Transfusions Flashcards
for each type of surgery, a max number of units that can be ordered for crossmatch are defined; prevents blood waste
maximum surgical blood order
how long are collected specimen good for?
72 hours
in which patients may antibodies be present in? (2)
past pregnancy
previously transfused
an antibody was found but we cannot find units lacking the antigen corresponding to that antibody. what can occur?
surgery may be delayed
when should we monitor / record vital signs when administering a transfusion?
prior to transfusion
15 mins
30 mins
every hour
adverse effects related to transfusions can be due to what products? (2)
cellular (RBCs)
plasma
an immediate intravascular hemolysis that is most often related to ABO incompatibility
acute hemolytic transfusion reaction (AHTR)
a patient begins to experience symptoms within 15 mins of transfusion. they feel pain at site, back pain, dread feeling, fever, chills, dyspnea, hypotension, increased pulse, and diffuse bleeding in a surgical field. what are they experiencing?
acute hemolytic transfusion reaction
what are 4 complications of an acute hemolytic transfusion reaction?
shock
renal failure
DIC
death
production of antibodies post-transfusion 2-14 days after.
delayed hemolytic transfusion reaction
a patient is asymptomatic but may have a fever and elevated bilirubin. what are they experiencing?
delayed hemolytic transfusion reaction
reaction of recipient antibodies to donor HLA antigens (on leukocytes and platelets)
febrile, non hemolytic transfusion reaction
a patient presents with fever, chills, headache, flushing, and rare muscle/chest pain. what are they likely experiencing?
febrile, non-hemolytic transfusion reaction
what can we give a patient before their transfusion to prevent a febrile, non-hemolytic transfusion reaction?
anti-pyretic
a patient presents with dyspnea, cyanosis, hypotension, hypoxemia, fever/chills, and pulmonary edema. what are they experiencing?
transfusion related acute lung injury
what is the onset of a transfusion-related acute lung injury?
4-6 hours post-transfusion
what is the treatment for a patient experiencing a transfusion-related acute lung injury?
oxygen / ventilation assistance
what is contraindicated in a patient experiencing a transfusion related acute lung injury? (2)
diuretics
corticosteroids
due to recipient antibodies to donor plasma proteins
allergic reaction
a patient presents with urticaria, wheezing/dyspnea. what are they experiencing? what is the treatment?
allergic reaction
antihistamine
recipient has antibodies to donor plasma IgA
anaphylactic reaction
a patient presents with respiratory arrest and cardiac arrest. what are they experiencing?
anaphylactic reaction
volume overload with pulmonary edema that occurs in elderly or neonates after a transfusion
transfusion associated circulatory overload
a patient presents with hypertension, tachycardia, and respiratory distress. what are they experiencing? how should we treat it? (2)
transfusion associated circulatory overload
diuretics
oxygen
occurs when bacterial endotoxins are in blood products, usually platelets and PRBCs
septic shock
a patient presents with fever, chills, rapid heart/resp rate, hypotension, N/V, and bleeding that leads to DIC. what are they experiencing?
septic shock
if a transfusion reaction is suspected, what should we send to the lab? (3)
new patient sample
blood bag + solutions
first post-transfusion urine
which test identifies if antibodies are coating the RBCs?
direct antiglobulin test
what are 3 mandatory tests if we suspect a transfusion reaction?
direct antiglobulin test
inspection of post-transfusion plasma for hemolysis
clerical check
if a patient is in DIC, what blood products should be used?
fresh frozen plasma
a 21 yo comes into the ER with a massive hemorrhage. we have difficulty stopping the bleeding due to large number of internal injuries. hemoglobin is at 4. what do we do?
massive transfusion protocol
replacement of body’s blood volume within 24 hours
massive transfusion
how many units are used in a massive transfusion?
over 20 units of PRBCs in 24 hours
what is the replacement in a massive transfusion?
over 50% replacement within 3 hours
if we have decreased volume in a patient, what do we give?
fluids - crystalloids or colloids
if a patient has dilutional coagulopathy, what do we give?
fresh frozen plasma
if a patient has dilutional thrombocytopenia, what do we give?
platelets
if a patient has trouble with oxygen delivery, what do we give?
PRBCs
a patient presents with signs of hemolysis, decreased platelet count, and schistocytes. what are they experiencing?
thrombotic microangiopathic hemolytic anemia (TMA)
what is the treatment for thrombotic microangiopathic hemolytic anemia?
therapeutic plasma exchange (decrease antibodies)
+
caplacizumab OR rituximab