transfusion facts
Universal donor for PRBCs
Type O
the universal donor for FFP
Type AB- because plasma antibodies are present in type O
In general, 1 unit of FFP will increase most coagulation factors by 3% to 5% in a 70-kg adult. For clinically relevant correction a dose of 15 mL/kg (or 4 units in a 70-kg adult) is often required
55 yo F receiving transfusion for vaginal bleeding with a Hgb of 5. While receiving the transfusion she develops fever, chills, back pain and tachycardia. Which is most important next thing to administer after stopping the transfusion
IV fluids
this is an acute hemolytic RXN with recipients Ab to donor RBC from ABO incompatibility
Associated with fall in hgb and rise in bilirubin 3-4 weeks after transfusion as a result of primary response to RBC antigen
Delayed transfusion reaction
Total blood volume in 70 kg adult
5 L
Used for urgent reversal of overanticoagulation from vitamin K antagonists. Contains prothrombin and factors 7,9,10
Prothrombin complex concentrate
3 factor PCC is without factor 7
52 yo F presents with multiple stab wounds to abdomen. She’s hypotension and tachycardic, massive transfusion is initiated and is transfused PRBCs and FFP. Shortly after she develops severe respiratory distress, severe angioedema and hives. What is the likely cause
IgA deficiency
- anaphylactic reaction- stop transfusion and give IM Epi
- must receive IgA deficient transfusions in future
MCC of immediate transfusion reactions
Febrile transfusion rxn
Blood loss of what percent in healthy adult will typically start showing signs/Sx
30%
Contains factor VIII and fibrinogen and used in hypofibrinogenemia and hemophilia
Cryoprecipitate
45 yo M presents with hematemesis. He has a hgb of 5 and receives PRBCs. One hour later he is tachycardic. After reevaluation the pt is well appearing with no complaints. Vitals: HR 120, BP 140/90, T 39 What is the most likely cause
Recipient Ab against donor leukocytes
febrile nonhemolytic rxn
tx with supportive care and antipyretics
_____ is defined as either the replacement of one blood volume (approximately 10 units of PRBCs) within a 24-hour period, replacement of 50% of blood volume within 3 hours, or ongoing transfusion during a period of rapid bleeding
massive transfusion
A single unit of PRBCs will raise hGB By what and Hct by what %
Hgb will raise by 1 gm/dL and Hct by 3% in adults
( in children 10-15 ml/kg PRBC will raise Hct by 6-9% and hgb by 2-3 g/dL)
One apheresis single-donor platelet unit will increase the platelet count by up to
50,000
General indications for platelet transfusion:
Platelet count <5000/mm3
Platelet count <10,000/mm3 for therapy-induced thrombocytopenia (e.g., chemotherapy)
Platelet count <20,000/mm3 with a coagulation disorder or low-risk procedure (including central line placement)
Platelet count <50,000/mm3 with active bleeding, lumbar puncture, or major surgery
Platelet count <100,000/mm3 with intracranial hemorrhage, or major multisystem trauma
What is the best approach to treat a hemodynamically stable pt who begins to complain of hives and pruritis shortly after starting transfusion
Continue and give antihistamines
What electrolyte Abnormality is common with massive transfusions
Hypocalcemia from the preservative citrate chelating calcium may occur with a massive transfusion.
*Blank* cells eliminates the capacity of T lymphocytes to proliferate, thereby preventing the donor’s T lymphocytes from reacting to the recipient’s cells and thus reducing the risk for graft-versus-host disease. these cells are used in transplant patients, neonates, and immunocompromised patients
Irradiated cells
You are transfusing the 10th unit of PRBC in bleeding patient. Hgb is 10, platelets 95k, INR 2.2, fibrinogen 250. you should administer ___
FFP
- administer for INR>1.5
- cryo if fibrinogen <150
- platelets <50k
28 yo M presents with rectal bleeding and is found to be hypotensive, thrombocytopenic, with melena. 20 minutes after the start of his platelet and PRBC transfusion his BP is 90/50 he is dyspneic and O2 drops to 91% on 2L O2. you note rales on lung apices and CXR shows diffuse interstitial infiltrates, what is the most likely cause
TRALI
- immediately stop transfusion. Supportive care
Reaction to transfusion in immocompromised pts with rash, pancytopenia, increased LFTs
GVHD
- prevent with irradiated blood products