Blood bank 2 (Test 1) - Transfusion therapy

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Whole Blood

- Acute massive blood loss (over 30 % blood volume). For actively bleeding patients, the goal is to stop bleeding.
- Restore intravascular volume.
- Prevent hypovolemic shock.
- Increase Hgb concentration
Are Indications of what donor blood component?

Whole Blood

- Severe chronic anemia. Patients with chronic anemia have reduced RBC's; transfusion of plasma from whole blood may adversely respond to develop pulmonary edema and heart failure.
- May cause heart failure due to volume overload. This volume overload is more likely to occur in patients with kidney failure or pre-existing heart failure.
Are Contraindications of what donor blood component?

Packed Red Blood Cells

- Increase oxygen carrying capacity in anemic patients.
- Chronic anemia.
- Symptomatic anemia (Hct <21%)
- Specifically indicated for "compromised" patients such as elderly patients who may be subject to volume overload if other products such as whole blood are used.
- Infants and children in cases where concentrated red cells are required and dilutional effects should be avoided.
- Cardiac patients who are more sensitive to volume overload.
Are Indications of what donor blood component?

Packed Red Blood Cells

- Volume expanders.
- In place of B12/Fe/Folate.
- To enhance wound healing.
- To improve general "well-being".
- For patients with low operative blood loss.
Are Contraindications of what donor blood component?

Washed Red Cells

- Removal of plasma proteins, antibodies electrolytes.
- Prevents alloimunization
- Blood for severely immunocompromised recipients
Are Indications of what donor blood component?

Platelets

- Control bleeding.
- Prevent bleeding: less than 10,000-20,000
- Less than 50,000/uL preoperative.
- Deficiency in number or function.
Are Indications of what donor blood component?

Platelets

- Idiopathic Thrombocytopenic Purpura (ITP)
- Disseminated Intravascular Coagulation (DIC)
- Prophylactically with massive transfusion
- Prophylactically following cardiopulminary bypass
Are Contraindications of what donor blood component?

Fresh Frozen Plasma

- To treat coagulation factor deficiency.
- Used when specific coagulation factor concentrates are not available.
Are Indications of what donor blood component?

Fresh Frozen Plasma

- For volume expansion (hepatitis risk)
- As nutritional supplement for Vitamin K dependent factors and Factor II, VII, IX, X.
- Prophylactically with massive transfusion
- Prophylactically following cardiopulminary bypass
- PT/PTT less than 1.5 times normal.
Are Contraindications of what donor blood component?

Cryoprecipitate

- von Willebrand Disease (deficient vWF)
- Abnormal platelet plug formation.
- Partial deficiency of Factor VIII.
- Prolonged bleeding time and PTT.
Are Indications of what donor blood component?

Fibrinogen Abnormalities

- Congenital deficiency
- Acquired through DIC
- Severe liver disease
Are Indications of what cryoprecipitate concentrated factor?

Factor VIII deficiency

Replacement therapy for Hemophilia A

Fibronectin

- Opsonic glycoprotein
- Value in treating patients with sepsis, burns, and trauma.
Are Indications of what cryoprecipitate concentrated factor?

Fibrin Glue

- Made from cryoprecipitate and Thrombin.
- Topical administration.
Are Indications of what cryoprecipitate concentrated factor?

Factor IX

Hemophilia B or Christmas Disease can be treated by _______

Albumin Plasma Protein Fraction

- Correct large scale volume loss:
- Hypovolemic shock
- Burn patients
- Retroperitoneal surgery
Are Indications of what donor blood component?

Albumin Plasma Protein Fraction

- Correct hypoalbuminemia due to nutritional deficiency.
- No viral disease transmission
Are Contraindications of what donor blood component?

Leukocyte-Reduced Blood Components (RBCs/PLTs)

- Prevention of Human Leukocyte Antigen
- Febrile Transfusion Reactions or cytokine buildup.
Are Special Transfusion situations that would require?

Apheresis Platelets (single donor platelet SDP)

- Limit exposure to foreign antigens and Transfusion Transmitted Disease because it is collected from a single donor.
- Usually transfused without matching for HLA or platelet antigen.
- Can provide HLA matched, since it comes from only one donor.
Describe what type of special transfusion component?

Irradiated RBCs/Platelets

- Prevent Graft Versus Host Disease.
- Gamma irradiation used to prevent lymphocytes from replicating.
Describe what type of special transfusion component?

Irradiated RBCs/Platelets

- Blood relative donor
- Intrauterine transfusions
- Severely immunosuppressed (chemotherapy)
- Hodgkin's disease
- Bone marrow transplantation
Are Indications of what type of special transfusion component?

Autoimmune Hemolytic Anemia

- Conservative approach advised due to serological difficulties, and expected short red cell survival.
- Helpful to phenotype patient prior to transfusion.
Describe what type of special transfusion situation?

Massive Transfusion

Emergency issue-uncrossmatched, Group O only.

Pre transfusion

Which stage is the following procedure:
- Informed consent
- component selection: emergency Release and component preparation.

Patient prep

Which stage is the following procedure:
- Transfuser's responsibilities
- Explain procedure
- Check pre existing lines
- Check medical record

Patients history of allergic reaction

Which stage is the following procedure:
- Pre medication with antihistamines, antipyretics or pre medication orders.
- Medications given intravenously may be given immediately before transfusion.
- Orally administered drugs must be given 30-60 mins prior to start of transfusion

18-19

Select needles and catheters depending on the location, size and integrity of patients veins, usually ____ gauge.

23

Select a ____ gauge scalp vein needle for pediatrics.

Standard

In-line filters with a pore size of 170-260 microns.

Standard

Most filters are designed to filter 2-4 units of blood, but if the first unit requires 4 hours for transfusion, the filter should not be reused due to risks of bacterial contamination.

Rapid infusion devices

Pore size of >or= to 300 microns

Gravity-drip sets

Used for Platelets and Cryoprecipitate.

Syringe-push sets

Used for small volumes and in-line blood filter.

Micro-aggregate filters

- Designed for transfusion of PRBCS.
- Effective pore size of 20-40 microns.
- Trap leukocytes and fibrin strands.

Leukocyte-Reduction filters

- Reduces the risk of HLA alloimmunization.
- Contain multiple layers of synthetic non-woven fibers that trap leukocytes, but not RBC and platelets.

Blood Warmers

- Used to decrease incidence of cardiac arrest and transfusion reaction for patients with a cold antibody.
- Must not warm blood to a temperature above 42 C, which could cause hemolysis.
- Devices should have a visible thermometer and an audible alarm that sounds when temperature limit is exceeded.

Electromechanical infusion devices

Mechanical pumps that deliver infusion at a controlled rate. Pressure devices. Intraoperative and postoperative blood collection (cell saver).

At time of donor unit issue

When should the following be done?
- Review the Blood Request form to verify the intended recipient and the blood component intended to be transfused.
- Review recipient name, identification numbers, and test interpretation on the patient's work sheet.
- Review the blood component label and ID tag attached to the blood unit to verify the right component for the right recipient.

At time of donor unit issue

When should the following be done?
- Check appearance of unit and expiration date.
- Verify person issuing and receiving blood or blood component.

At time of blood infusion

When should the following be done?
- CHECK recipient identification
- CHECK unit identification
- CHECK the ABO/Rh on the label to make sure it agrees with the transfusion form

At time of blood infusion

When should the following be done?
- Check unit expiration date
- Check compatibility result
- Check physicians order

Delays in starting the transfusion

If transfusion cannot be started within 30 minutes, blood should be returned to the Blood Bank for proper storage.

Patient care during the transfusion

Transfusionist should remain with the patient for at least the first 15 minutes

Blood infusion

Maximum duration of ________ is 4 hours.

Cardiac status

Factors which affect rate of transfusion are patient's blood volume, hemodynamic condition, and ?

No crossmatch required

The SF-518 requires the statement "______" if the component contains less than 2mL of red cells.

Rh type

The SF-518 must contain recipients name, ID number, ABO group and?

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