Transfusions

appearance of a bacterially contaminated unit

typically signs of clotting

what is the most important step to ensure safe transfusions

patient identificiation

infusion sets

blood is administered through a filter designed to retain blood clots and particles potentially harmful to the recipient

blood warmers

needed if cold blood is infused very rapidly to reduced the risk of cardiac arrest

mechanical pumps

deliver infusion at a controlled rate

pressure devices

most often used in surgery to infuse blood very rapidly

What type of needle is recommend to reduce risk of hemolysis

large bored needles

only acceptable additive solution to a unit of blood

normal saline (0.9%)

maximum time that a unit can be transfused to a patient

4hrs

how is the patient monitored during a blood transfusion

periodically throughout transfusion (every 30min typically)

What do you do if there is a suspected transfusion reaction occurring

stop the transfusion and call the doctor immediately

What units are placed on the ‘emergency shelf”

4 O= and 4 O+ units

What blood is administered in emergency when there is no time to type

Group O

What type of blood is administered in emergency for women in child-bearing age and males under 13 yrs

O=

Why is blood <7 days old preferred for neonates

reduce risk of hyperkalemia and maximize 2,3-DPG levels

refractoriness

lack of adequate rise in plt count following 2 consecutive transfusions

GVHD

donors immune cells attack the recipients body because they are seen as foreign

Fibrin glue

forms when fibrinogen is mixed with thrombin and is used in surgery

Surgical blood order schedule

set of guidelines for surgical procedures and their anticipated blood dosage

intraoperative hemodilution

donated in the OR just prior to start and released when OP is done

salvage blood

collected during surgery and includes other fluids that get centrifuged out

What is the time limit of when blood can be returned to the center if not used in the case of transfusion delays

30 min

hemophilia A

factor VII or DDAVP for mild cases

Hemophilia B

factor IX

von willebrand disease

Factor VII and cryoprecipitate for mild cases

Factor XIII deficiency

cryoprecipitate

multiple coagulation deficiencies

plasma products

liver failure

plasma products

hypofibrinogenemia

cryoprecipitate when fibrinogen <100 mg/dL

TTP

plasma products

novo seven

hemophilia A and B with inhibitors

Immune globulins (IVIGs)

RHIG, Winrho, HBIG

DDAVP

chemical used to stimulate in vivo factor VII

Iron therapy/ VitB12/ Folic acid

supplements used to correct deficiencies as opposed to transfusion

erythropoietin (EPO)/Procrit

stimulates production of RBCs

autologous

self-donation

directed

friend or family donation

interval for autologous whole blood donation

at least 3 days before intended use

interval for a whole blood donation

56 days (8 weeks)

interval for Double red cell apheresis

16 weeks

minimun HCT for double red cell aphaeresis

40%

interval for platelet aphaeresis

4 weeks

deferral time in platelet aphaeresis for aspirin consumption

at least 2 days

min. platelet count for platelets aphaeresis

platelet count above 150,000

interval for occasional plasmapheresis

4 weeks

interval for serial plasmapheresis

2 days

allogenic donation age req.

>17 yrs old or 16 with permission

Autologous donation age req.

none

allogenic/autologous donation weight req.

>110lbs

allogenic/autologous donation temp req.

<37.5C or 99.5F

allogenic/autologous donation pulse req.

50-100 bpm

allogenic/autologous donation BP req.

90-180mmHg(systolic) and 50-100mmHg(diastolic)

autologous donation HGB and HCT req.

>11g and 33%

allogenic donation HGB and HCT req.

males 13g (39%) and females 12.5g(38%)

deferral times for rubeola, mumps, polio, typhoid, yellow fever, Hep A/B

2 weeks

deferral time for rubella, chickenpox

4 weeks

deferral time for smallpox

8 weeks

deferral time for HBIG

3 months

deferral time for flu shot, tetanus, toxoids, killed synthetic, bacterial vaccines

there is not one

mild donor reaction

in shock but remains conscious

moderate donor reaction

in shock and loss of consciousness

severe donor reaction

convulsions (tetany)

what type of response is it when a donor faints

vasovagal

hematoma

localized collection of blood under skin

what causes a hematoma

needle going through the veins with subsequent leakage of blood

how to treat a hematoma

apply pressure, raise arm above head, and apply ice for 5 mins

donor reaction seen only in aphaeresis donations

citrate toxicity

what is citrate toxicity

anticoagulant infused when blood is returned to the donor

transport temp for blood that will be processed into components from collection site to the processing lab

1-6C for all unless being used for platelets (20-24C)

trisodium citrate

binds Ca and prevents clotting

citric acid

maintains pH

Na phosphate

maintains 2,3 DPG levels and pH

adenine

increases ADP levels which results in synthesis of more ATP

mannitol

protects against spontaneous storage hemolysis

Benefits of providing leukoreduced products for transfusion as discussed in lecture

everyone benefits from it too 100% products will be

why do platelet products need constant agitation

to prevent clotting

max HCT of packed cells in CPD or CPDA

65-80%

max HCT of packed cells in ADSOL

<80%

max residual WBCs in leukoreduced RBCS

< 5 X 10⁶

Max residual WBC in leukoreduced platelet aphaeresis

< 5 X 10⁶

platlet count of random platelet concentrate

> 5.5 × 10¹¹

min pH of platelet products

>6.2

min platelet count in platelet aphaeresis products

>3.0 × 10¹¹

min fibrinogen of cryoprecipitate

>150 mg

min factor VII of cryoprecipitate

>80 IU

packaging for shipment of red cell products

ship with wet or crushed ice, not touching units, and separated by cardboard

packaging for shipment of platelet products

ship at RT

packaging for shipment of frozen products

ship with dry ice

continuous centrifugation

simultaneous draws, separate, and returns blood (done through 2 site or dual lumen)

intermittent centrifugation

each cycle of draw, separate, and return of blood is complexed before the next one begins

membrane filtration

allows plasma and associated proteins to pass through pores in a membrane complex

appropriate replacement fluid for TTP

FFP donor plasma (10-12 units)

syngeneic donation

identical sibling donation

most common cause of a stem cell infusion reaction

DMSO toxicity

how can DMSO toxicity be minimized

washing the cells prior to infusion

what is the primary method for deterring success of a stem cell transplant

engraftment