PAS 604 Transfusion Medicine

concentrated preparation of red blood cells that is obtained from whole blood by removing the plasma (as by centrifugation) and is used in transfusion

What are Packed Red Blood Cells (pRBC)?

hemorrhage and improve oxygen delivery to tissues

What are Packed Red Blood Cells (pRBC) used to tx?

- sickle cell crisis

- blood loss of > 30% of blood volume

- symptomatic anemia

What are indications for Packed Red Blood Cells (pRBC)?

- Hgb < 7 g/dL

- Hgb < 8 g/dL in patients with cardiovascular disease

When should a patient be transfused with pRBC?

1 g/dL

One unit PRBC should increase Hgb by ______

3%

One unit PRBC should increase HCT by ______

more

Whole blood has ______ complications than using pRBCs

setting of massive transfusion protocol (10 units of blood in a 70kg person within 24 hours)

When may whole blood be considered?

Hypocalcemia

What can result from whole blood binding with citrate, which is used in the storage of blood products?

< 10,000/µL

When is prophylactic transfusion done?

20,000-30,000/µL

What is therapeutic transfusion goal for bleeding?

at least 50,000/µL (in some cases 100,000/µL)

What is therapeutic transfusion goal for major surgery?

30,000/µL

One unit of apheresis platelets should increase the platelet count in adults by ~ _____________

Contains all of the coagulation factors

What is fresh frozen plasma (FFP)?

Thawed

_________ plasma has lower factors V and VIII and is not indicated in consumption coagulopathy (DIC)

- active bleeding and an INR > 1.6

- before an invasive procedure if a patient has been anti-coagulated

- emergent reversal of warfarin

- DIC

When is FFP indicated?

thawing fresh frozen plasma and collecting the precipitate

How is cryoprecipitate prepared?

factor VIII and fibrinogen

What is there high concentrations of in cryoprecipitate?

DIC

When is cryoprecipitate MC used?

5-10 mg/dL

Each unit of cryoprecipitate raises fibrinogen by:

100 mg/dL

Cryoprecipitate goal to maintain a fibrinogen level of at least:

mismatch or incompatibility of transfused product and recipient; involves naturally occurring antibodies and alloantibodies

What is an immune mediated transfusion reaction?

caused by the physical effects of blood components or the transmission of disease

What is a non-immune mediated transfusion reaction?

What is a mild allergic transfusion rxn?

more severe allergic reaction

What is an anaphylactic allergic transfusion rxn?

due to cytokines released from blood donor leukocytes

What is a febrile non-hemolytic transfusion rxn?

caused by bacteria or bacterial byproducts (e.g. endotoxin)

What is a septic transfusion rxn?

can result in hemolysis; immune mediated reactions due to recipient antibodies present to blood donor antigens; non-immune mediated when RBCs damaged before transfusion

What is an acute hemolytic transfusion rxn?

volume of product causes volume overload

What is Transfusion-associated circulatory overload (TACO)?

antibodies in donor product react with antigens in recipient; recipient immune system responds & releases mediators that cause pulmonary edema

What is Transfusion-related acute lung injury (TRALI)?

Rise in body temperature at least 1.8°F (1°C) above 98.6°F (37°C) within 24 hours after transfusion

What indicates Febrile Non-hemolytic Transfusion Reactions (FNHTR)?

platelets > pRBCs

When are Febrile Non-hemolytic Transfusion Reactions (FNHTR) MC?

Rigors, chills, discomfort

What are Febrile Non-hemolytic Transfusion Reactions (FNHTR) sx?

Leukoreduction

What decreases FNHTR rates?

patients who have been transfused repeatedly or those who have been pregnant

Who do Febrile Non-hemolytic Transfusion Reactions (FNHTR) happen in?

- release of antibody-mediated endogenous pyrogen

- release of cytokines

What is the mechanism of FNHTR?

broad spectrum abx

If suspicion for Transfusion-Associated Sepsis is high, start:

Destruction of donor RBCs within 24 hours

What are Acute Hemolytic Reactions?

aggressive hydration and diuresis

How are Acute Hemolytic Reactions managed?

fever, chills, rigors, nausea, vomiting, dyspnea, hypotension, diffuse bleeding, hemoglobinuria, oliguria, anuria, pain at the site, chest/back/abdomen

What are the sx of Acute Hemolytic Reactions?

rapid transfusion of blood that overwhelms the circulatory system

What causes Transfusion-Associated Circulatory Overload (TACO)?

antibody

Transfusion-Associated Circulatory Overload (TACO) is not _______________ mediated

tachycardia, cough, dyspnea, hypertension; cardiomegaly and pulmonary edema are seen on CXR

What are signs and sx of Transfusion-Associated Circulatory Overload (TACO)?

measuring a BNP/NT-proBNP may assist; echocardiogram (know your patient’s EF)

How is Transfusion-Associated Circulatory Overload (TACO) dx?

diuresis and supplemental oxygen; ventilation support may be required

How is Transfusion-Associated Circulatory Overload (TACO) tx?

Transfusion-Associated Circulatory Overload (TACO)

Non-cardiogenic pulmonary edema causing acute hypoxemia within 6 hours of the transfusion with clear temporal relationship to the transfusion

What is Transfusion-Related Acute Lung Injury (TRALI)?

Antineutrophil cytoplasmic antibodies or anti-HLA antibodies activate the recipient's immune system

What causes edema in Transfusion-Related Acute Lung Injury (TRALI)?

TRALI

Donor products that contain large amounts of plasma from multiparous women are associated with:

TRALI

- stop the transfusion

- save remaining bag

- maintain a patent IV line with normal saline

- confirm correct product was transfused

- contact transfusion service

What are immediate actions for acute rxns?

Donor lymphocytes recognize the patient as foreign and react against the recipient's body. The patient's immune system cannot clear the foreign lymphocytes

What is Transfusion-associated graft versus host disease?

anamnestic antibody response occurring after re-exposure to a foreign red cell antigen previously encountered by transfusion, transplantation, or pregnancy

What causes Delayed Hemolytic Reactions (DHTR)?

3-30 days after transfusion

When does Delayed Hemolytic Reactions (DHTR) occur?

falling Hct, slight fever, mild increase in serum indirect bilirubin, and spherocytosis on the smear

What are sx of Delayed Hemolytic Reactions (DHTR)?

by blood bank when a new positive direct antiglobulin test and new positive antibody screen are found

How is dx of Delayed Hemolytic Reactions (DHTR) often made?

1-6 weeks after transfusion

When does Graft versus Host Disease (GVHD) occur?

rash, fever, diarrhea, liver dysfunction, pancytopenia

What are signs and sx of Graft versus Host Disease (GVHD)?

irradiation of blood products

Gamma ____________ keeps donor lymphocytes from proliferating and can prevent transfusion-associated GVHD

Repeated failure of platelets to rise post transfusion

What is Platelet Refractory?

antibodies against HLA antigens

What causes immune Platelet Refractory?

splenomegaly, fever, sepsis, ABO mismatch, age of platelets

What causes nonimmune Platelet Refractory?

freshest, ABO-matched; HLA-matched

If immune cause, then _________, if HLA antibodies detected, then ___________

limited resource

Blood products are a:

diuresis

Blood products = volume; may need to balance transfusions with:

consent

Blood transfusion requires:

Acetaminophen and antihistamines

What are routinely given prior to transfusions to prevent FNHTRs or allergic reactions?