- Fresh Whole blood (<24hrs) - PRBC - filtered RBC - frozen RBC - irradiated RBC - platelets - FFP - Cryoprecipate

Lecture 5 - tranfusion Flashcards by john Thompson

Why are RBC transfusions given?

To raise H/H levels

anemia pts
replace after bleeding

Simple answer: to increase OT carrying capacity

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Give a transfusion if?

Hb is <7g/dL
Or
Significant hemorrhage

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Transfusion reaction?

STOP the transfusion

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Blood products list?

Fresh Whole blood (<24hrs)
PRBC
filtered RBC
frozen RBC
irradiated RBC
platelets
FFP
Cryoprecipate

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What makes fresh whole blood better?

Nothing really, we can get all the components seperately

We do use them a lot when we anticipate a lot of blood loss

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MC use for PRBC?

To raise HCT

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Volume of PRBC?

Approx 300mL

- (200mL of RBC)

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PRBC expect what lab changes per unit?

HCT: 3-4%
Hb: 1g/dL increase

(Test Q)

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What are CMV neg leukocyte-reduced filtered RBCs?

Aka “leukocyte-poor”

They have the donor WBC’s filtered out

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Why give CMV neg filtered RBCs?

Reduces risk of febrile nonhemolytic reaction

Prevents CMV transmission

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Who gets CMV neg RBC’s?

previous transfusion reaction
cardiovascular surgery
potential transplant
chronically transfused pt
hx of sever leukoagglutinization reaction to PRBC

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How long can frozen RBC’s keep?

Up to 10 yrs

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Who gets irritated RBCs?

Immunocompromsied pts at risk for transfusion-associated graft vs host disease
(TA-GVHD)

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Will leukoreduced blood products prevent TA-GVHD?

Nope

They need irradiated RBCs

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5types of lympohcytes?

B Cells
T Cells
NK Cells

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Autologous PRBC?

Pts own blood given back to them

- good for elective surgeries

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Only way to completely (almost) eliminate infection with blood products

Autologous blood

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1 unit of apheresis platelets =?

“6 pack”

- 6 units of whole blood derived platelets

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apheresis definition?

Fancy medical speak for:

Selective collection of specific component of blood and return of the remainder of circulation

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What will one 6 pack provide?

Increase platelet count by 5,000 to 10,000 in 1 hr

Lasts 2-3 days

If you dont see the rise it is “refractoriness”

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Causes for refractoriness to platelets

Common

fever
sepsis
bleeding
splenomegaly
alloimmunization
ABO mismatch

Less common
- hematopoietic cell transplant
—> autolgous or allogenic
- disseminated intravascular coagulation

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What is FFP used for?

It contains all coagulation factors

Used to replace depleted coag factors in pts with active bleeding or high-risk for bleeding

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Volume of FFP

200-250mL

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What is cryoprecipate?

Three seperate remains from thawing FFP?

Contains

factor VII
factor VIII
vWF
fibrinogen
fibronectin

Can be refrozen

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When do you give cryoprecipate?

When the pt needs only clotting factors

What is done w a type and screen?

ABO and RH type of pt Antibody screen of pts serum

If the recipients antibody screen is neg?

No further type and screening is needed

Type and cross?

Matches the pt serum with donors RBC 45-60 min Used to avoid hemolytic transfusion reactions

Universal recipient?

AB pos

Universal donor?

O neg

Compatibility explanation?

Slide 27

Types of transfusion complications?

Non hemolytic Hemolytic Blood product contamination Transfusion-associated infection

Non-hemolytic complications?

Febrile non-hemolytic transfusion reaction

Hemolytic transfusion complications?

Acute and Delayed hemolytic transfusion reaction

Leukoagglutination reaction is aka?

Febrile, non-hemolytic transfusion reaction

MC transfusion reactions are?

Not hemolytic

What causes febrile, non-hemolytic transfusion reaction?

Small amount of transfused donor WBC found in PRBC that gets to pts with prior sensitization

MC leukoagglutination reaction?

Mild fever and chills w/in 12 hrs of transfusion

Sever leukoagglutination reaction?

Dypsnea and cough Pulmonary infiltrates 1% of all PRBC transfusions (MC)

Tx for leukoagglutination reaction?

Diphenhydramine Tylenol Corticosteroids

When does acute hemolytic transfusion reaction (AHTR) occur?

With mismatched ABO/Rh blood is give -> massive intravascualr hemolysis

MC reason for AHTR reaction?

Clerical error

Severity of AHTR is dependent on?

Amount transfused | - usually its surgery pts that get it

Classic signs fo AHTR

``` Fever Rigors HOTN Subjective pain at infusion site HA Back pain ``` Not seen in pts under gen anesthesia

Severe AHTR symptoms?

``` Acute renal failure - acute tubular necrosis Circulatory shock DIC Death ```

Delayed hemolytic transfusion reaction occurs?

5-10 days later

Why is delayed hemolytic transfusion reaction delayed?

Less antigen-antibody burden (recipient has low alloantibody levels) - results in less of a hemolytic response that may not occur for up to several days after the transfusion “amnestic response”

Where does hemolysis occur with the DHTR?

Extravascularly (in spleen)

How common is delayed hemolytic transfusion reaction ?

1 in 260,000 transfusions | - greater incidence in high-risk groups (SCD, rare blood types etc)

Blood product contamination is usually?

Gram neg organisms - yersinia enterocolitica MC

How common is contamination?

1 of ever 2000 - 5000 platelet donations (cannot be refrigerated so its worse)

Reaction to gram neg contamination?

Septic shock Acute DIC Acute kidney injury - transfused endotoxin Usually fatal

Gram pos contamination leads to?

Fever/bacteremia Rarely proceeds to sepsis

Common viral contamination for blood products?

Hep B Hep C HTLF (human T-lymphotrypic virus) HIV

Viral transmission is common?

Not really Hep B - 1 in 290,000 The rest are 1 in 2 million ish

TRALI’?

Transfusion associated lung injury Noncardiogenic pulmonary edema after blood product transfusion without other explanation

What happens with TRALI?

allogenic antibodies in donor plasma component that bind to recipient leukocyte antigen

Who usually gets TRALI?

Surgical and critically ill pts

Warning signs for TRALI?

Hypoxemia and Pulmonary edema followed by ARDS w/in hrs of transfusion

What is considered a “massive” transfusion?

50% of pts blood volume in 12-24hrs Approx 10 units of PRBC in 24hrs

What type of complications come from massive transfusion?

- Coagulopathy - Dilution thrombocytopenia - Metabolic acidosis - Hypocalcemia - Hypothermia - Hyperkalemia

Massive transfusion recommendation?

Strive for 1:1:1 FFP: PRBC:Platelets Mortality = 20% If FFP:PRBC ratio of 1:4 or less mortality = 65%

Chronic anemia and transfusions?

Last resort

When giving PRBC you can expect what lab changes?

HCT increase 3-4% Hb increase 1g/dL 300mL impact on blood volume

Yo mama so dumb

She studied for the blood test

Lecture 5 - tranfusion Flashcards

(65 cards)