Week 6

Question 1

Indications for RBC transfusion

Answer 1

• Acute blood loss (loss of ~15% blood volume)
• anemia in patient with other cause of hypoxia
• anemia in patient with hx of heart disease
• patient with hgb less than 7-8
• symptomatic anemia

Question 2

Steps after determining patient needs blood transfusion

Answer 2

• blood typing
• antibody screen
• cross match

Question 3

antibody screening

Answer 3

Looking for antibodies against antigens on RBC that are already in patients serum

Question 4

cross match

Answer 4

Testing donor and recipient blood types to ensure there will not be hemolytic event

Question 5

packed RBC dosing

Answer 5

• one unit with raise adults hgb by 1g/dL

- children dosed based on weight

Question 6

what happens if patient is given a unit and does not gain 1g/dL

Answer 6

most likely due to autonomic hemolytic anemia or mechanical hemolysis

Question 7

How to decide if patient needs blood transfusion

Answer 7

• Iron panel
• EPO
• Vitals
• Check creatinine

Question 8

Anemia and packed RBC

Answer 8

• RBC not indicated for all anemic patients
• patients with chronic anemia can receive ib hgb is less than 7
• patients with potentially correctable cause of anemia

Question 9

platelet transfusion indications

Answer 9

• platelet count less than 10,000 in a non-bleeding patient
• patient with platelet type bleeding and platelets are under 20,000
• patient undergoing surgical procedure with platelet count less than 50,000

Question 10

Why give patient platelets the day of surgery

Answer 10

• give platelets the morning of surgery, could sequester platelets if given day before, platelts also have shorter half life
• Platelet transfusion would only last about 7 days

Question 11

Types of platelets available for transfusion

Answer 11

• pooled platelets: Platelets from 6 different donors- not enough platelets from any one of those donors
• apheresis platelets: Platelets all from one donor– blood is being taken out, platelets are centrifuged out, blood is put back into patient allowing for patient to donate more since RBC’s are being returned

Question 12

How high would a 6 pack of platelets raise patients platelet count?

Answer 12

-30-50 K/uL

Question 13

What is patient receives a unit of platelets and count only raises by 5k?

Answer 13

• Immune thrombotic cytopenic pupura

- Any disease causing platelet destruction

Question 14

Situations where platelet transfusion might not be helpful

Answer 14

• Autoimmune platelet lysis (ITP) - will not get as high of rise as normal
• DIC: disseminated activation of coagulation system - would form clots all over body
• TTP: systemic activation of platelets- would form clots all over body
• Patient on aspirin: platelets will be useless in surgery- unless it was emergent

Question 15

What does liver disease do to platelets?

Answer 15

• Liver forms lots of clotting factors

- Cirrhosis: can decrease platelet count and cause them to be abnormal

Question 16

Risks of transfusion

Answer 16

○ Death: medical error- causing transfusion reaction; Hospitals now doing electric cross match, but problem is if patient is typed wrong will still have hemolytic event, Other problem would be hanging wrong bag of blood in room where two patients need transfusion
○ Infection (viruses, specifically HIV in 80’s); Bacterial contamination
-Transfusion reaction

Question 17

Which product carries greatest risk of hemolytic transfusion

Answer 17

packed RBC

Question 18

Which product carries the greatest risk of bacterial contamination

Answer 18

platelets bc they are stored at room temp

Question 19

Which product has the largest delay from the time of order to the time of delivery to the patient

Answer 19

plasma bc it has to be thawed

Question 20

Which produc is most difficult to keep in stock and why

Answer 20

platelets, only stored for 5 days