Blood products and transfusion therapy

Question 1

In the US, ___ million units of blood are transfused annually

Answer 1

15
About 1 out of every 3 Americans will require a blood transfusion during their lifetime

Question 2

The standard blood donation involves removal of approximately ____ of blood through a large-bore IV

Answer 2

450 mL

Question 3

Additive to blood donations

Answer 3

Citrate-Phosphate-Dextrose
Solution with Adenine, used to
to help prevent the clotting of the
blood, provide energy, and ensure
longevity of the sample

Question 4

What does each part of the blood transfusion additive do?

Answer 4

● Citrate – prevents coagulation
● Phosphate – buffer maintains pH
● Dextrose – source of energy
● Adenine – enhances viability of RBCs

Question 5

To separate the whole blood donation into different blood products, there are a few steps, including two centrifuge spins:

Answer 5

Soft spin: Results in separation of Packed RBCs and Platelet-Rich Plasma
Hard spin: Results in separation of Platelet Concentrate (sensitive to cold) and Cell-Free Plasma which is frozen to form Fresh Frozen Plasma (FFP)

Question 6

Why are the WBCs removed in transfusion samples?

Answer 6

It will be spun off because they tend to cause more transfusion reactions

Question 7

Pretransfusion testing process includes

Answer 7

● Recipient and donor blood undergoes the same ABO and D typing. In addition, the patient’s serum is tested for the presence of alloantibodies other than anti-A and anti-B (MANY of them)
● Each selected donor unit is also tested against serum from the patient
● This whole process is called “Type and Crossmatch”

Question 8

Type and Screen

Answer 8

Screen recipient blood for specific antigens and their
alloantibodies in addition to ABO/Rh typing

Question 9

Type and Cross

Answer 9

■ Final safeguard
■ Blood from donor is mixed with recipients blood to ensure it is fully compatible

Question 10

Whole Blood

Answer 10

● Provides good source of RBCs, clotting factors and volume for hemorrhage
when rapid transfusion is needed
● Can be stored at 4 C for about 21- 35 days
● Donor and recipient must be compatible

Question 11

Whole blood indications

Answer 11

○ Autologous donation (for elective surgery)
○ Hemorrhage
■ Rapid correction of anemia
■ Coagulopathy
■ Major trauma

Question 12

What can be given as a Transfusion?

Answer 12

Whole Blood
Packed Red Blood Cells (PRBC)
Fresh Frozen Plasma (FFP)
Platelets (Platelet Concentrate)
Platelet Rich Plasma

Question 13

Whole Blood contraindications

Answer 13

○ Heart Failure – Potential for volume overload.
○ Whole blood should not be used when other blood products (separated blood components) are indicated, such as…
■ PRBC for anemia, FFP for coagulopathy, etc.

Question 14

Whole blood side effects

Answer 14

○ Volume overload
○ Arrhythmias
○ Heart failure
○ Hypothermia

Question 15

Packed Red Blood Cells

Answer 15

● Used to increase O2 carrying capacity
● Helps body get rid of CO2
● 1 unit of PRBCs increases Hgb by 1-1.5 g/dL and HCT by 2-3%

Question 16

Packed Red Blood Cells indications

Answer 16

○ Anemia and/or hypoxia
■ When? Hgb < 7. (If 7- 10, it’s a clinical call, if > 10, not indicated)
■ Severe Thalassemia – abnormal Hgb
■ Sickle cell anemia

Question 17

Packed Red Blood Cells contraindications

Answer 17

○ Not for use if anemia can be corrected with supplements
■ Ferrous sulfate, B12, Folate
○ An illegal use to increase O2 carrying capacity for
sports – “blood doping”

Question 18

What transfusion type is used with “blood doping?”

Answer 18

Packed Red Blood Cells

Question 19

Packed Red Blood Cells side effects

Answer 19

○ Volume overload
○ Heart failure
○ Hypothermia

Question 20

Fresh Frozen Plasma

Answer 20

Concentrated plasma without platelets or RBCs
○ Contains multiple coagulation factors and other important proteins
○ Can store at -18 C for up to 1 year

Question 21

Fresh Frozen Plasma indications

Answer 21

○ Liver disease coagulopathy
○ TTP - Plasma exchange
○ Manage bleeding in Pts that require replacement of multiple coag factors
(like in DIC)
○ Patients on Warfarin with bleeding or anticipating surgery
○ Rare specific plasma protein deficiencies
○ Occasionally after surgeries, like cardiac surgery

Question 22

Fresh Frozen Plasma contraindications

Answer 22

○ Not indicated for correcting labs (PT/ PTT) without active bleeding being present
○ Not to be used alone to reverse Warfarin if Vitamin K can be used
○ Not to be used in Protein S deficiency

Question 23

Fresh Frozen Plasma side effects

Answer 23

○ Headaches
○ Paresthesias
○ Pruritus
○ Urticaria

Question 24

Platelet Concentrate

Answer 24

● Concentration of platelets, with either 1 unit obtained from a pooling from 6 donors, or from a single donor through the process of apheresis
● Irradiated platelets are given to immunocompromised
● Stored at room temp for up to 5 days only
○ Platelets lose function when refrigerated
○ Increased risk for bacterial infection
● Platelet transfusions should be administered sparingly, only when truly indicated

Question 25

Platelet Concentrate indications

Answer 25

○ Significant Thrombocytopenia ○ Treat of active bleeding due to platelet dysfunction or absence ○ Prophylaxis in those at risk for bleeding – thrombocytopenia ○ Leukemia patients with thrombocytopenia ○ Aplastic anemia ○ ITP – autoimmune destruction of platelets

Question 26

Platelet Concentrate contraindications

Answer 26

○ Microangiopathic Hemolytic processes ■ TTP – Thrombotic thrombocytopenic purpura ■ HUS – Hemolytic uremic syndrome ○ HIT – Heparin induced thrombocytopenia ○ History of PTP- post transfusion purpura ○ Avoid in DIC as it can make conditions worse

Question 27

A rare adverse reaction where the body quickly destroys newly transfused platelets (which leads to worsening thrombocytopenia)

Answer 27

PTP - post transfusion purpura

Question 28

Platelet Rich Plasma

Answer 28

● PRP is plasma with concentrated platelets and growth factors ● These growth factor proteins are believed to promote healing of joints and soft tissue ● Blood is drawn from patient, centrifuged, and PRP removed and concentrated ● The PRP is then injected into the injured area

Question 29

Transfusion Process

Answer 29

● Informed consent must be obtained ● Check vital signs ● Type and Crossmatch ● Check expiration date of blood product ● Obtain blood samples within 30 minutes of beginning ● Compare name and ID number on label and wristband ● Double check ABO blood type and Rh compatibility

Question 30

Nurse must remain with patient for first ____ minutes to watch for signs and symptoms of transfusion reaction

Answer 30

15

Question 31

You are most likely to have transfusion reactions in first ____

Answer 31

15 minutes

Question 32

Important transfusion reactions

Answer 32

○ Acute hemolysis ○ Febrile reaction ○ Allergic reactions ○ Anaphylaxis ○ Transfusion-Associated Circulatory Overload ○ Sepsis ○ Transfusion-Related Acute Lung Injury ○ Delayed hemolytic reaction - later transfusions

Question 33

How to deal with acute hemolysis of a transfusion reaction

Answer 33

Supportive care

Question 34

How to deal with a febrile reaction with transfusion

Answer 34

APAP

Question 35

How to deal with an allergic reaction with transfusion

Answer 35

Diphenhydramine

Question 36

How to deal with an anaphylaxis with transfusion

Answer 36

Epinephrine, prepare for ACLS

Question 37

How to deal with a Transfusion-Associated Circulatory Overload with transfusion

Answer 37

Diuretics and Oxygen

Question 38

How to deal with a Sepsis with transfusion

Answer 38

IV abx, IV fluids

Question 39

How to deal with a Transfusion-Related Acute Lung Injury with transfusion

Answer 39

O2, pressors if needed

Question 40

How to deal with a Delayed hemolytic reaction with transfusion

Answer 40

IVIG with possible EPO

Question 41

Hemolytic reaction: Acute

Answer 41

■ ABO Incompatibility ■ Severity depends on how much blood is given before the transfusion is halted, particular problem in surgery ■ 1 in 70,000 units transfused ■ Fatal reaction is 1 in a million

Question 42

Hemolytic reaction: Delayed

Answer 42

■ Essentially incompatibility to a given antigen, but slower response, or within days of the transfusion ■ Alloantibodies form to other antigens and present as a problem on future transfusions. These are not as severe as ABO incompatibility

Question 43

T/F The donor blood is also screened for several blood-borne infectious disorders, so as not to transmit the disease

Answer 43

T

Question 44

What diseases are screened for in a blood transfusion?

Answer 44

HIV Hep B and C Lymphotropic viruses West nile Syphilis Chagas disease Bacteria

Question 45

Transfusions should only be given when ____

Answer 45

benefits outweigh the risk