Transfusion Therapy (Exam 3)

What are the different types of blood used for transfusions?

- Whole blood

- RBCs

- Leukocyte-reduced RBCs

- Washed and frozen/deglycerolized RBCs

- Platelets

- Plasma

- Granulocytes

- Cryoprecipitate

- Factor VIII

- Albumin

- Immune globulin

- CMV negative cellular blood components

- Irradiated cellular blood components

What are some unique types of transfusions?

- Autologous

- Emergency

- Massive

- Neonatal

- Txn in oncology

Transfusion therapy is used to treat inadequate ______ capacity.

oxygen-carrying

Transfusions can also be used to treat insufficient ______ proteins or ______ to provide adequate homeostasis.

coagulation, platelets

Whole blood is used to replace both ______ and ______.

RBC mass, plasma volume

One unit of whole blood in adults has an anticipated increase of ______g/dL hemoglobin and ______% hematocrit.

1g/dL, 3%

Whole blood is usually only used for transfusions when ______ in involved.

trauma

RBCs are used for increasing the RBC mass for those who require increased ______.

oxygen carrying capacity

The threshold value of hemoglobin to elicit a RBC transfusion is ______g/dL.

7g/dL

With each RBC unit, there is an anticipated increase of ______g/dL of hemoglobin and ______% hematocrit.

1g/dL, 3% hematocrit

Leukocyte-reduced RBCs are used to reduce ______ exposure, ______ transmission and ______.

HLA, CMV, FNHTR

Leukocyte-reduced RBCs are used for transfusion-related ______.

immune suppression

Leukocyte-reduced RBCs are considered a ______ safe product.

CMV

Leukocyte content must be reduced to less than ______ after leukocyte reduction filters.

5 x 10^6

When are washed RBCs used for transfusion?

- Patients who can't tolerate high K+ levels

- Have persistent anaphylactic transfusion reactions

- IgA deficient patients with anti-IgA

- Patients with an incompatible heart transplant (or candidates for)

You can freeze ______ or ______ RBC units to extend their shelf life.

rare, autologous

In order to freeze RBCs, ______ must first be added, which MUST be removed before transfusion into a patient.

glycerol

Platelets can be used in patients with ...

- Severe thrombocytopenia

- Abnormal PLT function

- Hemorrhage

Plateletpheresis must contain a minimum of _____ PLTs.

3 x 10^11

Plateletpheresis increases patient PLT count ______/uL.

20,000-60,000/uL

Whole blood derived platelets must contain a minimum of ______ PLTs.

5.5 x 10^10

Whole blood derived platelets increase patient PLT count ______/uL.

5,000-10,000/uL

Within an hour after a patient has received a PLT transfusion, if their platelet count is under ______% of expected on two occasions, the patient is refractory.

<50%

Most of the time, refractoriness is caused by ______.

non-immune causes

(Splenomegaly, DIC, fever, sepsis, ongoing bleeding, GVHD, medications)

30% of the time, refractoriness has an ______ cause.

immune

(ABO, HLA and PLT specific antigens in PLT transfusions)

______ antibodies are the most common target in immune mediated platelet refractoriness.

HLA

HLA-PRA predicts the incompatibility of PLTs in a ______ due to anti-HLA.

population

HLA-PRA uses ______ with HLA antigen coated beads.

flow cytometry

HLA-PRA quantifies ______ and gives ______ specificity.

sensitization, antibody

Once thawed, fresh frozen plasma and FP-24 have an expiration of ______.

24 hours

If not used after 24 hours, the product can be modified to ______, which has a 5 day expiration.

thawed plasma

When can plasma transfusion be important?

- Coagulation deficiencies

- Vitamin K deficiency

- Warfarin overdose

- DIC treatment

Plasma and plasma 24 contain all ______.

coagulation factors

If giving a patient a plasma transfusion/exchange, it should be ______ compatible.

ABO

Granulocyte Pheresis is for patients with ...

- Fever

- Neutrophils <500/uL

- Septicemia

- Bacterial infection unresponsive to antibiotics

Granulocyte pheresis requires a _____ due to RBC presence in the product.

crossmatch

Cryoprecipitate is used primarily for ______ replacement.

fibrinogen

Patients with Hemophilia A or Factor VIII deficiency are treated with ______.

Factor VIII

What are the AAB requirements for cryoprecipitate content?

- 150mg fibrinogen

- 80 units of Factor VIII/unit

Only Factor VIII products labeled as containing ______ should be used for patients with von Willebrand's Disorder.

vWF

Albumin is prepared from ______, yielding 96% of protein content as albumin.

plamsa

Albumin is used for patients needing ______ replacement.

volume

Albumin is used as replacement fluid in _______.

plasmapheresis

Albumin can also be used in treatment of ______.

burns

Immune globulin is prepared from ______ and is primarily class ______.

plasma, IgG

Immune globulin is used for patients with ______ or who have been exposed to ______.

hypogammaglobulinemia, Hepatitis A

IGIV is also used to increase ______ in ITP.

platelets

CMV negative or leukocyte-reduced cellular blood components are indicated for patients who are ______ and at risk for ______ infections.

CMV negative, severe CMV

What are some examples of this?

- CMV negative pregnant women

- Allogeneic CMV negative BM and SC recipients

- Premature infants weighing <1200g

Cellular blood components can be irradiated with ______ or ______.

gamma radiation, X-ray

Irradiation of cellular blood components can prevent ______.

GVHD

Irradiation can be used with transfusion or transplantation of immunocompetent ______.

T lymphocytes

Irradiated cellular blood components can be used with HLA differences in ______ patients or ______ recipients.

immunocompromised, blood relative

What are the three types of autologous transfusion/donation?

- Donation

- Intraoperative hemodilution

- Postoperative cell salvage of shed blood during surgical procedures

In the event of an emergency transfusion, if you don't have the patient's blood type on file, use ______ RBCs.

O- (for women)

O+/- (for men)

Emergency transfusions require ASAP completion of a ______.

type and screen (allows for switching to ABO and Rh type specific blood for txn)

Massive transfusion is defined as the replacement of one or more blood volumes, or about ______ units in adults within 24 hours.

10

In massive transfusion situations, a patient in critical condition and a limited supply of type specific blood may require a change in ______.

ABO or Rh types

If an Rh negative woman of childbearing age requires a massive transfusion, she should receive ______ RBC products for as long as possible.

Rh negative

Massive transfusion protocols (MTPs) are set up to get the patient ______ all together.

all components (RBCs, PLTs, plasma)

Neonatal blood must be tested the same as ______.

adults (can use mom's plasma if needed)

Neonates require blood units less than ______ old.

7 days

Neonates require ______ blood to prevent CMV infection

CMV negative or leukocyte reduced

Neonatal txn units are usually _____ and are negative for ______.

irradiated, hemoglobin S

Once ABO/Rh and Abs are tested, a neonate does not require ______ for the remainder of the hospital admission or until 4 months (whichever is sooner).

additional testing

Units used in oncological transfusion are always ______ to prevent GVHD.

irradiated

Blood filters at the bedside remove ______ and ______ from units to be transfused.

air, clots