What is a contraindication to a blood transfusion?
any pt whose Hb is >10g/dl
What is the indication for a blood transfusion?
any pt whose Hb is <7 g/dl. it is better to wait til their Hb is lower such as this to give a transfusion (maintain Hb at 7-9)
What is the leading cause of fatal transfusion reactions?
accidental transfusion with ABO incompatible RBCs
***What is transfusion-related acute lung injury (TRALI)?
leading cause of transfusion-related death
serious pulmonary reaction possibly associated with leukocyte antibodies/cytokines in donor blood, and recipient’s neutrophil priming and activation
almost always occurs within 6hrs of transfusion
Symptoms include bilateral pulmonary edema, dyspnea, hypoxemia, fever, and hypotension
What is transfusion-associated graft-vs-host disease?
occurs when immunosupressed/deficient pt is given cellular blood products that possess immunologically competent lymphocytes
it can be prevented by gamma irradiation og the blood to innactivate the donor lymphocytes
Indications for platelet transfusion.
used to prevent bleeding in pts with thrombocytopenia
the cut off is:
10x10^3 for pts with no other complications
20x10^3 with bleeding risk factors
50x10^3 if uncomplicated surgery is planned
100x10^3 if CNS surgery is planned
Contraindications for platelet transfusion.
Platelet transfusions are no helpful in pts with hemolytic syndromes such as ITP, TTP, HUS, HIS
What are the indications for fresh frozen plasma (FFP) transfusion?
must ABO compatible
reversal of warfarin od
replacement of single congenital factor def when specific concentrates are not available
When is fresh frozen plasma (FFP) contraindicated?
intravascular volume expansion, correction/prevention of protein malnutrition, and when specific concentrates are available
What are some adverse effects/complications of FFP transfusion?
adverse immune responses
What is cryoprecipitate?
it is precipitate from FFP that contains concentrated levels of factor VIII, factor XIII, vWF, fibronectin, and fibrinogen
Indications for the use of cryoprecipitate.
pts with vWF disease who require vWF multimer replacement
acute bleeding in pts with fibrogenemias
What should cryoprecipitate not be considered a first line tx for and why?
it is not first line for Hemophilia A or B or vWF dz
this is because there is no standard concentration of factors in it
there are better commercial factor concentrates
What are plasma derivatives?
concentrates of plasma proteins (clotting factors) prepared from large donor pools of plasma or cryoprecipitate--> the specific protein is purified
What are human-plasma derived and recombinant factor VIII and factor IX preperations used for?
they are used for tx of hemophilia A or B
What is human-dervied factor VIII preparations used for?
significant bleeding in vWF dz
What is recombinant factor VIIa used for?
it is used to tx acute bleeding and prohilaxis in hemophilia A and B
What is albumin used for?
it is used for volume expansion but the results of tx with this showed poorer outcomes than using just nml saline
What is hemacord?
it contains hematopoietic progenitor cells (CD34+) from humancord blood
What are the indications for hemacord?
For use in hematopoietic stem cell transplantation procedures in patients with disorders affecting the hematopoietic (blood forming) system. For example, cord blood transplants have been used to treat patients with certain blood cancers and some inherited metabolic and immune system disorders.
How does hemacord work?
Once these HPCs are infused into patients, the cells migrate to the bone marrow where they divide and mature. When the mature cells move into the bloodstream they can partially or fully restore the number and function of many blood cells, including immune function.
What are warnings assoc with hamacord?
What is sargromastim, its MOA, and adverse effects?
it is a GM-CSF (granulocyte monocyte conlony-stimulating factor)
it stimulates neutrophil production and enhances neutrophil action
often used for pts receiving bone marrow or stem cell transplantation