Types of Transfusion Lecture Notes

Comprehensive practice flashcards covering types of blood transfusions, indications, specs, and monitoring based on lecture notes.

What are the three primary indications for Whole Blood (WB) transfusion?

1. Evident massive blood loss 2. Trauma casualties (when specific products are unavailable) 3. Patients with hemorrhagic shock (when specific products are unavailable).

What is the specific composition used for Whole Blood Neonatal Exchange Transfusion?

Group O or group compatible erythrocytes suspended in group compatible or AB plasma.

To ensure a $>90\%$ post transfusion survival, how old should Whole Blood be?

Whole Blood should be less than 7 days old.

In what timeframe must a Whole Blood transfusion be completed?

Within 4 hours.

What is the rule regarding adding medication to a unit of blood during transfusion?

NEVER add medication to a unit of blood or administer medication through a transfusion line during the transfusion.

When should a new transfusion set be used for Whole Blood?

Every unit or if the transfusion set has been used 6 hours or more.

Why must a Whole Blood transfusion set be changed every 6 hours?

To prevent bacterial growth.

What Hemoglobin (hgb) and Hematocrit (hct) levels indicate Packed Red Blood Cell (PRBC) transfusion in general patients?

Hemoglobin level of $<8-10\,g/dl$ and hematocrit of $0.25-0.30$.

What clinical manifestations accompany Hgb $<8-10\,g/dl$ to justify PRBC transfusion?

Tachypnea, tachycardia, recurrent apnea, poor feeding, and poor weight.

What is the PRBC transfusion threshold for acutely ill neonates with cardiorespiratory disease?

Hemoglobin level of $<130\,g/dl$.

For a stable neonate with anemia, what are the PRBC transfusion thresholds?

Hemoglobin level of $<80\,g/L$ or hematocrit $< 25\%$.

When is PRBC transfusion indicated for neonates and premature infants regarding blood loss?

When there is shock associated with blood loss or sepsis, or a cumulative loss of $10\%$.

What amount of volume or percentage of blood loss qualifies for PRBC transfusion in acute surgical blood loss?

$2,000\,ml$ or $40\%$ loss of blood volume.

What is the typical volume of a PRBC unit?

$230\text{ to }330\,ml$.

What is the approximate hemoglobin content and hematocrit percentage in a unit of PRBC?

Approximately $20\,g/100ml$ (not less than $45\,g/unit$) and Hematocrit of $55\%\text{ to }75\%$.

What is the standard duration for a PRBC transfusion?

$2-3\,hours$.

How should PRBC be transfused during the first 10 minutes?

Slowly at $10-15\,drops/minute$.

How much does the infusion of 1 unit of PRBC increase Hemoglobin and Hematocrit?

Hemoglobin increases by $1\,gm/dl$ and hematocrit by $3\%$.

In patients who are not actively bleeding, when should hemoglobin determination be repeated after PRBC transfusion?

$15\,minutes$ after transfusion.

What are the three clinical indications for Washed Red Cells?

1. Confirmed deficiency of immunoglobulin A 2. Recurrent severe allergic-type adverse events 3. PNH (Paroxysmal Nocturnal Hemoglobinuria).

What are the volume and hematocrit specifications for Washed Red Cells?

Volume is $>130\,mL$ and hematocrit is $0.50 - 0.70$.

Washed Red Cells must be transfused within how many hours after washing?

Within 24 hours.

What is the completion time limit for Washed Red Cell transfusion?

Within 4 hours.

Which patients are considered immunocompromised for Leucocyte-reduced Red Cell transfusion?

Premature and acutely-ill neonates, patients with congenital deficiency syndromes, patients on chemotherapy, and transplant patients.

Why are Leucocyte-reduced Red Cells used for immunocompromised patients?

To reduce the risk of CMV and TAGVHD.

Why is Leucocyte-reduced Red Cell support used for patients dependent on long-term RC support?

To prevent recurrent febrile non-hemolytic transfusion reactions (FNHTR).

What is the goal of using Leucocyte-reduced Red Cells after hematopoietic cell transplantation in aplastic anemia patients?

To reduce, but not totally prevent, graft rejection.

What are the Hgb and Hct specifications for Leucocyte-reduced Red Cells?

Hemoglobin $\ge 40\,g/unit$ and hematocrit is $0.50 - 0.70$.

What is the transfusion completion deadline for Leucocyte-reduced Red Cells?

Within 4 hours.

Which blood component recipients require irradiated products to prevent complications?

Recipients of intrauterine transfusion, neonates, patients with congenital immune deficiencies, Hodgkin's disease, or those receiving purine analogue drugs.

Are direct donations from family members required to be irradiated?

Yes, recipients of direct donations from family members should receive irradiated blood components.

When can Red Cells be irradiated and how long can they be stored afterward?

Irradiated any time up to 14 days after collection and stored for another 14 days from irradiation.

What is the storage rule for irradiated Platelets?

They can be irradiated at any stage in their 5-day storage and stored up to their normal shelf life of 5 days after collection.

What is the procedure for Irradiated Granulocytes?

They should be irradiated ASAP after production and transfused with minimal delay.

How soon should blood for intrauterine and exchange transfusion be used?

Within 24 hours.

Within what timeframe should blood for pediatric patients be used?

Within 48 hours.

How is a Random Donor Platelet (RDP) unit derived?

Derived from Whole Blood within 8 hours of donation.

What is the average platelet content in an RDP bag?

Approximately $8.0 \times 10$ (minimum $\ge 5.5 \times 10$) in approximately $50\,mL$ of plasma.

What is the acceptable pH range for Random Donor Platelets?

$$6.4-7.4$$

What is the RDP dosage for neonates?

$5\,ml\text{ to }10\,ml/kilo$.

What is the RDP dosage for children?

$1\,unit\text{ per }10\,kg$.

What platelet count threshold should be maintained during massive bleeding and CNS trauma?

$>50 \times 10^{9}/L$ for massive bleeding; $>100 \times 10^{9}/L$ for CNS trauma or bleeding.

An RDP transfusion is indicated for patients with massive blood transfusion and a platelet count below what level?

$$<20 \times 10^{9}/L$$

What is the RDP transfusion threshold for adult patients receiving therapy for acute leukemia?

$10,000\,u/L$.

What RDP threshold is maintained for patients with solid or necrotic tumors receiving aggressive therapy?

$20,000\,u/L$.

At what three time points should a platelet count be obtained to measure post-transfusion response?

1. Before transfusion 2. 1 hour after transfusion 3. 24 hours after transfusion.

What is the expected increase in platelet count for each unit given to an adult?

Approximately $7-10,000/mm^{3}$.

In neonates and infants, what increase is expected from $5-10\,ml/kg$ of platelets?

$50-100,000/mm^{3}$.

What does Fresh Frozen Plasma (FFP) contain?

The non-cellular portion of blood and functional quantities of all coagulation factors.

What compatibility requirement exists for FFP?

Must be transfused ABO-compatible with the recipient's red cells.

What is the typical dose of FFP to achieve minimum factor concentration?

$10\,ml/kg - 20\,ml/kg$ (to achieve minimum $30\%$ plasma factor concentration).

Name three conditions that are indications for FFP transfusion.

1. Multiple coagulation factor deficiencies (with bleeding/DIC) 2. Hemorrhagic disease of the newborn 3. Severe bleeding due to warfarin.

When is FFP indicated in trauma casualties?

With $30\%$ or more blood loss requiring massive transfusion.

What values for PT and APTT indicate a response measurement for FFP transfusion?

PT $= >1.5 \times$ the mid-range of normal; APTT $= >1.5 \times$ the top of the normal range.

Why is compatibility testing not necessary for Cryoprecipitate?

Because it is considered an acellular blood component.

What are the requirements for ABO and Rh compatibility in Cryoprecipitate?

Should be ABO compatible with recipient’s red cells, but Rh need NOT be considered.

What amount of Fibrinogen and Factor VIII is found in at least $75\%$ of Cryoprecipitate packs?

At least $140\,mg$ of fibrinogen and $70\,IU/ml$ of Factor VIII.

What is the dosage of Cryoprecipitate for treating hypofibrinogenemia?

$1\,unit / 7\,kg - 10\,kg$ body weight.

How is Cryoprecipitate administered?

As a fast drip.

How do you calculate blood volume for Cryoprecipitate requirement estimation?

$$\text{Weight (kg)} \times 70\,ml/kg = \text{blood volume (ml)}$$

How do you calculate plasma volume for Cryoprecipitate requirement estimation?

$$\text{Blood Volume (ml)} \times (1.0 - \text{hematocrit}) = \text{plasma volume (ml)}$$

How is the amount of Fibrinogen required (mg) calculated?

$$(\text{desired fibrinogen level, mg/dl} - \text{initial fibrinogen level, mg/dl}) \times \text{plasma volume in ml / 100}$$

How do you determine the number of bags of cryoprecipitate required?

$$\text{mg of fibrinogen required} / 250\,mg \text{ fibrinogen per bag}$$

What are the schedule intervals for monitoring a patient during transfusion?

Before starting, as soon as started, every 15 minutes after start, on completion, and 4 hours after completion.

What vital signs must be recorded in the patient's chart according to the monitoring schedule?

Temperature, Pulse rate, Blood pressure, and Respiratory rate.

Besides vitals, what other physical data must be recorded during monitoring?

Patient's general appearance and fluid balance (oral/iv intake and urine output).

What subjective information should be noted in the patient's record during transfusion?

The patient's subjective complaints.

What details about the blood product itself must be recorded in the chart?

Volume and type of products transfused, and the Donation # of the products.

What timing details are required in the patient's transfusion record?

Time the transfusion started and the time it was completed.

What must be documented regarding the clinical outcome of the transfusion?

Any adverse effects.