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IBI Test 3 > B3.050 Prework 2 Transfusion Components, Triggers and Reactions > Flashcards

B3.050 Prework 2 Transfusion Components, Triggers and Reactions Flashcards

(59 cards)

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1
Q

what process is used to collects RBCs?

A

whole blood

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2
Q

what process is used to collect platelets?

A

apheresis

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3
Q

shelf life of RBCs

A

CPD = 21 d
CPDA = 35 d
AS (additive solutions) = 42 d

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4
Q

expected Hc increment after 1 unit of RBC

A

1 g/ dL

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5
Q

what is RDP?

A

random donor platelet
platelets from whole blood donation
5.5 x 10^10 platelets/bag

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6
Q

what is SDP?

A

single donor platelets
platelets from apheresis
3 x 10^11 platelets/bag

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7
Q

1 unit SDP = ?

A

6 units RDP (1 dose RDP)

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8
Q

what is leukoreduced product?

A

leukocytes removed

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9
Q

why do we need LR product?

A

prevent:

  1. febrile non hemolytic transfusion reaction (FNHTR)
  2. CMV
  3. HLA-alloimmunization
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10
Q

what is irradiation?

A

kill T cells in donor blood

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11
Q

why do we need irradiation?

A

prevent TA-GVHD
transfusion associated graft versus host disease
donor T cells attack recipient skin, oral/GI, lung, ad marrow

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12
Q

what is washing?

A

removes potassium, cytokines, antibodies, and allergens from unit
IgA deficient recipient

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13
Q

how do you wash blood?

A

saline, 30-40 min

double wash for IgA def patients

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14
Q

problems with washing

A

lose 15% RBCs

outdated after 24 h

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15
Q

discuss the TRICC trial

A

restrictive group: transfused when Hgb <7
liberal group: transfused when Hgb <10
no demonstrable benefit to a liberal strategy
in younger patients, mortality higher in liberal group

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16
Q

AABB 2016 Guidelines for RBC transfusion

A

Hb 7 = hospitalized patients who are hemodynamically stable

Hb 8 = patients under going surgery or with preexisting cardiovascular disease

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17
Q

indications for platelet transfusion

A

to control or prevent bleeding due to def of platelet number or function
platelet count without active bleeding = <10-20K
platelet count with bleeding or invasive procedure = <50K
massive transfusion and bleeding
bleeding w evidence of platelet dysfunction

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18
Q

indications for FFP

A

to control or prevent bleeding in patients with a documented clotting factor def

  1. active bleeding, invasive procedure and massive transfusion with INR >2
  2. emergency of warfarin
  3. TTP - plasmapheresis
  4. antithrombin 3 def, or protein C, S or heparin cofactor 2 def
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19
Q

contraindications for FFP

A

not for volume or protein replacement
not bleeding or low risk procedure
if elevated INR and bleeding not controlled after receiving plasma, consider other possibilities

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20
Q

top 3 causes of transfusion related death

A

TRALI (38%)
TACO (24%)
HTR (21.5%)

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21
Q

what do you do If you suspect a transfusion reaction?

A
  1. stop transfusion
  2. keep IV open with saline
  3. product tags and pt ID
  4. notify blood bank and physician
  5. collect and send blood and urine samples to blood bank
  6. send the unit, tags, and admin set to blood bank
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22
Q

information needed by blood bank physician

A

products
premedication
vitals (before and after)
symptoms

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23
Q

acute hemolytic transfusion reactions etiology

A 
1:25,000-50,000 transfusions
incompatible blood
usually due to misidentification
10-20% mortality
>50% acute renal failure
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24
Q

HTR signs and symptoms

Study These Flashcards
A

fever and chills

back pain, chest pain, nausea, flushing, dyspnea, DIC, hemoglobinuria, acute renal failure

25
HTR management
steps 1-6 aggressive fluid furosemide to increase renal blood flow/urine output red cell exchange if feasible
26
FNHTR signs and symptoms
``` fever chill/rigor dyspnea and wheezing due to high O2 demand hypertension due to rigor flushing due to cytokines ```
27
FNHTR etiology
cytokine and WBC in the bag
28
FNHTR management
steps 1-6 r/o hemolysis, DAT, CXR Tylenol, meperidine for chill/rigor
29
FNHTR prevention
leukoreduction and premedication (Tylenol)
30
sepsis signs and symptoms
fever chills hypotension- may progress rapidly to endotoxic shock
31
sepsis etiology
bacterial contamination of the unit | usually skin flora
32
sepsis management
steps 1-6 draw blood cultures sent unit to blood bank for culture IV antibiotics, fluids, pressors
33
sepsis prevention
careful donor screening thorough cleansing of phlebotomy site bacterial screening
34
allergic rxn signs and symptoms
uticaria and local erythema pruitis no fever
35
etiology of allergic rxn
allergic reaction to transfuses plasma proteins
36
management of allergic rxn
stop transfusion administer antihistamine if symptoms subside MAY RESTART slowly and observe
37
prevention of allergic rxn
antihistamine premed
38
anaphylaxis signs and symptoms
hypotension/shock wheezing/resp distress laryngeal edema
39
anaphylaxis etiology
anti IgA Abs in IgA deficient recipients (naturally occurring) rarely Abs to other plasma proteins (haptoglobin) or drugs
40
anaphylaxis management
steps 1-6 vigorously treat hypotension subQ epinephrine
41
anaphylaxis prevention
premed with antihistamines and steroids for cellular components, washed products are indicated for plasma, IgA deficient donors are required (hard to get)
42
TRALI signs and symptoms
``` during or w/in 6 hours of transfusion resp distress and severe hypoxemia non cardiogenic pulmonary edema (lung infiltrates on CXR) fever and chills hypotension ```
43
TRALI criteria
no evidence of acute lung injury (ALI) before transfusion onset during or within 6 hours of transfusion hypoxemia bilateral infiltrates no evidence of circulatory overload
44
TRALI pathophys
2 hit: patient needs inflammatory insult + transfusion -inflammatory insult = neutrophils primed for trauma, sepsis immune: anti-WBC Abs (HLA or HNA) in the transfused blood component non-immune: non-Ab component in the blood (phospholipis)
45
tests for TRALI
CXR, EKG, troponin, Echo, blood culture, BNP
46
TRALI management
``` steps 1-6 oxygen and mechanical ventilation ICU support most recover w/in 4 days mortality 5-25%, up to 58% in critically ill ```
47
TRALI risk factors
recipient related: inflammatory insult transfusion related: high plasma volume products donor related: HLA or HNA antibody (related to number of pregnancies)
48
TRALI prevention
male donor plasma only | defer TRALI confirmed donors
49
TACO signs and symptoms
``` dyspnea, orthopnea, cough positive fluid balance cardiogenic pulmonary edema on CXR elevated central venous pressure elevated serum BNP, may have elevated pro-BNP ```
50
TACO etiology
volume infusion not tolerated by patient -high infusion rate or volume -underlying cardiopulm disease albumin/plasma infusion may shift large volumes of extracellular fluid into vascular space, acutely expanding blood volume
51
TACO vs TRALI
TACO- heart failure, transudate trach tube, diuretic response, no WBC change, elevated BNP TRALI- no heart failure, exudate trach tube, minimal diuretic response, decreased WBC, normal BNP
52
TACO management/prevention
cautious transfusion in patients with cadiopulm status stopping or slowing transfusion diuretics and oxygen phlebotomy in emergencies
53
TA-GVHD etiology
engraftment and proliferation of donor T-cells > attack recipient tissues including bone marrow
54
TA-GVHD signs/symptoms
begins 8-10 days post transfusion | fever, rash, enterocolitis, hepatitis, pancytopenia
55
TA-GVHD risk/prevention
does not occur in AIDs patients degree of HLA similarity between donor and recipient prevent with irradiation usually fatal 90% mortality
56
delayed hemolytic transfusion reactions
accelerated clearance/extravascular hemolysis of crossmatch compatible RBCs, usually due to anamnestic antibody response in a previously sensitized patient
57
delayed hemolytic transfusion reaction pathophys
transfused foreign RBC antigens stimulate production of Ab > hemolysis of transfused cells, extravascular
58
DHTR symptoms
mild, may be undetectable DAT positive Ab detectable in serum or eluate
59
DHTR treatment
IV fluids to maintain urine output

IBI Test 3 (19 decks)

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