Transfusions and Apheresis Flashcards
How much blood does the average adult have in their circulation?
about five liters
Most prevalent blood type? least common blood type?
O+ (37%) folloewed closely by A+ (36%)
AB- is the more rare at 1%
What does a type and screen entail? (what do they do in the lab?)
The blood is typed (for ABO and Rh type)
and
Screened (tested for atypical antibodies)
What does a type and cross entail? (what do they do in the lab?)
The blood is typed (for ABO and Rh type)
and
Crossmatched (test donor’s blood to recepient’s blood to look for harmful interactions between donors and recipients blood)
Under what conditions would you order a type and cross over a type and screen?
You would order a type and cross when you are likely going to need to administer blood. A type and screen is used more as a precaution and “to be safe” (probably don’t need to give blood).
What is the universal donor? universal recipient?
Donor- O neg
Recipient- AB pos
Blood product examples
- Whole blood
- washed RBCs
- leukocyte-poor RBCs
- platelets
- FFP (Fresh frozen plasma)
- cryoprecipitate
- granulocytes
- other
What do you need to verify BEFORE you transfuse? (3)
verify:
- physicians order
- that consent was obtained
- patient and blood unit identification
What blood products do not need a filter?
Albumin, plasma protein fraction (PPF) and IV immunoglobulin
** Do not use leukocyte reduction filters for granulocytes or hematopoiectic progenitor cells
What is the timeframe in which blood products should be infused?
4 hours
Can you add medication to blood?
NO way
What solutions can you infuse blood products with?
0.9% NaCl injection, USP is acceptable
DO NOT USE:
5%-dextrose- may induce hemolysis
Lactated ringers- may induce clotting
What are the components of whole blood?
RBCs
plasma
WBCs
platelets
*no constituent has been removed
How long can whole blood be stored in refrigeration?
21-35 days
Indications of whole blood
cardiac surgery or massive hemorrhage
What are packed cells?
how long can they stored in refrigeration?
Indications?
Red cells (HCT 60%)
35-42 days
indications
- symptomatic anemia
- need to increase red cell mass
- symptomatic deficit of oxygen-carrying capacity
- HCT of 30% (Hgb
What is filtered leukocyte-poor RBCs?
Indications?
WBCs removed
We dont really know why this is on there…
- leukocytes
- -febrile reactions
- -CMV transmission
Indications
- H/O previous febrile transfusion reactions
- reduce immunological reactions
What are washed red blood cells?
Indications?
RBCs with NO plasma, minimal platelets, and 90% WBC removal
Indications-
need to increase red cell mass
AND
prevent febrile or allergic reactions
What are platelets (the blood product)?
Indications?
Storage?
platelet rich plasma from donated whole blood
indications
- thrombocytopenia
- platelet function disorder
- actively bleeding orto prevent spontaneous bleeding
- 50,000 platelets/micro liter or less
Can be stored for 5 days with continuous agitation
What is FFP?
How long can it be stored?
Indications?
SE?
plasma proteins with all coagulation factors except calcium
frozen- 1 year
thawed- 24 hours
- treatment of stable clotting factor deficiencies for which no concentrates are available (other than I, VIII, or vWF (cant use in these people))
- warfarin reversal (emergent/bleeding)
SE
- disease transmission
- bacteremia (rare)
- transfusion reactions
- volume overload
Cryoprecipitate
how is it manufactured/ what is it?
manufactured by slowly thawing a unit of FFP at temperatures just above freezing.
Centrifuged to remove the makority of the plasma, and the remaining precipitate is collected
A single unit contains 400-460mg of fibrinogen
fibrinogen, factor VIII and XIII, vonWillebrand factor
Cryoprecipitate
how is it stored?
what are the indications?
Contraindications
Frozen for 1 year
thawed should be infused immediately
Indications
- vWD
- hypofibrinogenemia
- factor XIII deficiency
- “fibrin glue”
Should not be transfused to patents with deficiencies of factors other than: fibrinogen, factor XIII, vWF
Risks of blood transfusions
- transfusion transmitted diseases
- immunological reactions (acute hemolytic, allergic, bacterial)
- non-immunological reactions (volume overload, hypocalcemia, graft vs. host)
Signs and symptoms of transfusion reactions
fever dyspnea (serious) bronchospasm (serious) rash uriticaria flank pain (serious) hypotension (serious) shock (serious)
Protocols of transfusion reaction
- STOP THE TRANSFUSION
- contact provider
- check vital signs every 15 min until stable
- check labels, tags, and pt ID band
- notify blood bank
- complete forms
What are alternatives to allogenic blood transfusion?
autologous (pre-surgical donations, intraop blood salvage) intraoperative hemodilution cell saver blood salvage medications ((amicar/ EPO/protamine)
What is Aphersis? AKA?
the removal of whole blood from the body, its seperation into plasma and cells, one particular conponent removed and the remaining components re-transfused. Used especially to remove antibodies in treating autoimmune diseases.
AKA- hemapheresis/ pheresis
*terminology reflects component (plasma=plamapheresis)
Indications of pheresis
collection of blood product
treatment of certain medical conditions
Diseases that might use plasmapheresis
hyperviscosity syndrome
myasthenia gravis
goodpastures syndrome
TTP
Diseases that might use cytapheresis
hyperleukemis leukostasis in AML or CML
thrombocytemia (ET)-bone marrow problem-cancer
sickle crisis
blood components prepared by hemapheresis
- granulocyte concentrate
- single donor apheresis platelets- remove platelets give everything else back
- peripheral blood stem cells
What is granulocyte concentrate?
how long can it be stored?
Indications?
- up to 1.0x10^10 granulocytes per concentrates
- use ASAP, max storage is 24 hours
Indications
-febrile neutropenia which is unresponsive to broad spectrum antimicrobial therapy
What is apheresis platelets?
how long can it be stored?
Indications?
- contain at least 3.0x10^11 platelets in 250mL plasma, equivalent of 6 random donor platelet concentrates
- store at room temp for 5 days
Indications
- thrombocytopenia not caused by increased destruction (TTP, ITP)
- platelet function disorder
When might you use therapeutic phlebotomy?
- polycythemia vera
- hemochromatosis
