Transfusions

Question 1

for each type of surgery, a max number of units that can be ordered for crossmatch are defined; prevents blood waste

Answer 1

maximum surgical blood order

Question 2

how long are collected specimen good for?

Answer 2

72 hours

Question 3

in which patients may antibodies be present in? (2)

Answer 3

past pregnancy
previously transfused

Question 4

an antibody was found but we cannot find units lacking the antigen corresponding to that antibody. what can occur?

Answer 4

surgery may be delayed

Question 5

when should we monitor / record vital signs when administering a transfusion?

Answer 5

prior to transfusion
15 mins
30 mins
every hour

Question 6

adverse effects related to transfusions can be due to what products? (2)

Answer 6

cellular (RBCs)
plasma

Question 7

an immediate intravascular hemolysis that is most often related to ABO incompatibility

Answer 7

acute hemolytic transfusion reaction (AHTR)

Question 8

a patient begins to experience symptoms within 15 mins of transfusion. they feel pain at site, back pain, dread feeling, fever, chills, dyspnea, hypotension, increased pulse, and diffuse bleeding in a surgical field. what are they experiencing?

Answer 8

acute hemolytic transfusion reaction

Question 9

what are 4 complications of an acute hemolytic transfusion reaction?

Answer 9

shock
renal failure
DIC
death

Question 10

production of antibodies post-transfusion 2-14 days after.

Answer 10

delayed hemolytic transfusion reaction

Question 11

a patient is asymptomatic but may have a fever and elevated bilirubin. what are they experiencing?

Answer 11

delayed hemolytic transfusion reaction

Question 12

reaction of recipient antibodies to donor HLA antigens (on leukocytes and platelets)

Answer 12

febrile, non hemolytic transfusion reaction

Question 13

a patient presents with fever, chills, headache, flushing, and rare muscle/chest pain. what are they likely experiencing?

Answer 13

febrile, non-hemolytic transfusion reaction

Question 14

what can we give a patient before their transfusion to prevent a febrile, non-hemolytic transfusion reaction?

Answer 14

anti-pyretic

Question 15

a patient presents with dyspnea, cyanosis, hypotension, hypoxemia, fever/chills, and pulmonary edema. what are they experiencing?

Answer 15

transfusion related acute lung injury

Question 16

what is the onset of a transfusion-related acute lung injury?

Answer 16

4-6 hours post-transfusion

Question 17

what is the treatment for a patient experiencing a transfusion-related acute lung injury?

Answer 17

oxygen / ventilation assistance

Question 18

what is contraindicated in a patient experiencing a transfusion related acute lung injury? (2)

Answer 18

diuretics
corticosteroids

Question 19

due to recipient antibodies to donor plasma proteins

Answer 19

allergic reaction

Question 20

a patient presents with urticaria, wheezing/dyspnea. what are they experiencing? what is the treatment?

Answer 20

allergic reaction
antihistamine

Question 21

recipient has antibodies to donor plasma IgA

Answer 21

anaphylactic reaction

Question 22

a patient presents with respiratory arrest and cardiac arrest. what are they experiencing?

Answer 22

anaphylactic reaction

Question 23

volume overload with pulmonary edema that occurs in elderly or neonates after a transfusion

Answer 23

transfusion associated circulatory overload

Question 24

a patient presents with hypertension, tachycardia, and respiratory distress. what are they experiencing? how should we treat it? (2)

Answer 24

transfusion associated circulatory overload

diuretics
oxygen

Question 25

occurs when bacterial endotoxins are in blood products, usually platelets and PRBCs

Answer 25

septic shock

Question 26

a patient presents with fever, chills, rapid heart/resp rate, hypotension, N/V, and bleeding that leads to DIC. what are they experiencing?

Answer 26

septic shock

Question 27

if a transfusion reaction is suspected, what should we send to the lab? (3)

Answer 27

new patient sample blood bag + solutions first post-transfusion urine

Question 28

which test identifies if antibodies are coating the RBCs?

Answer 28

direct antiglobulin test

Question 29

what are 3 mandatory tests if we suspect a transfusion reaction?

Answer 29

direct antiglobulin test inspection of post-transfusion plasma for hemolysis clerical check

Question 30

if a patient is in DIC, what blood products should be used?

Answer 30

fresh frozen plasma

Question 31

a 21 yo comes into the ER with a massive hemorrhage. we have difficulty stopping the bleeding due to large number of internal injuries. hemoglobin is at 4. what do we do?

Answer 31

massive transfusion protocol

Question 32

replacement of body's blood volume within 24 hours

Answer 32

massive transfusion

Question 33

how many units are used in a massive transfusion?

Answer 33

over 20 units of PRBCs in 24 hours

Question 34

what is the replacement in a massive transfusion?

Answer 34

over 50% replacement within 3 hours

Question 35

if we have decreased volume in a patient, what do we give?

Answer 35

fluids - crystalloids or colloids

Question 36

if a patient has dilutional coagulopathy, what do we give?

Answer 36

fresh frozen plasma

Question 37

if a patient has dilutional thrombocytopenia, what do we give?

Answer 37

platelets

Question 38

if a patient has trouble with oxygen delivery, what do we give?

Answer 38

PRBCs

Question 39

a patient presents with signs of hemolysis, decreased platelet count, and schistocytes. what are they experiencing?

Answer 39

thrombotic microangiopathic hemolytic anemia (TMA)

Question 40

what is the treatment for thrombotic microangiopathic hemolytic anemia?

Answer 40

therapeutic plasma exchange (decrease antibodies) + caplacizumab OR rituximab