
Q

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

A

True

282
Q

In many plasmapheresis procedures, what is routinely used as the replacement fluid for the colloid that is removed during the procedures?

A

Albumin (blood product)

283
Q

What is the action of albumin (w/ diuretics)?

A

It can induce diuresis in pts who have low total protein

284
Q

What are the causes of low total protein to pts who are induced of diuresis (due to the action of albumin w/ diuretics)?

A

Severe liver / protein-losing disease

285
Q

What is the action of 25% solution (of albumin)?

A

It brings about 5 times its volume from extravascular H2O into the vascular space

286
Q

Due to the action brought by 25% solution (of albumin), pts receiving 25% albumin need to have what?

A

They need to have adequate extravascular H2O and compensatory mechanisms (to deal w/ the expansion of the blood volume)

287
Q

How is immune globulin (blood product) preped?

A

It is preped from pooled plasma

288
Q

What is the primary type of Ig for immune globulin (blood product) w/c is preped from pooled plasma?

A

IgG

289
Q

What are the other types of Ig that may be present in some preparations of immune globulin (blood product)?

A

1) IgM

2) IgA

290
Q

What is the characteristic of other preparations of immune globulin (blood product)?

A

Others are free of the contaminating proteins

291
Q

What are the contaminating proteins that are not present in other preparations of immune globulin (blood product)?

A

1) IgM

2) IgA

292
Q

What are the methods of administration of immune globulin (blood product)?

A

1) Intramuscular administration

2) Intravenous administration

293
Q

Can the intramuscular product (of immune globulin [blood product]) be given / administered intravenously?

A

No

294
Q

Why is the intramuscular product (of immune globulin [blood product]) cannot be given / administered intravenously?

A

Because severe anaphylactic rxns may occur

295
Q

What must be done to intravenous product (of immune globulin [blood product]) in terms of its administration?

A

It must be given / administered slowly

296
Q

Why must intravenous product (of immune globulin [blood product]) be given / administered slowly?

A

To lessen the risk of rxn

297
Q

What are the uses / indications of immune globulin (blood product)?

A

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

298
Q

What should be the frequency of administration of immune globulin (blood product) for pts w/ hypogammaglobulinemia?

A

Monthly injections (intramuscular administration) / infusions (intravenous administration) (usual)

299
Q

Why are monthly injections / infusions usually given to pts w/ hypogammaglobulinemia?

A

Because of the 22-day half-life of IgG

300
Q

What is the recommended dose for intramuscular administration of immune globulin (blood product)?

A

0.7 mL/kg intramuscularly

301
Q

What is the recommended dose for intravenous administration of immune globulin (blood product)?

A

100 mg/kg intravenously

302
Q

What is the method of administration of immune globulin (blood product) that is recommended to be done for hepatitis A prophylaxis?

A

Intramuscular administration

303
Q

What is the recommended dose for intramuscular administration of immune globulin (blood product) for hepatitis A prophylaxis?

A

0.02 - 0.04 mL/kg

304
Q

What is the use / indication of intravenous preparation of immune globulin (blood product)?

A

It is used increasingly in the therapy of autoimmune diseases

305
Q

What are the autoimmune diseases whereas intravenous preparation of immune globulin (blood product) is used increasingly for therapy?

A

1) Immune thrombocytopenia

2) Myasthenia gravis

306
Q

True or False

Various mechanisms of action (regarding intravenous preparation of immune globulin [blood product]) have been postulated

A

True

307
Q

Conceivably, what are the actions of infused immune globulin (blood product)?

A

It blocks the:

1) Reticuloendothelial system (RES)
2) Or mononuclear phagocytic system

308
Q

True or False

Various hyperimmune globulins are not available to treat such viruses

A

False, because various hyperimmune globulins are available to treat such viruses

309
Q

What are the viruses that can be treated by various hyperimmune globulins?

A

1) Hepatitis B
2) Varicella zoster
3) Rabies
4) Mumps

310
Q

How are various hyperimmune globulins preped?

A

These are preped from the plasma of donors (who have high Ab titers to the sp. virus w/c causes the disease)

311
Q

The dose of various hyperimmune globulins is recommended to be present where?

A

It is recommended to be in the package insert

312
Q

True or False

It should be noted that preparations such as hepatitis B hyperimmune globulin provide only passive immunity after an exposure

A

True

313
Q

True or False

Preparations such as hepatitis B hyperimmune globulin does confer permanent immunity and so must be accompanied by active immunization

A

False, because preparations such as hepatitis B hyperimmune globulin does not confer permanent immunity and so must be accompanied by active immunization

314
Q

What is the meaning of RhIG?

A

Rh-immune globulin

315
Q

RhIG was developed to protect whom?

A

1) Rh-(-) female who is pregnant

2) Or who delivers an Rh-(+) infant

316
Q

Much of the IgG in the preparation of RhIG is directed against what?

A

D Ag (within the Rh system)

317
Q

Administration of the preparation of RhIG allows what?

A

It allows attachment of anti-D to any Rh-positive cells of the infant that have entered the maternal circulation

318
Q

What happens to Ab-bound cells?

A

These are subsequently removed by the mother’s macrophages (preventing active immunization or sensitization)

319
Q

What are the methods of administration of Rh-immune globulin products?

A

1) Intravenously

2) Intramuscularly

320
Q

Rh-immune globulin products (w/c can be administered intravenously or intramuscularly) are approved for use in pts w/ what condition / disorder?

A

These are approved for use in idiopathic thrombocytopenic purpura pts (who are Rh-[+])

321
Q

What is the proposed mechanism of action (of Rh-immune globulin products)?

A

Blockage of the RES by anti-D coated RBCs (thereby reducing the destruction of autoAb-coated PLTs)

322
Q

How is the number of standard-dose RhIG vials (for RBC transfusion accidents) calculated?

A

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

323
Q

Can the intravenous preparation (of RhIG) may also be used?

A

Yes

324
Q

*What is another approach that can be done / performed?

A

Perform an exchange transfusion w/ Rh-(-) blood and then calculate the dose based on the number of Rh-(+) RBCs remaining in the circulation

325
Q

How many vial/s is/are sufficient (for plateletpheresis) for 30 or more products?

A

1 vial

326
Q

Why is 1 vial (for plateletpheresis) sufficient for 30 or more products?

A

Because each unit contains fewer than 0.5 mL RBCs

327
Q

How can the dose for leukocyte concentrates can be calculated?

A

It can be calculated by obtaining the hct and volume of the product from the supplier

328
Q

Immune globulins may cause what conditions / disorders?

A

Anaphylactic rxns

 a. Flushing
 b. Hypotension
 c. Dyspnea
 d. Nausea
 e. Vomiting
 f. Diarrhea
 g. Back pain
329
Q

True or False

Caution should be used in pts w/ known IgA deficiency and previous anaphylactic rxns to blood components

A

True

330
Q

Certain categories of pts require what?

A

Require the selection of blood products that are:

1) Leukocyte-reduced
2) CMV-negative
3) Irradiated

331
Q

What is the action of leukocyte-reduction filters (in relation w/ leukocyte-reduced cellular blood components [special product])?

A

These are designed to remove 99.9% > of leukocytes from RBCs and PLT products

332
Q

What is the use of leukocyte-reduction filters (in relation w/ leukocyte-reduced cellular blood components)?

A

1) They can be used in the lab (prestorage)

2) Or can be used at the bedside during blood transfusion

333
Q

What is the goal that can be achieved via the use of leukocyte-reduction filters?

A

Fewer than 5 x 10^6 leukocytes remaining in the RBC or apheresed PLT unit

334
Q

When is prestorage filtration more reliable for leukocyte reduction?

A

Prestorage filtration in the lab or at the time of collection rather > at the bedside

335
Q

Why is prestorage filtration in the lab or at the time of collection more reliable for leukocyte reduction > prestorage filtration at the bedside?

A

Because leukocytes degranulate, fragment, or die during storage, releasing their contents (that could result in febrile and allergic transfusion rxns)

336
Q

What is the sp. cytokine that accumulate during storage w/c have been implicated for some failures of bedside filtration to prevention febrile rxn?

A

IL-8

337
Q

What are the uses of leukocyte-reduced RBCs and PLTs?

A

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

338
Q

What are the controversial effects of leukocyte reduction?

A

1) Decreased mortality

2) Decreased of length of hospital stay

339
Q

True or False

CMV is carried, in a latent or infectious form, in neutrophils and lymphocytes

A

False, because CMV is carried, in a latent or infectious form, in neutrophils and monocytes

340
Q

If transfusion of virus-infected cell (CMV) in a cellular product (such as RBCs / PLTs) is done, can it transmit infection?

A

Yes

341
Q

What can be used to reduce the CMV infection of the pts?

A

1) Leukocyte-reduction filters

2) Or by providing CMV Ab-(-) blood

342
Q

What are the indications of CMV-negative or leukocyte-reduced components?

A

These are indicated for:

1) Recipients who are CMV-(-)
2) Pts who are at risk for severe sequelae of CMV infections

343
Q

*Who are the pts who are at greatest risk for CMV infections?

A

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)

344
Q

What is done to blood components?

A

These are irradiated w/ gamma radiation (irradiated cellular blood components [special product])

345
Q

Why are blood components irradiated w/ gamma radiation?

A

To prevent GVHD

346
Q

What are the 3 conditions that are required to occur for GVHD to occur?

A

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

347
Q

What condition / disorder is common after allogeneic bone marrow or hematopoietic progenitor cell transplantation?

A

GVHD

348
Q

What are affected by GVHD?

A

It is a syndrome affecting mainly:

1) Skin
2) Liver
3) Gut

349
Q

*W/c occurs less frequently, GVHD or TA-GVHD?

A

TA-GVHD

350
Q

What is the cause of TA-GVHD?

A

It is caused by viable T lymphocytes in cellular blood components (ex. RBCs and PLTs)

351
Q

What is the mortality rate in TA-GVHD?

A

The mortality rate is high

352
Q

Since the mortality rate in TA-GVHD is high, what should be done?

A

Prevention is the key

353
Q

What is the focus of prevention for TA-GVHD?

A

Prevention focuses on irradiating cellular components before administration to significantly immunocompromised individuals

354
Q

True or False

Irradiation doses does not vary

A

False, because irradiation doses can vary

355
Q

What are the characteristics of high irradiation doses?

A

1) These are more effective

2) But these are more damaging to RBCs

356
Q

What is the std dose of gamma radiation?

A

2,500 cGy (centigray)

357
Q

The std dose of gamma irradiation is targeted to what?

A

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

358
Q

What are the actions of irradiation (in relation to TA-GVHD)?

A

It decreases or eliminates the mitogenic (blastogenic) capacity of the transfused T cells, rendering the donor T cells immunoincompetent

359
Q

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)?

A

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

360
Q

What is the condition that immunocompetent recipients have experienced after receiving nonirradiated directed donations primarily from first-degree relatives?

A

TA-GVHD

361
Q

What will happen if the related donor is homozygous for 1 of the pt’s (host’s) HLA haplotypes (in relation to TA-GVHD)?

A

The pt is incapable of rejecting the donor’s (graft’s) T lymphocytes

362
Q

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?

A

These then can act against the HLA Ags encoded by the pt’s other haplotype

363
Q

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?

A

The donor lymphocytes then reject the host

364
Q

True or False

The lvl of immunosuppression a recipient must have to develop TA-GVHD is unknown

A

True

365
Q

True or False

The dose of lymphocytes needed for TA-GVHD to occur is unknown

A

True

366
Q

Since the dose of lymphocytes needed for TA-GVHD to occur is unknown, what should be done / observed?

A

Prevention (w/c depends on irradiation and not on reduction of lymphocytes by filtration) should be done / observed

367
Q

True or False

All pts require policies and procedures that address particular clinical situations

A

False, because some pts require policies and procedures that address particular clinical situations

368
Q

True or False

All surgical procedures do not require blood transfusion

A

False, because most surgical procedures do not require blood transfusion

369
Q

What are the results of crossmatching for procedures w/ a low likelihood of transfusion?

A

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

370
Q

What are the procedures that are prudent to be performed prior to surgery?

A

1) Type

2) Screen (/ Ab screen)

371
Q

What must be done if Ab screen is (+)?

A

Ab identification must be completed and compatible units found

372
Q

What may be done if Ab screen is (-)?

A

ABO- and Rh-type-specific blood may be released after an immediate spin or electronic crossmatch in those rare instances when transfusion is required

373
Q

What is the requirement of number of crossmatched units for a pt who is likely to require blood transfusion?

A

The number of crossmatched units should be no more than twice those usually required for that surgical procedure

374
Q

What is the meaning of C/T ratio?

A

Crossmatch-to-transfusion ratio

375
Q

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?

A

It will be between 2:1 and 3:1 (w/c has been shown to be optimal practice)

376
Q

Do some transfusion services extend the practice of C/T ratio between 2:1 and 3:1 to non-surgical pts?

A

Yes

377
Q

When is crossmatching done to non-surgical pts?

A

It is done only when the RBCs are requested for issue to the pt

378
Q

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)?

A

It increased the inventory of uncrossmatched units that can be used for immediate needs

379
Q

*What are different types of transfusion therapy in special conditions?

A

1) Autologous transfusion
2) Emergency transfusion
3) Massive transfusion
4) Neonatal transfusion
5) Transfusion in oncology

380
Q

What is autologous (self) transfusion?

A

It is the donation of blood by the intended recipient

381
Q

What is allogeneic transfusion?

A

It is the infusion of blood from another donor

382
Q

What are the benefits of autologous transfusion?

A

The pt’s own blood:

1) Reduces the possibility of transfusion rxn
2) Reduces the transmission of infectious disease

383
Q

What are the types of autologous transfusion?

A

1) Predeposit of blood by the pt

2) Intraoperative hemodilution

384
Q

How is predeposit of blood (by the pt) collected?

A

It is collected by / via regular blood donation procedure

385
Q

What are the ways that can be done to store predeposit of blood (by the pt)?

A

1) The blood can be stored as liquid

2) The blood can be frozen (for longer storage)

386
Q

True or False

Pts may donate several units of blood over a period of wks

A

True

387
Q

Pts may donate several units of blood over a period of wks, but what should they do?

A

They should take iron supplements

388
Q

Why should pts who may donate several units of blood over a period of wks intake iron supplements?

A

To stimulate erythropoiesis

389
Q

To whom are predeposit autologous donation usually reserved?

A

For pts anticipating a need for transfusion (such as for a scheduled surgery)

390
Q

What is the characteristic of predeposit autologous transfusion?

A

It is expensive

391
Q

Why are predeposit autologous transfusion expensive?

A

Because about half of the donated units are not used

392
Q

What are units given to pts present for surgery w/ lower hcts?

A

Increased transfusion of allogeneic units in addition to autologous units

393
Q

What can pts w/ multiple RBC Abs or Abs to high-incidence Ags may do?

A

They may store frozen units for use by themselves or others

394
Q

What is intraoperative hemodilution?

A

It is the collection of 1 / 2 units of blood from the pt just before a surgical procedure

395
Q

What should be done if intraoperative hemodilution is done?

A

The removed blood volume should be replaced w/ crystalloid or colloid solution

396
Q

At the end of surgery, what is done to the blood units (w/c are obtained via intraoperative hemodilution)?

A

These are infused into the pt

397
Q

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

A

True

398
Q

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?

A

1) Meticulous attention to hemostasis

2) Meticulous attention to salvage of shed blood

399
Q

Several types of equipment (in relation to salvage of shed blood) are available for what purposes?

A

1) Collecting, 2) washing, and 3) filtering shed blood before reinfusion

400
Q

What is recommended to be done (in relation to salvage of shed blood)?

A

Washing of intraoperative or postoperative salvaged blood

401
Q

Why is washing of intraoperative or postoperative salvaged blood recommended to be done?

A

To remove the:

1) Cellular debris
2) Fat
3) Other contaminants

402
Q

What anticoagulants may be used for the anticoagulation of the shed blood?

A

1) Heparin

2) Or citrate solutions

403
Q

Who are the pts who require immediate transfusion?

A

Pts who are rapidly / uncontrollably bleeding

404
Q

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?

A

Grp O RBCs

405
Q

What is the ABO and Rh type of the RBC units that should be used if the pt is a female of childbearing potential?

A

Grp O-negative RBC units

406
Q

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?

A

They can be switched from Rh-(-) to Rh-(+) RBCs

407
Q

What may be more dangerous, delaying blood transfusion in emergency situations or transfusing incompatible blood before the Ab screen and crossmatch are completed?

A

Delaying blood transfusion in emergency situations may be more dangerous > small risk of transfusing incompatible blood before the Ab screen and crossmatch are completed

408
Q

What can be done after issuing O blood or type-specific blood?

A

1) Ab screen can be completed

2) Decisions can then be made for the selection of additional units of blood

409
Q

What can be done if the pt has been typed and screened for a surgical procedure and his/her Ab screen is (-)?

A

ABO- and Rh-type-specific blood can be given after an immediate spin crossmatch

410
Q

Transfusions should be reserved to whom?

A

To / for those pts losing 20% > of their blood volume

411
Q

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

A

True

412
Q

What is massive transfusion?

A

It is defined as the replacement of 1 or more blood volumes within 24 hrs, or about 10 units of blood in an adult

413
Q

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

A

True

414
Q

True or False

Most medical centers w/ high-level trauma services have adopted a massive transfusion protocol

A

True

415
Q

What are essential for guiding appropriate transfusion therapy?

A

Analysis of the pt’s:

1) Clinical status
2) Lab tests

416
Q

Can the massive transfusion pack be adjusted for low hgb or PLTs or prolonged coagulation tests?

A

Yes

417
Q

Provide exs of application where massive transfusion pack can be adjusted for low hgb or PLTs or prolonged coagulation tests

A

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

418
Q

Should fibrinogen lvls be monitored (in massive transfusion)?

A

Yes

419
Q

Why should fibrinogen lvls be monitored?

A

Because replacement by cryoprecipitate may be indicated when the fibrinogen lvl is < 100 mg/dL

420
Q

A pt in critical condition and a limited supply of type-specific blood may require what?

A

May require a change in ABO or Rh types

421
Q

Why is an Rh-(-) male or a postmenopausal female pt being switched from Rh-(-) to Rh-(+) blood?

A

To avoid depleting the inventory of Rh-(-) blood

422
Q

Can an Rh-(-) potentially childbearing woman be switched from Rh-(-) to Rh-(+) blood?

A

No, because she should receive Rh-(-) RBC products for as long as possible

423
Q

Premature infants frequently require what (in relation to neonatal transfusion)?

A

Transfusion of small amts of RBCs

424
Q

Why are premature infants frequently require transfusion of small amts of RBCs?

A

1) To replace blood drawn for lab tests

2) To treat the anemia of prematurity

425
Q

What is the effect of a dose of 10 mL/kg (of RBCs)?

A

The hgb is increased by approx 3 g/dL

426
Q

True or False

There are no methods available for preping small aliquots for transfusion

A

False, because various methods are available for preping small aliquots for transfusion

427
Q

What can be done to small aliquots of donor blood?

A

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)

428
Q

Can RBCs in CPD, CPDA-1, or additive solution be used safely?

A

Yes

429
Q

What must be done to the preped aliquots of donor blood?

A

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)

430
Q

What is the blood preferred to reduce the risk of hyperkalemia and to maximize the 2,3-diphosphoglycerate (2,3-DPG) lvls?

A

Blood units that are < 7 days old

431
Q

In some institutions, what is the blood used?

A

CPDA-1 RBCs (14 - 21 days old)

432
Q

What should be the blood (/ requirements | that will be transfused) for very-low-birth-weight infants?

A

1) CMV-seronegative

2) Leukocyte-reduced

433
Q

Why should the blood (for transfusion) for very-low-birth-weight infants be CMV-seronegative or leukocyte-reduced?

A

To prevent CMV infection (w/c can be serious in premature infants)

434
Q

What blood (/ requirements | for transfusion) should be given for pregnant women (if they test [-] for CMV)?

A

1) CMV-negative

2) Leukocyte-reduced cellular components

435
Q

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)?

A

Irradiation of the blood is recommended

436
Q

Are transfusions in a full-term newborn infant require routine irradiation?

A

No, transfusions in a full-term newborn infant do not require routine irradiation

437
Q

What should be done to infants who are hypoxic or acidotic?

A

They should receive blood (tested and [-] for hgb S)

438
Q

What are the effects that can be experienced by the bone marrow of oncology pts (in connection to transfusion in oncology)?

A

It may be suppressed due to:

 1) Chemotherapy
 2) Radiation therapy
 3) Infiltration 
 4) Replacement of bone marrow w/ malignant cells
439
Q

Repeated RBC and PLT transfusions may lead to what?

A

These may lead to the need for rare RBC units or HLA-matched plateletpheresis components (because of incompatibility problems)

440
Q

PLT transfusion requirements may also necessitate what?

A

It may also necessitate a change from Rh-(-) to Rh-(+) products

441
Q

Can RhIG may be given to a woman w/ childbearing potential?

A

Yes

442
Q

What is the purpose of giving RhIG to a woman w/ childbearing potential?

A

To protect against immunization

443
Q

What is the volume / amt of Rh-(+) RBCs present in each Rh-(+) plateletpheresis component?

A

< 0.5 mL

444
Q

What is the volume / amt of RBCs that a pool of PLTs may contain?

A

As much as 4 mL of RBCs

445
Q

What is the action of one 300-ug dose of RhIG?

A

It can neutralize the effects up to 15 mL of Rh-(+) cells

446
Q

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?

A

It could be used for 30 plateletpheresis or 4 PLT pools

447
Q

What are the conditions / disorders that are frequently complicating some malignancies (such as chronic lymphocytic leukemia [CLL] and lymphoma)?

A

1) Autoimmune hemolytic anemia (AIHA)
2) Increased destruction of RBCs
3) Pretransfusion testing problems

448
Q

Who are the pts that are at increased risk of TA-GVHD?

A

Oncology pts w/ hematologic malignancies (such as Hodgkin’s disease and lymphoma)

449
Q

Why are oncology pts w/ hematologic malignancies (such as Hodgkin’s disease and lymphoma) at increased risk of TA-GVHD?

A

Because of the chemotherapy drugs used for treatment

450
Q

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?

A

Irradiated cellular components

451
Q

*What are the exs of coagulation factor deficiencies?

A

1) Hemophilia A (/ classic hemophilia | factor VIII deficiency)
2) Hemophilia B (factor IX deficiency)
3) DIC

452
Q

What are the characteristics of factor VIII?

A

It is normally complexed w/ another plasma protein (w/c is vWF)

453
Q

What are the proteins that are both necessary for normal hemostasis?

A

1) Factor VIII

2) vWF

454
Q

Pts w/ hemophilia A (/ classic hemophilia) have what?

A

They have factor VIII deficiency (factor VIII lvls < 50%)

455
Q

Is the clinical disease (hemophilia A) generally apparent if the pt’s factor VIII lvls are < 50%?

A

No

456
Q

When is the clinical disease (hemophilia A) generally apparent?

A

If the pt’s factor VIII lvl is < 10%

457
Q

What is the normal lvl of factor VIII?

A

50 - 150%

458
Q

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?

A

Severe and spontaneous bleeding

459
Q

The severe and spontaneous bleeding that are present if a pt has a factor VIII lvl of < 1% typically occurs where?

A

Typically into the:

1) Muscles
2) Joints

460
Q

Is the vWF lvl usually normal in pts w/ hemophilia A?

A

Yes

461
Q

What is vWD?

A

It is defined by a deficiency of vWF

462
Q

What are the different types of vWD?

A

1) Type I
2) Type IIA
3) Type IIB
4) Type III

463
Q

What are the characteristics of type I vWD?

A

1) It is characterized by a reduced amt of all sizes of vWF multimers
2) It is milder > type III

464
Q

What is type III vWD?

A

There is little or no vWF produced

465
Q

What is type IIA vWD?

A

It is distinguished by a deficiency of high MW multimers (that have an increased avidity for binding to PLTs)

466
Q

What is the ability that pts w/ type I vWD have?

A

They have the ability to make the full spectrum of vWF multimers (but do not produce them in normal amts)

467
Q

What is the meaning of DDAVP?

A

Desmopressin (1-deamino-8-D-arginine vasopressin)

468
Q

What is DDAVP?

A

It is a synthetic vasopressin analog

469
Q

What is the action of DDAVP?

A

It can stimulate release of the vWF from the vascular endothelium in type I pts

470
Q

In connection to the action by DDAVP, it is however contraindicated to what type of vWD?

A

Type IIB vWD

471
Q

What can be used for type III vWD or in type I or IIA disease when DDAVP treatment has failed?

A

Many factor VIII products (w/c are assayed for vWF)

472
Q

What is hemophilia B?

A

It is the congenital deficiency of factor IX

473
Q

What are the factors that activated factor IX?

A

1) Factor XIa

2) Factor VIIa

474
Q

What are the factors (and components) that activates factor X to Xa?

A

1) Factor IXa
2) Factor VIII
3) Ionized Ca
4) Phospholipid

475
Q

What are the components that should be used to treat factor IX deficiency?

A

1) Recombinant factor IX

2) PT complex concentrates

476
Q

What is the characteristic of factor IX concentrates?

A

These are made virus-safe

477
Q

How are factor IX concentrates made virus-safe?

A

These are made virus-safe by / via sterilization techniques

478
Q

Are all coagulation factors made in the liver?

A

No, because all coagulation factors (except vWF) are made in the liver

479
Q

What conditions can occur (/ what are the effects that can occur) if pt has severe liver failure?

A

1) Multiple coagulation factor deficiencies

2) Some of the coagulation factors produced may be abnormal

480
Q

Can the liver also produce many of the thrombolytic proteins?

A

Yes

481
Q

Since the liver also produces many of the thrombolytic proteins, what is its effect?

A

Imbalance between the coagulation process and the control mechanism

482
Q

What are the components of plasma?

A

Normal amts of proteins (coagulation factors and thrombolytic proteins)

483
Q

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)?

A

Plasma (w/ normal amts of these proteins [coagulation factors and thrombolytic proteins])

484
Q

What are the actions of vit K?

A

It aids in the carboxylation of factors:

1) II
2) VII
3) IX
4) X

485
Q

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?

A

The inactive coagulation proteins cannot be carboxylated to active forms

486
Q

What is recommended to correct vitamin K deficiency or warfarin overdose, vit K administration or plasma transfusion?

A

Vit K administration rather > plasma transfusion is recommended

487
Q

True or False

Several hrs are required for vit K effectiveness, depending on the route of administration

A

True

488
Q

Because several hrs are required for vit K effectiveness (depending on route of administration), signs of hemorrhage or impeding surgery may require what?

A

May require transfusion of plasma

489
Q

What is DIC?

A

It is the uncontrolled activation and consumption of coagulation proteins, causing small thrombi within the vascular system throughout the body

490
Q

What is the treatment for DIC?

A

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

491
Q

In some cases of DIC, what may be required to be done?

A

Transfusion of plasma, PLTs, and/or cryoprecipitate

492
Q

Monitoring of the PT, aPTT, PLT ct, fibrinogen, hgb, and hct lvls direct what?

A

Direct the choice of the next component to be used

493
Q

What may be the causes of PLT fxnal disorders?

A

1) Drugs
2) Uremia
3) Congenital abnormalities

494
Q

What should be reserved for pts w/ PLT fxnal disorders?

A

PLT transfusions

495
Q

What are the roles (/ purposes) of reserving PLT transfusions (for pts w/ PLT fxnal disorders)?

A

For treating hemorrhage or the impending need for adequate hemostasis (such as a surgical procedure) to decrease development of PLT refractoriness

496
Q

Provide a drug that can interfere w/ PLT fxn

A

Clopidogrel (Plavix)

497
Q

What is the common use of clopidogrel?

A

It is commonly used in cardiovascular disease

498
Q

What is the action of clopidogrel?

A

It is reversible for the life of the PLTs

499
Q

What should be done (in relation to clopidogrel) to minimize hemorrhage and lessen the need for massive transfusion?

A

The drug should be discontinued (for 5 - 7 days before surgery)

500
Q

What are the things that may be beneficial for pts w/ uremia?

A

1) DDAVP
2) Dialysis
3) RBC transfusions

501
Q

What is the action of DDAVP?

A

It releases fresh, fxnal vWF from endothelial cells

502
Q

What is the action of dialysis?

A

It removes by-products of protein metabolism that degrade vWF and coat PLTs, making both nonfxnal

503
Q

What is the action of RBC transfusion?

A

It increases viscosity

504
Q

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?

A

No

505
Q

True or False

Blood must be administered carefully for pt safety

A

True

506
Q

What are essential to be done (in terms of blood administration)?

A

(+) identification of:

1) The pt
2) Pt’s blood sx
3) Blood unit (for transfusion)

507
Q

What should be done to prevent transfusion-related deaths of ABO incompatibility?

A

Careful identification procedures

508
Q

The identification process (in terms of blood administration) begins w/ what?

A

(+) identification of the pt

509
Q

How is (+) identification of the pt done (in terms of blood administration)?

A

By asking pts to state or spell their name (while you read their armband)

510
Q

What should be done to the pt identification label?

A

It should be compared at the bedside to the pt’s hospital armband

511
Q

Comparing the pt identification label at the bedside to the pt’s hospital armband prevents what?

A

It prevents a sx tube labeled w/ 1 pt’s name being used for the collection of a sx from another pt

512
Q

What should be done to the labels (in terms of blood administration)?

A

These should be applied to the sx tubes before leaving the bedside

513
Q

Why should the labels be applied to the sx tubes before leaving the bedside?

A

To avoid labeling the wrong tube

514
Q

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

A

False, because in terms of labeling, electronic systems for pt and label identification are available and should be adopted to reduce clerical errors

515
Q

Where should (+) identification (in terms of blood administration) be carried out?

A

In the lab

516
Q

How many times should clerical check be performed?

A

3 times

517
Q

When is clerical check performed?

A

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)

518
Q

In combined fiscal yrs (2011 through 2015), what is the order of conditions that caused # of reported fatalities? Provide their corresponding percentages

A

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%

519
Q

What is the condition that continues to be 1 of the leading causes of transfusion-associated fatalities reported to the FDA?

A

TRALI

520
Q

What are taken by the transfusion community to reduce the risk of TRALI have coincided w/ a reduction in the # of TRALI deaths?

A

Voluntary measures

521
Q

What should be done if pt has difficult veins (in terms of blood administration)?

A

The intravenous infusion device should be in place before the blood is issued from the transfusion service

522
Q

What must be done to all blood components (in terms of blood transfusion)?

A

These must be filtered

523
Q

Why are all blood components must be filtered (in terms of blood administration)?

A

Because clots and cellular debris develop during storage

524
Q

What does the AABB Standards states (in terms of blood administration)?

A

“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”

525
Q

How are blood components infused (in terms of blood administration)?

A

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

526
Q

What should be monitored periodically during the transfusion?

A

The pt’s vital signs such as:

1) Pulse
2) Respiration
3) BP
4) Temp

527
Q

Why should the pt’s vital signs be monitored (in terms of blood transfusion)?

A

To detect signs of transfusion rxn

528
Q

What are the signs and symptoms (and their corresponding indication) that can / may be observed during blood transfusion?

A

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

529
Q

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)?

A

Jaundice, decreasing hct lvl: delayed hemolytic transfusion rxn

530
Q

What are the actions of the 150- to 260-um filter (in std blood administration)?

A

It removes:

1) Gross clots
2) Cellular debris

531
Q

What must be used for transfusion of all blood components (in terms of blood administration)?

A

A blood administration filter

532
Q

What should be done to the sp. product manufacturer’s package insert?

A

It should be reviewed for instructions pertaining to use of transfusion devices

533
Q

What are the transfusion devices that are used (in terms of blood transfusion)?

A

1) Filters
2) Blood administration sets
3) Blood warmers

534
Q

What is required to be done by rapid transfusion, including exchange transfusion?

A

Blood warming

535
Q

Why is blood warming required to be done by rapid transfusion (including exchange transfusion)?

A

Because the cold blood can cause hypothermia in the pt

536
Q

What are the effects of hypothermia in pt (w/c can be due to cold blood)?

A

It increases the possibility of:

1) Cardiac arrhythmia
2) Hemorrhage

537
Q

True or False

A pt w/ paroxysmal cold hemoglobinuria (PCH) or w/ potent cold agglutinins does not require blood warming

A

False, because a pt w/ paroxysmal cold hemoglobinuria (PCH) or w/ potent cold agglutinins does may also require blood warming

538
Q

What should be the characteristics of the blood warmer (that will be used for certain contexts for blood transfusion)?

A

It should have automatic temp control w/ an alarm that will sound if the blood is warmed over 42 DC

539
Q

Can blood units be warmed by immersion in a H2O bath or by domestic microwave oven? Why or why not?

A

No, because uneven heating can cause damage to blood cells and denaturation of blood proteins

540
Q

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)?

A

Only isotonic (0.9%) saline

541
Q

True or False

All drugs may cause hemolysis if injected through the blood infusion set

A

False, because some drugs may cause hemolysis if injected through the blood infusion set

542
Q

What may be done after transfusion (blood transfusion)?

A

The transfusion set may be flushed w/ isotonic saline

543
Q

What should be done to the empty blood bag (after blood transfusion)?

A

1) It can be discarded
2) Or it can be returned to the transfusion service
* accdg to hospital policy

544
Q

True or False

A copy of the blood bag tag is placed in the pt’s chart

A

True

545
Q

What does the Joint Commission require?

A

It requires all blood transfusion to be reviewed for appropriate use

546
Q

A hospital transfusion committee may serve as what?

A

It may serve as the peer review grp for transfusions

547
Q

True or False

Blood usage review should not be performed prospectively

A

False, because blood usage review may also be performed prospectively if criteria are approved by the transfusion committee and the medical staff

548
Q

What may be done by the blood bank director?

A

He/she may interact and correspond directly w/ the chair of individual hospital depts concerning medical staff blood cmpt usage patterns

549
Q

True or False

Appropriate criteria for blood transfusion have been published, serving as a guide for conducting audits

A

True

550
Q

Who can use the results of audits?

A

The transfusion committee

551
Q

Why does the transfusion committee can use the results of audits?

A

To recommend changes in practice by the hospital staff to improve pt care

552
Q

What are the other actions done by the transfusion committee?

A

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

553
Q

Why does the transfusion committee also reviews transfusion rxns?

A

To ensure that adverse rxns are unavoidable

554
Q

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?

A

The transfusion committee

555
Q

The transfusion committee must have what?

A

Must have a mechanism for reporting activities and recommendations to the medical staff and hospital administration

556
Q

What must be done to all adverse events related to transfusion?

A

These must be reported to the transfusion service (accdg to its local protocol)

557
Q

What are the primary uses of transfusion therapy?

A

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)

558
Q

What should be the action of a unit of whole blood (WB) / RBCs in an adult?

A

It should increase the:

1) Hct lvl (3%)
2) Or hgb lvl (1 g/dL)

559
Q

What is the indication of RBCs (blood product)

A

Indicated for increasing the RBC mass (in pts who require increased O2-carrying capacity)

560
Q

To whom are PLT (blood product) transfusions indicated?

A

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

561
Q

What should be the action of each dose of PLTs?

A

It should increase the PLT ct 20,000 - 40,000/uL (in a 70-kg pt)

562
Q

How is a plateletpheresis product collected?

A

It is collected from 1 donor

563
Q

A plateletpheresis product must contain how many PLTs?

A

Min. of 3 X 10^11 PLTs

564
Q

What is the cmpt that plasma (blood product) contain?

A

All coagulation factors

565
Q

To whom is plasma (blood product) indicated?

A

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

566
Q

What are the cmpts that cryoprecipitate (blood product) contain?

A

1) At least 80 units of factor VIII
2) 150 mg of fibrinogen
3) vWF
4) Factor XIII

567
Q

What is the indication of factor IX (blood product)?

A

It is used in the treatment of persons w/ hemophilia B

568
Q

What are the indications of immunoglobulin (IG; blood product)?

A

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)

569
Q

What is massive transfusion?

A

It is the replacement of 1 or more blood volume(s) within 24 hrs, or about 10 units of blood in an adult

570
Q

What is the ABO type of the RBCs warranted (in cases of emergency transfusions) if / when the pt type is not yet known?

A

Grp O RBCs

Immunohematology (Blood Banking) (Lecture) (10 decks)

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