Hemonc, Exam 1, Transfusion Medicine

Front 1

Allogeneic Blood Donor

Back 1

Hgb>12.5 g/dL
infx dz screen:
-hepB, hepC
-HIV
-HTLV
-Syphilis
-W Nile Virus
-Chagas

Front 2

pRBC

Back 2

RBC's suspended in: anticoagulant, additive solution (nutrients)
-vol: 250-300 mL
-65% RBCs, 35% plasma and AS
-contains WBC's, some plt, 200 mg Fe
-42 day shelf life

Front 3

pRBC Indications

Back 3

provides O2 carrying capacity
symptomatic anemia: tachy, AMS, ECG shows cardiac ischemia, angina, SOB, dizziness/lightheaded
-not based on lab values alone

Front 4

1 unit pRBC provides

Back 4

Hgb increase by 1g/dL
Hct increase by 3%

Front 5

pRBC transfusion

Back 5

-RBCs infuse alone or w/ 0.9% NaCl through 170 um clot-screen filter.
-don't mix w/ Ca, dextrose, meds, hypertonic soln
-avoid lactate infused ringers

Front 6

Type & Screen & Cross

Back 6

Type & Screen: determine ABO/Rh type and Ab screen. May need blood w/in 72 hr
Type & Cross: determine ABO/Rh type, Ab screen, and crossmatch w/ donor. Need blood immediately

Front 7

ABO Antigens

Back 7

-IgM>>IgG>IgA
-can bind C' -> intravascular hemolysis

Front 8

Rh Antigens

Back 8

-Rh+ = D+ = more common
-highly immunogenic
-important in both RBC and plt transfusion (product may contain some RBC components)

Front 9

Ab Screen

Back 9

see if pt has Ab's to other major blood grp (caused by exposure to others' blood)
-mix pt plasma + 3 other known blood grps
-if +rx, then do further testing of RBCs

Front 10

Plasma

Back 10

-5 day shelf life (room temp)
-pooled plt concentrates = multiple donors
-platelets, apharesis = one donor

Front 11

Indications for Plasma Transfusion

Back 11

Thrombocytopenia:
-prophylactic: <10k
-febrile/unstable: <20k
-surgery/trauma: <50k
-dramatically dropping plt count

Plt dysfx:
-uremia (renal)
-ASA
-post-cardiopulm bypass

Front 12

One therapeutic dose of Plts

Back 12

-apharesis or 6 pooled plt concentrates
-incr plt count by 30-50k

Front 13

Fresh Frozen Plasma (FFP)

Back 13

contains:
-all clotting factors
-400 mg fibrinogen
-citrate

Front 14

FFP Indications

Back 14

multiple factor deficiencies:
-massive transfusion
-liver dz
-trauma
-DIC
-unidentified deficiency
-wafarin reversal for emergent, invasive procedure
-PT/PTT >1.5x nl

goal: attain 30% factor level

Front 15

Cryoprecipitate

Back 15

precipitate that forms when FFP is thawed.
contains:
-factor 8
-vWF
-fibrinogen
-fibronectin
-factor 13

Front 16

Cryoprecipitate Indications

Back 16

-FVIII deficiency (better to use factor conc)
-fibrinogen def
-FXIII def
-improve plt fx in uremia

Front 17

Sx's of Suspected Rx to Transfusion

Back 17

-back pain
-F/C
-hypotension
-dyspnea

blood bank w/u: clerical check, serum color check, DAT, cx, retype pt, u/a (look for hgb)

Front 18

Transfusion Rx's

Back 18

Acute Immune
Delayed Immune
Acute non-Immune
Delayed non-Immune

Front 19

Hemolytic Rx

Back 19

(acute immune)
-etiology: red cell incompatibility (clerical error)
-1/76,000 transfusions
-sx's: F/C, hypotension, back pain, DIC/oozing, hemoglobinuria
-tx: pressors, fluids, blood products (PRN for DIC)

Front 20

Febrile Non-Hemolytic Transfusion Rx

Back 20

(acute immune)
-etiology: accumulated cytokines in blood products
-0.1-1% transfusions
-sx's: F/C, HA
-tx: acetaminophen

Front 21

Leukocyte Reduction

Back 21

-filter to remove leukocytes
-standard at UNC
-indications: reduc CMV transmission, reduc alloimmunization to WBC's in chronic transfusion pt's, reduces febrile non-hemolytic transfusion rx!

Front 22

ALL & Anaphylactic Rx

Back 22

-etiology: Ab to donor plasma proteins
-risk: 1 in 20-50,000 anaphylaxis; 1-3% allergic
-sx's: rash, flushing, hypotension, bronchospasm
-dx: Anti-IgA for anaphylaxis
-tx: antihistamines, epi, steroids, IgA-def or washed blood products

Front 23

Washing

Back 23

remove plasma, by washing RBC/plt w/ saline
-indications: prev ALL, anaphylaxis, IgA def.
-time consuming, work, lasts 24 hr

Front 24

TRALI

Back 24

transfusion related acute lung injury
-leading cause of transfusion-related mortality
-defn: new lung injury w/in 6 hr of transfusion, hypoxemia, bilateral infiltrates on CXR, no other risk factors for pulmonary edema
-usu w/ F/C, hypotension
ddx: ARDS, vol. overload

Front 25

TRALI

Back 25

(acute immune)
-etiology: WBC/HLA Ab in DONOR*
-risk: unclear
-sx's: new lung injury w/in 6hr transfusion
-dx: test donor for WBC/HLA Ab, CXR
-tx: supportive, defer donor

Front 26

Delayed Hemolytic Transfusion Rx

Back 26

(delayed immune)
-etiology: anamnestic immune response to red cell Ag's
-risk: 1 in 2500-11000
-sx's: F, back pain, decr Hgb
-Tx: usually none needed

Front 27

Transfusion-associated graft v. host

Back 27

(delayed immune)
-etiology: donor lymphocytes engraft in recipient and attack
-rare
-sx's: rash, N/V, hepatitis, pancytopenia
-Dx work-up: skin biopsy, analysis for donor DNA
-tx: no effective tx

Front 28

Irradiation

Back 28

prevents TA-GVHD
-indicated in severe immunodeficient settings (lymphopenia)
-cons: 28 day expiration, increased K in RBC product

Front 29

Alloimmunization

Back 29

etiology: immune response to transfused allogeneic RBCs
-risk: 1/100
-sx's: none
-tx: none needed, avoid unnecessary transfusions

Front 30

Transfusion associated Circulatory Overload (TACO)

Back 30

(acute non-immune)
-etiology: vol. overload
-risk: <1%
-sx's: dyspnea, htn, cough
-dx: CXR
tx: diuretic, upright posture, oxygen

Front 31

Transfusion-related sepsis

Back 31

-etiology: bacterial contamination
-risk: 1/75000 in plt, 1/500000 in pRBC
-sx's: F/C, hypotension
-supportive care, abx