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Flashcards in Blood transfusions wk7th10 Deck (15):
1

ABO blood groups

- ABH proteins mostly ocated on transport proteins of red blood cell membrane

- antigens differ with respect to one terminal sugar

- O: lack both A and B terminal sugars "H antigen"

- O: non-functioning enzyme

2

ABO blood type

erythrocytes

plasma

compatible RBCs

compatible plasma

A image thumb
3

Orderable transfusion tests

1. type and screen

- RBC need possible but too low to justify setting aside crossmatched unit

- Blood type (ABO-rh) and antibody screan (IAT) performed

2. Type and crossmatch

- RBC need likely of definite

- Requested # of RBCs crossmatched and reserved

4

Indication for transfusion of RBCs

restore O2 carrying capacity in symptomatic anemia 

symptomatic anemia:

- exertional dysphnea

- dyspnea at rest

- fatigue

- hyperdynamic state (bounding pulses, palpitations, roaring in ears"

more severe:

- lathargy and confusion

- congestive failure, angina, arrhythmia, MI

5

Transfusion triggers

high risk patients

- acuteMI, unstable angina, HgB<10

low risk

- young adults with out co-morbid illnesses

- consider transfusing when Hb falls below 7

6

Acute hemolytic transfusion reactions

Occurs with minutes to hrs after transfusion

- intravascular

- extravascular

Signs and symtoms

- chills

- fever

- hemoglobinuria

- hypotension

- renal failure with oliguria

- DIC (oozing from IV sites)

- back pain

- pain at infusion site

- anxiety

7

Acute hemolytic transfusion reactions

- managment

- maintain urine output

- analgesics

- pressors for hypotension

- hemostatic components for bleeding/coagulopathy

- follow-up labs

8

Hemolytics disase of fetus/newborn

- immune- mediated hemolytic disease caused by blood-type incompatibility between mother and child

- Maternal igG antibodies can cross placenta and coat fetl RBCs-> hemolysis

- Tx- transfuse group O and D negative blood- goal is to suppress fetal RBC production

9

Platelets products

1 PP (platelets phresis) should raise count by 30K

shelf life- 5 days, 4 hours if pooled

 

PP= single donor, majority plasma

Platelet concentrates (PCs)=pooled

10

Allergic transfusion reactions

Antibody (igE) to donor plasma proteins

signs and symptoms

- urticaria

- pruritis

- flushing

Therapeutic/prophylactic approach

- antihistamine

- many restart transfusion

11

Febrile non-hemolytic transfusion reaction

etiology:

signs and symptoms:

Tx:

etiology

- antibody to donor WBCs

- accumulated biologic response midifier (proinflammatory cytokines)

signs and symtoms:

- fever (increase 1 degree C)

- chills//rigors

- headache

- may have changes in BP and HR, dyspnea, nausea or vomiting

Tx:

- antipyretic premedication

- leukocyte reduced blood products

12

Transfusion- related acute lung injury

(TRALI)

mech

signs and symptoms

consequences

tx

lab testing

Transfusion reaction most frequently associated with transfusion related death

Mech:

- leakage of fluid into alveolar space due to diffuse alveolar capillary damage

signs and symptoms

- acute respiratory distress--severe bilateral pulmonary edema, severe hypoxia

- tachycardia

- fever

- hypotension/hypertension

- cyanosis

consequences

- mild to mod= lung injury and prolonged ventilator time, predispose to pulm infection

- severe= fatal

TX:

- supportive care

- provision of high-volume plasma products from low-risk donors

LAb testing:

- WBC antibody (HLA, granulocyte) screen in donor and recipient

 

13

Transfusion associated circulatory overload (TACO)

mech:

- volume overload temporally associated with transfusion

signs and symptoms:

- shortness of breath

- increased resp rate

- hypoxemia

- cough

- tachycardia

- elevted SBP

- jugular venous distension

- headache

TX:

- upright posture

- O2

- IV diuretic

- Transfuse split units

14

Transfusion of fresh frozen plasma

indications

contraindications

indications:

- correction of clotting factor deficiencies where concentrates not available or when multiple clotting deficiencies are present (ex. liver disease, coumadin reversal, DIC)

Therapy guided by coah studies (PT, PTT)

Contraindications:

- patients with igA anitbodies or selective igA deficiency

- volume expansion

15

Adverse effects of transfusion

- RBC

- WBC

- Plasma

RBC

- acute hemolytic

- delayed hemolytic

WBC

- febrile non-hemolytic

- graft vs. host disease

plasma

allergic

transfusion associated circulatory overload

transfusion related acute lung injury

infectious

- septic/bacterial

- viral and parasitic