Term
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Definition
o Allogenic – standard; go to Red Cross, give blood, goes to someone else
o Autologous – give blood to yourself; for a transfusion later during surgery (never proven useful)…
o Directed – choose your own donor |
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Term
| Methods of blood collection |
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Definition
o Whole blood – go to Red Cross, give 500cc of your blood
o Apheresis – hook up to dialysis, take only specific desired components of blood (platelets, etc) |
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Term
| • Blood Donor Qualification |
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Definition
very strict, FDA regulated; screen for health risks (diseases, medications, cancer, pregnancy)
o Infectious Diseases Screened – syphilis, HepBSurfAg, HepBCore, HIV, HTLV, HCV, West Nile, Typanosoma cruzi (Chagas), Hep B nuclear antigen
o Adverse Effects of Donation – iron def., hematoma, syncope, hyperventilation, arterial puncture, nerve injury
o Autologous Donation – less strict, since you’re giving to yourself |
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Term
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Definition
| RBCs, plasma, platelet concentration, granulocytes, mononuclear cells, hematopoietic cells, FFP, cryoprecipitate |
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Term
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Definition
| slight hemolysis (more if stronger anticoagulant used), K+ leakage (usually insignificant, unless transfusing large volume), decreased 2,3-DPG (thus cells hold on to O2 more), and senescence (RBCs filtered @ spleen), loss of SNO-Hb |
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Term
| plasma and platelet storage changes |
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Definition
• Plasma – clotting Factors V & VIII are somewhat decreased, but totally adequate
• Platelets – some will become activated, releasing granules, and Gp1b aggregation (store max 5d)
o Room temperature storage – if you store in cold, Gp1b aggregates & macrophages engulf & liver removes |
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Term
| RBC Ab screening: direct agglutination, indirect antiglobulin, DAT |
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Definition
• Direct Agglutination – mix plasma with RBCs known to have antigens look for IgM agglutination
• Indirect Antiglobulin – patient serum mixed w/ RBCs known phenotype, add anti-IgG & assess binding
o Use – assess blood type, look for RBC surface antigens
• Direct Antiglobulin (DAT) – patient RBCs mixed with anti-IgG/C3; assess binding
o Use – assess for AIHA, transfusion reactions, drug-induced hemolysis, cold agglutinin disease
o Transfusion reaction – see if transfused blood is covered with IgG… |
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Term
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Definition
• ABO Typing – test for A and B antigens, double-check by assessing for anti-A/B Ig’s
o Type A – has A antigen, no B; thus has antibodies to B, but not A can’t give to B or O
o Type O negative – has antibodies for A & B, and Rh (2o exposure, no Rh antigen)
• Rh Typing – do an Rh(D) antigen test
• RBC Antibody screening – described above (DAT, Indirect, etc) |
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Term
| Emergency Transfusions considerations |
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Definition
o RBCs – should be Type O (have no antigens = universal donor)
o Plasma – should be Type AB (has no antibodies)
o Rh – negative preferable, especially in women of child-bearing age (avoid newborn hemolytic)
o Pretransfusion sample – obtain a cross match ASAP |
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Term
| Indications for transfusion |
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Definition
o Symptomatic anemia – is patient showing elevated HR, low BP, fatigue, etc.?
o Bleeding >15% Blood Volume – is patient volume depleted?
o Chronic anemia – due to drugs, disease, etc eventually need x-fusion
o Hemolytic anemia – sickle cell, other congenital
o Uremic bleeding – keep hematocrit > 30%, helps push platelets to peripheral vasculature & clot |
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Term
| transfusion should be given to hemat 25% in px with AI hemolytic anemia? |
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Definition
| NO! . PX MUST BE SYMPTOMATIC!!!!!!!!!! |
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Term
| CIs to platelet transfusions |
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Definition
o Immune Thombocytopenic Purpura – platelets taken out of circulation within minutes
o TTP – platelet thrombi, risk of embolism
o Heparin-induced thrombocytopenia – risk of thrombosis high |
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Term
| indications for platelet transfusion |
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Definition
• Hemorrhage – due to thrombocytopenia or platelet dysfunction, should give more platelets!
• Hemorrhage Risk – thrombocytopenia < 10,000
• Surgery Risk – thrombocytopenia < 50,000, invasive surgical procedure
• Example of Not Indicated – patient with ITP, 20,000 count, no surgery |
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Term
| platelet transfusion success depends on the following factors (5) |
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Definition
• Body Size/Transfusion Rate –needs to be an adequate titration for patient transfused
• Antibodies – platelet specific antibodies must not react (HPA, HLA class I, ABO)
• Splenomegaly – greater proportion of transfused platelets will be stored in spleen, less successful
• Consumption/DIC, Sepsis – consume platelets!
• Drugs – can cause platelet consumption or deactivate platelets |
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Term
| plasma transfusion indications |
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Definition
• Coagulation Factor Deficiency – although may consider a single factor concentrate as better choice
• Disseminated Intravascular Coagulation – all plasma components consumed, need to re-stock
• Reversal of Warfarin Anticoagulation – need to re-stock free plasma components
• Dilutional Coagulopathy – receiving massive transfusions too much anticoagulant, need to correct
• Hemorrhage in Liver Disease – very complex coagulopathies
• TTP – replace enzyme which breaks down vWF (ADAMS 13)
• Trauma – studies have shown early and aggressive FFP + RBCs leads to increased survival |
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Term
| Indications for cryoprecipitate transfusion |
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Definition
• Cryoprecipitate Contents – contains Factor VIII, vWF, fibrin, Factor XII… thus replace these deficiency:
o Factor VIII Deficiency – although Factor VIII concentrate may be better choice
o Von Willebrand’s Disease – although vWF concentrate may be better choice
o Hypofibrinogenemia – only fibrinogen concentrate
o Factor XIII deficiency – rare, will help here
• Uremic Bleeding – high molecular weight vWF in high concentration likely what helps |
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