7.17 Transfusion

Question 1

what to give if DIC

Answer 1

FFP (fresh frozen plasma)

Question 2

what to give if liver disease

Answer 2

FFP (fresh frozen plasma)

Question 3

what to give if factor deficiency and no factor treatment

Answer 3

FFP (fresh frozen plasma)

Question 4

what to give if TTP

Answer 4

FFP (fresh frozen plasma) - replaces ADAMTS13

Question 5

what to give if gave too much Coumadin

Answer 5

FFP (fresh frozen plasma)

Question 6

what to give if hypofibrinogenemia

Answer 6

cryoprecipitate (contains fibrinogen)

Question 7

what to give if aplastic crisis

Answer 7

red cells

Question 8

what to give if thalassemia

Answer 8

red cells

Question 9

what to give in renal failure

Answer 9

red cells

Question 10

what to give during chemo

Answer 10

red cells

Question 11

what to give if hemoglobinopathy

Answer 11

red cells

Question 12

what to give in acute hemolysis

Answer 12

red cells

Question 13

what to give if spontaneous bleeding

Answer 13

platelets

Question 14

what to give if gave too much aspirin

Answer 14

platelets

Question 15

what to give if gave too much clopidogrel

Answer 15

platelets

Question 16

what to give if have glanzmann’s thrombasthenia

Answer 16

platelets

Question 17

what to give if Bernard-Soulier

Answer 17

platelets

Question 18

acute hemolytic transfusion reaction most commonly caused by

Answer 18

ABO incompatibility

Question 19

acute hemolytic transfusion reactions can lead to

Answer 19

intravascular hemolysis and DIC

Question 20

patient has fever, chills, 90/45, back pain, 120 bpm, sweating, can’t breathe well

• diagnosis
• what to do

Answer 20

acute intravascular hemolytic reaction

stop transfusion, maintain urine output with fluids and diuretics, cardiovascular support

Question 21

patient has fever, shaking chills during or shortly after transfusion of blood

• diagnosis
• mechanism
• what to do

Answer 21

febrile nonhemolytic transfusion reactions (not life threatening)

cytokines released from WBCs

• stop transfusion (don’t want to miss a hemolytic reaction)
• tylenol for fever, meperidine for rigors

Question 22

hypersensitivity reactions mediated by

Answer 22

IgE

Question 23

anaphylactic reactions mediated by

Answer 23

IgA

Question 24

how to prevent or treat an allergic transfusion reaction

Answer 24

antihistamines

Question 25

most common reported cause of death from transfusion

Answer 25

transfusion related acute lung injury

Question 26

breathing fast, skin is blue, short of breath, fever, hyperemic, needs intubation - diagnosis - mechanism - what to do

Answer 26

transfusion related acute lung injury - granulocyte or HLA antibodies in donor react w/ patient's white cells - white cells aggregate in lungs to mimic ARDS - respiratory support - only give male plasma b/c women make HLA Ab

Question 27

patient with impaired cardiovascular and pulmonary status with excessive transfusions - diagnosis - what to do

Answer 27

transfusion associated circulatory overload treat w/ diuretics

Question 28

patient has low white blood cells, platelets, and marrow aplasia, fever, rash on face and trunk which spreads to extremities, mucositis, NVD, hepatitis - diagnosis - mechanism - what to do (how to prevent)

Answer 28

transfusion associated Graft vs Host disease donor's T cells attack immunocompromised recipient prevented by irradiating blood products (inactivates T cells)

Question 29

septic, high fever, hypotension - diagnosis - what to do (how to prevent)

Answer 29

bacterial contamination of red cells and platelets RBCs are refrigerated, platelets tested for bacteria

Question 30

what you take blood out, inject saline, and then put blood back in (for Jehovah's witness)

Answer 30

acute normovolemic hemodilution

Question 31

taking out own blood, then putting it back in after surgery

Answer 31

preoperative blood donation

Question 32

suction out blood from wound, wash it, return RBCs to patient

Answer 32

blood salvage

Question 33

growth factors as alternatives to blood component therapy

Answer 33

EPO (for RBCs) Granulocyte colony stimulating factor / G-CSF (for WBCs) thrombopoietic growth factors (for platelets)

Question 34

Duffy antigen for

Answer 34

plasmodium vivax