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84 Cards in this Set
- Front
- Back
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What does FFP contain?
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-All clotting factors
-Proteins C/S, Antithrombin III |
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What is the universal FFP donor?
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AB type individual (their plasma has no antibody)
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What is the general indication for FFP?
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Replacing plasma proteins for hemostasis
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What are 4 scenarios in which you might see a multiple factor deficiency?
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-Liver disease
-Vit K deficiency -Warfarin therapy -DIC |
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What is a nonhemostatic indication for FFP?
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To replace fluid in therapeutic plasmapheresis (for thrombotic thrombocytopenia purpura)
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What is FFP NOT indicated for?
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-Volume expansion
-Heparin reversal |
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What is FFP incapable of doing?
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Completely correcting the PT in patients with severe liver disease
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What is the typical dose of FFP?
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3-4 units
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How is cryo prepared?
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By spinning down FFP
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What is Cryo mainly given for?
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Fibrinogen
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What else does Cryo contain?
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-Factor 8
-Factor 13 -vWF -Fibronectin -Fibrinogen |
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What are the 2 main indications for Cryo?
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-Hypofibrinogenemia
-Dysfibrinogenemia |
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What are 3 situations in which you might see hypofibrinogenemia?
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-DIC
-Severe liver disease -Congenital |
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What are 2 situations in which you might see dysfibrinogenemia?
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-Acquired (liver disease)
-Congenital |
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What is the goal in giving cryo?
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To get the fibrinogen level above 150 mg/dl
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How is Cryo dosed?
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1 unit/5 kg body weight
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What is the typical dose of cryo for the average 70 kg person?
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12 units
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What are the 2 types of Platelet transfusions that can be given?
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-Random donor
-Single donor apheresis |
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Why have random donor platelets fallen out of favor?
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Because they are susceptible to bacterial contamination
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What does a Single donor apheresis platelet unit have a lot more of than random donor?
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Plasma!
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So what must you be careful to do when giving platelets from a single donor apheresis unit?
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Don't give type O platelets to an AB individual - the plasma could contain antibodies.
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How much does 1 random donor unit of platelets raise the platelet count in an adult?
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By 50,000 platelets
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Who needs to be given the most consideration in matching platelet types?
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Women of childbearing age; if Rh neg, don't give them platelets that are from an Rh pos person
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Why is the Bleeding time not a good indicator of thrombocytopenia?
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It only begins to prolong at a platelet count of 10,000/dL!
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What do you need to keep the platelet count at in order to prevent major bleeding episodes?
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Above 10,000
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What are the 2 clinical cases in which you would consider transfusing platelets?
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-Marrow failure patients
-Prophylaxis before surgery |
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When is transfusion indicated or reasonable in marrow failure patients?
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Indicated: plt cnt <10K
Reasonable: plt cnt >10K/<20K |
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When would you consider transfusing platelets for:
-General surgery/procedures -eye, CNS or high risk surgeries |
General: <50K
Special: <100K |
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What are the only two situations that you might transfuse platelets regardless of the count?
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-Congenital plt dysfunction
-Platelet inhibitory drugs |
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When will the patient be refractory to platelet transfusion?
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When there is an antibody present
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So what should 6 units of platelets do for an average patient?
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Make the platelet count increase by 40-50,000
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If infusing 6 units of platelets makes the count increase but it quickly falls again, what is the presumption?
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The low platelet count is disease related
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If the platelet count fails to increase what is the presumtpion?
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There is an anti-HLA class I antibody in the patient
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What are 4 immediate immunologic reactions to transfusions?
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-Hemolytic transfn reaction
-Febrile nonhemolytic reaction -Hives/allergies -TRALI |
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What are 3 immediate NONimmunologic reactions to transfusions?
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-Volume overload
-Bacterial contamination -Massive transfusion effect |
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Which is most/least common: acute HTR, TRALI, or delayed HTR?
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1-Delayed HTR
2-TRALI 3-acute HTR |
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What is the most common cause of acute HTR?
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Identification error
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What is bacterial contamination most commonly seen in?
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Platelet transfusions
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Which is most/least common: Hep B, Hep C, or HIV?
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1. Hep B
2. Hep C 3. HIV |
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What is the cause of FNHTR in red blood cell transfusions?
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Recipient antibody to donor WBC
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What is the cause of FNHTR in platelet transfusions?
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Cytokines and biological response modifiers (BRMs) present in the platelet unit
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What type of transfusion are fNHTRs much more commonly seen in?
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Platelet
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When does FNHTR usually occur?
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at the end of the transfusion
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What are 5 signs/symptoms of FNHTR?
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-Fever
-Chills/rigors -Hypertension -Rapid heart rate -SOB |
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Why do we investigate FNHTR?
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To make sure it's not something else
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What are the 2 types/causes of hemolytic transfusion reaction?
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1. Acute - due to ABO incompatibility
2. Delayed - due to antibodies not picked up by the Ab screen |
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What type of hemolysis occurs in
-Acute HTR? -Delayed HTR? |
Acute = intravascular
Delayed = extravascular |
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What is the onset of Acute HTR?
What is the onset of Delayed HTR? |
Acute: 1-2 hours
Delayed: 5-7 days |
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What is a common sign of delayed HTR?
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Failure of the Hb level to rise
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What is the most common cause of acute HTR?
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Storing blood in inappropriate places and then administering it to the wrong person so it is ABO incompatible.
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What is the most common source of error that results in transfusing ABO incompatible blood?
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At the bedside - 67% of errors occur there.
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What will you more commonly see a fever in; acute or delayed HTR?
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Acute
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What is the difference between intravascular and extravascular hemolysis?
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-Intra occurs via complement fixation right in the vessels
-Extra occurs in the RES so hemolysis is sequestered from the vasculature |
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How can you differentiate intra vs extravascular hemolysis?
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Intra: plasma will be red
Extra: plasma will be yellow |
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What are 4 IgE mediated immune reactions to transfusions?
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-Anaphylactic
-Anaphylactoid -Allergic -Urticarial |
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What is the point at which you would discontinue transfusion during an IgE mediated reaction to transfusion?
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If the patient symptoms go beyond cutaneous itching to respiratory tightness and labor breathing.
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What are the distinctive symptoms of TRALI?
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-Sudden onset tachypnea/SOB
-Hypotension -Fever spike |
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What is TRALI defined as?
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The onset of Acute Lung Injury within 6 hours of transfusion, in the absence of any other evidence for cardiac dysfunction
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What is TRALI often confused for? Why?
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Transfusion volume overload - because of hearing bilateral crackles from pulmonary edema
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What is the "injury" that occurs in TRALI?
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Leaky pulmonary capillaries leading to pulmonary edema
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What transfusion product is mostly implicated in TRALI?
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Plasma
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What should you do to manage TRALI?
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-STOP THE TRANSFUSION
-support the resp and circulatory systems |
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What SHOULDN'T you do in TRALI?
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Don't diurese - it's not volume overload
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What needs to be done to transfusion products if the recipient has an antibody causing the TRALI?
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Leukoreduce
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In what 2 patient groups are HLA antibodies most common?
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-Multi-transfused
-Multiparous females |
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What is GVHD?
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Graft versus host disease
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What is the cause of GVHD?
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Immunocompetent lymphocytes in donor blood that recognize the recipient as FOREIGN
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Why don't recipient immune cells recognize donor lymphocytes as foreign first?
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-Immunocompromised
-Or they look similar to self |
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What are ALL CASES of GVHD?
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Acute
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When does Transfusion induced GVHD occur in onset?
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3 weeks after transfusion
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How does tiGvhd present?
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-High fever, diffuse rash
-Nausea/vomit/diarrhea -Liver damage -Pancytopenia |
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What does the pancytopenia differentiate tiGVHD from?
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post BMT GVHD
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What is the mortality rate of tiGVHD?
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>90%
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Who is at highest risk for tiGVHD?
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Immunocompromised patients
-SCID -BMT recipients -Fetal/neonates -Chemo patients |
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Does tiGVHD only occur in immunocompromised patients?
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No; it also happens when HLA haplotypes are shared between donor and recipient.
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What is the most common scenario for tiGVHD in a normal immune system patient?
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Donor is homozygous for one of the patient's HLA haplotypes.
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What is the treatment for tiGVHD?
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supportive
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How is tiGVHD prevented?
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By irradiating products for at risk recipients
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What are the risk factors for bacterial contamination?
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-Increased storage time
-Room temp storage |
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What is the immediate culprit of bacterial contamination reaction?
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Endotoxin
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What are the top three causes of fatality induced by transfusion reactions?
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1. TRALI
2. Bacterial contamination 3. ABO errors |
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How is bacterial contamination reaction managed?
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By stopping the transfusion and giving IV antibiotics and supportive care.
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What is a common virus transmitted in transfusions?
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CMV
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When is CMV transfusion bad?
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In immunocompromised patients
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