Intro to Blood Components and Transfuion - Mo

Question 1

What are the steps of blood component preparation

Answer 1

centrifuge and separate into red cells and platelet rich plasma

• take PRP and push it into separate bag
• hard spin which produces platelets that are separated out of the plasma

Question 2

apheresis blood componenets

Answer 2

• selective collection of individual components using specialized equipment
• blood is separated by a centrifuge and unused components are returned to the donor
• can get everything you need from one donor

Question 3

What are the components of a red cell product

Answer 3

200 - 400 mL

• 200 mL of RBC
• 30 mL of plasma
• 100 mL storage solution

Question 4

What is RBC dosing for adults?

Answer 4

1 unit

Question 5

What is RBC pediatric dosing?

Answer 5

5-15 mL/kG

Question 6

What temperature should platelets be stored at?

Answer 6

room temperature

• at higher risk for allowing bacterial growth
• extremely limited resource because not that good for that long

Question 7

What will 1 apherisis unit increase your platelet dose by?

Answer 7

30,000-60,000

Question 8

What is the platelet count target for neurosurgery

Answer 8

80-100,000

Question 9

What percent of blood is plasma?

Answer 9

55%

45% hematocrit

Question 10

What is plasma used for?

Answer 10

correct coagulopathy

• liver disease
• DIC
• warfarin reversal - replace vitamin K
• massive transfusion

Question 11

What should you be given if you need to replace a specific factor?

Answer 11

give factor concentrate

- don’t need to give plasma

Question 12

What are the indications for plasma

Answer 12

documented factor deficiency and active bleeding or about to have a procedure

Question 13

What is the best way to store plasma?

Answer 13

can be frozen

- but will expire quickly after defrosting

Question 14

What is the adult dosing for plasma

Answer 14

10-20 mL/kG to increase factor level by 20%

Question 15

What are the components of cryoprecipitate

Answer 15

• factor VIII, XIII, vWF, fibrinogen

- small volume - need to pool 6-10 units from diff adults to make one adult dose

Question 16

what are the indications for cryoprecipitate

Answer 16

hypofibrinogemia, DIC, obstetrical bleeding, massive transfusion

Question 17

How is cryoprecipitate stored

Answer 17

frozen

- need to use right away after defrosting

Question 18

What temp are RBC stored at

Answer 18

fridge

Question 19

What is the usual dose of RBC

Answer 19

1 unit

Question 20

What temp are platelets stored at

Answer 20

room temp

Question 21

What is the usual dose of platelets

Answer 21

1 apheresis

- 1-6 WBP pool

Question 22

What temp is plasma stored at

Answer 22

frozen

Question 23

What is the usual dose of plasma

Answer 23

1-4 units

Question 24

What temp is cryoprecipitate stored at

Answer 24

frozen

Question 25

What is the usual dose of cryoprecipitate

Answer 25

6-10 units in a pool

Question 26

leukoreduction

Answer 26

- filtration to remove WBC because they can contain infections

Question 27

irradiation

Answer 27

gamma or xray irradiation of cellular blood products | - prevent transfusion associated graft vs host disease in immunosuppressed patients

Question 28

washing

Answer 28

removal of plasma from cellular blood products - prevent hyperkalemia in pediatric patients - recurrent allergic reactions or igA deficiency - removal of incompatible antibodies

Question 29

volume reduction

Answer 29

- centrifuge and removal of plasma - get rid of extra volume - prevent volume overload - remove incompatible antibodies

Question 30

What antibodies do you have in your plasma if you're type A blood

Answer 30

anti-B antibody plasma

Question 31

What antibodies do you have in your plasma if you're type B blood

Answer 31

anti-A antibody plasma

Question 32

What antibodies do you have in your plasma if you're type AB blood

Answer 32

neither antibody

Question 33

What antibodies do you have in your plasma if you're type O blood

Answer 33

you don't have A or B antigen on your surface and you have both A and B antibodies

Question 34

How are the anti-ABO antibodies formed?

Answer 34

naturally occurring in the first 6 months of life

Question 35

Which group is the universal donor for RBC?

Answer 35

Group O - no antigens on the surface

Question 36

What type of red cells do group O people have to get?

Answer 36

Can only get O because they have both AB antibodies in their plasma

Question 37

Which group is the universal donor for plasma?

Answer 37

no antibodies in plasma | - AB

Question 38

What type of plasma can AB people get?

Answer 38

only from an AB person

Question 39

Which type of blood is the universal recipient

Answer 39

AB

Question 40

What can happen to Women that are Rh- and have an Rh+ fetus

Answer 40

can develop hemolytic disease of the newborn - first time women are exposed to the Rh they form antibodies - next time they are exposed the antibodies will bind and cause hemolysis

Question 41

D+ fetus inside of a D- mother

Answer 41

- she forms antibodies - fetal maternal hemmorhage - certain antibodies across the placenta can cause fetal death - hemolytic disease of newborn

Question 42

How can you avoid hemolytic disease of the newborn

Answer 42

Rhogam pre and post birth | - anti-D antibodies

Question 43

What is the most severe type of transfusion rxn

Answer 43

transfusion related acute lung injury and TACO (cardiac) - very severe - ventilator

Question 44

leukoreduction

Answer 44

decreased WBC to improve safety profile

Question 45

CMV infection

Answer 45

- stays in WBC for life - infection can be asymptomatic to tissue invasive - most donors have CMV

Question 46

how can you deal with CMV post-transfusion

Answer 46

- remove WBC to remove CMV = CMV safe - test some donors - to see if they have CMV and leukoreduction - leukoreduction and CMV negative have a similar safety profile

Question 47

What are the most common transfusion rxns

Answer 47

allergic and febrile non-hemolytic

Question 48

What are the most serious transfusion rxns

Answer 48

TRALI: acute lung injury due to neutrophil activation by donor antibodies - TACO: cardiac overload due to rapid transfusions - sepsis due to bacterial overgrowth

Question 49

What do you do for a septic rxn?

Answer 49

stop the transfusion - keep the IV line open - clerical check of product and patient - note type od product - notify and send patient tube and product to blood bank

Question 50

What are the signs and symptoms that need to be monitored for a transfusion rxn

Answer 50

vital signs, supportive treatment, anti-pyretics, anti-histamines, anti-inflammatories, send pertinent labs to assess hemolysis and bacterial contamination

Question 51

lower severity allergic rxn

Answer 51

- donor proteins cause histamine release in patient - flushing, urticaria - treat with anti-histamines - ok to re-start transfusion at slower rate if symptoms are mild

Question 52

higher severity allergic rxn

Answer 52

- hypotension, airway edema, larger rash - emergent care - anti-histamines, vasopressors, corticosteroids - can consider volume reducing platelets to reduce plasma exposure

Question 53

Which part of the transfusion leads to the allergic rxn that patients experience

Answer 53

plasma is where the proteins are found

Question 54

What causes a febrile non-hemolytic transfusion rxn

Answer 54

donor WBC that secrete cytokines - febrile - chills - N/V

Question 55

What is the treatment for a febrile non-hemolytic transfusion rxn

Answer 55

- discontinue transfusions | - if no hemolysis, can give another transfusion

Question 56

GVHD

Answer 56

graft vs host disease - due to donor lymphocytes start proliferating within the host - attack everything = everything is foreign