Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
58 Cards in this Set
- Front
- Back
Ultimate Principle to Remember in Transfusion Medicine
|
Does the patient need increased O2 Carrying Capacity?
|
|
What is the mortality benefit in empiric transfusion?
|
There is NO mortality benefit from EMPIRIC therapy.
|
|
When is transfusion considered in chronic anemia?
|
Only as a last resort
|
|
What is the most commonly used blood product?
|
Packed Red Blood Cells
|
|
What is the expected hematocrit increase with each unit of PRBC?
|
3 points with each unit
|
|
What is the impact on blood volume of one unit of PRBCs?
|
250-300 ml
|
|
When are leukocyte reduced filtered RBCs used?
|
in hematologic malignancy or other complex illnesses that require frequent transfusions
|
|
What is the benefit from using leukocyte reduced filtered RBCs?
|
It reduced (does not eliminate) leukoagglutination reactions secondary to WBCs in the RBC units
|
|
What is antilogous RBC transfusion?
|
The patient supplies their own blood in anticipation of loss
|
|
When is antilogous RBC transfusion most commonly used?
|
in major ELECTIVE surgeries
|
|
What is the only way to completely eliminate the risk for infectious risks in transfusion?
|
use of antilogous RBC transfusion (however clerical errors can occur)
|
|
When is frozen PRBC considered as an option?
|
used for rare blood types who may be unable to find suitable blood for transfusion
|
|
Drawbacks to needing frozen PRBC
|
expensive and cannot be stored indefinitely
|
|
When are CMV negative and irradiated PRBC used?
|
in immunocompromised patients that are at risk for graft vs. host disease or patients who may be future transplant pts.
|
|
What elements of fresh blood are found in whole blood?
|
all- platelets, plasma factors, WBCs- found when blood is less than 24 hrs old
|
|
When is whole blood used?
|
massive hemorrhage for volume resuscitation and O2 carrying capacity
|
|
What are apheresis platelets?
|
platelets collected from a single donor with a specific HLA-type and can be crossmatched.
|
|
Why can six packs of platelets no be crossmatched?
|
the blood is "pooled" from several donors
|
|
What concentration are platelets taken from a donated unit of whole blood concentrated to?
|
50 ml
|
|
What increase in platelet count will you get from transfusion of a "six pack"?
|
increase of 15,000-30,000 platelets in one hour
|
|
What should cause you to have suspicion of "refractoriness" when doing a platelet transfusion?
|
failure of the platelet count to rise by at least 10,000 with an average "six pack" infusion
|
|
Most common cause of refractoriness to platelet infusion
|
most commonly there is NO APPARENT EXPLANATION- but may also be fever, splenomegaly, prior pregnancies (2+)
|
|
Transfusion product prepared from whole blood by separating and freezing plasma within 6 hrs from phlebotomy
|
Fresh Frozen Plasma (FFP)
|
|
Which coagulation factors are found in FFP?
|
all coag factors, but factors V and VIII are decreased as a consequence of storage
|
|
What is FFP indicated for?
|
replace depleted coag factors in pts. w/ active bleeding or high risk for bleeding
|
|
What is the normal volume for a unit of FFP?
|
200-250 mL
|
|
This is FFP thawed and refrozen that contains increased concentration of fibrinogen, factors VIII:C and VIII:vWF and Factor XIII than FFP
|
Cryoprecipitate
|
|
unit volume of Cryoprecipitate
|
20 mL
|
|
Primary indication for use of cryoprecipitate
|
replacement of depleted coag factors, esp. in Von Wildebrand's dz or severe hypofibrinogenemia (i.e. DIC)
|
|
Explain Type and Screen Compatibility Testing.
|
get ABO and Rh type of Pt's blood, Ab screen the pt's serum---if Ab screen negative, usually no other testing needed
|
|
Explain Type and Cross Compatibility Testing or "cross matching".
|
matches the patient's serum with the donor's RBCs (matched for specific patient)
|
|
Universal Donor of RBCs
|
O negative
|
|
Universal Recipient of RBCs
|
AB positive
|
|
Universal Donor of Plasma Products
|
AB
|
|
Universal Recipient of Plasma Products
|
O
|
|
List the other RBC Antigens (4) that are freq. implicated in delayed hemolytic transfusion reactions
|
Kell, Kidd, Duffy, Other Rh
|
|
When do hemolytic transfusion reactions occur?
|
when mismatched ABO/Rh blood is given resulting in massive intravascular hemolysis
|
|
What is the MC reason for hemolytic transfusion reactions?
|
clerical error
|
|
What determines the severity of a hemolytic transfusion reaction?
|
amount transfused
|
|
When do the most severe cases of hemolytic transfusion reaction occur?
|
during surgery under general anesthesia
|
|
Classic signs of hemolytic transfusion reactions.
|
fever, rigors, hypotension, and subj. pain at the site (severe cases- DIC, renal failure, circulatory shock)
|
|
What is the difference b/w hemolytic and delayed hemolytic transfusion reactions?
|
in delayed, lesser Ag-Ab burden results in lesser hemolytic response that may not occur until several days after transfusion
|
|
AKA Febrile, Non-hemolytic Transfusion Reaction
|
Leukoagglutination Reaction
|
|
What causes Leukoagglutination Reaction?
|
induced by the small amt. of WBCS and cytokines found in PRBC
|
|
S/S of Leukoagglutination Reaction
|
mild fever and chills within hrs- not as profound as true hemolytic transfusion rxn
|
|
Most common transfusion reaction to PRBC
|
Leukoagglutination Reaction
|
|
Method to reducing leukoagglutination reactions.
|
Leukopoor filters
|
|
Infections associated with transfusion. (4)
|
Hep B, Hep C, HTLV (human T lymphotropic virus), HIV
|
|
If gram negative bacteria contaminate stored RBCs, what happens when they are transfused?
|
acute sepsis
|
|
MC bacteria that contaminates RBCs
|
Yersinia enterocolitica
|
|
Transfusion reaction that results in hypoxemia and pulm. Edema often followed by ARDS within hrs of transfusion
|
Transfusion Associated Lung Injury (TRALI)
|
|
Hallmark of TRALI
|
hypoxemia in peritransfusion period
|
|
Etiology of TRALI
|
uncertain but probably immune mediated through preferential activation of leukocytes w/in pulm, capillary bed
|
|
What would be considered a massive transfusion?
|
more than 50% of pt's volume in 12-24 hrs; more than 10 units PRBC in 24 hrs
|
|
In a massive transfusion, what should be given with PRBCs?
|
FFP also
|
|
Coagulopathy, dilutional thrombocytopenia, metabolic acidosis, hypocalcemia, hypothermia, hyperkalemia----complications of?
|
massive transfusions
|
|
If you think there is a problem with a transfusion, what do you do?
|
STOP
|
|
This type of blood product must be an EXACT match.
|
whole blood
|