Exam 7 L. 3 Flashcards Preview

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Flashcards in Exam 7 L. 3 Deck (21):
1

Indications for blood transfusion

1) temporary replacement of:
-RBC's
-platelets
-plasma proteins/factors

2

Stored whole blood

1) older than 6 hours but less than one month
2) RBCs and plasma
3) does NOT contain: viable platelets, leukocytes, or labile clotting factors (i.e. FVIII, vWF, fibrinogen)
4) indicated when patient needs multiple blood components and volume

3

Packed RBCs

1) contains cells and small amount of plasma and anticoagulant
2) indications: anemia

4

Fresh frozen plasma

1) plasma separated from whole blood and frozen within 8 hours of collection (less than 1 year old)
2) contains: coagulation factors, anti-thrombin and other anticoagulation factors, vWF, albumin, globulins
3) Indications: coagulation disorders resulting in hemorrhage, prophylaxis before surgery in animal with known clotting factor deficiency

Note: do NOT use as a source of albumin! But, plasma can be used as a COLLOID to increase osmotic pressure!

5

Frozen plasma

1) plasma is FFP that has been stored >1 year but <4 years, or plasma separated from RBCs and frozen >8 hours after blood collection
2) contains stable coagulation factors: II, VII, IX, X, albumin
-good product for rodenticide patients!
3) indications: coagulation deficiencies of the above listed factors resulting in active hemorrhage

6

Plasma components

1) fresh frozen plasma: contains all clotting factors and plasma proteins
-broken down into cryo- precipitate and supernatant
2) cryo- precipitate: vWF, F VIII, fibrinogen
3) supernatant: vitamin K-dependent factors, globulins, albumin, AT, other proteins

7

Cryo- precipitate

1) contains: factor VIII, vWF, fibrinogen
2) best product for treating hemophilia a (F VIII deficiency), vWD, and fibrinogen deficient patients

8

Cryo- supernatant

1) contains: active clotting factors (except FVIII and fibrinogen) albumin, and globulin
2) indications: treatment of hemophilia B (FIX deficiency), vitamin K deficiency, oncotic support in hypoproteinemia

9

Canine blood types

1) 5 defined blood groups
-dog erythrocyte antigen 1.1, 3, 4, 5, 7
-DEA 1.1: positive, negative, or weak positive
-DEA 3, 4, 5, 7: positive or negative

NOTE: 95% of dogs have DEA 4! (Not only DEA 4, but have at least this one present)

**DEA 1.1 IS THE MOST IMMUNOGENIC AND CLINICALLY SIGNIFICANT**
-no preformed antibodies to DEA 1.1: allows us one free transfusion in the canine! (Cats do have preformed antibodies versus the opposite RBC type)

10

Universal dog blood donor

A dog that is DEA 4 positive only!!
-Commonly greyhounds

11

Major Crossmatch

Mix washed donor RBCs with recipient plasma
-agglutination = incompatibility**

12

How much blood to transfuse?

ml of blood = blood volume x weight (kg) x ([PCV desired - PCV recipient]/PCV donor bag)

Blood volume = 90 ml/kg for dog, 60 ml/kg cat

If they aren't destroyed, the transfused RBCs will last ~3 weeks

13

How fast to transfuse blood

No pumps!
1) reactions occur in approximately 10% of pRBC transfusions
2) 1 ml/kg/hr for 15 minutes
3) if no problems, increase rate to give over 4 hours (up to 10 ml/kg/hr)
4) monitor TPR every 30 minutes and watch for nausea, vomiting, diarrhea, agitation

14

Feline blood types

1) AB system
- Type A: most common
- Type B: uncommon, more in purebred cats
- Type AB
2)**high levels of naturally occurring antibodies to foreign antigens
- Type B cats have a strong reaction to type A blood!
- Type A cats have a mild reaction to type B blood
3)**no universal cat donor**

15

Mik antigen

1) common RBC antigen
2) Mik negative cats have endogenous Mik antibodies
-can result in hemolytic reaction, even if AB compatible
-for this reason it is recommended to crossmatch ALL cats

16

Acute immune hemolytic reaction (type 2 hypersensitivity)

1) stop the transfusion!
2) begin crystalloid infusion to optimize blood pressure and maintain renal perfusion

Note: if it is a type I hypersensitivity, you may see an allergic reaction ranging from hives to severe anaphylaxis
-stop transfusion and given antihistamine (i.e. diphenhydramine)

17

Acute immune-febrile non-hemolytic reaction

1) temperature increase of more than 1 degree C associated with the transfusion
2) slow transfusion, consider stopping
-consider an antipyretic drug

18

TACO: transfusion-associated circulatory overload

1) blood products have significant oncotic pull
2) monitored closely for signs of volume overload
-retching, vomiting, tachypnea, dyspnea
3) Lasix, oxygen as needed

19

Non-immune transfusion reactions

1) TACO
2) transfusion associated sepsis
3) non-immune mediated hemolysis: improper temperature exposure, mechanical hemolysis from pumps
4)*citrate toxicity*: HYPOCALCEMIA can occur from the anticoagulant in the blood product!

20

Volume overload

Give diuretics and oxygen!

21

Urticaria, pruritus, edema after transfusion:

Give diphenhydramine and dexamethasone (antihistamine and steroid)