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Clin Med2- Hematology > Transfusions > Flashcards

Transfusions Flashcards

1
Q

what are the three phenotypes of blood

A

A, B and O

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2
Q

what blood phenotype has no antigents

A

O blood

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3
Q

what antibodies do type A blood have

A

anti-B antibodies

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4
Q

what type of antibodies do type B blood have

A

anti-B antibodies

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5
Q

what type of antibodies do type O blood have

A

anti-a and anti-b antibodies

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6
Q

what type of antibodies to type AB blood have

A

no antibodies

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7
Q

what is the universal donor blood

A

O blood

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8
Q

what can cause blood antigen changes

A

infections, malignancy, thalassemias, etc

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9
Q

what is the universal recipient

A

AB+

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10
Q

who gets transfused

A

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

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11
Q

what is a type and screen

A

first step if unsure if transufsion will be needed

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12
Q

what is a type and cross

A

need transfusion urgently

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13
Q

what is whole blood

A

includes RBCs, plasma and platelets
minimal processing; mixed with anticoagulant
store refrigerated for up to 35 days
try to give components separately as needed

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14
Q

when is whole blood the only absolute indications

A

massive transfusion to maintain ratio of blood components

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15
Q

what is the definition of mass transfusion

A

10+ units within 24 hours

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16
Q

What are PRBCs

A

packed red blood cells
most commonly transfused product
includes RBCs, platelets, some residual plasma and some WBCs
“cellular component”

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17
Q

what are PRBCs used for

A

used to raise hemoglobin/blood volume - transfusion guidelines
spun down from whole blood - plasma removed

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18
Q

how long are PRBCs good for once prepped for use

A

only good for 24 hours - order one unit at a time

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19
Q

what are leukocyte-reduced RBCs used for

A

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

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20
Q

what are washed RBCs

A

PRBCs ‘washed’ with saline
removes residual plasma, some WBCs, antibodies, cytokines

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21
Q

what are washed RBCs used for

A

used to reduce incidence of transfusion reactions - allergic, febrile or anaphylactic
primarily pts with IgA deficiency (anti-IgA antibodies)

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22
Q

what is frozen deglycerolized RBCs

A

glycerol added to PRBCs prior to freezing - protects against cell lysis
PRBCs thawed, then washed with saline to prevent hemolysis
considered prepared or ‘open’

23
Q

what is deglycerolized

A

removal of glycerol

24
Q

what is irardiated RBCs

A

PRBCs subjected to radiation
used to prevent allogenic immune reactions - transfusion-associated graft vs host disase

25
Q

who needs irradiated RBCs

A

immunosuppressed pts
stem cell or bone marrow transplants
intrauterine transfusions
premature infants
first degree relative donors

26
Q

what is FFP

A

Fresh Frozen Plasma
spun down from whole blood
contains proteins (albumin), electrolytes, molecules and lipoproteins
“acellular component”

27
Q

what does FFP provide

A

coagulation factors
vitamin K dependent factors (2,7,9,10)
Factor 5 (only source)

28
Q

what are the indications for FFP

A

abnormal PT/INR and/or aPTT and microvascular bleeding
Coagulation factor deficiency when specific concentrate unavailable
urgent warfarin reversal

29
Q

what is cryoprecipitate

A

collected from FFP by cooling then collecting precipitate
provides:
fibrinogen, vwf, factor 8, factor 13 and fironectn
only product that replaces fibrinogen

30
Q

what product replaces fibrinogen

A

cryoprecipitate

31
Q

what is the indication for cyroprecipitate

A

fibrinogen level < 100

32
Q

what are platelets

A

platelets suspended in FFP (platelet rich plasma)
whole blood centrifuged to collect PRP
multi-donor specimens combined to compile one ‘unit’

33
Q

how much does one unit of platelets increase the platelet count

A

by 10,000

34
Q

when do platelet transfusions not work

A

if thrombocytopenia from distruction
ITP, TTP, HIT

35
Q

what are the risks of transfusion

A

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)

36
Q

what are the non-hemolytic transfusion reactiosn

A

non-hemolytic febrile reaction
bacterial contamination
allergic reactions

37
Q

what is non-hemolytic febrile reaction

A

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

38
Q

what is the prevention of non-hemolytic febrile reaction

A

use leukocyte reduced blood products
pretreatement with tylenol reduces severity

39
Q

what is bacterial contamination transfusion reaction

A

VERY RARE
Symptoms: fever, chills, tachycardia, hypotension, GI symptoms
discontinue transfusion and culture donor blood

40
Q

what is allergic transfusion reaction

A

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

41
Q

what are acute hemolytic transfusion reactions

A

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

42
Q

what test is diagnostic of acute hemolytic transfusion rxn

A

positive Coombs test

43
Q

what is the treatment of acute hemolytic transfusion rxn

A

discontinue transfusion, vigorous hydration

44
Q

what is delayed hemolytic transfusion reactions

A

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

45
Q

What is TRALI

A

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

46
Q

what are the symptoms of TRALI

A

dyspnea, hypoxemia, fever, rigors, bilateral diffuse pulmonary infiltrates on CXR

47
Q

what is the treatment of TRALI

A

stop transfusion and provide pulmonary support (O2 - ventilation)

48
Q

what is TACO and what is it associated with

A

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

49
Q

what is the symptoms of TACO

A

presents within 6 hours
hypertension, dyspnea and respiratory distress, cough, rales on auscultation(pulm edema)

50
Q

what is the treatment of TACO

A

diuresis
reduced rate of transfusion or stop it
mechanical ventilation if needed
**reduced amount of IV fluids being administered during transfusion of blood products

51
Q

What is Transfusion-associated graft-vs-host-disease

A

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

52
Q

when does tranfusion-associated graft-vs-host disease present

A

presents 2-30 days after transfusion

53
Q

what is the presentation of Transfusion-associated graft-vs-host-disease

A

fever, rash, diarrhea, hepatitis, lymphadenopathy, pancytopenia

Clin Med2- Hematology (8 decks)

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