Component Therapy and Massive Transfusion

Identify the main goals of transfusion therapy

Correct abnormalities in hematologic or hemostatic systems

• Increase tissue oxygenation and/or restore hemostasis

State the purpose of using a blood warming device during transfusion of blood products

Used to prevent Hypothermia

• Which can cause fatal arrhythmia

What is acute normovolemic hemodolution?

Before surgery, whole blood is removed from patient

Simultaneously replacing volume with crystalloid and/or colloid solutions

What is Intraoperative blood salvage?

Blood collected from surgical site during or after surgery and reinfused

Why are packed red blood cells used?

Used to treat anemia with smaller volume than whole blood and less ABO restrictions

T or F: Granulocyte units are rareley irradiated?

FALSE. Granulocyte units should always be irradiated

What are granulocyte units used for?

Treat neutropenic patients who have bacterial and/or fungal sepsis

What are FFP units (fresh frozen plasma) & platelet concentrates used for?

• Decreased platelet production

• Increased platelet destruction

• Platelet dysfunction

• Treatment of coagulopathies

What are cryoprecipitate units used for?

Treat hemophilia A and source of fibrinogen

Treatment of coagulopathies

why do we leukoreduce blood?

Helps to prevent formation of antibodies to HLA antigens

Decreases viral load of CMV, HTLV, and EBV

Why do we Irradiate WBCs?

Used to prevent transfusion-associated graft versus host disease

Gamma irradiation disrupts DNA in WBC nuclei and stops replication

What are the two ways to decrease risk of transfusion-associated CMV transmission?

Leukoreduction

Testing blood donors for antibodies to CMV

Describe the purpose of tagging a unit and what required information must be present on the tag?

• Recipient’s full name

• Recipient identification number (MR #, hosp #, etc.)

• Recipient ABO/Rh type

• Donor unit ID number

• Name of product type (RBC, FFP, etc.)

• ABO/D phenotype of unit

• Expiration date of unit

• Interpretation of crossmatch (if performed)

• Identification of testing personnel

State what a MLS should visually inspect a unit for before issuing the unit?

• no bacterial contamination

• Clots

• hemolysis

How long a patient should be directly observed during a transfusion? and What IV therapies are acceptable for infusion at the same time as a transfusion is occurring?

Direct observation of patient for first 15 minutes of transfusion

Only normal saline is administered at the same time as transfusion

• Other fluids can cause hemolysis

In emergancy release, which blood type is issued?

Issue Group O, Rh-negative units

Under massive transfusion protocol, which blood group is issued?

RBC’s are Type O

Plasma is often Type AB or A

State the three potential complications of a massive transfusion protocol and the techniques used to avoid/remedy each

1.Citrate toxicity

• Fix via slower infusion and calcium replacement

2.Hypothermia

• Fix via high-flow blood warmers

3.Coagulation abnormalities

• Fix via platelet infusion, FFP, and controlling hypotension via colloids/crystalloids

Explain what may happen to a patient's ABO typing during a Massive transfuion protocol (MTP)

Patient’s ABO typing will most likely changes due to Massive Transfusion Protocol