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Flashcards in Blood Component Therapy Deck (73):
1

What are the two methods to get blood?

Donations
Apheresis

2

What is apheresis?

Drawing off plasma from RBCs

3

What happens to a unit of donated blood after it is spun?

Draw off plasma/platelets, and spin that to just get plasma

4

pRBC are used for what?

Transfusions for Hb, or replaced after acute bleeding

5

What happens to potassium are pRBCs are stored

Increased

6

What happens to RBC deformability are pRBCs are stored

Decreased

7

What happens to 2,3 BPG are pRBCs are stored

Decreased

8

What happens to ATP are pRBCs are stored

Decreased

9

What happens to glutathione are pRBCs are stored

Decreased

10

What happens to NO levels are pRBCs are stored

Decreases

11

Is there a clinical difference if giving older pRBCs compared to fresh pRBCs?

No

12

Which is has shown to provide better outcomes: transfusing at low Hb thresholds, or higher ones?

Lower

13

What is the Hb threshold for: a symptomatic pt?

10 g/dL

14

What is the Hb threshold for: preexisting CAD?

8 g/dL

15

What is the Hb threshold for: acute coronary syndromes?

8-10 g/dL

16

What is the Hb threshold for: heart failure?

8-8 g/dL

17

What is the Hb threshold for: ICU pts?

7 g/dL

18

What is the Hb threshold for: GI bleeds (stable)?

7 g/dL

19

What is the Hb threshold for: pts with non-cardiac surgery

8g/dL

20

What is the Hb threshold for: cardiac surgery

7-8 g/dL

21

What is the Hb threshold for: oncology pts in treatment?

7-8 g/dL

22

What is the Hb threshold for: the palliative care setting?

PRN for symptom management

23

What is the purpose of leuko-reducing units of blood?

Prevent fever, HLA alloimmunization, viruses

24

What is the specific virus that is concerning and a reason for performing a leukoreduction? Why?

CMV--carried in WBCs

25

True or false: Leukoreduced units are considered CMV negative

True

26

True or false: you have to specifically request leukoreduced RBC units in the US

False--virtually all RBC units in the US are leukoreduced

27

What is the purpose of irradiating pRBCs?

Prevent transfusion associated GVHD

28

What is the major indication for irradiating pRBCs?

If the pt is immunocompromised

29

What is the purpose of washing RBCs?

Remove IgA, or other allergic parts of plasma

30

What is volume reduction used for?

When circulatory overload is a concern

31

What are the indications for giving plasma?

1. Coagulation factor replacement
2. Massive tranfusions
3. TTP

32

True or false: it is rare that pts make antibodies to transfused platelets

True

33

What are the two antigens that pts make antibodies against when given platelets?

Anti-HLA
Anti-HPA

34

What is the concern with developing an immune rxn to platelets?

In future transfusions, the transfused platelets may be quickly destroyed

35

What is the treatment for refractory platelets?

1. Give random platelets units
2. Crossmatch
3. Find platelets that do not have the antigen that the antibody is directed toward

36

What is alloimmune platelet refractoriness?

Destruction of transfused platelets

37

What is non-alloimmune platelet refractoriness?

Splenomegaly/sepsis/DIC

38

What is in cryoprecipitate?

Factor VIII
Fibrinogen
vWF
Factor XIII

39

When is cryoprecipitate used?

Fibrinogen replacement in bleeding pts

vWF disease

40

What is the process to make plasma derivatives?

Plasma fractionation

41

What is prothrombin complex concentrate?

plasma concentrate that has factors
2
7
9
10

42

What fraction of the plasma concentrate does factor VIII come from?

1

43

What fraction of the plasma concentrate does IgG come from?

II and III

44

What fraction of the plasma concentrate does factor albumin come from?

V

45

When is prothrombin complex concentrate given?

To pts with hemophilia

46

When is recombinant factor VIII given?

Pts with hemophilia A

47

What is IVIG given?

Primary humoral immunodeficiencies

48

When is albumin given?

PRotein losing enteropathy
liver failure
Nephrotic syndrome

49

What is a massive transfusion?

replacement of entire RBC volume in 24 hours

REplacement of 50% of a pts total blood volume in 3 hours

50

What is the major issues with massive transfusions?

Coagulation abnormalities caused by dilution of existing platelets

51

What is the major issue with directed donation?

Riskier since the donor is more likely to be untruthful (since they want to help pt)

52

True or false: whole blood is rarely used in the US

True

53

What is the primary advantage of giving whole blood?

Has all three components of the blood

54

When is whole blood generally used?

Traumas

55

What is the first step to take if you suspect a transfusion rxn?

Stop the transfusion and keep the line open with saline

56

What is the pathophysiology of febrile transfusion reactions?

Cytokine release from leukocytes in the transfused blood

57

What is the presentation of febrile transfusion rxns?

Temp increase of >1C above 37C with no other etiology

58

How long can febrile transfusions present after transfusion?

up to 4 hours after

59

How do you prevent febrile transfusion reactions?

Leukoreductions

60

What is the pathophysiology of an allergic TR?

Preformed IgE against the RBCs that are transfused

61

What type of transfused material usually causes an allergic TR?

Plasma d/t platelets

62

What specific disease is a common cause of anaphylaxis post transfusion

IgA deficiency

63

Does pretreatment work for allergic reactions to transfusions?

No

64

What is the treatment for allergic TR?

Diphenhydramine

65

What is transfusion-associated circulatory overload?

Volume overload d/t transfusion

66

What is the most presentation of TACO?

increased BP and HR

67

What is the platelet transfusion threshold for: an active bleed?

50,000

68

What is the platelet transfusion threshold for: DIC or a CND bleed?

100,000

69

What is the platelet transfusion threshold for: neurosurgery?

100,000

70

What is the platelet transfusion threshold for: eye surgery?

less than 100,000

71

What is the platelet transfusion threshold for: major surgery (outside of eye or neurosurgery)

less than 50,000

72

What is the platelet threshold for central line placement?

less than 20,000

73

What is the platelet threshold for the prevention of spontaneous bleeding?

less than 5,000