Lecture 9: Blood Component Therapy

Question 1

When is whole blood used?

Answer 1

actively bleeding patients
lost at least 25% of their blood volume
patients requiring exchange transfusion

Question 2

What happens when whole blood is run out?

Answer 2

reconstituted whole blood may be used
(RBCs mixed with thawed type AB FFP from a different donor)

Question 3

When are RBCs used?

Answer 3

oncology patients undergoing chemotherapy or radiation therapy
trauma patients
surgery patients
dialysis patients
premature infants
patients with sickle cell anemia

Question 4

How does RBC transfusion affect the patient?

Answer 4

increases the patient’s hemoglobin approximately 1 g/dl and the hematocrit by 3 %

Question 5

When are Leukocyte-Reduced RBCs used?

Answer 5

chronically transfused patients
patients having known febrile transfusion reactions

Question 6

When is Leukoreduction (filtration) done?

Answer 6

72 hours from collection time

Question 7

AABB Standards for Leukocyte-Reduced RBCs

Answer 7

85% of RBCs must remain
leukocytes must be reduced to less than 5x106 WBC/unit

Question 8

What is added to Frozen RBCs

Answer 8

frozen by adding glycerol to prevent cell hydration and the formation of ice crystals that can cause cell lysis

Question 9

What is done for frozen RBCs to be used?

Answer 9

Thawed
Glycerol Removed by washing the RBCs with a series of saline solutions
Must be used within 24 hours

Question 10

What are washed RBCs used for?

Answer 10

Used for patients who have a reaction to plasma proteins
Used in infant or intrauterine transfusions

Question 11

For washed RBCs, how much RBCs are lost?

Answer 11

10-20%

Question 12

What are Irradiated RBCs used for?

Answer 12

prevents T cells proliferation using gamma radiation

Question 13

What do T cells cause

Answer 13

caused graft-versus-host disease, with 90% of cases being fatal

Question 14

What are platelets used for?

Answer 14

Use to control or prevent bleeding

Question 15

When is the need for platelets indicated?

Answer 15

Indicated in patients with chemotherapy
post-bone marrow transplant patients
patients experiencing postoperative bleeding

Question 16

Platelet concentrates

Answer 16

Contain approximately 5.5 x 1010 platelets/unit

Question 17

Pooled platelets

Answer 17

choose one platelet bag of those to be pooled and empty content of other bags into it

Question 18

What is the usual platelet order?

Answer 18

6-10 units

Question 19

Plateletpheresis

Answer 19

HLA matched patients who receive numerous platelet transfusions can develop antibodies to the class I

Question 20

What happens when HLA antigens are not matched?

Answer 20

platelets will not last for 5 days in the patient’s circulation

Question 21

Purpose of FFP?

Answer 21

replace coagulation factors in the patient

Question 22

When is the need for FFP indicated?

Answer 22

Bleeding patients who require factors II, V, VII, IX, and X
Abnormal coagulation due to massive transfusion
DIC when fibrinogen is > 100 mg/dL
Antithrombin III deficiencies
Patients on anticoagulants who are bleeding or require surgery

Question 23

Thawing process for FFP

Answer 23

in water bath at 30-37oC for 30-45 minutes in watertight container
agitators are preferred because the unit thaws faster

Question 24

Cryoprecipitated Antihemophilic Factor

Answer 24

It contains factor VIII, fibrinogen, Factor XIII, and von Willebrand factor

Question 25

When is Cryoprecipitated Antihemophilic Factor used?

Answer 25

with factor XIII deficiency as a fibrin sealant

Question 26

Pooled cryoprecipitate

Answer 26

pooled into one bag before transfusion thawed in a similar fashion to FFP before pooling

Question 27

Fibrin glue

Answer 27

1-2 units of cryoprecipitate are mixed with thrombin and applied topically to the bleeding area

Question 28

Granulocyte transfusions are considered?

Answer 28

rare and limited to septic infants

Question 29

What is in a pheresis bag for Granulocyte Pheresis?

Answer 29

> 1.0 x 1010 granulocytes, platelets, and 20-50 ml of RBCs

Question 30

How long does it take for cells to deteriorate in Granulocyte Pheresis?

Answer 30

2 hours

Question 31

Labeling Current labeling requirements include

Answer 31

proper name unique number amount of blood collected amount and type of anticoagulant volume of component expiration date storage temperature ABO/D type reference to the “Circular of Information for the Use of Human Blood and Blood Components,” warning regarding infectious agents prescription requirements donor classification FDA license number if applicable

Question 32

What are some additional labels that are needed?

Answer 32

Irradiated components- with facility name Autologous unit Circular of Information for the Ue of Human Blood and Blood Components” Pooled components: labels

Question 33

Emergency Transfusions

Answer 33

Rapid loss of blood can result in hemorrhagic shock

Question 34

Rapid blood loss symptoms

Answer 34

Hypotension, tachycardia, pallor, cyanosis, cold clammy skin, oliguria, decreased hematocrit, decreased (CVP), CNS depression, and metabolic shock

Question 35

What is are the priority of acute blood loss?

Answer 35

Replace and maintain blood volume Make sure oxygen carrying capacity is adequate Maintain coagulation system integrity Correct metabolic colloid osmotic pressure

Question 36

Massive transfusion

Answer 36

Replacement if a person’s entire blood volume (approximately 10 units) within 24 hours)

Question 37

If time is not available to type the patient

Answer 37

type O, D negative blood is transfused into women of childbearing age Type O, D positive blood is transfused into me

Question 38

What is one main difference with transfusing infants vs adults?

Answer 38

Smaller blood volume Transfusions are given in small volumes in multiple packs

Question 39

Premature infants need transfusion to do what?

Answer 39

offset the effect of hemoglobin F in their system Since HbF doesn't give up O2 easily

Question 40

Iatrogenic blood loss

Answer 40

blood taken from the neonate or infant for laboratory tests cause the neonate or infant to develop an anemia that may be severe enough to transfuse

Question 41

Why use warmer bloods on infants?

Answer 41

Neonates and infants do not tolerate hypothermia liver’s inability to metabolite citrate anticoagulants and potassium

Question 42

Liver transplant patients require large amounts of blood products because?

Answer 42

the liver produced many coagulation factors and cholesterol for RBC membranes

Question 43

What type of transplants need ABO compatibility?

Answer 43

kidney, liver, and heart transplants

Question 44

Progenitor cell transplants

Answer 44

Derived from bone marrow or umbilical cord blood

Question 45

Wiskott–Aldrich syndrome (WAS

Answer 45

rare X-linked recessive disease

Question 46

Wiskott–Aldrich syndrome (WAS) symtpoms

Answer 46

Eczema thrombocytopenia (low platelet count) immune deficiency bloody diarrhea

Question 47

Fanconi Anemia

Answer 47

the result of a genetic defect in a cluster of proteins responsible for DNA repair

Question 48

Fanconi Anemia symptoms

Answer 48

acute myelogenous leukemia (Most common) Bone marrow failure- about 90% 60-75% have congenital defects 75% have some form of endocrine problem

Question 49

Therapeutic Hemapheresis

Answer 49

Replacement of blood from a patient to improve a patient’s health

Question 50

Oncology

Answer 50

Chemotherapy drugs kill all cells that are undergoing mitosis

Question 51

Action of chemotherapist drugs

Answer 51

Stopping DNA replication Interfering with mRNA production

Question 52

Sickle Cell Anemia

Answer 52

abnormal hemoglobin (e.g., Hgb S) causes cells to be removed from circulation, resulting in a lowered hematocrit

Question 53

Thalassemia

Answer 53

Decreased synthesis of the alpha and beta globin chains Hemolytic anemia results Transfusion support necessary

Question 54

Aplastic Anemia

Answer 54

Blood transfusion support is usually needed until bone marrow transplant can occur