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Heme > Transfusions and Apheresis > Flashcards

Transfusions and Apheresis Flashcards

1
Q

How much blood does the average adult have in their circulation?

A

about five liters

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2
Q

Most prevalent blood type? least common blood type?

A

O+ (37%) folloewed closely by A+ (36%)

AB- is the more rare at 1%

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3
Q

What does a type and screen entail? (what do they do in the lab?)

A

The blood is typed (for ABO and Rh type)

and

Screened (tested for atypical antibodies)

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4
Q

What does a type and cross entail? (what do they do in the lab?)

A

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)

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5
Q

Under what conditions would you order a type and cross over a type and screen?

A

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).

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6
Q

What is the universal donor? universal recipient?

A

Donor- O neg

Recipient- AB pos

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7
Q

Blood product examples

A
  • Whole blood
  • washed RBCs
  • leukocyte-poor RBCs
  • platelets
  • FFP (Fresh frozen plasma)
  • cryoprecipitate
  • granulocytes
  • other
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8
Q

What do you need to verify BEFORE you transfuse? (3)

A

verify:

  • physicians order
  • that consent was obtained
  • patient and blood unit identification
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9
Q

What blood products do not need a filter?

A

Albumin, plasma protein fraction (PPF) and IV immunoglobulin

** Do not use leukocyte reduction filters for granulocytes or hematopoiectic progenitor cells

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10
Q

What is the timeframe in which blood products should be infused?

A

4 hours

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11
Q

Can you add medication to blood?

A

NO way

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12
Q

What solutions can you infuse blood products with?

A

0.9% NaCl injection, USP is acceptable

DO NOT USE:
5%-dextrose- may induce hemolysis
Lactated ringers- may induce clotting

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13
Q

What are the components of whole blood?

A

RBCs
plasma
WBCs
platelets

*no constituent has been removed

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14
Q

How long can whole blood be stored in refrigeration?

A

21-35 days

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15
Q

Indications of whole blood

A

cardiac surgery or massive hemorrhage

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16
Q

What are packed cells?
how long can they stored in refrigeration?
Indications?

A

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
17
Q

What is filtered leukocyte-poor RBCs?

Indications?

A

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
18
Q

What are washed red blood cells?

Indications?

A

RBCs with NO plasma, minimal platelets, and 90% WBC removal

Indications-
need to increase red cell mass
AND
prevent febrile or allergic reactions

19
Q

What are platelets (the blood product)?
Indications?
Storage?

A

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

20
Q

What is FFP?
How long can it be stored?
Indications?
SE?

A

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
21
Q

Cryoprecipitate

how is it manufactured/ what is it?

A

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

22
Q

Cryoprecipitate
how is it stored?
what are the indications?
Contraindications

A

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

23
Q

Risks of blood transfusions

A
  • transfusion transmitted diseases
  • immunological reactions (acute hemolytic, allergic, bacterial)
  • non-immunological reactions (volume overload, hypocalcemia, graft vs. host)
24
Q

Signs and symptoms of transfusion reactions

A 
fever
dyspnea (serious)
bronchospasm (serious)
rash
uriticaria
flank pain (serious)
hypotension (serious)
shock (serious)
25
Q

Protocols of transfusion reaction

A
  • 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
26
Q

What are alternatives to allogenic blood transfusion?

A 
autologous (pre-surgical donations, intraop blood salvage)
intraoperative hemodilution
cell saver
blood salvage
medications ((amicar/ EPO/protamine)
27
Q

What is Aphersis? AKA?

A

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)

28
Q

Indications of pheresis

A

collection of blood product

treatment of certain medical conditions

29
Q

Diseases that might use plasmapheresis

A

hyperviscosity syndrome
myasthenia gravis
goodpastures syndrome
TTP

30
Q

Diseases that might use cytapheresis

A

hyperleukemis leukostasis in AML or CML
thrombocytemia (ET)-bone marrow problem-cancer
sickle crisis

31
Q

blood components prepared by hemapheresis

A
  • granulocyte concentrate
  • single donor apheresis platelets- remove platelets give everything else back
  • peripheral blood stem cells
32
Q

What is granulocyte concentrate?
how long can it be stored?
Indications?

A
  • 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

33
Q

What is apheresis platelets?
how long can it be stored?
Indications?

A
  • 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
34
Q

When might you use therapeutic phlebotomy?

A
  • polycythemia vera

- hemochromatosis

Heme (13 decks)

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