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Flashcards in Blood products and transfusion Deck (98):
1

Available products for transfusion (5)

Red blood cells
Platelets
Coagulation products
Cryoprecipitate
Factor concentrates

2

Available products for transfusion (5)

Red blood cells
Platelets
Coagulation products
Cryoprecipitate
Factor concentrates

3

Centrifugation separates blood in to what components

RBC and platelet rich plasma

4

What is FFP

Plasma frozen within 24 hours of collection

5

What is cryoprecipitate

High MW component of FFP is thawed at low temperature

6

When are irradiated blood products used

Immunocomporomised
Chemotherapy
First degree relative
HLA matched products
IU products

7

When is CMV negative blood required (4)

Possible transplant recipients
Neonates
Seronegative pregnant women
AIDS

8

How much is the Hb expected to rise for each unit of pRBC given

Hb rise 10 for each unit (4%)

9

At what Hb would pRBC be indicated

10

During active bleeds what Hb is desirable

>70-100

11

When should Hb be kept higher

CAD/unstable angina
Active/unpredictable bleeds
Impaired pulmonary function
Increased oxygen consumption

12

When pRBC are anticipated, what should be ordered

Group and screen
Cross match

13

What options are available for pRBC transfusion

First line- group and screen, cross match
2. Same group and Rh status
3. O- for females of reproductive age, O+ for males

14

Platelet products available and indications

Pooled random->thrombocytopenia w/ bleeding
Single donor->potential BMT recipients
HLA matched->refractory to pooled or single, presence of HLA antibodies

15

How much does PLT increase from random donor pool and single donor

>15 X 10^9 for pooled
40-60 X 10^9 for single

16

Indications for platelet transfusion at levels

500

17

relative contraindications of PLT transfusion (4)

ITP
TTP
Post-transfusion -ve PLT
HELLP

18

Indications for FFP

Depletion of multiple coag factors
Emergency reversal of life-threatening bleeding secondary to warfarin overdose.

19

Etiology of multiple depleted coagulation factors

Sepsis
DIC
Liver disease
TTP/HUS
Dilution

20

Indications for cryoprecipitate

Factor 8 deficiency
vWF deficiency
Hypofibrinogenemia

21

Causes of immune acute blood transfusion reaction

Acute hemolytic transfusion reaction
Febrile non hemolytic transfusion reactions
Allergic nonhemolytic transfusion
Transfusion related acute lung injury

22

Causes of acute blood transfusion reaction

Acute hemolytic transfusion reaction
Febrile non hemolytic transfusion reactions
Allergic nonhemolytic transfusion
Transfusion related acute lung injury

23

DDX of post-transfusion dyspnea

Circulatory overload
TRALI
Allergy->bronchospasm, anaphylaxis

24

DDX of post-transfusion dyspnea

Circulatory overload
TRALI
Allergy->bronchospasm, anaphylaxis

25

Centrifugation separates blood in to what components

RBC and platelet rich plasma

26

What is FFP

Plasma frozen within 24 hours of collection

27

What is cryoprecipitate

High MW component of FFP is thawed at low temperature

28

When are irradiated blood products used

Immunocomporomised
Chemotherapy
First degree relative
HLA matched products
IU products

29

When is CMV negative blood required (4)

Possible transplant recipients
Neonates
Seronegative pregnant women
AIDS

30

How much is the Hb expected to rise for each unit of pRBC given

Hb rise 10 for each unit (4%)

31

At what Hb would pRBC be indicated

32

During active bleeds what Hb is desirable

>70-100

33

When should Hb be kept higher

CAD/unstable angina
Active/unpredictable bleeds
Impaired pulmonary function
Increased oxygen consumption

34

When pRBC are anticipated, what should be ordered

Group and screen
Cross match

35

Management of FNHTR

Stop transfusion
If 38 T, stop, paracetamol and anti-histamine

36

Platelet products available and indications

Pooled random->thrombocytopenia w/ bleeding
Single donor->potential BMT recipients
HLA matched->refractory to pooled or single, presence of HLA antibodies

37

How much does PLT increase from random donor pool and single donor

>15 X 10^9 for pooled
40-60 X 10^9 for single

38

Indications for platelet transfusion at levels

500

39

relative contraindications of PLT transfusion (4)

ITP
TTP
Post-transfusion -ve PLT
HELLP

40

Indications for FFP

Depletion of multiple coag factors
Emergency reversal of life-threatening bleeding secondary to warfarin overdose.

41

Etiology of multiple depleted coagulation factors

Sepsis
DIC
Liver disease
TTP/HUS
Dilution

42

Indications for cryoprecipitate

Factor 8 deficiency
vWF deficiency
Hypofibrinogenemia

43

How to categorise transfusion reactions

Acute vs Delayed
Immune vs non immune

44

Causes of acute blood transfusion reaction

Acute hemolytic transfusion reaction
Febrile non hemolytic transfusion reactions
Allergic nonhemolytic transfusion
Transfusion related acute lung injury

45

DDX of post-transfusion fever

AHTR
FNHTR
Bacterial contamination
Allergy

46

DDX of post-transfusion dyspnea

Circulatory overload
TRALI
Allergy->bronchospasm, anaphylaxis

47

Management of TRALI

Supportive->02, fluid if required

48

What is AHTR

Hemolysis due to ABO incompatability

49

Most common cause of AHTR

Patient misidentification

50

Onset of AHTR

Immediately

51

How does AHTR present

Fever, chills, hypotension, flank/back pain, dyspnea, haemaglobinuria

52

Severe complications of AHTR

Acute renal failure
DIC

53

Management of AHTR

Stop transfusion and notify
Maintain BP, urine output->IV fluids, catheter, ionotropes, diuretics

54

What is febrile non-hemolytic transfusion reactions

Due to alloautoantibodies against WBC, platelets, other antigens->cause cytokine release

55

Onset of FNHTR

1-6 hours after transfusion

56

Risk of minor and severe FNHTR

Minor 1 in 100
Major 1 in 10 000

57

How does the patient with FNHTR present

Fever, rigors, myalgia, hypotension

58

Management of FNHTR

Stop transfusion
If 38 T, stop, paracetamol and anti-histamine

59

What is allergic nonhemolytic transfusion reactions

IgE against plasma antigens which cause activation of mast cells and release of histamine

60

ANTR more common in which type of patients (2)

History of multiple transfusions and multiparity

61

Risk of ANTR

1 in 100

62

How does ANTR usually present and more seriously

Urticaria and pruritis
Angioedema
Bronchospasm
Hypotension

63

Management of ANTR if mild and moderate-severe

Mild- slow transfusion rate, give diphenyhydramine
Moderate-severe- stop transfusion, give IV diphenyhydramine, steroids, epinephrine, IV fluids, bronchodilators

64

What is TRALI

Acute lung injury during/shortly after transfusion

65

When does TRALI occur

During, within 6 hours of transfusion

66

What are the important features in TRALI (5)

Profound hypoxemia
Pulmonary insuffienciecy
Bilateral pulmonary infiltrates on CXR
Capillary wedge pressure not +
No evidence of atrial hyperplasia

67

What is pathogenesis of TRALI

Donor antibodies activatio WCC of recipient->+permeability and fluid shift

68

When does TRALI resolve

Usually within 24-72 hours

69

Risk of TRALI

1 in 10 000

70

Management of TRALI

Supportive->02, fluid if required

71

How can TGVHD be prevented

Giving irradiated products- eliminates lymphocytes

72

Risk of bacterial infection

1 in 100 000 for RBC
1 in 10 000 for platelets

73

management of bacterial infection

Stop transfusion
Antibiotics
Fluids
Contact blood bank
Blood cultures

74

What are the contributing factors to TACO

Poor cardiac function
Overload

75

Incidence of TACO

1 in 700

76

Clinical presentation of TACO

Breathless, orthopnea, PND, edema, crackles

77

Management of TACO

Transfuse at lower rate
Oxygen
Sit up
Diuretics

78

What causes hyperkalemia in transfusion reactions

Hemolysis of RBC

79

Occurence of hyperkalemia in massively transfused patients

5%

80

When can citrate toxicity occur

In people with +transfusion and poor liver function as not excreted

81

Management of citrate toxicity

Calcium gluconate

82

When does dilutional coagulopathy occur

Transfusion >10 units

83

Why does dilutional coagulopathy occur

RBCs do not contain coagulation factors, fibrinogen, platelets

84

Management of dilutional coagulopathy

FFR, platelets, cryoprecipitate

85

Types of delayed immune transfusion reactions

Delayed hemolytic TR

86

What is delayed hemolytic

Antibodies against minor antigens, at transfusion not enough to cause reaction, as time progresses level increase

87

Pathogenesis of delayed hemolytic

At transfusion antibodies level not increased enough, but after 5-7 days levels high enough

88

When does delayed hemolytic occur

5-7 days following transfusion

89

How does delayed hemolytic reaction present

Anemia
Jaundice

90

Management of delayed hemolytic

Nothing
Monitor Hb levels
Note reaction for future trasfusions

91

What is transfusion GVHD

T lymphocytes from donor attack recipient

92

When does TGVHD occur

4-30 days post transfusion

93

How does TGVHD present

Fever
Diarrhea
Liver function abnormalities
Pancytopenia

94

How can TGVHD be prevented

Giving irradiated products- eliminates lymphocytes

95

Causes of delayed non-immune transfusion reaction

Iron overload
Viral infection

96

How does iron overload in TR occur

Multiple, repeated transfusions over long period of time

97

What is a complication of repeated, long term transfusion

Secondary hemochromatosis

98

Management of iron overload with transfusion

Iron chelators
Phlebotomy