Blood Typing and Transfusions

Important Anemia History

-history and symptoms of anemia
-liver disease
-coagulopathies
-thrombotic history
-previous blood transfusions

Anemia Pre-Op Eval

-CBC (Hgb/Hct)
-identify cause
-build Hgb before surgery to avoid transfusion

Further work up is needed for a female pt with a Hgb ___ or male ___ before a surgical procedure

<12; <13

iron deficiency is a __________ anemia

microcytic

treatment for pre-op iron deficiency anemia

IV iron

B12 deficiency and folate deficiency are __________ anemias

macrocytic

treatment for pre-op macrocytic anemia

B12 or folate (oral or injection)

anemia of chronic disease is a ________ anemia

normocytic

treatment for anemia of chronic disease

epoetin

Blood Types

-A
-B
-O
-Rh

_____ consists of checking recipients' plasma for atypical antibodies

screening

Indirect Coombs Test

-screening test that mixes recipients blood with donor blood (cross matching)

-clumping indicates antibodies to antigens

-prevent transfusion reactions

O Neg

-universal donor
-lacks antigens

AB Positive

-universal recipient
-lack of antibodies

AB Plasma

universal plasma donor

___ and ___ can be given in emergent situations without knowing a recipient's blood type

AB plasma and O neg blood

__________ don't have to be crossmatched

platelets

Rh-negative patients should be transfused with only ___________

Rh negative RBCs

__________ should not be transfused to Rh- females of childbearing age

Rh + RBCs (okay in men or postmenopausal women)

Rh- mothers are given anti-Rh antibodies during pregnancy and at delivery to prevent ______________

hemolytic disease of the newborn

whole blood is primarily used in __________

hemorrhagic shock

Whole Blood contains which components?

RBCs, platelets, and coag factors

Packed Red Blood Cells

80% of plasma is removed so it is mostly just RBCs used for an anemic patient

transfusion of PRBCs considered in a stable patient at a HgB <_________

7

transfusion of PRBCs considered in a patient with pre-existing CV disease, or pts having cardiac or ortho surgery at a HgB <_________

8

Platelet Indications

-management of active bleeding in TCP patients

-prophylactically in pts undergoing minor surgery/ procedures when platelets <50,000

-prophylactically in patients undergoing major surgery when platelets <50,000-75,000

Platelets are not indicated in ___, ___, or ___ due to potential worsening of thrombosis

ITP, TTP, HIT

FFP

contains 1 unit of each coag factor and 2mg of fibrinogen

FFP indications

To replace coagulation factors in patients with deficiencies of multiple clotting factors (ex. liver disease, DIC, warfarin overdose)

FFP is NOT indicated for ____

overdose of DOACs

Transfusion Indications

-improve oxygen carrying capacity
-treat anemia
-replenish blood volume

Transfusion Complications

-infection (viral or bacterial)
-allergic reactions
-hemolytic reactions
-febrile nonhemolytic reactions
-transfusion associated circulatory overload (TACO)
-transfusion related acute lung injury (TRALI)

Possible Transfusion Infections

-HIV
-human T cell lymphotrophic virus type 1 and 2
-Hep B
-Hep C
-Parvovirus B19

Allergic Reaction

-most often urticaria and pruritus
-can cause anaphylaxis
-immune response to plasma proteins

Hemolytic Reactions

-acute or delayed
-recipients antibodies recognize and induce hemolysis of donor RBCs

hemolytic reactions are most commonly due to ______ incompatibility and can lead to DIC

ABO

Hemolytic Reaction S/S

-back pain
-fever
-dyspnea
-tachycardia
-bleeding
-shock

Febrile Nonhemolytic Reaction

-fever during or within 4 hours of transfusion

-recipient antibody against donor leukocytes and release of cytokines produced during storage

-platelet transfusions pose more risk

Transfusion associated circulatory overload (TACO)

-respiratory compromise from circulatory overload

-occurs with rapid infusion of blood, plasma, or crystalloids

-elderly with underlying heart disease most at risk

TACO S/S

-dyspnea
-hypoxia
-pulmonary edema
-normal to high BP
-exudative edema fluid (high protein, cloudy)

TACO diagnostics

-vascular congestion and pleural effusion on CXR
-high BNP
-abnormal ejection fraction
-high Pulmonary Artery Occlusion Pressure (PAOP) AKA Pulmonary Capillary Wedge Pressure (PCWP)

TACO treatment

diuresis and slow down infusion

Transfusion Related Acute Lung Injury (TRALI)

-uncommon

-due to Anti-leukocyte antibodies in donor product that produce PMN leukocyte degranulation in the lung

TRALI is most common with _______

plasma transfusions

TRALI S/S

-symptoms similar to ARDS
-noncardiogenic pulmonary edema
-low to normal BP
-normal to high temp
-transudative edema fluid (low protein, clear)

TRALI diagnostics

-no vasc congestion on CXR
-low BNP
-low-normal PAOP
-normal EJF

TRALI must be differentiated from circulatory overload as diuresis can cause _____________

rapid deterioration

TRALI treatment

supportive care, DO NOT DIURESIS

Avoiding Transfusion Reactions

-careful processing with type and cross
-start with slow infusion rate
-infuse each unit over 4 hours
-pretreat with Tylenol and/or Benadryl for patients with history of transfusion reaction

Transfusion Reaction Steps

1. Stop the transfusion
2. Contact blood bank that issued the product
3. Treat based on type of reaction