Blood Component Therapy

Question 1

What are the two methods to get blood?

Answer 1

Donations

Apheresis

Question 2

What is apheresis?

Answer 2

Drawing off plasma from RBCs

Question 3

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

Answer 3

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

Question 4

pRBC are used for what?

Answer 4

Transfusions for Hb, or replaced after acute bleeding

Question 5

What happens to potassium are pRBCs are stored

Answer 5

Increased

Question 6

What happens to RBC deformability are pRBCs are stored

Answer 6

Decreased

Question 7

What happens to 2,3 BPG are pRBCs are stored

Answer 7

Decreased

Question 8

What happens to ATP are pRBCs are stored

Answer 8

Decreased

Question 9

What happens to glutathione are pRBCs are stored

Answer 9

Decreased

Question 10

What happens to NO levels are pRBCs are stored

Answer 10

Decreases

Question 11

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

Answer 11

No

Question 12

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

Answer 12

Lower

Question 13

What is the Hb threshold for: a symptomatic pt?

Answer 13

10 g/dL

Question 14

What is the Hb threshold for: preexisting CAD?

Answer 14

8 g/dL

Question 15

What is the Hb threshold for: acute coronary syndromes?

Answer 15

8-10 g/dL

Question 16

What is the Hb threshold for: heart failure?

Answer 16

8-8 g/dL

Question 17

What is the Hb threshold for: ICU pts?

Answer 17

7 g/dL

Question 18

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

Answer 18

7 g/dL

Question 19

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

Answer 19

8g/dL

Question 20

What is the Hb threshold for: cardiac surgery

Answer 20

7-8 g/dL

Question 21

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

Answer 21

7-8 g/dL

Question 22

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

Answer 22

PRN for symptom management

Question 23

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

Answer 23

Prevent fever, HLA alloimmunization, viruses

Question 24

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

Answer 24

CMV–carried in WBCs

Question 25

True or false: Leukoreduced units are considered CMV negative

Answer 25

True

Question 26

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

Answer 26

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

Question 27

What is the purpose of irradiating pRBCs?

Answer 27

Prevent transfusion associated GVHD

Question 28

What is the major indication for irradiating pRBCs?

Answer 28

If the pt is immunocompromised

Question 29

What is the purpose of washing RBCs?

Answer 29

Remove IgA, or other allergic parts of plasma

Question 30

What is volume reduction used for?

Answer 30

When circulatory overload is a concern

Question 31

What are the indications for giving plasma?

Answer 31

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

Question 32

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

Answer 32

True

Question 33

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

Answer 33

Anti-HLA | Anti-HPA

Question 34

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

Answer 34

In future transfusions, the transfused platelets may be quickly destroyed

Question 35

What is the treatment for refractory platelets?

Answer 35

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

Question 36

What is alloimmune platelet refractoriness?

Answer 36

Destruction of transfused platelets

Question 37

What is non-alloimmune platelet refractoriness?

Answer 37

Splenomegaly/sepsis/DIC

Question 38

What is in cryoprecipitate?

Answer 38

Factor VIII Fibrinogen vWF Factor XIII

Question 39

When is cryoprecipitate used?

Answer 39

Fibrinogen replacement in bleeding pts vWF disease

Question 40

What is the process to make plasma derivatives?

Answer 40

Plasma fractionation

Question 41

What is prothrombin complex concentrate?

Answer 41

``` plasma concentrate that has factors 2 7 9 10 ```

Question 42

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

Answer 42

1

Question 43

What fraction of the plasma concentrate does IgG come from?

Answer 43

II and III

Question 44

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

Answer 44

V

Question 45

When is prothrombin complex concentrate given?

Answer 45

To pts with hemophilia

Question 46

When is recombinant factor VIII given?

Answer 46

Pts with hemophilia A

Question 47

What is IVIG given?

Answer 47

Primary humoral immunodeficiencies

Question 48

When is albumin given?

Answer 48

PRotein losing enteropathy liver failure Nephrotic syndrome

Question 49

What is a massive transfusion?

Answer 49

replacement of entire RBC volume in 24 hours REplacement of 50% of a pts total blood volume in 3 hours

Question 50

What is the major issues with massive transfusions?

Answer 50

Coagulation abnormalities caused by dilution of existing platelets

Question 51

What is the major issue with directed donation?

Answer 51

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

Question 52

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

Answer 52

True

Question 53

What is the primary advantage of giving whole blood?

Answer 53

Has all three components of the blood

Question 54

When is whole blood generally used?

Answer 54

Traumas

Question 55

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

Answer 55

Stop the transfusion and keep the line open with saline

Question 56

What is the pathophysiology of febrile transfusion reactions?

Answer 56

Cytokine release from leukocytes in the transfused blood

Question 57

What is the presentation of febrile transfusion rxns?

Answer 57

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

Question 58

How long can febrile transfusions present after transfusion?

Answer 58

up to 4 hours after

Question 59

How do you prevent febrile transfusion reactions?

Answer 59

Leukoreductions

Question 60

What is the pathophysiology of an allergic TR?

Answer 60

Preformed IgE against the RBCs that are transfused

Question 61

What type of transfused material usually causes an allergic TR?

Answer 61

Plasma d/t platelets

Question 62

What specific disease is a common cause of anaphylaxis post transfusion

Answer 62

IgA deficiency

Question 63

Does pretreatment work for allergic reactions to transfusions?

Answer 63

No

Question 64

What is the treatment for allergic TR?

Answer 64

Diphenhydramine

Question 65

What is transfusion-associated circulatory overload?

Answer 65

Volume overload d/t transfusion

Question 66

What is the most presentation of TACO?

Answer 66

increased BP and HR

Question 67

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

Answer 67

50,000

Question 68

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

Answer 68

100,000

Question 69

What is the platelet transfusion threshold for: neurosurgery?

Answer 69

100,000

Question 70

What is the platelet transfusion threshold for: eye surgery?

Answer 70

less than 100,000

Question 71

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

Answer 71

less than 50,000

Question 72

What is the platelet threshold for central line placement?

Answer 72

less than 20,000

Question 73

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

Answer 73

less than 5,000