Question | Answer |
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apheresis donor plts | plts that are harvested out of blood that is currently being withdrawn from a donor, all remaining blood products are immediately transfused back into the pt (opposite of whole blood donation and spinning plts out of it after) |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 |