Transfusion Therapy (Need to finish) Flashcards
List the signs and symptoms of anemia
- Generalized weakness
- Headache
- Dizziness
- Disorientation
- Breathlessness
- Palpitations
- Chest pain
- Pallor
- Tachycardia
Transfusion of RBC products
- Primary indication
Anemia
Transfusion of RBC products
- Tests indicating transfusion is necessary
- Hematocrit: ≤ 21%
- Hemoglobin: ≤ 7 g/dL
Transfusion of RBC products
- Expected rise in Hgb and hct values per unit of RBCs transfused
One unit should raise the hemoglobin by 1 g and hematocrit by 3%
Transfusion of RBC products
- Compatibility requirements
All red cell products MUST have some kind of XM (electronic, IS, or AHG)
- ABO/Rh compatibility is REQUIRED
- If whole blood is given, it must be ABO IDENTICAL
Transfusion of RBC products
- Contraindications to RBC transfusion
?
List red cell products
- Leukoreduced packed cells
- Washed packed cells
- Frozen/deglyc’d packed cells
List indications of leukoreduced packed cells (LPC)
- Febrile TX reactions
- Prevention of HLA Abs
- Oncology, transplant, neonate patients
List indications of washed cells (WC)
- IgA deficient patients
- EKMO patients/babies
- Removal of anticoagulant or ↑ K+
List indications of frozen/deglyc’d cells (FC)
- IgA deficient patients
- Rare phenotypes
Which blood product is capable of carrying CMV?
WBCs
Which blood products are capable of transmitting CMV?
RBCs and platelets
Which blood products are considered “CMV safe”, if CMV negative units aren’t available?
Leukoreduced and/or frozen/deglyc’d
Which 3 patient populations are at the highest risk for CMV infection if transfused w/ a CMV positive donor unit?
- BM transplant patients
- Infant/neonatal patients
- Pregnant women
What is the purpose of irradiation of blood products?
?
List recipient conditions requiring irradiated blood components
?
Calculate the expiration date of irradiated blood products
?
Transfusion of platelet products
- Primary indication for transfusion/clinical symptoms
- ↓ production
- ↑ destruction
- Splenic sequestration
Transfusion of platelet products
- Tests indicating transfusion is necessary
- < 50,000/uL for “therapeutic” platelet TX
- 10,000-20,000/uL for patients w/ chemotherapy-induced thrombocytopenia
Transfusion of platelet products
- Expected rise in platelet count for transfused random platelets
Should increase platelet count by 5-10,000/uL for each unit
Transfusion of platelet products
- Expected rise in platelet count for transfused platelet pheresis (“single-donor platelets”)
Should increase platelet count by 20,000-60,000/uL
Transfusion of platelet products
- Compatibility requirements
ABO compatible preferred
Transfusion of platelet products
- Contraindications to platelets transfused
?
How is platelet transfusion effectiveness assessed?
- Observation of stopped bleeding
- Look for refractoriness
Transfusion of granulocytes
- Primary indication for transfusion/clinical symptoms
Severe neutropenia (< 500/uL) and serious bacterial or fungal infection
Transfusion of granulocytes
- Compatibility requirements
ABO compatibility is required
Transfusion of granulocytes
- Effect of irradiation
RBCs become less contaminated?
Transfusion of plasma products
- Primary indication for transfusion/patient conditions
?
Transfusion of plasma products
- Tests indicating transfusion is necessary
PT/PTT > 1.5x reference range
Transfusion of plasma products
- Compatbility requirements
ABO compatibility preferred
Transfusion of plasma products
- Contraindications to a plasma transfusion
?
____ is whole blood that was frozen w/in 8 hours of collection
FFP (fresh frozen plasma)
____ is from whole blood frozen w/in 24 hours of collection
PF24 (plasma frozen w/in 24 hours)
____ is plasma collected by apheresis
AFFP (apheresis fresh frozen plasma)
____ is plasma left over after production of cryoprecipitate
CRP (cryo-reduced plasma)
____ is derived from FFP and PF24 that has been thawed in a closed system
Thawed plasma
Transfusion of cryoprecipitate
- Primary indication of transfusion
- Fibrinogen (with/out active hemorrhage)
- Factor XIII
- Fibrin glue
- von Willebrand’s disease
Transfusionof cryoprecipitate
- Tests that indicate a transfusion is necessary
- Fibrinogen deficiency: < 100 mg/dL
- Fibrinogen deficiency w/ hemorrhage: < 150 mg/dL
Transfusion of cryoprecipitate
- Compatibility requirements
ABO compatibility preferred
Transfusion of cryoprecipitate
- Contraindications to a cryoprecipitate transfusion
?
Alternative treatments for cryoprecipitate products
- Factor VIII concentrate
- Factor IX concentrate
- Novo Seven
- Immune Globulins (IVIGs)
- DDAVP
- Iron therapy/vitamin B12/folic acid
- EPO/Procrit
Coagulation therapy for hemophilia A
- Factor VIII
- Novo Seven
- DDAVP
Coagulation therapy for hemophilia B
- Factor IX
- Novo Seven
Coagulation therapy for von Willebrand’s disease
- Factor VIII
- DDAVP
Coagulation therapy for Factor XIII deficiency
?
Coagulation therapy for multiple coagulation deficiencies
FFP
Coagulation therapy for liver failure
?
Coagulation therapy for hypofibrinogenemia
Cryoprecipitate
Coagulation therapy for TTP
FFP
Why is Rh compatibility not important when choosing donor types for plasma product transfusions?
Does not contain RBcs or platelets
Process of issuing blood to nursing unit or surgery
- Transporter brings “pick-up slip”
- Positive ID of recipient using two identifiers (name and MRN)
- Dispense request sent to blood bank via computer
- Blood product sent to unit via tube system
- BB personnel review identifying info, inspect appearance of component, and ensure there’s a system to maintain proper storage during transport
Appearance of bacterially contaminated unit
- Purplish color above buffy coat (or cell/anticoag layer) or air seen in bag
Proper labeling of unit
- Tie tag or label must include: name, identifying # of intended recipient; component unit #; interpretation of compatibility tests if performed
- Expiration date
Corrective action if unit fails inspection
?
Process of returning blood when TX delays are encountered or if blood isn’t used in surgery
Should be returned to blood bank for storage unless TX can be completed w/in 4 hours
- Should not be left at RT ro stored in unmonitored fridge
- Blood is viable only for 30 minutes if not issued in validated ice coolers
Most important step to ensure safe transfusions?
PATIENT IDENTIFICATION
Only acceptable additive solution to a unit of blood
Normal saline
Maximum time that a unit can be transferred to a patient
4 hours
Purpose of infusion sets
Retain blood clots and particles potentially harmful to recipient
Purpose of blood warmers
Needed if cold blood is infused very rapidly (or in trauma settings) to reduce risk of cardiac arrest
What patient population need blood warmers?
- Patients w/ cold agglutinins
- Infant exchange TX
Purpose of mechanical pumps
Deliver infusions at a controlled rate
What patient population need mechanical pumps?
Peds and neonates
Purpose of pressure devices
Infuse blood very rapidly most often in surgery
How is a patient monitored during a transfusion?
- Transfusionist should stay w/ patient for first 15 minutes (start w/ slow rate of 2mL/minute; severe rxns occur w/in first 25 mL)
- Vital signs taken every 15 minutes; if all is good, increase rate to 4 mL/minute
- Observe patient periodically throughout TX (~30 minutes) and up to 1 hour after transfusion
What should be done when a potential transfusion reaction is suspected?
STOP THE TRANSFUSION and call the doctor immediately
Which units are placed on the “Emergency Shelf” in most hospital blood banks?
2 units of O= and 2 units of O+
In an emergency situation, give ____ to females of child-bearing age or males younger than 13 years old
O neg
In an emergency situation, how is emergency blood released?
Physician must sign a release form
Why does a neonate require less than 7 day old RBCs?
Reduces risk of hyperkalemia and maximize 2,3-DPG
