Ipapburke Hematology Test 1- Transfusion

Front 1

Ultimate Principle to Remember in Transfusion Medicine

Back 1

Does the patient need increased O2 Carrying Capacity?

Front 2

What is the mortality benefit in empiric transfusion?

Back 2

There is NO mortality benefit from EMPIRIC therapy.

Front 3

When is transfusion considered in chronic anemia?

Back 3

Only as a last resort

Front 4

What is the most commonly used blood product?

Back 4

Packed Red Blood Cells

Front 5

What is the expected hematocrit increase with each unit of PRBC?

Back 5

3 points with each unit

Front 6

What is the impact on blood volume of one unit of PRBCs?

Back 6

250-300 ml

Front 7

When are leukocyte reduced filtered RBCs used?

Back 7

in hematologic malignancy or other complex illnesses that require frequent transfusions

Front 8

What is the benefit from using leukocyte reduced filtered RBCs?

Back 8

It reduced (does not eliminate) leukoagglutination reactions secondary to WBCs in the RBC units

Front 9

What is antilogous RBC transfusion?

Back 9

The patient supplies their own blood in anticipation of loss

Front 10

When is antilogous RBC transfusion most commonly used?

Back 10

in major ELECTIVE surgeries

Front 11

What is the only way to completely eliminate the risk for infectious risks in transfusion?

Back 11

use of antilogous RBC transfusion (however clerical errors can occur)

Front 12

When is frozen PRBC considered as an option?

Back 12

used for rare blood types who may be unable to find suitable blood for transfusion

Front 13

Drawbacks to needing frozen PRBC

Back 13

expensive and cannot be stored indefinitely

Front 14

When are CMV negative and irradiated PRBC used?

Back 14

in immunocompromised patients that are at risk for graft vs. host disease or patients who may be future transplant pts.

Front 15

What elements of fresh blood are found in whole blood?

Back 15

all- platelets, plasma factors, WBCs- found when blood is less than 24 hrs old

Front 16

When is whole blood used?

Back 16

massive hemorrhage for volume resuscitation and O2 carrying capacity

Front 17

What are apheresis platelets?

Back 17

platelets collected from a single donor with a specific HLA-type and can be crossmatched.

Front 18

Why can six packs of platelets no be crossmatched?

Back 18

the blood is "pooled" from several donors

Front 19

What concentration are platelets taken from a donated unit of whole blood concentrated to?

Back 19

50 ml

Front 20

What increase in platelet count will you get from transfusion of a "six pack"?

Back 20

increase of 15,000-30,000 platelets in one hour

Front 21

What should cause you to have suspicion of "refractoriness" when doing a platelet transfusion?

Back 21

failure of the platelet count to rise by at least 10,000 with an average "six pack" infusion

Front 22

Most common cause of refractoriness to platelet infusion

Back 22

most commonly there is NO APPARENT EXPLANATION- but may also be fever, splenomegaly, prior pregnancies (2+)

Front 23

Transfusion product prepared from whole blood by separating and freezing plasma within 6 hrs from phlebotomy

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Fresh Frozen Plasma (FFP)

Front 24

Which coagulation factors are found in FFP?

Back 24

all coag factors, but factors V and VIII are decreased as a consequence of storage

Front 25

What is FFP indicated for?

Back 25

replace depleted coag factors in pts. w/ active bleeding or high risk for bleeding

Front 26

What is the normal volume for a unit of FFP?

Back 26

200-250 mL

Front 27

This is FFP thawed and refrozen that contains increased concentration of fibrinogen, factors VIII:C and VIII:vWF and Factor XIII than FFP

Back 27

Cryoprecipitate

Front 28

unit volume of Cryoprecipitate

Back 28

20 mL

Front 29

Primary indication for use of cryoprecipitate

Back 29

replacement of depleted coag factors, esp. in Von Wildebrand's dz or severe hypofibrinogenemia (i.e. DIC)

Front 30

Explain Type and Screen Compatibility Testing.

Back 30

get ABO and Rh type of Pt's blood, Ab screen the pt's serum---if Ab screen negative, usually no other testing needed

Front 31

Explain Type and Cross Compatibility Testing or "cross matching".

Back 31

matches the patient's serum with the donor's RBCs (matched for specific patient)

Front 32

Universal Donor of RBCs

Back 32

O negative

Front 33

Universal Recipient of RBCs

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AB positive

Front 34

Universal Donor of Plasma Products

Back 34

AB

Front 35

Universal Recipient of Plasma Products

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O

Front 36

List the other RBC Antigens (4) that are freq. implicated in delayed hemolytic transfusion reactions

Back 36

Kell, Kidd, Duffy, Other Rh

Front 37

When do hemolytic transfusion reactions occur?

Back 37

when mismatched ABO/Rh blood is given resulting in massive intravascular hemolysis

Front 38

What is the MC reason for hemolytic transfusion reactions?

Back 38

clerical error

Front 39

What determines the severity of a hemolytic transfusion reaction?

Back 39

amount transfused

Front 40

When do the most severe cases of hemolytic transfusion reaction occur?

Back 40

during surgery under general anesthesia

Front 41

Classic signs of hemolytic transfusion reactions.

Back 41

fever, rigors, hypotension, and subj. pain at the site (severe cases- DIC, renal failure, circulatory shock)

Front 42

What is the difference b/w hemolytic and delayed hemolytic transfusion reactions?

Back 42

in delayed, lesser Ag-Ab burden results in lesser hemolytic response that may not occur until several days after transfusion

Front 43

AKA Febrile, Non-hemolytic Transfusion Reaction

Back 43

Leukoagglutination Reaction

Front 44

What causes Leukoagglutination Reaction?

Back 44

induced by the small amt. of WBCS and cytokines found in PRBC

Front 45

S/S of Leukoagglutination Reaction

Back 45

mild fever and chills within hrs- not as profound as true hemolytic transfusion rxn

Front 46

Most common transfusion reaction to PRBC

Back 46

Leukoagglutination Reaction

Front 47

Method to reducing leukoagglutination reactions.

Back 47

Leukopoor filters

Front 48

Infections associated with transfusion. (4)

Back 48

Hep B, Hep C, HTLV (human T lymphotropic virus), HIV

Front 49

If gram negative bacteria contaminate stored RBCs, what happens when they are transfused?

Back 49

acute sepsis

Front 50

MC bacteria that contaminates RBCs

Back 50

Yersinia enterocolitica

Front 51

Transfusion reaction that results in hypoxemia and pulm. Edema often followed by ARDS within hrs of transfusion

Back 51

Transfusion Associated Lung Injury (TRALI)

Front 52

Hallmark of TRALI

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hypoxemia in peritransfusion period

Front 53

Etiology of TRALI

Back 53

uncertain but probably immune mediated through preferential activation of leukocytes w/in pulm, capillary bed

Front 54

What would be considered a massive transfusion?

Back 54

more than 50% of pt's volume in 12-24 hrs; more than 10 units PRBC in 24 hrs

Front 55

In a massive transfusion, what should be given with PRBCs?

Back 55

FFP also

Front 56

Coagulopathy, dilutional thrombocytopenia, metabolic acidosis, hypocalcemia, hypothermia, hyperkalemia----complications of?

Back 56

massive transfusions

Front 57

If you think there is a problem with a transfusion, what do you do?

Back 57

STOP

Front 58

This type of blood product must be an EXACT match.

Back 58

whole blood