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