Blood Component Therapy
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Created by:
brandonadyer on May 10, 2012
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Terms | Definitions |
|---|---|
 What are the four (4) main components made from donated blood? What volume does each component contribute? | + RBC; 340mL of 520mL total = 65% + Plasma = whole blood w/o RBC (contains proteins, glucose, clotting factors, mineral ions, hormones and carbon dioxide, etc) = 180mL of 520mL total = 35% + Platelets > can make cryoprecipitate (fibrinogen, 8, vWF, fibronectin) + WBC |
| List three (3) reasons why blood component therapy is preferred to whole blood therapy. | + Decrease expense + Decrease waste + Decrease hazard of unneeded components + 1 unit of blood can be used by multiple patients, shelf life is prolonged because components can be stored at different (ideal) conditions |
| What use(s) are whole blood indicated? What components are significantly decreased after only two days? | + Complex cardiac surgeries in neonates + Resuscitate an exsanguinating patient who needs RBC and plasma + Factors 5 & 8 are dramatically decreased after 2 days |
| What use is whole blood NOT indicated for? | + Routine blood transfusion when packed red cells will do |
| What is the clinical indication for RBC transfusion? What is the shelf life of RBCs? | + Anemia that compromises a patient that cannot be reversed or in those with symptomatic reversible anemia + Patients who need increased O2 delivery that cannot otherwise be achieved + 42d vs. 35d (5 weeks) for whole blood |
| + What is a transfusion trigger? | + Transfusion trigger refers to the Hct below which you automatically transfuse > there is NO SUCH ARBITRARY TRIGGER! Each patient must be considered individually. |
| + At what Hct level is a transfusion trigger justified? By what % does one unit of RBC raise the Hct? | + RARELY if Hct > 30 (10g/L) + FREQUENTLY if Hct < 20 (6g/L) + 1 unit RBC raises the Hct by 3% |
| What is the evidence that "topping off" the Hct to > 30% before surgery improves survival and wound healing? | + There is NONE |
| What are the effects of storing RBCs? Potassium? 2,3-DPG, cell viability, pH, etc? | + Potassium (K) is lost + 2,3 DPG levels fall (Left Shift) + Cells become swollen and fragile + pH falls + Cells hemolyze + Hb released onto plasma + WBC die releasing enzymes and cytokines |
| What are two methods of platelet product preparation? | + Concentrate + Plateletpheresis |
| What is platelet concentrate? How many units are necessary to replenish thrombocytopenia? Advantages? Disadvantages? | + 1 unit of platelets derived from 1 unit of blood + 6-10 concentrates necessary to replenish PT with thrombocytopenia (1 concentrate per 10kg body weight) + Advantage is that dosing is more specific to patient needs + Disadvantage is that platelets are sourced from MULTIPLE DONORS |
| What is platelet plateletpheresis? How much is 1 unit compared to concentrate? How many units are necessary to replenish thrombocytopenia? Advantages? | + Platelets harvested from ONE donor via pheresis + 1 unit = 5-6 units of concentrate + Need 1 to 1.5 units to replenish PT with thrombocytopenia + Advantage is that patient is exposed to only one donor source (vs. 6-10 different donors with concentrate) + Reduces chance of alloimmunization and infection (Yersinia - i.e. Plague) |
| What are the indications for platelet transfusion? What is the trigger point for platelet transfusion? How should platelet count be monitored after transfusion? | + < 50k and actively bleeding + PT preparing for invasive surgery with low platelets + Automatically if < 10k + Check platelets at 15 & 60 minutes after transfusion for suspected alloimmunization |
| Platelet transfusion is NOT indicated in what type of patient? | + Stable patient with thrombocytopenia & counts > 10k |
| What are HLA matched platelets and platelet cross matched platelets? Benefits? Disadvantages? When should alloantibody destruction of platelets be considered? | + Platelets that have been HLA matched + Reduces allo-antibody reactions + $$$ + Consider alloantibodies if patient does not increase their platelet count 15-60 minutes after transfusion |
| What does becoming alloimmunized mean? In what PT population does this occur? How is this managed clinically? | + Alloimmunization is the production of antibodies towards foreign antigens (previous transfusions, pregnancy, transplant). HLA antigens exist on both WBC and platelets. + Occurs in PTs that are transplanted, receive repeated platelet transfusions + Prevented by giving leukodepleted blood products (irradiated) |
| What is an indication for granulocyte transfusion? | + Neutropenic patient that is unlikely to recover their WBC count and has demonstrated bacterial and fungal infection refractory to antibiotics |
| What % of the PDX population is CMV positive? | + 50% |
| Where in the body is CMV latent? How does transfusion activate it? What PT population is at risk? How is transfusion transmission prevented? | + Leukocytes store the latent virus + Transfusions that contain WBC (whole blood, platelet concentrate, platelet pheresis) allow donor WBC to infect the host + Immunocompromised patients (premature babies, transplant patients, AIDS, MDN) are at high risk + Blood can be filtered to remove WBC, irradiated to wipe out WBC (ONLY used to prevent transfusion assoc. GVHD) or tested prior to transfusion for CMV |
| What are three (3) indications for transfusing fresh frozen plasma (FFP)? | + Documented coagulation factor deficiency + Warfarin OD (pick a better drug!) + TTP + DIC |
| What three (3) components does FFP contain? | + Plasma proteins, all coagulation factors (pro-coag. & anti-coag.), complement |
| What are two (2) examples where FFP was PREVIOUSLY used but is now considered INAPPROPRIATE? | + NOT to improve nutrition + NOT to act as coagulation "quick-fix" for abnormality or bleeding |
| What are four (4) major therapeutic constituents of cryoprecipitate? What are the clinical indications for its use? | + Fibrinogen, factor 8, fibronectin, vWF (also, factor 13) + Used to quickly raise the fibrinogen concentration in a PT with DIC + Hemodilution d/t massive transfusion + 3rd line for Type 1 vWF deficiency (partial quantitative deficiency) + Hemophilia A (replace 8) + Shorten the bleeding time in uremic patients (liver or renal failure) |
| What is an indication for factor 8? | + Hemophilia A or vWF deficiency |
| What is an indication for prothrombin? | + RARE; severe 8 deficiency or bleeding |
| What is an indication for albumin? | + Osmotic pressure regulation + TTP + Liver failure |
| What portions of whole blood does plasma protein fraction contain? What is an indication for plasma protein fraction? | + Contains albumin (83%) and globulin (17%) + CONTROVERSIAL use in hypovolemia - crystalloid is fine |
| What is an indication for IVIG? | + Hypogammaglobulinemia + Antibody mediated autoimmune disease (RA, SLE, Sjrogen's, Behcet's Disease) |
| What volume defines a "massive transfusion"? What are some coagulation and metabolic abnormalities that occur after massive transfusion? | + Replacement of 1 blood volume (5 LITERS!) + Dilutional thrombocytopenia + Low [fibrinogen] --> DIC + Factor V deficiency + Hypothermia d/t cold blood (can't heat above 40C) + Acid/base disturbance - RBC cause acidosis (pH 6.6), citrate storage preservative causes alkalosis + Hyperkalemia d/t K leaking out of cells + Hypocalcemia d/t citrate sequesteration |
| How are metabolic/coagulation abnormalites following massive transfusion treated clinically? | + Prophylactic platelets, cryoprecipitate, FFP |
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