TM / path Flashcards by Kyle Mendonça

PRBC: preparation, storage temp, storage duration

centrifuge whole blood and filter (leukoreduction, remove plt)

2-6C storage

35 d

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plt: preparation, storage temp, storage duration

apheresis
pooled: 4 donors; whole blood buffy coat + filter leukoreduction

20-24C (room temp) w constant gentle agitation

5-7d

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FFP : preparation, storage temp, storage duration

apheresis
whole blood centrifugation
- FFP means frozen <8h from collection

< -18C, 2-6C once thawed

1y
5d thawed
28d never frozen

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Cryo: preparation, storage temp, storage duration

insoluble precipitate on centrifugation of FFP

< -18C

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plasma derived product preparation

pooled samples from cold ethanol fractionation

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Cryo includes:

Fibrinogen, VIII, XIII, VWF

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examples of plasma derived products

IVIG
albumin
PCC
rhogam
coagulation factors

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IVIG indications

ITP, NAIT, HDNF
primary immunodeficiency
secondary immunodeficiency (hypogamm, post ritux, post BMT)
Kawasaki
HIV
neuro: GBS, chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, myasthenia gravis

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IVIG S/E

common: rash, h/a, flushing, arthralgia, mild temp increase, tachypnea/tachycardia
severe: hypotension, fever/chill/rigor, bronchospasm, allergy/anaphylaxis, rare aseptic meningitis

Post: neutropenia, hemolytic anemia (10%), h/a, fluid overload, thrombus (1%)

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Dose and expected rise with PRBC, plt, FFP, cryo

PRBC: 15 cc/kg - 20 point rise
plt: 10 cc/kg - 30-50 point rise
FFP: 10-20 cc/kg - increase of 30-50%
cryo: 1 U/10kg to max 10 U - fibrinogen increase by 0.5 g/L

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FFP indications

TTP
INR >1.8, PTT > 1.5x ULN
MTP
PLEX replacement fluid

factor deficiency replacement (no specific product available)
warfarin reversal (if PCC unavailable)

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Cryo indications

Riastap preferred!

APL
DIC
MTP
hypofibrinogenemia

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leukoreduction benefits

reduced TA-GVHD
reduced FNHTR
reduced HLA alloimmunization
reduced CMV

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PRBC irradiation pro/con, indications

Pro: reduces TA-GVHD risk (by removing T cells)
Con: shortens shelf life, may increase K

IUT
immunocompromised
directed donation
post BMT/some chemo, malignancy (HL)
neonates <1yo

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when/how to cryopreserve PRBC

rare blood donor program
< -65C in glycerol
lasts 10y

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which viruses not destroyed by viral inactivation

parvovirus
hepatitis A

development of RBC Ag/Ab

Glycotransferases add A or B Ag to H Ag (fucose) base chain
lack of H = Bombay

anti-A and -B Ab are formed early in life from exposure to similar appearing Ag

Bombay phenotype is

lack of H (fucose) base chain

Describe forward vs reverse typing

forward: pt RBC + anti_ reagant (testing for pt Ag)
reverse: pt plasma + test RBCs (testing for pt Ab)

blood group incidence (including Rh)

O 45%
A 40%
B 10%
AB 5%

Rh+ 85%

forward/reverse typing inconsistency reasons

lab error
immunosuppression
young infants
ABO-mismatch HSCT
chimerism

extra reverse typing: recent non-matched transfusion, autoAb, Rouleaux
missing reverse: infant, immunosuppression

standard vs extended vs full phenotype matching

Standard: Rh (DCE), K
Extended: Rh, K, Jka, Jkb, Fya, Fyb
Full: Ss

Most immunogenic RBC Ag

D (50%) > K (5%) > c > E > k > e …

risk with directed donations

increased:
- TA-TMA
- infection
- cost/waste

plt refractoriness assessment

CCI = [ (plt increment/u] x BSA ] / #plt transfused x10^11 (use 3x10^11 for standard transfusion) refractory is CCI <5000 x2

Transfusion infectious risks

HIV 1/ 21.4 M HCV 1/ 12.6 M HBV 1/ 7.5 M HTLV 1/ 7.6 M plt bacteria 1:10k - death 1:200k

Common transfusion risks

mild allergic 1/100 FNHTR 1/200 TACO 1/700 TRALI 1/5000 DHTR 1/7000 anaphylaxis 1/40k death 1/1M

transfusion fever DDx

FNHTR hemolysis sepsis TRALI non-transfusion related

Transfusion reaction mgt

stop transfusion vitals symptom mgt check product report investigations return blood to lab

transfusion major vs minor ABO incompatability

major: recipient anti-donor minor: donor anti-recipient

when can you do electronic over serologic crossmatch

if 2 previous ABO, no Ab hx, negative Ab screen

review Ab screening (:

(': (See TM/HP Answers document @ bottom)

Fridge-thriving bacteria (PRBC)

yersinia listeria serratia CONS

TRIPICU study results

PRBC threshold of 70 vs 95 had 50% decrease in transfusions, no clinic differences

plasmapheresis indications

TTP neuro: myasthenia gravis, GBS, transverse myelitis autoimmune: ANCA vasculitis, FSGS CAPS Ab mediated solid organ transplant rejection

Extracorporeal photopheresis method and indications

apheresis with UV light crosslinks DNA to prevent T cell proliferation GVHD steroid refractory cellular solid organ transplant rejection cutaneous T cell leuk/loma

Small round blue cell tumors

LEARN NMR lymphoma Ewing ALL RMS NBl neuroepithelioma Medullo Retinoblastoma