Rapid Review Transfusion

Question 1

what is typing and how long does it take

Answer 1

determines presence of ABO and Rh-D antigens

takes 5 min

Question 2

what is screening and how long does it take?

Answer 2

determines presence of most clincally significant antibodies

takes 45min

Question 3

what is cross matching and how long does it take?

Answer 3

mix recipiants plasma with actual uni to be transfused

takes 45min

Question 4

order to transfuse blood in an emergency

Answer 4

1. type-specific partially crossmatched
2. type-specific uncrossmatched
3. O negative uncrossmatched

Question 5

how much does cryo increase fibrinogen level?

Answer 5

5 bag pool will increase it 50mg/dL

Question 6

what is in cryo

Answer 6

fibrinogen
factor 8
factor 13
vWF

Question 7

indications for cryo

Answer 7

hypofibrinogenemia
von willebrand dz
hemophilia

Question 8

should you use filter or warmer with plateletes?

Answer 8

no filter and no warmer

Question 9

what is in FFP

Answer 9

all coagulation factors
fibrinogen
plasma proteins

Question 10

FFP indications

Answer 10

PT/PTT > 1.5x control
acute warfarin reversal
anti-thrombin deficency
massive transfusion
DIC
C1 esterase deficiency

Question 11

what guides tranfusion decision when Hgb is between 6 and 10?

Answer 11

patients phyiologic response to anemia

Question 12

what is the purpose of phosphate in PRBCs

Answer 12

serves as a buffer

Question 13

I unit of PRBCs volume and Hct?

Answer 13

300ml and 70% Hct

Question 14

1u prbc will raise Hgb and Hct how much?

Answer 14

^ Hgb 1g/dL
^ Hct 2-3%

Question 15

what does leukoreduction do?

Answer 15

removes WBCs from PRBCs and Platelets

Question 16

leukoreduction decreases the risk of what?

Answer 16

HLA sensitization
febrile non-hemolytic reactions
CMV transmission

Question 17

what does washing do?

Answer 17

removes any remainig plasma from PRBCs

prevents anaphylaxis in IgA deficient patients.

Question 18

what does irradiation do? why do we use it clinically?

Answer 18

destroys donor leukocytes.
decreaes risk of graft-vs-host disease in immunocompromised patients

Question 19

what is most common infectious complication of tranfussion?

Answer 19

CMV

Question 20

immunocompromised patients should recive what kind of blood? why?

Answer 20

leukoreduced to decrase risk of CMV transmission

Question 21

what causes hemolytic reaction? what kind is the most severe?

Answer 21

from incompatible blood products

ABO incompatability is the most lethal

Question 22

complications of hemolytic reaction

Answer 22

flushing, acute tubular necrosis, DIC, hemodynamic instability

Question 23

s/s of hemolytic reaction

Answer 23

hemoglobinuria, HotN, fever, chills, flushing

Question 24

hemolytic reaction treatment

Answer 24

stop transfussion
promote renal blood flow (fluids)
alalinize the urine (bicarb)

Question 25

febrile non-hemolytic reactions s/s

Answer 25

fever, chills, headache, nausea, malaise

Question 26

febrile non-hemolytic reaction treatment

Answer 26

supportive care and tylenol

Question 27

what is the most common adverse reaction associated with tranfusions?

Answer 27

febrile non-hemolytic reactions

Question 28

s/s of allergic reaction. are they severe?

Answer 28

rarely severe s/s urticaria and facial swelling

Question 29

tx for allergic reactions

Answer 29

antihistamines and supportive care

Question 30

what causes TRALI?

Answer 30

HLA and neutrophil antibodies in donor plasma

Question 31

donors that incrase risk of TRAl?

Answer 31

multiparous women, hx of blood tranfusions, hx organ transplant

Question 32

why do some donors increase risk of TRALI?

Answer 32

they have more antibodies

Question 33

recipients at greater risk of TRALI

Answer 33

critical illness, sepsis, burns, post CPB

Question 34

what blood products have the highest risk of TRALI?

Answer 34

FFP and Platelets

Question 35

s/s of TRALI

Answer 35

symptom onset within 6hrs bilateral infiltrates on CXR low oxygenation

Question 36

tx for TRALI

Answer 36

supportive care maximize PEEP lung protective techniques avoid over hydration.

Question 37

TACO s/s

Answer 37

pulm edema, hypervolemia, ^ PAOP, LV dysfunction

Question 38

TACO tx

Answer 38

supportive care

Question 39

when should intraoperative blood salvage be used?

Answer 39

expected blood loss > 1,000ml or >20% EBV pre-existing anemia JWs that won't consent to tranfusion

Question 40

what is not returned to patient with intraoperative blood salvage? what should you watch for?

Answer 40

platelets and coagulation factors watch for dilutional coagulopathy

Question 41

what is the O2 carrying capacity like of salvaged blood?

Answer 41

higher than stored banked blood

Question 42

CI to intraoperative blood salvage?

Answer 42

sickle cell anemia, thalassemia, oncologic procdures, infected surgical sites

Question 43

is tranplant surgery a contraindication to intraoperative blood salvage?

Answer 43

No