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Transfusion Medicine Flashcards

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1
Q

Cutoff for women donors (Hgb).

A

12.5

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2
Q

Crossing needed for Plasma

A

ABO but not Rh

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3
Q

Crossing needed for platelets

A

Neither ABO or Rh

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4
Q

What test is run if there is a suspected hemolytic transfusion reaction?

A

Direct Coombs

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5
Q

Hematocrit level of pRBCs

A

55-65%

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6
Q

Response to 1 unit pRBC

A

Hct by 3%, Hgb by 1 g/dL

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7
Q

Difference between plasma and FFP

A

FFP was frozen within 6 hours of collection (lasts 1 year if it stays frozen)

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8
Q

What is cryoprecipitate?

A

The small fraction of plasma that precipitates when FFP is thawed at 1 to 4°C

(Contains mostly fibrinogen and factor VIII)

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9
Q

What is the shelf life of platelets?

A

5 days

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10
Q

How do apheresis platelets differ from platelet concentrate (taken from whole blood)?

A

1 bag apheresis platelets = 4-6 units platelet concentrate

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11
Q

How much does a bag of apheresis platelets increase the count?

A

20-25k

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12
Q

What does Leukoreduction mean?

A

Decrease in the number of leukocytes present in transfused erythrocytes or platelets

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13
Q

Why would you used Leukoreduced products?

A
  • reduces class I-HLA allo-Ab production (decrease platelet refractoriness)
  • decrease febrile nonhemolytic transfusion reactions
  • decrease CMV transmission
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14
Q

Why do you irradiate blood products?

A

To prevent replication of lymphocytes and circulating stem cells present

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15
Q

Who needs irradiated products?

A
  • patients with severe immunodeficiency

- immunocompetent patients receiving HLA matched platelets or transfusions from relatives

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16
Q

What does irradiating products prevent?

A

Transfusion- associated GVHD

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17
Q

What does it mean to wash blood products?

A

Removes proteins remaining in the plasma of erythrocyte and platelet products

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18
Q

What two types of patients need washed products?

A
  • IgA deficient patients

- patients with complement mediated AHA

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19
Q

What is another reason someone might use washed blood products?

A

Reduces the amount of potassium for patients at high risk of hyperkalemia

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20
Q

What are recombinant factor concentrates and who are they used for?

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A

Blood factors not containing any donor plasma

Used for younger patients with Hemophilia A and B

21
Q

Which product do you use during warfarin associated bleeding?

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A

Prothrombin complex concentrates (factors II, VII, IX and X)

22
Q

What is a contraindication to PCC (prothrombin complex concentrates)?

Study These Flashcards
A

History of HIT

23
Q

Which product do you use during PLEX for TTP?

24
Q

Which product do you use during DIC (fibrinogen deficiency)?

Study These Flashcards
A

Cryoprecipitate

25
Which product do you use during Hemophilia A?
Factor VIII
26
Which product do you use during Von-Willebrand associated bleeding?
vW protein rich factor VIII | Or cryoprecipitate
27
Which product do you use duringfacgor XIII deficiency?
Cryoprecipitate
28
Which product do you use during hemophilia B?
Factor IX
29
What is the only trial that showed liberal transfusion threshold was better than restrictive?
TITRe (cardiac surgery patients)
30
What are the three most common causes of death related to transfusions?
- hemolysis - TRALI - TACO
31
Why do acute hemolytic transfusion reactions occur?
Clerical errors
32
What are the symptoms of an acute hemolytic transfusion reaction?
Fever, flank pain, and may develop hypotension and diffuse bleeding (DIC)
33
If a patient receiving product has a new positive direct anti-globulin test or an unexpected drop and hematocrit, what might you expect?
Hemolytic transfusion reaction secondary to platelets (not ABO screened so group O patients May have issue with high titer ABO antibodies)
34
Who can get a delayed hemolytic transfusion reaction?
People who have had prior transfusions, people who have had a baby
35
When do delayed transfusion reactions occur?
7 to 14 days after the transfusion
36
How do you assess for a delayed transfusion reaction?
Check markers of hemolysis, and a direct anti-globulin test
37
What are the symptoms of TACO?
Respiratory distress within six hours of transfusion, elevated BNP, pulmonary edema
38
How do you treat TACO?
Diuretics, slow the rate of blood administration
39
What is the pathophysiology of TRALI?
HLA or neutrophil specific antibodies in multiparous donors bind to and activate recipient leukocytes in the pulmonary vasculature
40
How do patients with TRALI typically present?
Fever, hypotension, and non-cardiogenic pulmonary edema within six hours of transfusion (Less likely to have overt signs of volume overload)
41
What do you do if you expect a febrile nonhemolytic transfusion reaction?
Inspect the patient plasma for hemolysis and run a direct antiglobulin test Also consider blood cultures
42
What causes a febrile nonhemolytic transfusion reaction?
Inflammatory cytokines elaborated by donor leukocytes during storage
43
Which bug thrives in red blood cells?
Yersinia
44
How do you manage a mild allergic reaction to blood?
Give an anti-histamine and continue the blood transfusion There is no evidence for prophylaxis
45
What is the special consideration given to patients who have had a stem cell transplant?
They need irradiated blood products for life to prevent transfusion associated graft versus host disease
46
What are electrolyte considerations for patients with massive transfusion?
Monitor for hypocalcemia (citrate binds free calcium), metabolic alkalosis (citrate metabolism), hyperkalemia
47
What consideration should be given to a patient with autoimmune hemolytic anemia?
ABONRH matched, they will have IgG auto- antibodies against any blood, so you just try your best
48
How does plasmapheresis for GBS differ to that for TTP?
GBS you replace with crystalloud or colloid and avoid plasma, TTP you replace with FFP
49
What are three indications for erythrocyte exchange?
- sickle cell disease with acute cerebral infarct - sickle cell disease with severe acute chest syndrome - severe babesiosis

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