tx 2 : lec 5 blood and blood products

when are circumstances that whole blood is used (as it is extremely limited in use)

• for massive transfusion to correct for hypovolemia (low blood volume)

  • trauma

  • shock

• exchange transfusion

• autologous donation

what is the #1 characteristic whole blood needs to have if it is getting used in a transfusion?

MUST be ABO identical

vast majority of the red cell units you see in the transfusion medecine lab in canada fall into what catregory

packed RBC leuco reduced

indication for use of rbcs

• Symptomatic anemia caused by

  • decreased bone marrow production (lekemia or aplastic anemia)

  • decreased rbc survivqal (hemolytic anemia)

  • surgical/traumatic anemia

typically, prbcs should increase hb how much in adults and children?***

adults: 10-15 g/L

children: 20-30 g/L

typically prbcs should increase hct how much in adults and children?***

adults: 3-5%

children: 6-9%

is there a Hb value that triggers the need for transfusion?

no

• every institution has their own policy

• tx are based on more factors than Hb

A patient has a baseline hemoglobin
count of 60g/L. After receiving 4 units
of packed red blood cells, what would
you expect the post-transfusion
hemoglobin count to be?

****each unit of prbc typically increases Hb by 10 g/L

therefore 4 × 10 = 40

40 + 60 = 100

we would expect the post transfusion hb count to be 100 g/L

when would we used deglycerolized rbcs (lr)

• rare blood types

• IgA antibodies

• ppl w multiple abs

• ppl w abs that are high incidence abs

when are washed red cells used

• for people experiencing allergic reactions (usually to plasma components)

• neonates undergoing replacement tx / massive tx

when to use irradiated rbc

• immunocomps

• pts needing bone marrow/ stem cell transplant

• intrauterine tx

when would you tx plts

• pts actively bleeding and are experiencing thrombocytopenia/ thrombocytopathy

generally plt tx is given when plt count is below what value

20 × 10⁹/L

if a pt has <20 × 10 ^9/L plts (thrombocytopenia), you would give them a tx unless they have?

• ITP idiopathic thrombocytopenic purpura)

• TTP (thrombotic thrombocytopenic purpura)

• DIC (inc consumption)

• HUS (hemolytic uremic syndrome)

THESE CONDITIONS ARE A RESULT FROM INCREASED DESTRUCTION SO THERES NO POINT TO TX BC ITS GNA GET DESTROYED ANYWAYS

***generally, ABO specific compatibility is recommended for plt tx. when can this rule be “broken”

INCOMPATIBLE GROUPS MAY BE GIVEN USUALLY IN SHORT TERM BUT MUST DO SPECIAL TEST

• isohemagglutinins

• monitor pt for complications

what is/why is an isohemagglutinin test done and when is it done?

• it is a titration test done to detect high titer of anti-A or anti-B abs in donor/ pt samples.

• usually done when group O plts/ plasma is given to non group O individuals.

• done to reduce the risk of acute hemolytic transfusion reaction

one unit of buffy coat poor platelet is expected to raise the adult count by *****

20.0 × 10^9/L

one unit of random donor platelet raises adult count by ******?

5 × 10^9/L

what is it called when you dont get the expected incremental increase of platelets (20.0 × 10^9/L for buffy coat poor plts or 5 × 10^9/L in randim donor)

platelet refractoriness

platelet refractoriness can be treated by giving?

Apheresis HLA matched plts

the rate of increase for apheresis plts are?****

8-10 × 10^9/L

PLTS should be ____ compatible with the recipient

ABO/Rh (bc there may still be a little amt of rbc in it)

A patient has a baseline platelet count
of 30.0 x 10⁹/L. After receiving two
unit of BCP platelets, what would you
expect the post-transfusion platelet
count to be?

2 × 20= 40

40+30 = 70.0 × 10^9/L

when would you transfuse granulocytes

• pts w very low neutrophil counts

• bacterial infection (unresponsive to antibiotics)

t/f granulocytes need to be crossmatched for tx****

T

granulocytes for transfusion are stored at what temp and expire when?

RT (20-24 DEGC), expire in 24 hours but best if given ASAP

who are CMV negative cellular blood products for?

• CMV negative individuals that are at risk for CMV infections

  • CMV negative women

  • those getting bone transplant

  • prenatal infants/ premature infants

which plasma derivative: is defined as plasma collected by plasmapheresis and
intended for further manufacture into plasma derivatives

source plasma

which plasma derivative: is plasma recovered from whole blood donations that is
shipped frozen to a manufacturer

recovered plasma

which plasma derivative is separated from the plasma and used for the production of
Factor VIII concentrate.

cryoprecipitate

cryoprecipitate is separated from the plasma and used for the production of _______

Factor VIII concentrate.

when would u use FFP/ FP24

used to treat replacement of multiple clotting factors in pts w/

• liver disease

• DICe

• vit K deficiency

• warfarin overdose

• massive tx

would you use ffp / fp24 for volume expansion or protein replacement? why or why not

no, safer products are available

when is cryoprecipitate reduced plasma used for in tx

• for tx/ plasma exchange in TTP patients

t/f you are not able to used thawed and liquid plasma for factor V and/ or factor VIII deficiency

t

what population can get transfused with thawed and / or liquid plasma

• those experiencing warfarin overdose

• those w factor XI deficiency

• plasma exchange for TTP, HUP, HELLP (abbreviation of the 3 main features of a syndrome found in pregnant individuals: hemolysis, elevated liver enzymes, low platelet count)

if doing plasma tx, does it need to be ABO/Rh compatible

should be ABO compatible with the recipient but the Rh type doesnt need to be compatible

(competency) each bag of cryo should contain at least ____ of fibrinogen and __ of factor VIII/unit.

150 mg/dL of fibrinogen and 80 units of factor VIII

(competency) each bag of cryo should contain at least 150 mg/dL of _____ and 80 units of ____ /unit

fibrinogen; factor VIII

cryo was used as?

a fibrin sealant/ glue now replaced w safer products; forms a quick plug to minimize the bleeding

instead of with cryo, mild/ moderate factor VIII deficiency is now treated with _____

desmopressin acetate

t/f for cryoprecipitate it is best to be ABO compatible but not important due to the
small volume

t

whats the formula for the adult dosage for Cryo

number of units = (required increase in Fibrinogen (mg/dL)/ 100) x Plasma volume (mL)/150

Consider an example of an adult patient with a fibrinogen of
60 mg/dL and a fibrinogen goal of 100 mg/dL. Assuming that
the patient has a plasma volume of 3000 mL, the correct
number of units of cryoprecipitate to transfuse is:

x= (100mg/dL- 60 / 100) x (3000/150)

= 0.4× 20

= 8 units of cryo

patients with Hemophilia A or Factor VIII deficiency are treated with ____

Factor VIII

Patients with _______ or Factor VIII deficiency are treated with factor VIII

Hemophilia A

A 70kg hemophiliac patient has Hct
of 30% an initial Factor VIII level of
4%(4 units/dL or 0.04 units/mL). How
many units of Factor VIII should be
given to raise the Factor VIII level to
50% or 0.50?

Formula:
(Desired factor- initial factor)x plasma volume(mL)=
Units of Factor VIII Required.

Step 1:

Calculate blood volume= weight (kg) x 70 mL/kg

70 kg x 70 mL/kg = 4900 mL

Step 2:

Calculate plasma volume = blood volume(mL) x (1.0 – Hct)

4900 mL x (1.0 - 0.30) = 3430 mL

Step 3: USE FORMULA

(0.50 - 0.04) x 3430 mL = 1578 units

what is factor IX used to treat

• ppl w factor IX deficiency (hemophilia b)

• pts w factor VII or X deficiency

• selected pts w factor VIII inhibitors

• reversal of warfarin overdose

formula to calculate dose needed of factor 9

(Desired factor- initial factor)x plasma volume(mL)=
Units of Factor IX Required.

FXIII is used to treat?

factor XIII deficiency ( severe autosomal recessive bleeding disorder)

_______ concentrates are licensed for use in
the United States for patients with hereditary
deficiency of antithrombin.

antithrombin

Largely replaced immune serum globulin as
the therapeutic agent for patients with
congenital immune deficiency

intravenous immune globulin (ivig)

Licensed indications for IVIG available in
Canada:

– Primary immunodeficiencies
– Secondary
hypogammaglobulinemia
- CLL with
hypogammaglobulinemia
in patients who have had
at least one episode of
major infection
- Hypogammaglobulinemia
in post bone marrow
transplant recipients
– Immune thrombocytopenic
purpura (ITP)
– Kawasaki syndrome
– Guillain-Barré syndrome

RhIg is used to treat

– Prevention of Rh HDN
– Treatment of ITP

Prepared from pooled human plasma from donors with high titers
of anti-D

RHIg(D) Immune Globulin
Passive anti-D globulin

what is immune serum globulin (IM) used for

used as a prophylaxisis

• used in exposure
  to Hepatitis A, and measles
  Dose ordered by MD

what tx product is used for patients requiring volume replacements

albumin

____ solution acts with
diuretics and brings
extravascular water into vascular
space to dilute albumin

25% albumin

what tx product can be used with jehovahs witnesses

PENTASPAN (10% PENTASTARCH IN 0.9% NaCl)

in an emergency tx, what blood products do u use and dk the pts blood type

Use of Group O Rh negative and Rh positive RBCs

during the tx process, how long should the nurse stay witht he patient

for the first 15 mins

the tx should not take longer than ___ hours bc of the risk of bacterial proliferation at RT

4 hrs

what are the characteristics needed to return a blood bag that has been sent out back into the blood bank

• bag ports not opened

• they have ot been issued longer than 30 mins unless stored in a controlled blood storage environment

• temo is less that 1 deg C

• at least one sealed segment is still attached

_____ is given now instead of cryoprecipitate

fibrinogen

Jenna has been typed and screened. her results indicate that she is B Rh neg, and has an allo ab to a clinically sig high incidence ag. she decides to store her blood in case she requires a transfusion in the future.

a) what would he blood component be?

b) how would this component be stored?

c) what is added to this unit prior to storage?

a) what would he blood component be?

prbc

b) how would this component be stored?

-65 deg c (good for up to 10 yrs)

c) what is added to this unit prior to storage?

glycerol (so they don’t burst at that temp)

a) cryoprecipitate

b) calculate the dosage, thaw, and pool the cryo

a) cryoreduced plasma (bc plasma)

b) ffp

c) cryoprecipitate

a) washed rbcs

b) 24 hrs if open system

a) plts

b) RT, expires after 7 days agitation needed thruout

c) plt refractoriness; switch to apheresis plts

d) dic, hus, ttp (eats up plts)

a) any antithrombolytic component, ffp, help for dic

b) o rh neg, ab plasma, a pos or o pos with Rhig

a) irradiated, cmv neg

b) rbc = -60 deg, irradiated therefore 14 days

a) prothrombin complex, cryorecipitate, ffp

b) -60 deg c

c) defrost, completely thaw

d) transfuse w/ in 24 hrs if stored at 1-6 deg c

a (25 % is for hypotonic individuals)

d

c

a (whenever the question mentions liver disease, think ffp bc thats where we make all our coag factors and stuff yar)

c

b

d (liquid plasma doesnt have labile factors)

NONE OF THE ABV: granulocytes are only good for 24 hrs (should be march 14)

b

c

b

a

7 units

c

13

a