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Apex Review > Transfusion 2 > Flashcards

Transfusion 2 Flashcards

1
Q

Match each blood additive with its function.
Dextrose
Phosphate
Citrate
Adenine
Anticoagulant
Substrate for glycolysis
buffer
substrate for ATP synthesis

A

Dextrose–> substrate for glycolysis
Citrate–> anticoagulant
Phosphate–> buffer
adenine–> substrate for ATP synthesis

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2
Q

One unit of packed red blood cells contains about __________ mLs with a hematocrit of ________

A

300 mLs; 70%

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3
Q

Transfusion of one unit of PRBCs raises hemoglobin by ___________ g/dL and hematocrit by _____________

A

1 g/dL; 2-3%

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4
Q

Citrate is an anticoagulant that inhibits

A

calcium (factor 4)

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5
Q

A large citrate load can cause

A

hypocalcemia

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6
Q

Phosphate, dextrose, adenine, and other preservatives help to

A

offset the consequences of blood preservation (RBC storage lesion)

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7
Q

Consequences of the RBC storage lesion include

A

decreased 2,3- DPG, decreased pH, increased potassium, impaired ability to change shape, hemolysis, and increased production of proinflammatory mediators

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8
Q

_________________ removes WBCs from PRBCs and platelets

A

Leukoreduction

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9
Q

Leukoreduction reduces the risk of

A

HLA sensitization
febrile nonhemolytic transfusion reactions
CMV transmission

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10
Q

________________ removes any remaining plasma from donor RBCs

A

Washing

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11
Q

Washing prevents

A

anaphylaxis in IgA deficient patients

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12
Q

__________ destroys donor leukocytes

A

Irradiation

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13
Q

Irradiation reduces the risk of

A

graft vs. host disease in immunocompromised patients

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14
Q

Phosphate is a __________– that combats ______–

A

buffer; acidosis

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15
Q

Dextrose is the primary

A

substrate for glycolysis

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16
Q

Adenine is a substrate that

A

helps RBCs re-synthesize ATP

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17
Q

Adenine extends storage time from

A

21 to 35 days

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18
Q

Newer preservatives (Adsol, Nutricel, and Optisol) extend storage time to

A

42 days

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19
Q

The most common cause of platelet refractoriness is

A

HLA alloimmunization

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20
Q

Populations that benefit from irradiated cells include

A

leukemia
lymphoma
hematopoietic stem cell transplants
DiGeorge syndrome

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21
Q

Rank each infectious complication of transfusion from MOST common to LEAST common:
HIV, Hep C, CMV, Hep B

A

CMV, Hep B, Hep C, HIV

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22
Q

The most common infectious complication of transfusion is

A

cytomegalovirus

23
Q

__________ greatly reduces the risk of cytomegalovirus

A

Leukoreduction

24
Q

Immunocompromised patients should receive

A

leukoreduced blood

25
Q

Risk of sepsis is most common with

A

platelets

26
Q

Why is risk of sepsis most common with platelets?

A

b/c they are stored at room temperature which explains why bacterial contamination is more common

27
Q

A patient with O blood received AB blood during surgery. Within five minutes, you observe hemoglobinuria, hypotension, and increased surgical bleeding. What actions should you perform at this time? (select 2)
a. slow the rate of transfusion
b. send an AST/ALT to the lab
c. administer sodium bicarbonate
d. give a crystalloid bolus

A

c. administer sodium bicarbonate
d. give a crystalloid bolus

28
Q

____________ occurs when a patient receives an incompatible blood product.

A

A hemolytic transfusion reacton

29
Q

The most lethal hemolytic transfusion reaction is

A

ABO incompatibility

30
Q

Complications of a hemolytic transfusion reaction include

A

flushing, renal failure (acute tubular necrosis), DIC, & hemodynamic instability

31
Q

Signs & symptoms of hemolytic transfusion reaction include

A

hemoglobinuria, hypotension, fever, chills, and flushing

32
Q

Treatment of hemolytic transfusion reaction includes

A

stopping the transfusion, promoting renal blood flow, and alkalinizing the urine

33
Q

Allergic transfusion reactions are rarely

A

severe

34
Q

Allergic transfusion reactions present with

A

urticaria & facial swelling

35
Q

Treatment for allergic transfusion reactions is

A

supportive and includes antihistamines

36
Q

The most common adverse reaction associated with transfusion is

A

febrile transfusion reactions (non-hemolytic)

37
Q

Patients with febrile transfusion reactions present with

A

fever
chills
headache
nausea
malaise

38
Q

Treatment of febrile transfusion reactions is

A

supportive and includes acetaminophen

39
Q

Signs and symptoms of an acute hemolytic reaction that are masked by anesthesia include

A

fever
chills
chest pain
dyspnea
nausea
flushing

40
Q

List the 7 steps to treating an acute hemolytic reaction

A
  1. stop the transfusion
  2. maintain UO >75-100 mL/hr with: IV fluids, mannitol (12.5-25 g), furosemide (20-40 mg)
  3. alkalinize the urine with sodium bicarbonate
  4. send urine & plasma hemoglobin samples to the blood bank
  5. check platelets, PT, & fibrinogen
  6. Send unused blood to the blood bank to double-check the cross match
  7. Support hemodynamics with IVF and vasopressors as needed
41
Q

What is the cause of allergic transfusion reactions?

A

foreign proteins in the donor blood product

42
Q

Should a transfusion be continued if a patient has an allergic transfusion reaction?

A

minor rxn= continue transfusion
major reaction (dyspnea, laryngeal edema, or hemodynamic instability)= stop the transfusion and treat it as anaphylaxis

43
Q

Fresh frozen plasma from which donor population imparts the HIGHEST risk of transfusion-related acute lung injury?
a. Jehovah’s witness
b. organ recipient
c. multiparous female
d. Creutzfeldt jakob

A

c. multiparous female

44
Q

___________________ is a form of non-cardiogenic pulmonary edema that occurs following transfusion.

A

Transfusion related acute lung injury

45
Q

The most common cause of transfusion-related mortality in the United States is

A

TRALI

46
Q

TRALI is caused by

A

human leukocyte antigens (HLA) and neutrophil antibodies present in the donor plasma

47
Q

The highest risk of TRALI stems from

A

FFP & platelets

48
Q

High-risk donors for TRALI development includes

A

women with a history of multiple births
people with a prior hx of transfusions
people with a history of organ transplants

49
Q

Signs and symptoms of TALI include

A

the onset of symptoms within 6 hours
bilateral infiltrates via CXR & low oxygenation

50
Q

Management of TRALI is

A

supportive: maximize PEEP, use LPV techniques and avoid overhydration

51
Q

_________________ is a state of volume overload caused by expanding the circulatory volume beyond the patient’s compensatory ability

A

Transfusion associated circulatory overload (TACO)

52
Q

Signs and symptoms of TACO include

A

pulmonary edema, hypervolemia, increased PAOP, and left ventricular dysfunction

53
Q

Treatment of TACO is

A

supportive

54
Q

Patients at higher risk of suffering from TRALI include

A

critically ill (highest risk)
anyone susceptible to acute lung injuries such as sepsis, burns, or post-CPB

Apex Review (224 decks)

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