CHAPTER 03- BLOOD PRODUCTS.txt

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scottmreis
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CHAPTER 03- BLOOD PRODUCTS.txt
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2012-01-07 17:54:01
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  1. Risk of HIV and hepatitis in blood products:
    All blood products carry the risk of HIV and hepatitis, except albumin and serum globulin (these are heat treated)
  2. When do you use CMV-negative blood?
    • 1) use in low-birth-weight infants
    • 2) bone marrow transplant patients
    • 3) other transplant patients
  3. Whats the #1 cause of death from transfusion reaction?
    clerical error leading to ABO incompatibility
  4. What is low in stored blood?
    Stored blood is low in 2,3-DPG--> causes left shift (increasing affinity for oxygen)
  5. Acute hemolysis:
    • 1) ABO incompatibility; antibody mediated
    • 2) back pain, chills, tachycardia, fever, hemoglobinuria
    • 3) can lead to ATN, DIC, shock
    • 4) Haptoglobin <50 mg/dL (binds Hgb, then gets degraded), free hemoglobin >5g/dL, increase in unconjugated bilirubin
    • 5) Tx:
    • 1- fluids
    • 2- diuretics
    • 3- HCO3-
    • 4- pressors
    • 5- histamine blockers (benadryl)
    • 6) in anesthetized patients, transfusion reactions may present as diffuse bleeding
  6. Delayed hemolysis:
    • 1) antibody-mediated against minor antigens
    • 2) Tx: observe if stable
  7. Nonimmune hemolysis:
    • 1) from squeezed blood
    • 2) Tx: fluids and diuretics
  8. Febrile nonhemolytic transfusion reaction:
    • 1) most common transfusion reaction
    • 2) usually recipient antibody reaction against WBCs in donor blood
    • 3) Tx: discontinue transfusion if patient had previous transfusions or if it occurs soon after transfusion has begun
    • 4) use WBC filters for subsequent transfusions
  9. Anaphylaxis
    • 1) bronchospasm, hypotension, urticaria
    • 2) usually IgG agains IgA in IgA-deficient recipient
    • 3) Tx:
    • 1- fluids
    • 2- lasix
    • 3- pressors
    • 4- steroids
    • 5- epinephrine
    • 6- histamine blockers
  10. Urticaria
    • 1) usually nonhemolytic
    • 2) usually a reaction against plasma proteins or IgA in the transfused blood
    • 3) Tx: histamine blockers (benadryl), supportive
  11. Transfusion-related acute lung injury (TRALI)
    • 1) rare
    • 2) caused by antibodies to recipient's WBCs
    • 3) clot in pulmonary capillaries
  12. What effect does cold temperature have on clotting?
    Cold- poor clotting can be cuased by cold products or cold body temperature; patient needs to be warm to clot correctly
  13. Dilutional thrombocytopenia
    occurs after 10 units of PRBCs
  14. Hypocalcemia:
    • 1) occurs with massive transfusions
    • 2) calcium is required for clotting cascade
  15. Antiplatelet antibodies
    develop in 20% of patients after 10-20 transfusions
  16. Hetastarch (hespan)
    can use up to 1L without the risk of bleeding complications
  17. Whats the most common bacterial contaminate?
    GNRs (usually E. coli)
  18. Most common blood product source of contamination?
    platelets (not refrigerated)
  19. How can chaga's disease be transmitted?
    chagas' disease- can be transmitted with blood transfusion
  20. Risk of transfer of infectious diseases:
    Disease/Approx risk per unit of blood

    • HIV- 1:1,000,000-2,000,000
    • Hepatitis B or C- 1:250,000-500,000
  21. Frequency of blood types in the United States:
    • O+: 38%
    • A+: 36%
    • B+: 8%
    • O-: 7%
    • A-: 6%
    • AB+: 3.4%
    • B-: 1.5%
    • AB-: 0.6%
  22. Blood product compatibility
    • Whole blood- must be identical to recipient's blood
    • RBCs- must be compatible with recipient's plasma
    • WBCs- must be compatible with recipient's plasma
    • FFP- should be compatible with recipient's RBCs
    • Cryoprecipitate- all ABO groups compatible
    • Platelets- all ABO groups acceptable; components compatible with recipient's RBCs are preferred
  23. See two tables on pg 14+15

    Routinely performed infectious disase screening tests on US blood donations in 2005

    Blood Component Characteristics

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