Transfusion Medicine Flashcards
(39 cards)
1
Q
What underlying diseases cause anemia?
A
- hemolytic disease
- Hemorrhagic disease
- Severe non-regenerative disease
2
Q
What underlying diseases cause Thrombocytopenia
A
- ITP
- DIC
- Severe bone marrow disease
3
Q
What are the underlying causes of coagulation factor deficiencies?
A
- Congenital/hereditary
- Acquired
4
Q
What blood products are available for transfusions?
A
- Fresh Whole blood
- Packed red blood cells
- Plasma products
- Cryoprecipitate/Cryosupernatant
5
Q
What is Fresh Whole Blood? (contents, storage, uses?)
A
- RBC, WBC, platelets, and plasma proteins
- Refrigeration renders WBCs and platelets inactive: stable 28-30 days at 1-6C
- Indicated for anemic animals, especially if coagulation factors are needed
6
Q
What is packed red blood cells (pRBC)? (contents, storage, uses?)
A
- Whole blood - plasma = pRBC
- Storage 3-4 weeks (refrigerate with RBC preservative)
- Storage leads to reduced deformability and 2,3-DPG levels within RBC
- Indications for use: anemia
7
Q
what plasma products are there?
A
- Fresh/Fresh frozen plasma (FFP)
- Frozen Plasma
- Platelet-rich plasma
- Cryoprecipitate
- Cryosupernatant
8
Q
What is Fresh/Fresh Frozen plasma (FFP)? (contents, storage, uses?)
A
- Administered immediately or frozen within 6 hours
- Pro-coagulant and anti-coagulant factors, Ig, albumin
- Uses: coagulopathy of any cause, DIC
9
Q
What is Frozen Plasma (FP)? (contents, storage, uses?)
A
- Factors V, VII, vWF no longer considered viable
- Source of albumin, Ig, Vit K-dependent factors
- Uses: rodenticide toxicity, oncotic support
- ~45ml/kg required to increase albumin 1g/dL
10
Q
What is Platelet-rich plasma? (contents, storage, uses?)
A
- Warm, slow centrifugation of fresh whole blood
- No storage
- Limited use: intracranial hemorrhage
11
Q
What is cryoprecipitate? (contents, storage, uses?)
A
- Precipitate formed by thawing FFP
- vWf, fibrinogen, VII, XIII
- Uses: vonWillebrands disease, Hemophilia A
12
Q
What is cryosupernatant? (contents, storage, uses?)
A
- Fraction remaining after production of cryoprecipitate
- Factors II, VII, IX, X
- Indications: Rodenticide, Hemophilia B
13
Q
What is a transfusion trigger?
A
- Point were oxygen delivery has dropped enough to stimulate anaerobic metabolism
- Packed cell volume, HR, BP, Pulse quality, Alertness
14
Q
What factors influence transfusion triggers?
A
- Concurrent disease
- Rate at which anemia developed
- Need for interventional procedures (Surgery)
15
Q
What testing is required for canine blood donors?
A
- Routine health screening:
- CBC, Chemistry, UA, Fecal
- Blood type
- Heartworm, Babesia, Ehrlichia
- Anaplasma, Mycoplasma
16
Q
What testing is needed for feline blood donors?
A
- Routine health screening:
- CBC, Chemistry, UA, Fecal
- Blood type
- FeLV, FIV, Mycoplasma
- Bartonella, others (?)
17
Q
What are the canine blood groups? what are some important factors of each?
A
- Most greyhounds are negative for DEA 1.1 and positive for DEA 3
- Most Labs are positive for DEA 1.1
- Dogs negative for DEA 1/1 and ½ do NOT have naturally occurring antibodies and can be transfused one time
- 60% of dogs are DEA 1 positive
- DEA 4 also antigenic (~98% of days are DEA4 positive)
18
Q
What are the downsides of blood typing?
A
- does NOT imply immunologic compatibility
- Affected by autoagglutination and severe anemia
19
Q
What are the Feline blood groups? Importance of the groups?
A
- 3 Groups: A, B, AB
- Naturally occurring antibodies
- Type B cats have strong alloantibodies vs A blood
- Type A cats have weak alloantibodies to B blood
- AB cats (<1% in US) are universal recipients but cannot donate
- Small % of cats lack the MiK antigen and have antibodies against it
20
Q
What is neonatal isoerythrolysis?
A
- Type A kittens born of type B queen
- Kittens nurse during the first 24 hours of life will infest anti-A antibodies from the queen
- results in life threatening hemolysis
21
Q
What is cross-matching?
A
- Helps to define immunological compatibility
- Ideally should always be carried out
- Not always required in first transfusion if:
- Donor is DEA-1 negative
- Recipient is DEA-1 positive
- questionable value in cats for 1st transfusion
- Will not predict delayed immune-mediated reactions
- Recommended if previous transfusion > 7 days prior
22
Q
What is a Major crossmatch?
A
- Donor erythrocyte + recipient serum
- Incompatibility predicts immune-mediated hemolytic reaction to donor blood
23
Q
What is minor crossmatch?
A
- Recipient erythrocyte + donor serum
- Incompatibility suggests possible reaction against recipient erythrocytes
24
Q
How much blood can a dog give?
A
15-20 ml/kg
25
How much blood can a cat give
10-15 ml/kg
26
How is blood collected from dogs/cats?
* Syringe method
* CPDA-1 or ACD anticoagulant added
* 1ml per 9ml blood
27
What is the protocol for transfusions?
* Administer blood through an appropriate filter
* Use largest IV catheter possible
* No pump with RBC products (syringe pump -ok)
* No medications through the same IV set-up
* Only 0.9% saline may be infused simultaneously
* flush with saline pre and post-transfusion
* Rate depends upon product and patient
* slow infusion recommended for first 10-30 mins while monitoring for incompatibilities (0.5-1ml/kg)
* Parameters monitored every 5-15 minutes for 15-30 minutes then every 15-30 minutes until completion
* Warm products to body temperature (water bath)
* complete transfusion w/in 2-4hrs
* Avoid volume overload
* Target PCV dependent on patient/disease
* Recheck PCV 2hrs post-transfusion then as required
* Keep transfusion record
* product information
* transfusion monitoring
28
What are the transfusion totals for the different blood/plasma products?
* Whole blood: 12-20 ml/kg
* pRBC: 6-15ml/kg
* FFP: 10-30 ml/kg (repeat if coag times not improved)
* Cryoprecipitate: 1 unit/10kg until hemorrhage controlled
* Cryosupernatant: 6-10ml/kg until hemorrhage controlled
* Platelet-rich plasma: 1unit/10kg
29
How is the WB/pRBC transfusion amount determined?
[(PCV desired - PCV actual)/PCV donor] x blood volume x weight
30
Why does a transfusion need to be completed in 2-4hrs
* Product viability
* risk of contamination
31
What are the different possible Transfusion reactions?
32
Why does Immune-mediated hemolysis occur after transfusion? signs? treatment?
* Recipients Ab's react against donor RBC
* Type II hypersensitivity
* PCV drops 3-5 days after transfusion due to production of antibodies
* **Not predicted by cross-matching**
* Signs:
* Fever, salivation, restlessness, shock, hemoglobinemia, hemoglobinuria
* Treatment:
* Antihistamines, glucocorticoids, treatment for shock
33
Why does a non-hemolytic reaction occur following transfusions? how can this be prevented
* WBC-derived cytokines or recipient Ab's react against donor WBC or plasma proteins
* Slow administration rate and/or hemolytic reaction, sepsis
* Minimized with leukoreduction filters during collection
34
Why do allergic reactions occur following transfusions? Signs? Treatment?
* Donor protein binds pre-formed IgE on recipient mast cells
* Type I hypersensitivity
* Signs:
* urticaria, hives, anaphylaxis, bronchoconstriction
* Treatment:
* antihistamines, treatment for shock
35
What is a Transfusion related lung injury?
* clinically resembles ARDS (acute respiratory distress)
* Occurs w/in 24 hrs and no pre-existing lung disease
* usually self-limitinga
36
What is Post-transfusion purpura?
* Thrombocytopenia develops 1-2 weeks after transfusion
* Usually self-resolving in 1-4 weeks
37
What is TACO?
* Transfusion associated cardiac overload
* At risk:
* normovolemia, cardiac disease, renal disease
38
Why does non-immune-mediated hemolysis occur?
* Incorrect warming
* incompatible solutions, medications
39
When does citrate toxicity occur?
* Massive transfusion (dogs \>90ml/kg/day)
* Clinical signs reflect hypocalcemia and/or hypomagnesemia
