Blood Transfusions and Transfusion Reactions

Question 1

What blood product has the simultaneous presence of red blood cells, plasma, and fresh platelets in the perfect 1 to 1 to 1 ratio and it still retains all the clotting factors as well.

Answer 1

Fresh whole blood

Question 2

What are indications for use of fresh whole blood?

Answer 2

1) Massive hemorrhage when more than 10 units are expected to be required.
2) Cardiac surgery.

Question 3

True/False
For whole blood use
Must be ABO type and Rh specific unless low titer O unit donors have been previously drawn or identified.

Answer 3

True

Question 4

What percent of the crew must be identified for walking blood bank when deploying?
What forms?

Answer 4

10 percent of crew

DD572’s

Question 5

What Blood Product?

(a) Most commonly used to raise hemoglobin. Each unit is about 300mL, of which 200mL consist of red blood cells. One unit will usually bring up the hemoglobin by about 1 g/dL.
(b) Current guidelines suggest giving units once hemoglobin falls below 7-8g/dL threshold for critically ill patients.
(c) Ratio for transfusion – for every unit of packed RBCs given you should give a unit of FFP and unit of platelets for a 1 to 1 to 1 ratio.

Answer 5

Packed RBCs

Question 6

For every unit of packed RBCs given you should

give a unit of FFP and unit of platelets for what ratio?

Answer 6

1 to 1 to 1

Question 7

What blood product is used reduce incidence of leukoagglutination reactions, platelet alloimmunization, transfusion related acute lung injury and CMV exposure.
- is comprised of most products used today

Answer 7

Leukocyte poor blood

Question 8

What Blood Product?
Patients scheduled for elective surgery may donate their own blood to transfuse if it becomes necessary.

Units can be stored in refrigerator up to 35 days or longer depending on anticoagulant used. After that unit should be frozen.

Answer 8

Autologous Packed RBC’s

Question 9

Current DoD guidelines allow units to be glycerolized and frozen for how long?

Answer 9

10 years

Question 10

One ACP215 instrument can deglycerolize one unit in about….

Answer 10

1 Hour

Question 11

After deglycing a unit the blood is ready for transfusion or can be stored in refrigerator for how long?

Answer 11

14 days

Question 12

The most severe are acute, involving incompatible mismatches in the ____ system.

Answer 12

ABO

Question 13

Most Hemolytic transfusion reactions happen because of?

Answer 13

clerical errors and mislabeled specimens

Question 14

Patient has these symptoms.
-Fever and chills with backache and headache.
-There may be apprehension (sense of impending doom), dyspnea, hypotension and cardiovascular collapse.
What is happening.

Answer 14

Hemolytic transfusion reaction

Question 14

Patient has these symptoms.
-Fever and chills with backache and headache.
-There may be apprehension (sense of impending doom), dyspnea, hypotension and cardiovascular collapse.
What is happening.

Answer 14

Hemolytic transfusion reaction

Question 15

True/False
Pts under anesthesia will not manifest Transfusion Reaction symptoms and the first indication may be tachycardia, generalized bleeding or oliguria.

Answer 15

True

Question 16

Treatment for a Transfusion reaction

Answer 16

1) Stop transfusion immediately.
2) Vigorously hydrate patient to prevent acute tubular necrosis.
3) Forced diuresis with mannitol may help prevent or minimize acute kidney injury.

Question 17

What type of reaction/tx
Most transfusion reactions are not hemolytic but represent reactions to antigens present on transfused passenger leukocytes in patients who have been sensitized to leukocytes antigens through previous transfusions or pregnancy.
(b) Symptoms:
1) Fever and Chills within 12 hours after transfusion.
2) Cough and dyspnea in severe cases.
(c) Lab findings:
1) Chest radiograph may show transient pulmonary infiltrates.
2) Hemoglobin rises by expected amount despite reaction because there is no hemolysis.

Answer 17

Leukoagglutinin reactions
Treatment:
1) Acetaminophen 500-600mg orally
2) Diphenhydramine 25mg orally or IV
3) Hydrocortisone 1mg/kg IV

Question 18

What reaction/ treatment
Occurs in 1 out of every 5,000 transfusions. It is associated with allogeneic antibodies in the donor plasma that bind to recipient leukocyte antigens. Is clinically defined as non-cardiogenic pulmonary edema after blood product transfusion without other explanation.
-Surgical and critically ill patients are most susceptible.
-Risk for this reduced through use of male only plasma donors when possible because only 1-5% of male donors have antileukocyte antibodies in their serum while females are 10-20%.

Answer 18

Transfusion Related Acute Lung Injury (TRALI)

Treatment – none only supportive care.