Transfusion 2 Flashcards by Hannah Garrison

Match each blood additive with its function.
Dextrose
Phosphate
Citrate
Adenine
Anticoagulant
Substrate for glycolysis
buffer
substrate for ATP synthesis

Dextrose–> substrate for glycolysis
Citrate–> anticoagulant
Phosphate–> buffer
adenine–> substrate for ATP synthesis

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One unit of packed red blood cells contains about __________ mLs with a hematocrit of ________

300 mLs; 70%

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Transfusion of one unit of PRBCs raises hemoglobin by ___________ g/dL and hematocrit by _____________

1 g/dL; 2-3%

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Citrate is an anticoagulant that inhibits

calcium (factor 4)

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A large citrate load can cause

hypocalcemia

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Phosphate, dextrose, adenine, and other preservatives help to

offset the consequences of blood preservation (RBC storage lesion)

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Consequences of the RBC storage lesion include

decreased 2,3- DPG, decreased pH, increased potassium, impaired ability to change shape, hemolysis, and increased production of proinflammatory mediators

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_________________ removes WBCs from PRBCs and platelets

Leukoreduction

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Leukoreduction reduces the risk of

HLA sensitization
febrile nonhemolytic transfusion reactions
CMV transmission

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________________ removes any remaining plasma from donor RBCs

Washing

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Washing prevents

anaphylaxis in IgA deficient patients

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__________ destroys donor leukocytes

Irradiation

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Irradiation reduces the risk of

graft vs. host disease in immunocompromised patients

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Phosphate is a __________– that combats ______–

buffer; acidosis

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Dextrose is the primary

substrate for glycolysis

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Adenine is a substrate that

helps RBCs re-synthesize ATP

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Adenine extends storage time from

21 to 35 days

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Newer preservatives (Adsol, Nutricel, and Optisol) extend storage time to

42 days

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The most common cause of platelet refractoriness is

HLA alloimmunization

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Populations that benefit from irradiated cells include

leukemia
lymphoma
hematopoietic stem cell transplants
DiGeorge syndrome

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Rank each infectious complication of transfusion from MOST common to LEAST common:
HIV, Hep C, CMV, Hep B

CMV, Hep B, Hep C, HIV

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The most common infectious complication of transfusion is

cytomegalovirus

__________ greatly reduces the risk of cytomegalovirus

Leukoreduction

Immunocompromised patients should receive

leukoreduced blood

Risk of sepsis is most common with

platelets

Why is risk of sepsis most common with platelets?

b/c they are stored at room temperature which explains why bacterial contamination is more common

A patient with O blood received AB blood during surgery. Within five minutes, you observe hemoglobinuria, hypotension, and increased surgical bleeding. What actions should you perform at this time? (select 2) a. slow the rate of transfusion b. send an AST/ALT to the lab c. administer sodium bicarbonate d. give a crystalloid bolus

c. administer sodium bicarbonate d. give a crystalloid bolus

____________ occurs when a patient receives an incompatible blood product.

A hemolytic transfusion reacton

The most lethal hemolytic transfusion reaction is

ABO incompatibility

Complications of a hemolytic transfusion reaction include

flushing, renal failure (acute tubular necrosis), DIC, & hemodynamic instability

Signs & symptoms of hemolytic transfusion reaction include

hemoglobinuria, hypotension, fever, chills, and flushing

Treatment of hemolytic transfusion reaction includes

stopping the transfusion, promoting renal blood flow, and alkalinizing the urine

Allergic transfusion reactions are rarely

severe

Allergic transfusion reactions present with

urticaria & facial swelling

Treatment for allergic transfusion reactions is

supportive and includes antihistamines

The most common adverse reaction associated with transfusion is

febrile transfusion reactions (non-hemolytic)

Patients with febrile transfusion reactions present with

fever chills headache nausea malaise

Treatment of febrile transfusion reactions is

supportive and includes acetaminophen

Signs and symptoms of an acute hemolytic reaction that are masked by anesthesia include

fever chills chest pain dyspnea nausea flushing

List the 7 steps to treating an acute hemolytic reaction

1. stop the transfusion 2. maintain UO >75-100 mL/hr with: IV fluids, mannitol (12.5-25 g), furosemide (20-40 mg) 3. alkalinize the urine with sodium bicarbonate 4. send urine & plasma hemoglobin samples to the blood bank 5. check platelets, PT, & fibrinogen 6. Send unused blood to the blood bank to double-check the cross match 7. Support hemodynamics with IVF and vasopressors as needed

What is the cause of allergic transfusion reactions?

foreign proteins in the donor blood product

Should a transfusion be continued if a patient has an allergic transfusion reaction?

minor rxn= continue transfusion major reaction (dyspnea, laryngeal edema, or hemodynamic instability)= stop the transfusion and treat it as anaphylaxis

Fresh frozen plasma from which donor population imparts the HIGHEST risk of transfusion-related acute lung injury? a. Jehovah's witness b. organ recipient c. multiparous female d. Creutzfeldt jakob

c. multiparous female

___________________ is a form of non-cardiogenic pulmonary edema that occurs following transfusion.

Transfusion related acute lung injury

The most common cause of transfusion-related mortality in the United States is

TRALI

TRALI is caused by

human leukocyte antigens (HLA) and neutrophil antibodies present in the donor plasma

The highest risk of TRALI stems from

FFP & platelets

High-risk donors for TRALI development includes

women with a history of multiple births people with a prior hx of transfusions people with a history of organ transplants

Signs and symptoms of TALI include

the onset of symptoms within 6 hours bilateral infiltrates via CXR & low oxygenation

Management of TRALI is

supportive: maximize PEEP, use LPV techniques and avoid overhydration

_________________ is a state of volume overload caused by expanding the circulatory volume beyond the patient's compensatory ability

Transfusion associated circulatory overload (TACO)

Signs and symptoms of TACO include

pulmonary edema, hypervolemia, increased PAOP, and left ventricular dysfunction

Treatment of TACO is

supportive

Patients at higher risk of suffering from TRALI include

critically ill (highest risk) anyone susceptible to acute lung injuries such as sepsis, burns, or post-CPB