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36 Cards in this Set
- Front
- Back
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What type of surgeries typically require blood transfusion?
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-Cardiovascular
-Orthopedic |
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What type of decision should or should not the decision to transfuse be?
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Clinically based; not based solely on lab values.
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What is the general hemogloblin level at which you'll start to consider transfusion?
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6-8 g/dl
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What Hb level frequently requires transfusion?
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<6 g/dl
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What is the general guideline for how FAST to transfuse?
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2-4 hrs; not longer than 4 hours
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What are 3 symptoms that would alert you to an adverse transfusion event?
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-Red urine
-Oozing from venipuncture sites -Hypotensive (very low BP) |
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What are key symptoms of Anaphylatic transfusion reaction?
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-SWELLING of the face/larynx
-Hypotensive -Dyspnea -Increased respiratory rate |
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What are the key symptoms of TRALI?
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-Fever
-Hypotensive -Dyspnea/SOB -Increased RR |
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What are the 3 major mechanisms that result from Ab binding RBC antigens during acute HTR?
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1. Complement activation
2. ROS/leukotriene/cytokine release 3. IL6 and TNF release |
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What are the 3 main effects of IL6 and TNF?
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-Fever
-Hypotension -DIC |
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What is the major complication of acute HTR that we worry about?
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Renal failure
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What are the 3 immediate causes of renal failure in hemolytic transfusion reactions?
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1. Hemoglobinuria
2. Hypotension 3. Fibrin degradation products |
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What is the cause of hemoglobinuria?
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Hemolysis in excess of the carrying capacity of Albumin and Haptoglobin
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What is the cause of Hypotension?
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Vasodilation induced by C3a/C5a anaphylatoxins
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What is the cause of FDPs?
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DIC induced by complement activation
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What are 4 steps involved in a transfusion reaction workup?
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-Clerical check
-Serum/Urine check for hemolysis -DAT -Repeat ABO type |
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What 4 lab tests would you order to investigate a HTR?
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-CBC for hemoglobin (decreased or failed to increase
-LDH (increased via release) -Haptoglobin (decreased) -Total bilirubin (increased) |
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What are the 4 major complications that can arise from HTR?
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-Shock
-DIC -Renal failure (ARF) -Death |
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What are 80% of major transfusion complications due to?
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Giving the wrong blood
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What is the #1 reason for giving the wrong blood?
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human error
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What is a good way to differentiate FNHTR from TRALI and Bacterial contamination?
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It will normally have hypertension, not a decrease; the fever won't spike as high as in bacterial sepsis.
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What is the general CAUSE of FNHTR?
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Antibodies in the recipient to donor WBCs - reaction elicits IL1, IL6, and TNF which induce fever/chills, etc.
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When does FNHTR usually occur?
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At the end of a transfusion (2hrs)
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Why do we investigate fever during or after a transfusion?
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To make sure it's not something more severe.
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What is the universal donor prior to completion of a crossmatch?
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O neg packed RBCs
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What is the best product for replacing fibrinogen?
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cryo
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What is the recommended treatment for a patient that is not bleeding but has a prolonged PT?
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-Discontinue or decrease warfarin
-Give vit K |
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What is the recommended treatment for a patient that is bleeding and has a prolonged PT?
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It depends on the severity of bleeding; if severe give FFP and monitor INR closely, in addition to D/C warfarin and give vit K
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How long does giving vit K take to see an effect?
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24 hours
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How much FFP should you transfuse to a 70 kg patient?
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3-4 units
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What are 4 possible adverse effects of FFP transfusion?
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-Allergic reaction
-TACO (1/700) -TRALI (1/5000) -Infectious disease (rare) |
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What is TACO? What is it often confused with?
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Transfusion associated circulatory overload - may often be confused as this in TRALI cases
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Do blood transfusions require informed consent?
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yes
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What is informed consent?
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A process of communication between the ordering physician and recipient.
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What are the basic elements of Informed consent?
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-Indications
-Benefits -Risks -Alternatives |
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Whose resposnibility is it to obtain informed consent?
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The ORDERING PHYSICIAN'S.
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