Term
| Whole blood contains what 3 components, and when is this used? |
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Definition
| This contains RBC, clotting factors, and platelets. It is rarely used, and is used more commonly in military resuscitation. |
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Term
| How do PRBCs increase hgb/hct? |
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Definition
| These increase hgb level 1 g/dL or hct by ~3%/unit. |
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Term
| What contains clotting factors? |
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Definition
| These are contained in ffp and whole blood. |
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Term
| What is a concentrate of factor VIII, XIII, vWf, and fibrinogen? |
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Definition
| These are 4 components of cryoppt. |
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Term
| What replaces depleted or deficit coag factors? |
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Definition
| Bo ffp adn cryoppt replace these. |
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Term
| When are platelets indicated? |
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Definition
| These are pooled from several donors and tx thrombocytopenia. |
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Term
| What platelet level is required for sx and what level causes spontaneous bleeding? |
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Definition
| >50,000 required for sx and <10,000 cause spontaneous bleeding. |
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Term
| When is autotransfusion indicated? |
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Definition
| This collection of shed blood is used during trauma and sx. |
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Term
| What blood type is a universal donor? |
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Definition
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Term
| What blood type is an universal recipient? |
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Definition
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Term
| What procedure is preferred before blood is transfused? |
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Definition
| Cross matched blood is preferred. |
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Term
| What type blood is used in uncross matched tx of exsanguinating hemorrhage? |
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Definition
| For this situation, use Type O, Rh(-). |
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Term
| In what population is Rh(-) particularly important for transfusion? |
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Definition
| This type is important in women and children to prevent sensitization and future complications. |
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Term
| What is a more common cause of blood contamination? |
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Definition
| A more common cause is bacterial/endotoxic contamination d/t improper storage. Other cuases are improperly sealed/opened container, bacteria on pt/donor's skin, donors w/asymptomatic bacteremia, and endotoxin growth during storage. |
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Term
| What are 3 viral contaminations of blood and which is most common? |
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Definition
| Of HIV, HebB, and HepC, HepB is most common. |
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Term
| What do you do if blood for transfusion is contaminated w/abx or virus? |
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Definition
| Contact blood bank. You may need an ID consult. (You should probably also stop the transfusion if it has started.) |
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Term
| What is a rxn to cytokines, Ags, leukocytes, plasma, or platelets that accumulate in stored blood? |
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Definition
| These cause febrile (non-hemolytic) rxns. |
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Term
| What are the *most common* types of rxns found w/blood transfusions? |
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Definition
| Febrile (non-hemolytic rxns) are most common; results in varied rxns from ea individual. |
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Term
| What is the *most common* symptom of febrile (non-hemolytic) rxns? |
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Definition
| Fever is the most common s/s. |
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Term
| 8 hrs after transfusion w/FFP, pt develops fever, chills, cough, and dypsnea. What test do you order and what do you suspect? How do you tx? |
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Definition
| This clinical scenario describes a febrile (non-hemolytic) rxn. Order a cxr to r/o pulmonary infiltrate, which can indicate TRALI. Tx: D/C TRANSFUSION and fever usually resolves in 15-30 min. You can tx prophylactically or tx after symptoms occur w/T or diphenhydramine (and sometimes corticosteroids). If TRALI, STOP TRANSFUSION; ventilatory support. |
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Term
| What is the MOST COMMON cause of death after transfusion? How do you tx? |
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Definition
| The most common cause is TRALI: Transfusion Rxn w/Acute Lung Injury. Tx: STOP TRANSFUSION; ventilatory support. |
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Term
| Which is more common: allertic or anaphylactic rxns to blood transfusions? |
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Definition
| Allergic rxns are more common but typically benign and easily tx. |
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Term
| What causes allergic rxns to blood transfusions? |
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Definition
| These are caused by proteins, foods, or meds in the donor's blood. |
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Term
| How common and serious are anaphylactic rxns to blood transfusions? |
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Definition
| These are uncommon and rarely fatal. Only one case ID in the last 5 yrs resulting in death. |
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Term
| 20 min after beginning blood transfusion, pt develops maculopapular urticarial rash. Pt is afebrile and normotensive. What do you suspect and how do you tx? |
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Definition
| This clinical scenario indicates allergic rxn. Tx: STOP THE TRANSFUSION. Give Diphenydramine 25 mg IV/PO |
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Term
| 5 min after beginning blood transfusions, pt develops urticarial rash, dyspneea, wheezing, anxiety, hypotension. Pt is afebrile. What do you suspect, and how do you tx? |
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Definition
| This clinical scenario describes anaphylactic transfusion rxn. Tx: STOP THE TRANSFUSION. ABCs. Administer Diphenydramine 25 mg IV. |
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Term
| What is the MOST COMMON cause of a hemolytic transfusion rxn? |
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Definition
| This most commonly occurs w/ABO mismatch d/t clerical errors and improper labeling of blood specimens. |
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Term
| Which type of hemolytic transfusion rxn is most severe and potentially fatal rxn? From what does it result? |
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Definition
| Ab mediated rxns result from renal failure and DIC. |
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Term
| What is a common cause of Ab mediated hemolytic transfusion rxns? |
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Definition
| A common cause is an inadvertent tranfusion of mismatched blood. |
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Term
| What type of hemolytic transfusion rxn is typically a benign rxn caused by the transfusion of compatible blood w/hemolyzed RBCs? |
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Definition
| This is a non-ab mediated hemolytic rxn. |
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Term
| 20 min after beginning of transfusion, pt develops fever, wheezing, ha, bachache, anxiousness, hypotension. Pt's urine begins to turn brownish-red and pt begins to bleed from tranfusion site. What do you supect and how do you tx? |
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Definition
| This clinical scenario describes hemolytic transfusion rxn. Tx: IMMEDIATELY STOP THE TRANSFUSION. Anticipate hypotension, ARF, DIC: Tx: IV pressors, Vigorous IV infusion of crystalloid soln, ffp, platelets, or fibrinogen. |
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Term
| What are 3 potential electrolyte disturbances that can accompany transfusions? |
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Definition
| 3 include hypocalcemia (b/c citrate binds to Ca2+), Hypokalemia or hyperkalemia (b/c K is released from PRBCs when they lyse during storage). |
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Term
| Why might hypothermia occur w/transfusion? |
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Definition
| This could occur b/c blood is stored at 4 degrees C. |
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Term
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Definition
| For every 100 cc of blood loss, pts generally require 300 cc of crystalloid soln. |
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Term
| How do you transfuse pt w/massive blood loss? |
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Definition
| After 2 units of crystalloid, use 1:1 prbcs and ffb w/o crystalloids. Military 1st escribed its use to prevent complications of lg volume crystalloids. |
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Term
| Why do renal transplant pts have better graft survival if they recieve blood transfusions? |
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Definition
| This occurs b/c blood is immunosuppressive. |
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Term
| What are 3 negative effects of blood transfusions d/t its immunosuppressive effect? |
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Definition
| 3 effects include: 1) increased rate of infection, 2) p/o infections and 3) poor outcomes in critically ill. |
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Term
| How do stored RBCs differ from pt's RBCs? |
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Definition
| Stored blood has: decreased 2,3-dpg levels, decreased atp concentrations, decreased ability to unload o2, change from nml discoid shape, increased aggregability. |
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Term
| If a pt does not have acute MI or unstable angina, will outcomes improve w/blood transfusion? |
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Definition
| No. Hgb of 7 g/dL was same/better than Hgb 10g/dL. Same 30 day mortality. Decrease in cardiac and pulmonary dysfunction (in pts w/o transfusion). |
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Term
| When are PRBCs most commonly used? |
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Definition
| These are most commonly used to raise hct. |
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Term
| Why is frozen blood stored? |
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Definition
| The major application is for the purpose of maintaining a supply of rare blood types. |
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Term
| For how long may autologous PRBCs be stored? |
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Definition
| These may be stored 35 days. |
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Term
| What pt population has the most severe hemolytic transfusion rxns? |
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Definition
| The most severe are pts under anethesia. |
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Term
| Anaphylactic rxn to transfusion is almost always caused by what blood element? |
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Definition
| These are almost always caused by plasma proteins rather than wbc. |
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Term
| Most alloAbs causing platelet destruction are directed at what cell marker? |
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Definition
| Most are directed at HLA ags. |
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Term
| When is a transfusion of FFP indicated? |
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Definition
| This is indicated to correct coag factor deficiencies and tx TTP. |
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Term
| When is transfusion of cryoppt indicated? |
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Definition
| This is used to supplement fibrinogen in cases of congenital deficiency or DIC. |
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