TRANSFUSION THERAPY IN SPECIAL CONDITIONS

Question 1

Donation of blood by the intended recipient to reduce transfusion reactions and transmission of infectious diseases.

Answer 1

Autologous Transfusion

Question 2

• Blood collected before surgery and stored for later use, either as liquid or frozen.

Answer 2

• Predeposit autologous donation

Question 3

• Typically reserved for patients anticipating a need for transfusion.

Answer 3

• Predeposit autologous donation

Question 4

• Collection of blood from the patient before surgery, replaced with fluid, then reinfused at the end of surgery.

Answer 4

• Intraoperative hemodilution

Question 5

• Group O RBCs used for patients needing immediate transfusion when ABO and Rh type aren’t known.

Answer 5

• Emergency Transfusion

Question 6

• Group O-negative RBCs preferred for females of childbearing potential.

Answer 6

Emergency Transfusion

Question 7

• Additional blood units selected based on antibody screen after initial transfusion.

Answer 7

Emergency Transfusion

Question 8

• Replacement of one or more blood volumes within 24 hours, usually around 10 units of blood in adults.

Answer 8

Massive Transfusion

Question 9

• Premature infants frequently need RBC transfusions for laboratory tests and to treat anemia.

Answer 9

Neonatal Transfusion

Question 10

Neonatal Transfusion
• Dose: [?] with specific considerations for blood units (age, compatibility, CMV status, hemoglobin S).

Answer 10

10 mL/kg over 2 to 3 hours

Question 11

likely to be required when 30–40% blood volume is lost (approximately 2,000 mL in an adult)

Answer 11

Red cells

Question 12

> 40% blood volume loss is immediately life-threatening.

Answer 12

Red cells

Question 13

Pretranfusion compatibility testing should be done early

Answer 13

Red cells

Question 14

It’s best practice to transfuse [?] of the same ABO and RhD group as the patient, however if there are insufficient supplies of the patient’s ABO group available locally, [?] of another ABO compatible group may be released by the Transfusion Service Provider.

Answer 14

Red cells

Question 15

In an emergency situation, uncrossmatched Group O RhD negative red cells (especially for females of childbearing age) may be appropriate.

Answer 15

Red cells

Question 16

Should be given through a blood warmer.

Answer 16

Red cells

Question 17

to maintain PT & APTT ≤ 1.5x the normal range, or according to institutional viscoelastic testing algorithm

Answer 17

Fresh frozen plasma (FFP)

Question 18

Usual dose is 15 ml/kg.

Answer 18

Fresh frozen plasma (FFP)

Question 19

If the patient’s blood group is unknown, give group AB or group A FFPaccording to jurisdictional guidelines.

Answer 19

Fresh frozen plasma (FFP)

Question 20

Allow 1/2 hour thawing time.

Answer 20

Fresh frozen plasma (FFP)

Question 21

• FFP will not provide adequate fibrinogen to correct hypofibrinogenemia in a critically bleeding patient. This should be used.

Answer 21

Cryoprecipitate

Question 22

• In obstetrics haemorrhage, early DIC is often present so consider it early in this situation.

Answer 22

Cryoprecipitate

Question 23

• Usual dose is 3–4 g of fibrinogen which is roughly equivalent to 10 units of [?] or 5 units of [?]- your local Transfusion Service Provider can advise on the number of units to provide this dose.

Answer 23

whole blood cryoprecipitate

apheresis cryoprecipitate

Question 24

• Allow up to 1/2 hour thawing time.

Answer 24

Cryoprecipitate

Question 25

• Thrombocytopenia <50 x 109/L can be anticipated after two blood volume replacementdue to dilution and increased consumption.

Answer 25

Platelets

Question 26

• Aim to keep the platelet count >50 x 109/L (or >100 x 109/L in situations such as CNS injury or diffuse microvascular bleeding).

Answer 26

Platelets

Question 27

• The usual dose in an adultis 1 unit.

Answer 27

Platelets

Question 28

• For life-threatening (critical organ) and clinically significant bleeds, the consensus is to use a combination of.

Answer 28

Prothrombinex-VF, Vitamin K and FFP

Question 29

• Vitamin K1:

Answer 29

5–10 mg IV

Question 30

• Prothrombinex (PTX-VF):

Answer 30

50 IU/kg

Question 31

• Fresh frozen plasma: [?] if Prothrombinex-VF not available

Answer 31

150–300 mL or 15 mL/kg

Question 32

• Note that the use of blood components in patients with critical bleeding is lifesaving, but increased volumes may be independently associated with

Answer 32

mortality and ARDS.

Question 33

• [?] on specimen tubes compared to patient’s hospital armband at bedside to prevent mislabeling.
• [?] applied to tubes before leaving bedside to avoid errors.

Answer 33

Labels

Question 34

require sterile, pyrogen-free transfusion sets with filters designed to retain harmful particles.

Answer 34

AABB standards

Question 35

• Blood components infused slowly for [?], with close observation for reactions.

Answer 35

10-15 minutes

Question 36

• Subsequent infusion should be as rapid as tolerated, ideally within [?].

Answer 36

4 hours

Question 37

• Standard sets include a [?] to remove gross clots and cellular debris.

Answer 37

150-260 μm filter

Question 38

• Mandatory use of [?] for all blood component transfusions.

Answer 38

blood administration filter

Question 39

• Current good manufacturing practice (cGMP) regulations set by the FDA govern the entire process of blood component management, from receipt to transfusion.

Answer 39

cGMP Regulations

Question 40

• These regulations provide standards for the collection, processing, storage, and distribution of blood and blood components.

Answer 40

cGMP Regulations

Question 41

• Compliance with cGMP regulations is essential to maintain the quality, purity, and potency of blood products, minimizing the risk of adverse events during transfusion.

Answer 41

cGMP Regulations

Question 42

• Each blood product is prepared and stored under specific conditions to preserve its purity and potency until the time of transfusion.

Answer 42

Optimizing Purity and Potency

Question 43

• Proper storage temperatures and conditions are maintained to prevent degradation of components and ensure their efficacy.

Answer 43

Optimizing Purity and Potency

Question 44

• Techniques such as leukoreduction (removal of white blood cells) and irradiation may be employed to enhance the safety and quality of blood components.

Answer 44

Optimizing Purity and Potency

Question 45

1.Quality control parameters are established by regulatory bodies like the FDA and professional organizations like AABB.

Answer 45

Quality Control

Question 46

2.These parameters encompass various aspects of blood component management, including collection methods, processing techniques, storage conditions, and testing protocols.

Answer 46

Quality Control

Question 47

3.Regular quality control checks and audits are conducted to monitor compliance with established standards and identify any deviations that may affect product quality or patient safety.

Answer 47

Quality Control

Question 48

1.Component indications refer to specific guidelines and criteria for the selection and transfusion of different blood components based on patient needs and clinical indications.

Answer 48

Component Indications

Question 49

2.Indications help healthcare providers make informed decisions regarding the use of whole blood, packed red blood cells, platelets, plasma, and other blood products.

Answer 49

Component Indications

Question 50

3.Adhering to component indications minimizes the risk of adverse transfusion reactions, such as hemolytic reactions, transfusionrelated acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO).

Answer 50

Component Indications

Question 51

4.Indications may include factors such as patient diagnosis, hemoglobin level, platelet count, coagulation profile, and specific clinical scenarios (e.g., massive transfusion, neonatal transfusion).

Answer 51

Component Indications

Question 52

• A single unit of packed red blood cells (pRBCs) is usually infused over 1 to 4 hours, depending on the transfusion rate and the patient’s tolerance.

Answer 52

Red Blood Cell (RBC) Transfusion:

Question 53

• Multiple units of pRBCs may be administered sequentially, extending the overall duration of the transfusion session.

Answer 53

Red Blood Cell (RBC) Transfusion:

Question 54

• Platelet transfusions are typically infused over 30 to 60 minutes per unit, but the duration may vary based on institutional protocols and patient factors.

Answer 54

Platelet Transfusion:

Question 55

1.Fresh frozen plasma (FFP) or other plasma components are generally infused over 30 to 60 minutes per unit.

Answer 55

Plasma Transfusion

Question 56

2.Additional plasma products, such as cryoprecipitate or prothrombin complex concentrate (PCC), may also be administered, each with its own infusion duration.

Answer 56

Plasma Transfusion

Question 57

1.Whole blood transfusions, while less common than component transfusions, are typically infused over 1 to 4 hours, similar to pRBC transfusions.

Answer 57

Whole Blood Transfusion: