Blood Bank: Hemotherapy/Transfusion Therapy

• Red cell products (need compatibility test)

• Non Red Cell Products (just ABO/Rh)

Transfusions can be classified into 2 basic categories… (2)

Crystalloid

(Common intravenous solutions) Isotonic aqueous solution that can contain electrolytes and glucose

Normal saline

Only crystalloid that can be used in conjunction with a blood/blood component transfusion

• Lactated Ringer’s

• Normal saline

• Dextrose

Examples of crystalloids (3)

Colloids

(Common IV solutions) Isotonic aqueous solution containing macromolecular weight particles (e.g., proteins and hydroxyethyl starch (HES)) that are suspended in a crystalloid solution

• Albumin

• Dextran

Examples of colloids (2)

• Anemia (Hb ≤ 7 g/dL)

• Thrombocytopenia (<50,000/µL pre-surgical or ≤10,000/µL therapeutic)

• PLT function disorder (Clot retraction/PLT function tests)

• Coagulopathy/Coag deficiency/Acute hemorrhage (FFP for INR < 1.5 and Cryo for fibrinogen < 80-100 mg/dL)

Triggers for transfusion (4)

• DAT (+)

• HTR

• Positive blood culture w/ transfusion rxn

• New positive ABS

• Nonavailability of ordered transfusion

• Incompatible xmat

• fetal-maternal hemorrhage

In addition to the transfusion triggers, critical limits are test results that require immediate notification (via telephone) of the patient’s nurse and clinician. These results for HDFN are… (7)

Routine

(Tx therapy) Not needed until hours later or the next day

ASAP

(Tx therapy) needed within the next few hours, e.g., patient going into surgery, patient has low Hb, etc.

MD approval

In very rare cases and with (——), an Rh neg male may receive Rh positive blood when Rh neg blood is not available and transfusion is necessary/required

Correct anemia via maintaining O2 carrying capacity to vital organs

Treatment objective for RBCs tx

• Maintain coagulation scheme

• Correct coagulopathy

• Blood volume

• Osmotic pressure

Treatment objective for plasma tx (4)

• Correct thrombocytopenia

• Maintain clotting mechanism

Treatment objective for platelet tx (2)

• Adult: 1-2 minutes

• Babies/children: seconds

Amount of time arterial bleed leads to death (2)

• Emergency Waver

• Uncrossmatch

In the event of an emergency transfusion, a (——) is usually created and must be signed by the requesting patient’s physician. The tag on the donor unit indicates emergency release with a (——) red sticker affixed to the unit

Massive Transfusion Protocol (MTP)

Regardless of how a transfusion request is initially received, a bleed-out can occur at an unexpected time and turn into a (——). When initiated, the focus is all on this one patient (priority over routine work, usually a number of CLS working together)

• Give as little clear fluid as possible

• Give LTOWB (carefully interpret ABO typing if LTOWB administered before admission)

• Give plasmas (FFP, thawed plasma, liquid plasma)

Primary treatment of emergency transfusion therapy (3)

• Storage = 1-6°C

• Expiration = 5 days after WB expiration

Liquid plasma storage temperature and expiration

• O2 carrying capacity

• Coagulation scheme and clotting mechanism

• Balanced osmotic pressure

• Body temperature (37°C) (blood warmer)

Emergency transfusion therapy treatment objective (4)

1:1:1 (RBC:Plsm:PLT)

Massive transfusion protocol is usually seen in trauma cases or in certain types of surgeries, where a (——-) ratio is present

• 6 RBCs, 6 FFPs, 1 PLTPH (13 unit component)

• 6 LTOWB then follow with 13 unit component

Different MTP unit makeup (2)

10 minutes

MTPs can be issued every (——) and can go on for hours

• 10 WB

• 5 L

• 2 MTPs (~12 WB units)

Within a few hour period, a patient could use enough blood to completely exchange all of their total blood volume greater than one time. In general, after a patient receives approximately (——) WB units, it is considered as “an exchange”. The human body contains about (——) L of blood, or (——) MTPs

24 hour period

Massive transfusion is defined as a patient’s total blood volume exchange through transfusion within a (——) (average adult vol ~ 10 units)

Draw new pt sample and test passively transfused anti-A, anti-B, and anti-A,B

In an emergency, O neg blood is first administered, but once typed, ABO identical blood is given, and ABO compatible if the identical units run out. Because of this, the only way to determine the safe point to switch back to original ABO-Rh type is to…

• RBCs and Plasma

• PLTs

During transportation of blood products, use the appropriate cooler. One cold cooler for (—2—) and one room temperature cooler for (——)

5,000/µL

Platelet concentrate product raises PLT count to about (——) in a 70 kg adult

40,000/µL

Plateletpheresis product raises PLT count to about (——-)

• PLT Ab

• HLA Ab

• Passive immunity

Immune causes for PLT refractoriness (3)

• Sepsis

• Splenomegaly

• Aplasia

• Cirrhosis

• Drugs/Antibiotics

• Bleeding

• DIC

Non-immune causes for PLT refractoriness (7)

• Normal >7,500/µL at 1 hr OR >5,000/µL at 24 hours

• Abnormal <5,000/µL at 24 hours

CCI normal and abnormal values

(Δ PLT count) x (BSA) / (# PLTs transfused x10^11)

Formula for corrected count increment

• Pt name and MRN

• Pt ABO/Rh type

• Unit ABO/Rh

• Blood product

• Donor unit #

• Unit expiration date

• Interpretation of xmat

• CLS ID

The tag on the blood unit must contain the following information: (8)

Two RNs at bedside

When transfusing the unit, (——) must verbally verify the pt’s information by comparing the wristband information to the transfusion tag on the unit

15 minutes

When all information (pt info and unit info) is verified, one of the RNs must stay with the patient for (——) from the start of the transfusion to look for any immediate adverse reaction to occur

4 hours

The transfusion must be completed within (——). If the patient is small in size (neonate or elderly), the unit can be split and each aliquot can be transfused in increments. This process helps prevent hypervolemia

< 4 months

Antibodies found in an infant (——) are of maternal origin

• ABO forward typing and Rh

• Ab screen (infant or mother)

Testing involved in crossmatching infants < 4 months old (2)

• LTOWB

• RBCs

• Cold stored PLTs

• FFP

What units are transfused in pre-hospital transfusion? (4)