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Transfusion Medicine Flashcards

1
Q

Cutoff for women donors (Hgb).

A

12.5

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2
Q

Crossing needed for Plasma

A

ABO but not Rh

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3
Q

Crossing needed for platelets

A

Neither ABO or Rh

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4
Q

What test is run if there is a suspected hemolytic transfusion reaction?

A

Direct Coombs

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5
Q

Hematocrit level of pRBCs

A

55-65%

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6
Q

Response to 1 unit pRBC

A

Hct by 3%, Hgb by 1 g/dL

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7
Q

Difference between plasma and FFP

A

FFP was frozen within 6 hours of collection (lasts 1 year if it stays frozen)

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8
Q

What is cryoprecipitate?

A

The small fraction of plasma that precipitates when FFP is thawed at 1 to 4°C

(Contains mostly fibrinogen and factor VIII)

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9
Q

What is the shelf life of platelets?

A

5 days

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10
Q

How do apheresis platelets differ from platelet concentrate (taken from whole blood)?

A

1 bag apheresis platelets = 4-6 units platelet concentrate

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11
Q

How much does a bag of apheresis platelets increase the count?

A

20-25k

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12
Q

What does Leukoreduction mean?

A

Decrease in the number of leukocytes present in transfused erythrocytes or platelets

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13
Q

Why would you used Leukoreduced products?

A
  • reduces class I-HLA allo-Ab production (decrease platelet refractoriness)
  • decrease febrile nonhemolytic transfusion reactions
  • decrease CMV transmission
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14
Q

Why do you irradiate blood products?

A

To prevent replication of lymphocytes and circulating stem cells present

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15
Q

Who needs irradiated products?

A
  • patients with severe immunodeficiency

- immunocompetent patients receiving HLA matched platelets or transfusions from relatives

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16
Q

What does irradiating products prevent?

A

Transfusion- associated GVHD

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17
Q

What does it mean to wash blood products?

A

Removes proteins remaining in the plasma of erythrocyte and platelet products

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18
Q

What two types of patients need washed products?

A
  • IgA deficient patients

- patients with complement mediated AHA

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19
Q

What is another reason someone might use washed blood products?

A

Reduces the amount of potassium for patients at high risk of hyperkalemia

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20
Q

What are recombinant factor concentrates and who are they used for?

A

Blood factors not containing any donor plasma

Used for younger patients with Hemophilia A and B

21
Q

Which product do you use during warfarin associated bleeding?

A

Prothrombin complex concentrates (factors II, VII, IX and X)

22
Q

What is a contraindication to PCC (prothrombin complex concentrates)?

A

History of HIT

23
Q

Which product do you use during PLEX for TTP?

A

FFP

24
Q

Which product do you use during DIC (fibrinogen deficiency)?

A

Cryoprecipitate

25
Q

Which product do you use during Hemophilia A?

A

Factor VIII

26
Q

Which product do you use during Von-Willebrand associated bleeding?

A

vW protein rich factor VIII

Or cryoprecipitate

27
Q

Which product do you use duringfacgor XIII deficiency?

A

Cryoprecipitate

28
Q

Which product do you use during hemophilia B?

A

Factor IX

29
Q

What is the only trial that showed liberal transfusion threshold was better than restrictive?

A

TITRe (cardiac surgery patients)

30
Q

What are the three most common causes of death related to transfusions?

A
  • hemolysis
  • TRALI
  • TACO
31
Q

Why do acute hemolytic transfusion reactions occur?

A

Clerical errors

32
Q

What are the symptoms of an acute hemolytic transfusion reaction?

A

Fever, flank pain, and may develop hypotension and diffuse bleeding (DIC)

33
Q

If a patient receiving product has a new positive direct anti-globulin test or an unexpected drop and hematocrit, what might you expect?

A

Hemolytic transfusion reaction secondary to platelets (not ABO screened so group O patients May have issue with high titer ABO antibodies)

34
Q

Who can get a delayed hemolytic transfusion reaction?

A

People who have had prior transfusions, people who have had a baby

35
Q

When do delayed transfusion reactions occur?

A

7 to 14 days after the transfusion

36
Q

How do you assess for a delayed transfusion reaction?

A

Check markers of hemolysis, and a direct anti-globulin test

37
Q

What are the symptoms of TACO?

A

Respiratory distress within six hours of transfusion, elevated BNP, pulmonary edema

38
Q

How do you treat TACO?

A

Diuretics, slow the rate of blood administration

39
Q

What is the pathophysiology of TRALI?

A

HLA or neutrophil specific antibodies in multiparous donors bind to and activate recipient leukocytes in the pulmonary vasculature

40
Q

How do patients with TRALI typically present?

A

Fever, hypotension, and non-cardiogenic pulmonary edema within six hours of transfusion

(Less likely to have overt signs of volume overload)

41
Q

What do you do if you expect a febrile nonhemolytic transfusion reaction?

A

Inspect the patient plasma for hemolysis and run a direct antiglobulin test

Also consider blood cultures

42
Q

What causes a febrile nonhemolytic transfusion reaction?

A

Inflammatory cytokines elaborated by donor leukocytes during storage

43
Q

Which bug thrives in red blood cells?

A

Yersinia

44
Q

How do you manage a mild allergic reaction to blood?

A

Give an anti-histamine and continue the blood transfusion

There is no evidence for prophylaxis

45
Q

What is the special consideration given to patients who have had a stem cell transplant?

A

They need irradiated blood products for life to prevent transfusion associated graft versus host disease

46
Q

What are electrolyte considerations for patients with massive transfusion?

A

Monitor for hypocalcemia (citrate binds free calcium), metabolic alkalosis (citrate metabolism), hyperkalemia

47
Q

What consideration should be given to a patient with autoimmune hemolytic anemia?

A

ABONRH matched, they will have IgG auto- antibodies against any blood, so you just try your best

48
Q

How does plasmapheresis for GBS differ to that for TTP?

A

GBS you replace with crystalloud or colloid and avoid plasma, TTP you replace with FFP

49
Q

What are three indications for erythrocyte exchange?

A
  • sickle cell disease with acute cerebral infarct
  • sickle cell disease with severe acute chest syndrome
  • severe babesiosis

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