Blood Transfusion Reaction

what are the requirements for one to be a blood donor?

1. healthy/volunteer/blood donor

2. older than 17

3. have Hgb> 12.5

4. no history of hepatitis

5. free of any transmissible infectious dx

6. blood should not test positive for any inectious markers

what age does one have to be in order to be able to give blood?

17

what should one's Hb be in order to be capable of giving Hb?

Hgb> 12.5

what is the significance of apheresis?

it is a medical technology- and that enables one to pass the blood of the donor or patient through the apparatus-

what is usually the volume of RBC's?

250-300 mL

how is it stored?

1-6C for 35 days or 42 days

what are some of the actions?

they increase the oxygen carrying capacity by increasing the RBC mass. And oxygen delivery

when do you give blood transfusions?

1. symptomatic anemia

2. acute blood loss with signs

3. symptoms of hypoxia

4. exchange transfusions

what is symptoms of anemia?

1. generalized weakness

2. headache

3. dizziness

4. disorientation

5. breathlessness

6. palpitations

7. chest pain

what are some signs you get with acute blood loss?

1. pallor

2. tachycardia

3. hypotension

what are some of the symptoms of hypoxia?

1. perioperative

2. result of trauma

what are some of the contraindications for transfusions?

1. nutritional anemias- iron, folate, B12

2. asymptomatic anemia

3. volume expansion

4. to promote general well being

5. to treat a "number" (b/c Hb is below a defined level- such as

what are some of the side effects/hazards associated with RBC transfusion?

1. disease transmission

2. transfusion reaction (allergic, hemolytic)

3. TRALI- transfusion related acute lung injury

4. alloimmunization

5. Transfusion related immunomodulation

6. circulatory overload (TACO)

7. GVHD

CATTT DG

what is the amount of Hgb that is increased in a non-bleeding patient?

increment in Hgb is 1 g/dL per unit transfused

what is the mean survival for a transfused cell?

3-4 weeks

what is the amount that is infused?

infuse each unit about more than 1-2 hours in a non-bleeding patient

Can you add anything at the same tubing at the rbc's?

no, no medications or solutions other than normal saline maybe added to or infused through the same tubing

how much time can you infuse each unit in a non-bleeding patient?

infuse each unit over 1-2 hours

what should the RBC be?

ABO-compatible

what do you do to the RBC's so they can be "tolerated"?

1. volume reduced

2. irradiated

3. washed

4. frozen

5. leukoreduced

why would you want the volume to be reduced for RBC's?

for patients with CHF/Renal failure

why would you RBC's irradiated?

to prevent GVHD

why would you want RBC washed?

to remove plasma- to prevent allergy/anaphylaxis

why would you want to have RBC frozen?

to preserve rare or autologous RBC's

why would you want RBC leukoreduced?

to prevent the multiple complications that are caused by leukocytes and/or the cytokines produced by leukocytes.

what should the number of leukocytes reduction be?

they must be fewer than 5 x 10^6 leukocytes after filtration

what are some of the adverse consequences associated with leukocytes in transfused blood?

1. febrile, non-hemolytic transfusion reactions

2. allosensitization-refractoriness

3. microaggrgate

4. TRALI

5. dx transmission (CMV, HTLV, HIV)

6. immunomodulatory effects- TRIM

7. Reactivation of HIV

why do you want to have it leukoreduction for?

1. chronically transfused patients

2. potential transplant recipients

3. patients with prior transfusion rx

4. CMV seronegative at risk pt for whom seronegative blood is not available

5. patients undergoing cardiac surgery

6. all surgical patients

7. all patients

35 Female, fatigue/weakness: Hgb 7.5, MCV 70, ferritin

no, because the patient is definitely iron deficient. so you would want to correct the underlying problem first.

18 y/o with AML c/o lightheadedness and SOB, Hgb 5.5?

yes- he shows signs of anemia

45 y/o- pre-op for meningioma Hgb 8.5?

no, because this age group is ok for them to handle 8.5 Hb and they do surgery quiet well.

22 female acute splenic rupture (auto accident) Hgb bp 70/50?

yes

50 y/o- in OR for CABG: Anesthesia calls for RBC to get Hgb from 9-->10?

yes

how much platelets do you see in a single unit?

5.5 x 10^10 platelets in 40-70 ml plasma

what temperature are platelets stored?

they are stored at room temperature 20-24C with continuous gentle agitation for unto 5 days

why should the platelets be stored?

they should be stored for bacterial growth

Describe the pooling process for the platelets?

they are always pooled prior to transfusion to achieve a therapeutic dose- (4-6 to a pool)

what is the single donor platelets?

they are therapeutic dose of platelet and they are obtained form a single donor by hemapharesis

how much platelets apharesis are present in?

it contains 3x10^11 platelets in 200-500 mL plasma

what should all platelets be done during collection?

they should all be leukoreduced

what are the storage conditions associated with platelets?

they are identical to the whole blood-derived platelets

why are platelets important?

they are important in the early stages of hemostasis through the formation of platelet plugs

...

platelet plug the "hole" and then provide a nidus- for the development of the fibrin clot

...

they provide a source of phospholipid- which is required for coagulation and surface upon which

what should the platelet count have to be in a non-bleeding patient to give transfusion?

it has to be less than 10,000/uL in a non-bleeding patient

what is the normal count of platelet?

150,000-400,000/uL

what should the platelet count have to be in a bleeding patient?

What should the platelet count have to prior to invasive procedure?

what should the platelet count have to be prior to neurologic operative procedure?

what can cause one to have functionally abnormal platelets?

bleeding/pre-op in a patient with functionally abnormal platelets

why can you have abnormal number of platelet count?

they can be either abnormal platelets- because congenital or acquired

what are some congenital cause of abnormal platelets? what is the treatment?

transfusion- and it is thrombasthenia

what are some acquired causes of platelet transfusion?

uremia/ASA/Ticlid, RheoPro

when do you not give platelets?

1. bleeding not related to TTP

2. ITP

3. TTP/HUS

4. replacement "cocktail" in a massive transfusion situation- where platelet are "washed out"- and it is suspected but not demonstrated

do you give platelet transfusion in ITP?

no

do you give platelet transfusion in TTP?

no

TTP/HUS microangiopathic hemolytic proces?

no

In a situation in which you have "massive transfusion situation"- wash out is suspected?

no

Should ABO compatibility be present in platelets?

yes

Is compatability testing required?

no

If an individual is Rh positive patient- what should one do?

it should avoid giving its platelets to Rh negative young females

what is the Avg dose of platelets?

it is 1 unit per 10kg body weight.

what is the expected increment after transfusion?

the increment is about 5000/uL per platelet concentrate or roughly 30-40,000 per single donor dose

what are some side effect associated with platelet transfusion?

they are very similar to those of RBC transfusion- but there is additiona- fluid overload

what is the difference between whole-blood derived vs apheresis?

whole blood derived- cheaper/better/available- a byproduct of whole blood collections

apheresis- fewer donor exposure- leukoreduced at collection- easier to culture/can be HLA matched to prevent or treat allosensitization or refractoriness

10,000 platelet count?

for bleeding patient

50,000?

nonbleeding/invasive procedure

100,000?

neurological condition

150,000-400,000

normal condition

AML with 5,000?

treat

AML with 15,000?

not treat

AML with 30,000?

not treat

nonbleeding

a patient with GI bleed and 40,000?

yes, anything

a patient requiring brain surgery with 50,000 platelets?

treat, anything less than 100,000 for neurological TREAT

eye surgery 60,000?

yes

A patient with ITP and 6,000 pt?

don't treat- because HUS/ITP not treat

TTP and 9,000?

not treat

A patient having laparoscopy with 60,000 plts?

No, because invasive procedure- so anything below 50,000 treat-

how are granulocytes for transfusion collected in U.S?

apheresis

how much granulocytes do you get from "unstimulated donors"?

1 x 10^10 granulocytes

how much granulocytes do you get from "stimulated" donors

3-7x greater and it depends on the method of stimulation

where are granulocytes stored?

they are stored 20-24C for unto 24 hrs

what is the amount of Neutropenia does it have to be?

What should Neutropenia be associated with?

fever, but it is unresponsive to antibiotic therapy

how long should the fever be present and it is unresponsive to antibiotic therapy and you have granulocyte levels

48 hours

Can you give neutrophils to someone who has (

yes, if it is unresponsive to antibiotics

What if a patient has myeloid hypoplasia and it is has neutropenia

yes

what if it has reasonable chance for bone marrow recovery

yes

what is BBFM?

BBFM

bacterial sepsis

Bonemarrow recovery

Fever

Myeloid hypplasia

When should one not use granulocytes?

1. prophylaxis for infection

2. treatment of infections due to agents other than bacteria

3. without adequate trail of antibiotics and evidence that the infection is unresponsive for them

...

absolute granulocyte count returns to 500/uL

...

granulocytes should be transfused as soon as possible after collection

Can we use leukocyte-reduced filters?

no

what drug should I be cautious with if I give granulocytes?

Aphotericin B- it should not be transfused within several hours of an Amphotericin B infusion- and this can be associated with severe plum reactions

After you collect granulocytes- when should one give granulocytes?

ASAP

what should the granulocyte number be to discontinue once the concentrate ?

the concentration should be transfused daily until the infection is cured or absolute count returns to at least 500/uL

given the high level of RBC contamination what should one do?

cross-match is required

what is the side effects associated with granulocytes?

alloimmunziation, allergic rx, febrile reactions and severe pulm reactions

what are some plasma components?

1. fresh frozen plasma

2. "jumbo" fresh frozen plasma

3. plasma frozen within 24 hrs

4. thawed plasma

5. liquid plasma

6. cryoprecipitate

7. plasma cryprecipitate reduced