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lecture 14 burner

transfusion isn't indicated unless Hgb level is below 10 g/dL even if pt has severe cardiopulmonary dz
one unit of PRBCs will change Hgb by? 1 g/dL or increases Hct by 3%
type and screen requested in circumstances when pt is not likely to require blood transfusion. blood bank knows pt's type and can ready units if necessary within short period of time
type and cross requested when pt is expected to need transfusion (as during total hip replacement surg). blood bank knows pt's type and has crossmatched 2 PRBCs which are reserved specifically for that pt
soft spin of whole blood results in PRBCs and plt-rich plasma (PRP)
hard spin of PRP results in ~ 50 mL of plts and 200 mL of FFP
FFP thawed at 4 deg C yields cryoprecipitate (contains vWF, fibronectin, factors VIII and XIII and fibrinogen), remaineder will be CPP or cryo-poor plasma
indications for leukoreduction leukoreduced PRBCs are usually needed for pts with h/o non-hemolytic febrile transfusion rxns, exchange transfucions, pts who need CMV-neg blood & for prevention of plt alloimmunization
apheresis donor plts plts that are harvested out of blood that is currently being withdrawn from a donor, all remaining blood products are immediately transfused back into the pt (opposite of whole blood donation and spinning plts out of it after)
abx listed that are known to cause thrombocytopenia through Ab-mediated mechanism tobramycin and vancomycin
clinical indication for cryo infusion to replace fibrinogen. vWF and factor VIII are available in recombinant forms now
clinical indication for plt infusion bleeding pts with plt dysfunction (on ASA/Plavix), for neurosurg with plts < 100K, those wit dilutional thrombocytopenia, surg with extracorporeal circulation
clinical indication for RBC infusion symptomatic pts with Hct < 22% or burn pts with Hct < 35%, neurosurg perioperative period, hypovolemia due to blood loss with strict parameters
clinical indication for plasma infusion neurosurg perioperative period, Coumadin reversal, TTP, PT > 16 sec or long PTT due to factor XI deficiency
sx suggestive of a transfusion rxn chills, rigors, fever, dyspnea, lightheadedness, flank pain, urticaria and itching (last 2 most are minor & won't warrant stopping transfusion in most cases)
acute hemolytic transfusion rxn usually due to complement-mediated IV hemolysis due to naturally-occurring anti-A/b Abs (usually IgM), happens with ABO incompatibility
labs to order to confirm acute hemolytic transfusion rxn urine Hgb, free plasma Hgb, bilirubin and haptoglobin levels; BUN & creat due to acute renal failure
danger of transfusion in pts with renal or cardiac insufficiency circulatory volume overload - when products are transfused, it brings water in from EV space and can overload pt thus whole blood transfusion is never indicated in these pts
transfusion-related acute lung injury (TRALI) usually occurs b/c anti-HLA or anti-granulocyte Abs in donor plasma attack recipient WBCs within the lung capillaries causing endothelial damage and leak of fluid; most common cause of death related to transfusion
Transfusion-Associated Graft versus Host Disease (TA-GVHD) occurs when transfusion of product with immunocompetent lymphocytes from donor enter immunocompromised host OR pt receives transfusion from relative that is homozygous for HLA when pt is heterozygous. almost 100% fatal, no tx known
complications of massive transfusion (greater than or equal to 10 units of blood in 24 hrs for 70 kg adult) dilutional thrombocytopenia, hypothermia if products aren't warmed gently, microvascular bleeding
risks for acquiring HIV or Hep C from blood transfusion 1:3 million for each
Created by: sirprakes