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Clin Med2- Hematology > Transfusions > Flashcards

Transfusions Flashcards

1
Q

what are the three phenotypes of blood

A

A, B and O

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2
Q

what blood phenotype has no antigents

A

O blood

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3
Q

what antibodies do type A blood have

A

anti-B antibodies

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4
Q

what type of antibodies do type B blood have

A

anti-B antibodies

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5
Q

what type of antibodies do type O blood have

A

anti-a and anti-b antibodies

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6
Q

what type of antibodies to type AB blood have

A

no antibodies

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7
Q

what is the universal donor blood

A

O blood

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8
Q

what can cause blood antigen changes

A

infections, malignancy, thalassemias, etc

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9
Q

what is the universal recipient

A

AB+

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10
Q

who gets transfused

A

anyone with Hgb < 7g/dL, regardless of symptoms
pts with Hgb <8 g/dL and asymptomatic if: sx patients, pre-existing CVD, actively bleeding
pts with a Hgb >7g/dL (but < 8) and symptomatic

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11
Q

what is a type and screen

A

first step if unsure if transufsion will be needed

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12
Q

what is a type and cross

A

need transfusion urgently

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13
Q

what is whole blood

A

includes RBCs, plasma and platelets
minimal processing; mixed with anticoagulant
store refrigerated for up to 35 days
try to give components separately as needed

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14
Q

when is whole blood the only absolute indications

A

massive transfusion to maintain ratio of blood components

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15
Q

what is the definition of mass transfusion

A

10+ units within 24 hours

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16
Q

What are PRBCs

A

packed red blood cells
most commonly transfused product
includes RBCs, platelets, some residual plasma and some WBCs
“cellular component”

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17
Q

what are PRBCs used for

A

used to raise hemoglobin/blood volume - transfusion guidelines
spun down from whole blood - plasma removed

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18
Q

how long are PRBCs good for once prepped for use

A

only good for 24 hours - order one unit at a time

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19
Q

what are leukocyte-reduced RBCs used for

A

used to reduce risk of immune reactions
- pts at risk for HLA mediated reactions
patients who previously had febrile non-hemolytic transfusions reactions
- organ transplant recipients
-prevention of CMV transmission
-pregnant patients

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20
Q

what are washed RBCs

A

PRBCs ‘washed’ with saline
removes residual plasma, some WBCs, antibodies, cytokines

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21
Q

what are washed RBCs used for

A

used to reduce incidence of transfusion reactions - allergic, febrile or anaphylactic
primarily pts with IgA deficiency (anti-IgA antibodies)

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22
Q

what is frozen deglycerolized RBCs

A

glycerol added to PRBCs prior to freezing - protects against cell lysis
PRBCs thawed, then washed with saline to prevent hemolysis
considered prepared or ‘open’

23
Q

what is deglycerolized

A

removal of glycerol

24
Q

what is irardiated RBCs

A

PRBCs subjected to radiation
used to prevent allogenic immune reactions - transfusion-associated graft vs host disase

25
who needs irradiated RBCs
immunosuppressed pts stem cell or bone marrow transplants intrauterine transfusions premature infants first degree relative donors
26
what is FFP
Fresh Frozen Plasma spun down from whole blood contains proteins (albumin), electrolytes, molecules and lipoproteins "acellular component"
27
what does FFP provide
coagulation factors vitamin K dependent factors (2,7,9,10) Factor 5 (only source)
28
what are the indications for FFP
abnormal PT/INR and/or aPTT and microvascular bleeding Coagulation factor deficiency when specific concentrate unavailable urgent warfarin reversal
29
what is cryoprecipitate
collected from FFP by cooling then collecting precipitate provides: fibrinogen, vwf, factor 8, factor 13 and fironectn only product that replaces fibrinogen
30
what product replaces fibrinogen
cryoprecipitate
31
what is the indication for cyroprecipitate
fibrinogen level < 100
32
what are platelets
platelets suspended in FFP (platelet rich plasma) whole blood centrifuged to collect PRP multi-donor specimens combined to compile one 'unit'
33
how much does one unit of platelets increase the platelet count
by 10,000
34
when do platelet transfusions not work
if thrombocytopenia from distruction ITP, TTP, HIT
35
what are the risks of transfusion
transfusion reactions: non-hemolytic reactions, hemolytic reactions transfusion related acute lung injury(TRALI) transfusion associated cardiac overload (TACO) Transfusion-associated graft-versus-host-disease(TAGVH)
36
what are the non-hemolytic transfusion reactiosn
non-hemolytic febrile reaction bacterial contamination allergic reactions
37
what is non-hemolytic febrile reaction
fairly common likely realted to cytokines or antibody reactions manifest as a temperature increase of >1 degree Celsius symptoms begin in 1-6 hours; fevers, riggors, HA, flushing no specific treatment: pause transfusion
38
what is the prevention of non-hemolytic febrile reaction
use leukocyte reduced blood products pretreatement with tylenol reduces severity
39
what is bacterial contamination transfusion reaction
VERY RARE Symptoms: fever, chills, tachycardia, hypotension, GI symptoms discontinue transfusion and culture donor blood
40
what is allergic transfusion reaction
more likely with FFP or platelets, but can occur with any blood products manifests usually as hives, rashes, itching - treat with antihistamines rarely progresses to anaphylactic shock
41
what are acute hemolytic transfusion reactions
results of transfusing ABO incompatible blood fatal in 6% of cases symptoms: pain at transfusion site, facial flushing, back and chest pain fever, respiratory distress, hypotension, tachycardia
42
what test is diagnostic of acute hemolytic transfusion rxn
positive Coombs test
43
what is the treatment of acute hemolytic transfusion rxn
discontinue transfusion, vigorous hydration
44
what is delayed hemolytic transfusion reactions
resulting of transfusing ABO incompatible blood onset within 2-10 days after transfusion symptoms: extravascular hemolysis: anemia and indirect hyperbilirubinemia, fever, jaundice Direct coombs test is diagnostic treatment: self-limited
45
What is TRALI
Transfusion Related Acute Lung Injury non-cardiogenic pulmonary edema donor antibodies attack recipeients WBCs and pulmonary endothelial cells - always within 6 hours of transfusion Plasma containing blood products
46
what are the symptoms of TRALI
dyspnea, hypoxemia, fever, rigors, bilateral diffuse pulmonary infiltrates on CXR
47
what is the treatment of TRALI
stop transfusion and provide pulmonary support (O2 - ventilation)
48
what is TACO and what is it associated with
Transfusion Associated Cardiac Overload associated with Rapid transfusion, especially with pre-existing cardiac disease can occur with any blood products, all include fluids which can cause overload
49
what is the symptoms of TACO
presents within 6 hours hypertension, dyspnea and respiratory distress, cough, rales on auscultation(pulm edema)
50
what is the treatment of TACO
diuresis reduced rate of transfusion or stop it mechanical ventilation if needed **reduced amount of IV fluids being administered during transfusion of blood products
51
What is Transfusion-associated graft-vs-host-disease
immune reaction produced by discordant HLA types occurs in immunosuppressed pts graft (competent donor WBCs) attacks host WBCS host cant mount immune response nearly 100% FATAL no treatment
52
when does tranfusion-associated graft-vs-host disease present
presents 2-30 days after transfusion
53
what is the presentation of Transfusion-associated graft-vs-host-disease
fever, rash, diarrhea, hepatitis, lymphadenopathy, pancytopenia

Clin Med2- Hematology (8 decks)

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