Heme Exam 1 - Engle Transfusion 2

Front 1

RBCs:
List them all:

Back 1

Whole Blood
PRBCs
Leukocyte-Reduced RBCs
Washed RBCs
Frozen / Deglycerolized RBCs
Irradiated RBCs

Front 2

List the blood components

Back 2

List the blood components

RBCs:
Whole Blood
PRBCs
Leukocyte-Reduced RBCs
Washed RBCs
Frozen / Deglycerolized RBCs
Irradiated RBCs

Platelets: Singles or Pheresed

FFP: Fresh Frozen Plasma

Cryoprecipitate (Cryo)

Front 3

When To Transfuse RBCs
Current Medical Consensus:
***

Back 3

When To Transfuse RBCs

eval. each pt

Current Medical Consensus:
HgB < 8.0 g/dL with disease for patients with heart, lung, or cerebral vascular disease

HgB < 6.0 g/dL in the absence of disease

Each unit will raise the HgB level 1.0 – 1.5 g/dL (HCT 3-5%).*****

raise to 9 by given 3 units from 6.0 Hb

Front 4

Whole Blood transfusion
indication, composition, volume, major risk

Back 4

Whole Blood transfusion


Very rarely transfused today

Indication For Use:
To replace the loss of both RBC mass and plasma volume.

Composition:
40% HCT with platelets

Volume:
450-570 mls

Major Risk: Volume overload can trigger congestive heart Failure, pullmonary edema, etc

Front 5

PRBCs transfusion
indication, composition, volume, shelf-life

Back 5

PRBCs transfusion
indication, composition, volume, shelf-life

Commonly transfused today
Both ABO identical and ABO compatible options are available for transfusion.

Indications For Use:
To increase the oxygen-carrying capacity in anemic patients
Each unit will raise the HgB level 1.0 – 1.5 g/dL (HCT 3-5%).

Composition:
HCT 55% - 70%

Volume:
330 mLs

Shelf-Life:
35 days in APDA-1

Front 6

Leukocyte-Reduced RBCs

Back 6

Leukocyte-Reduced RBCs

Leukocytes in PRBCs may cause the following:
Febrile nonhemoltyic transfusion reactions
Transfusion associated Graft Versus Host Disease (GVHD)
CMV transmission
HIV transmission
Epstein-Barr virus transmission

Leukocyte-Reduced RBCs reduce all these, mainly fever.

Front 7

Washed RBCs
Indications For Use:

Back 7

Washed RBCs
Indications For Use:

**Patients with a history of severe allergic (anaphylactic) transfusion reactions to ordinary units of RBCs.
The washing process removes plasma proteins that causes most of the allergic reactions.

Washed RBCs are especially useful for rare IgA deficient patients who develop an anti-IgA antibody that reacts with IgA in donor blood.

Front 8

Frozen / Deglycerolized RBCs

Back 8

Frozen / Deglycerolized RBCs

save up own blood a months before surgery.

Indication For Use:
Long-term storage of very rare blood donor units
Autologous units

The Action of Glycerol:
Glycerol crosses the cell membrane, enters the cytoplasm, and prevents water from migrating outward as extracellular ice is formed and thus prevents intracellular dehydration.

Composition:
HCT: 75%

Volume:
180 mls

Front 9

Irradiated RBCs

Back 9

Irradiated RBCs

Major Goal:
Prevention of Graft-vs-Host Disease

Preparation:
1500-5000 rads of radiation prior to administration which renders the donor T cells incompetent.

Indications For Use: (FIRM)
(Fetus) Intrauterine transfusions, Immunocompromised patients, recipients of blood from a Relative, bone Marrow transplant patients, etc.

Shelf Life:
Original outdate or 28 days from irradiation, whichever comes first.

Front 10

Platelets and Plateletphereis

Back 10

Platelets and Plateletphereis

Platelets are essential for the formation of the primary hemostatic plug and the maintenance of normal hemostasis.

Indications For Use:
Severe Thromobcytopenia (<50,000 plts/uL)

Composition:
Pooled Platelet (Plt Single): >5.5 x 1010 plts
Platelet Pheresis (Plt-P): >3.0 x 1011 plts

Volume:
Pooled Platelet (Plt Single): 60 mls/unit
Platelet Pheresis (Plt-P): 300 mls

Storage Temperature & Shelf Life:
Room Temperature: 20 – 24 ° C with gentle agitation for up to 5 days

Important Note:
1 Plt-P or 6 Plt-S should increase the platelet count by 5,000 – 10,000 plts/uL in a typical 70-kg human.

6 pack or (singles)= 1 freezed unit

6 pack (singles)- from 6 different people
1 freezed unit- from1 person (better)******

Front 11

Severe Thromobcytopenia:
Causes:

Back 11

Severe Thromobcytopenia:
Causes:

Causes:
Decreased platelet production (chemotherapy)
DIC
Dilution effect caused by resuscitation fluids and RBC transfusion

Symptoms:
Petechaie, ecchymoses, mucosal or spontaneous hemorrhage.

Front 12

Fresh Frozen Plasma (FFP)
indication, important facts

Back 12

Fresh Frozen Plasma (FFP)
indication, important facts

Indications For Use:
Contains all coagulation factors

Used to treat multiple coagulation deficiencies occurring in patients with liver failure, DIC, or massive RBC transfusion (which dilutes the coagulation factors’ concentration.

FFP is the product of choice for patients with multiple-deficiencies.

Important Facts:
FFP is not crossmatched; type the patient and choose the correct type to give the patient.

Typically 4 -6 FFP units is needed to correct a coagulopathy such as in liver disease or DIC.

Front 13

Cryoprecipitate

Back 13

Cryoprecipitate

Indication For Use:
Originally prepared as an excellent source of factor VIII but now recombinant factor VIII is available.
Today, used mainly for fibrinogen replacement and to treat Factor XIII deficiency.
AABB Requirement: Each unit of cryo must contain at least 150 mg of fibrinogen; This is why cryo is the specimen of choice for fibrinogen replacement.


Composition:
All coagulation factors including fibrinogen plus significant amounts of vWF (von Willebrand’s Factor).

Volume:
15 mls

Front 14

General Overview of Pretransfusion Practices

Back 14

Patient sample less than 3 days old

Record Check (Every patient, every time)
Honor all clinically significant alloantibodies, even if currently undetectable

Type & Screen:
ABO and Rh type, & Antibody Screen
Purpose: This ensures that if the patient does have an antibody, the blood bank has adequate time to provide antigen negative blood.

Type & Cross
Type & Screen
Crossmatch: In vitro mix of patient’s blood with the donor’s blood
Goal: To provide a reasonable confidence that transfused RBCs have a acceptable survival rate and there should not be significant destruction of the recipient’s own RBCs.

Front 15

Pretransfusion Compatibility Testing

Back 15

Pretransfusion Compatibility Testing

Important Facts:
Pretransfusion compatibility testing cannot guarantee normal survival of transfused RBCs in the recipient’s circulation.

The potential benefits of RBC transfusion should always be weighed against the potential risks.

Front 16

Blood Administration

Back 16

Blood Administration

1. Base line vital signs are taken
Blood pressure, respiration, pulse, temperature, etc.

2. Blood components are infused slowly during the first 10-15 minutes while the patient is observed closely for signs of a transfusion reaction.
At the 15 minute mark, the vital signs are retaken as compare to the base line vital signs.
Acute hemolytic Trans Rxn
Anaphylatic Trans Rxn

3. All transfusions must be completed within 4 hours.
AABB Standard Requirement

4. Vital signs are checked periodically during the entire course of the transfusion.