Transfusions Flashcards
what are the three phenotypes of blood
A, B and O
what blood phenotype has no antigents
O blood
what antibodies do type A blood have
anti-B antibodies
what type of antibodies do type B blood have
anti-B antibodies
what type of antibodies do type O blood have
anti-a and anti-b antibodies
what type of antibodies to type AB blood have
no antibodies
what is the universal donor blood
O blood
what can cause blood antigen changes
infections, malignancy, thalassemias, etc
what is the universal recipient
AB+
who gets transfused
anyone with Hgb < 7g/dL, regardless of symptoms
pts with Hgb <8 g/dL and asymptomatic if: sx patients, pre-existing CVD, actively bleeding
pts with a Hgb >7g/dL (but < 8) and symptomatic
what is a type and screen
first step if unsure if transufsion will be needed
what is a type and cross
need transfusion urgently
what is whole blood
includes RBCs, plasma and platelets
minimal processing; mixed with anticoagulant
store refrigerated for up to 35 days
try to give components separately as needed
when is whole blood the only absolute indications
massive transfusion to maintain ratio of blood components
what is the definition of mass transfusion
10+ units within 24 hours
What are PRBCs
packed red blood cells
most commonly transfused product
includes RBCs, platelets, some residual plasma and some WBCs
“cellular component”
what are PRBCs used for
used to raise hemoglobin/blood volume - transfusion guidelines
spun down from whole blood - plasma removed
how long are PRBCs good for once prepped for use
only good for 24 hours - order one unit at a time
what are leukocyte-reduced RBCs used for
used to reduce risk of immune reactions
- pts at risk for HLA mediated reactions
patients who previously had febrile non-hemolytic transfusions reactions
- organ transplant recipients
-prevention of CMV transmission
-pregnant patients
what are washed RBCs
PRBCs ‘washed’ with saline
removes residual plasma, some WBCs, antibodies, cytokines
what are washed RBCs used for
used to reduce incidence of transfusion reactions - allergic, febrile or anaphylactic
primarily pts with IgA deficiency (anti-IgA antibodies)
what is frozen deglycerolized RBCs
glycerol added to PRBCs prior to freezing - protects against cell lysis
PRBCs thawed, then washed with saline to prevent hemolysis
considered prepared or ‘open’
what is deglycerolized
removal of glycerol
what is irardiated RBCs
PRBCs subjected to radiation
used to prevent allogenic immune reactions - transfusion-associated graft vs host disase
who needs irradiated RBCs
immunosuppressed pts
stem cell or bone marrow transplants
intrauterine transfusions
premature infants
first degree relative donors
what is FFP
Fresh Frozen Plasma
spun down from whole blood
contains proteins (albumin), electrolytes, molecules and lipoproteins
“acellular component”
what does FFP provide
coagulation factors
vitamin K dependent factors (2,7,9,10)
Factor 5 (only source)
what are the indications for FFP
abnormal PT/INR and/or aPTT and microvascular bleeding
Coagulation factor deficiency when specific concentrate unavailable
urgent warfarin reversal
what is cryoprecipitate
collected from FFP by cooling then collecting precipitate
provides:
fibrinogen, vwf, factor 8, factor 13 and fironectn
only product that replaces fibrinogen
what product replaces fibrinogen
cryoprecipitate
what is the indication for cyroprecipitate
fibrinogen level < 100
what are platelets
platelets suspended in FFP (platelet rich plasma)
whole blood centrifuged to collect PRP
multi-donor specimens combined to compile one ‘unit’
how much does one unit of platelets increase the platelet count
by 10,000
when do platelet transfusions not work
if thrombocytopenia from distruction
ITP, TTP, HIT
what are the risks of transfusion
transfusion reactions: non-hemolytic reactions, hemolytic reactions
transfusion related acute lung injury(TRALI)
transfusion associated cardiac overload (TACO)
Transfusion-associated graft-versus-host-disease(TAGVH)
what are the non-hemolytic transfusion reactiosn
non-hemolytic febrile reaction
bacterial contamination
allergic reactions
what is non-hemolytic febrile reaction
fairly common
likely realted to cytokines or antibody reactions
manifest as a temperature increase of >1 degree Celsius
symptoms begin in 1-6 hours; fevers, riggors, HA, flushing
no specific treatment: pause transfusion
what is the prevention of non-hemolytic febrile reaction
use leukocyte reduced blood products
pretreatement with tylenol reduces severity
what is bacterial contamination transfusion reaction
VERY RARE
Symptoms: fever, chills, tachycardia, hypotension, GI symptoms
discontinue transfusion and culture donor blood
what is allergic transfusion reaction
more likely with FFP or platelets, but can occur with any blood products
manifests usually as hives, rashes, itching - treat with antihistamines
rarely progresses to anaphylactic shock
what are acute hemolytic transfusion reactions
results of transfusing ABO incompatible blood
fatal in 6% of cases
symptoms: pain at transfusion site, facial flushing, back and chest pain
fever, respiratory distress, hypotension, tachycardia
what test is diagnostic of acute hemolytic transfusion rxn
positive Coombs test
what is the treatment of acute hemolytic transfusion rxn
discontinue transfusion, vigorous hydration
what is delayed hemolytic transfusion reactions
resulting of transfusing ABO incompatible blood
onset within 2-10 days after transfusion
symptoms: extravascular hemolysis: anemia and indirect hyperbilirubinemia, fever, jaundice
Direct coombs test is diagnostic
treatment: self-limited
What is TRALI
Transfusion Related Acute Lung Injury
non-cardiogenic pulmonary edema
donor antibodies attack recipeients WBCs and pulmonary endothelial cells - always within 6 hours of transfusion
Plasma containing blood products
what are the symptoms of TRALI
dyspnea, hypoxemia, fever, rigors, bilateral diffuse pulmonary infiltrates on CXR
what is the treatment of TRALI
stop transfusion and provide pulmonary support (O2 - ventilation)
what is TACO and what is it associated with
Transfusion Associated Cardiac Overload
associated with Rapid transfusion, especially with pre-existing cardiac disease
can occur with any blood products, all include fluids which can cause overload
what is the symptoms of TACO
presents within 6 hours
hypertension, dyspnea and respiratory distress, cough, rales on auscultation(pulm edema)
what is the treatment of TACO
diuresis
reduced rate of transfusion or stop it
mechanical ventilation if needed
**reduced amount of IV fluids being administered during transfusion of blood products
What is Transfusion-associated graft-vs-host-disease
immune reaction produced by discordant HLA types
occurs in immunosuppressed pts
graft (competent donor WBCs) attacks host WBCS
host cant mount immune response
nearly 100% FATAL
no treatment
when does tranfusion-associated graft-vs-host disease present
presents 2-30 days after transfusion
what is the presentation of Transfusion-associated graft-vs-host-disease
fever, rash, diarrhea, hepatitis, lymphadenopathy, pancytopenia
