Blood Products
This unfortunate event is fatal in more than 90% of cases.
What is transfusion-associated graft-versus-host disease?
Pt presents with fever, chills, and malaise after getting 1U of pRBC's. The reaction is caused by this mechanism and this is what you do
febrile transfusion rxn
FYI: This is the Most common transfusion rxn.
Treatment: stop transfusion, supportive care, Acetaminophen
consider obtaining a CBC, LDH, DAT, LDH, haptoglobin, fibrinogen
This is the generally accepted Hgb below which transfusion of PRBCs is appropriate without symptoms.
What is 7?
Rapid onset of Hypotension, angioedema and respiratory distress, with in minutes of receiving transfusion is caused by what Anti body.
Anaphylactic Rxn.
Anti IgA AB
How do you diagnosis ITP?
Its a diagnosis of exclusion. (isolated thrombocytopenia) < 100 000/microL
Delayed hemolytic transfusion reaction is caused by this type of immunoglobulin.
What is IgG?
Immediate s/p transfusion pt develops fever/chills, HA, N/V dark urine hypotensive
What type of Rxn is this?
(hemolytic transfusion reaction)
Stop transfusion, immediate vigorous crystalloid infusion, Use diuretic's to maintain Urine Output, CBC, haptoglobin, DAT, LDH, fibrinogen
What is the Ratio of products in the massive transfusion Protocol?
1:1:1 (pRBC: platelets: FFP)
Cryoprecipitate may be used when fibrinogen levels are critically low (< 100 mg/dL)
Immediate hemolytic transfusion reaction is caused by this type of immunoglobulin.
What is IgM?
Pts Presents with AMS, Fever Anemia, Thrombocytopenia, and Normal PT/PTT. What is the most likely DDX and labs you want?
TTP Pneumonic (FAT RN)
Labs: LDH, CBC, CMP, retic count, PT/PT, Urine preg
Approximately this amount of plasma is removed from each unit of blood to prepare packed RBC
What is 250 ml
Classified as Class 2 hemorrhage.
Approx 15-30% of blood volume has been lost
Acute sickle cell crisis is an indication for this blood product
What is packed RBC's
Transfusing slowly and using plasma reduced products are both ways to help prevent this transfusion.
What is TACO
Commonly used drugs that can induce DITP.
List 3.
Heparin, Zosyn, Ibuprofen, Acetaminophen, Sulfa, Vanc.
These are two ways of drastically reducing the chance of CMV transmission with transfusion of PRBCs (name both).
What are irradiation and leukocyte reduction?
What is the platelet threshold for Patients requiring endoscopic procedures?
50,000/microL for therapeutic procedures; 20,000/microL for low risk diagnostic procedures
What is the platelet threshold for pts going for neuro or ocular surgery
100,000/microL
Primary Hypotension reaction during a blood transfusion is a result of what mechanism? This more commonly occurs in patients that are on ACE-I
Caused by bradykinin in blood products (that are normally degraded by angiotensin-converting enzymes)
What are 2 causes/condtions that can result in Secondary ITP?
SLE, HIV, HCV, CMV, RA, IBD
Receiving a transfusion from a relative is a risk factor for this condition.
What is transfusion-associated graft-versus-host disease?
What class of hemorrhage And/OR % volume loss would you expect to occur before you start to see the BP fall.
Drops in blood pressure are generally not manifested until Class III hemorrhage develops, and up to 30-40 percent of a patient's blood volume can be lost before this occurs.
What is the difference between therapeutic vs prophylactic transfusion of platelets? What level do you transfuse pts that are also septic?
Therapeutic = treating active bleeds or in prep for a procedure
Prophylactic = to prevent a spontaneous bleeds
- ppx based on clinical presentation
Afebrile pts - 10 000
febrile or septic pts - 20 000
pt w/ Acute promyelocytic leukemia (APL) have a coexisting coagulopathy - 30,000 to 50,000
Risk factors for this transfusion mishap are being very old or very young.
What is TACO?
Transfusion-associated circulatory overload
pts Has TTP. What is the Tx and what should you avoid doing unless its a life-threatening emergency?
Tx = plasmapheresis, Steriods
Consider 1 mg/kg prednisone PO or methylprednisolone 125 mg IV
Avoid giving plt?
Platelet infusion may lead to acutely worsened thrombosis, renal failure, and death