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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)
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When do you use CMV-negative blood?
- 1) use in low-birth-weight infants
- 2) bone marrow transplant patients
- 3) other transplant patients
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Whats the #1 cause of death from transfusion reaction?
clerical error leading to ABO incompatibility
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What is low in stored blood?
Stored blood is low in 2,3-DPG--> causes left shift (increasing affinity for oxygen)
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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
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Delayed hemolysis:
- 1) antibody-mediated against minor antigens
- 2) Tx: observe if stable
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Nonimmune hemolysis:
- 1) from squeezed blood
- 2) Tx: fluids and diuretics
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Febrile nonhemolytic transfusion reaction:
- 1) most common transfusion reaction2) usually recipient antibody reaction against WBCs in donor blood
- 4) use WBC filters for subsequent transfusions
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Anaphylaxis
- 1) bronchospasm, hypotension, urticaria
- 2) usually IgG agains IgA in IgA-deficient recipient
- 1- fluids
- 2- lasix
- 3- pressors
- 4- steroids
- 5- epinephrine
- 6- histamine blockers
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Urticaria
- 1) usually nonhemolytic
- 2) usually a reaction against plasma proteins or IgA in the transfused blood
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Transfusion-related acute lung injury (TRALI)
- 1) rare
- 2) caused by antibodies to recipient's WBCs
- 3) clot in pulmonary capillaries
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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
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Dilutional thrombocytopenia
occurs after 10 units of PRBCs
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Hypocalcemia:
- 1) occurs with massive transfusions
- 2) calcium is required for clotting cascade
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Antiplatelet antibodies
develop in 20% of patients after 10-20 transfusions
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Hetastarch (hespan)
can use up to 1L without the risk of bleeding complications
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Whats the most common bacterial contaminate?
GNRs (usually E. coli)
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Most common blood product source of contamination?
platelets (not refrigerated)
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How can chaga's disease be transmitted?
chagas' disease- can be transmitted with blood transfusion
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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
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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%
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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
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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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