Transfusion Practices 8.9

What are the three General indications of transfusion?

O2 content is determined by ____ concentrations.

Transfusions are contraindicated for what four patients.

What are the four indications for transfusion of whole blood?

What volume of blood loss is indicated for whole blood transfusion?

These patients should not receive whole blood due to adverse response to plasma by developing pulmonary edema and heart failure due to volume overload.

pulmonary edema and heart failure due to whole blood transfusion is more likely in patients with ______ and ________ failure.

what are the three indications for packed dred blood cell transfusion.

A unit of PRBC increases HgB by ___ g/dL and HcT by ___.

true or false
a unit of PRBC and a unit of whole blood will increase HgB and HCT equally.
True False

PRBC's are specifically indicated for what three compromised patients du to possible volume overload?

what are the five contraindications of PRBCs?

what are the three indications for washed PRBCs.

what are the three indications for platelets?

what quantity of platelets is indicative of transfusion? preoperative?

what are the four contraindications of platelets?

what are the two indications of fresh frozen plasma?

Fresh Frozen Plasma id contraindicated for volume expansion due to what disease risk?

Fresh Frozen Plasma is contraindicated as a nutritional supplement for what factors?

Fresh Frozen Plasma is Contraindicated prophylactically in what two conditions?

Fresh Frozen Plasma is contraindicated in a Pt/Ptt less than ____ times normal.

This is a high molecular weight plasma protein concentrate that precipitate in cold.

Cryoprecipitate contains at least _____ mg fibrinogen and ____ units of AHF suspended in ___ mL of plasma.

what are the five concentrated factors in cryoprecipitate?

This disease caues prolonged bleeding time, prolonged PTT, and abnormal platelet plug formation.

Von Willebrand Syndrome is caused by a partial deficiency of what factor?

what blood product is indicated for Vonwillebrand syndrome?

what are three Fibrinogens abnormalities that indicate use of cryoprecipitate?

This factor deficiency is indicative of cryoprecipitate as replacement therapy for hemophila A

This is an opsonic glycoprotein that helps clear blood borne particulate such as bacteria and protein aggregates?

This this cryoprecipitate product is used as treatment for sepsis, burns and trauma.

this cryoprecipitate product can be administrated topically?

Fibrin glue is made from ___________ cryoprecipitate.

Cryoprecipitate is indicated for this factor deficiency as therapy for hemophilia B and christmas disease.

this blood product is used to correct large scale loss of colloids, such as hypovolemic shock, burn patients, and retroperitoneal surgery.

this blood product is contraindicated to correct hypoalbuminemia due to nutritional deficiency.

this is a non-human blood product derivative so it has no viral disease transmission risk.

what are the the two leukocyte reduced products?

what are the three preparation methods for Leukocyte Reduced Products?

What are the two indications for Leukocyte reduced products?

this is an alternative to pooled random platelets?

1 RP contains _________ platelets
1 SDP contains __________ platelets
1 SDP = ____ RP

What are three advantages to Apheresis platelets?

Irradiated RBCs/Platelets are used to prevent what disease?

This is a disorder in which the grafted tissues or donor cells attack the hosted tissue.

this disease may occur on immunocompromised patients who received an HLA-matched lymphocyte.

This prevents lymph replication in graft versus host disease.

what are the five indications of Irradiated RBCs/Platelets?

These patients require a conservative approach due to serological difficulties and expected short red cell survival. patients must be phenotyped prior to transfusion.

this is when transfusion exceeds patient's blood volume withna a 24 hr period or about 10 units of blood in an adult.

abbreviated crossmatch in massive transfusion is performed only in what phase?

changing these depends on gender and age of patients?

This may be seen in massive transfusion patients due to active metabolism uptake of potassium by the red blood cells.

This may be seen in massive transfusion patients due to citrate anticoagulant.

These two disorders may be caused by a decrease in citrate and lactate metabolism.

cold toxicity (hyopthermia) and increased cardiac dysrhthmias may be seen in what transfusion patients?

This abnormalities may be due to dilution of platelets or coagulation factors during massive transfusion.

hemostatic derangement in massive transfusion is due to ____________ mor than transfusion.

before transfusion patient must give _________ consent.

patient preparations, is who's responsibility?

History of what two drugs should be checked before transfusion?

IV meds may be given immediately _______ to transfusion.

oral meds are give ________ prior to transfusiton

what gauge needle is used for transfusion?

what gauge needle is used for pediatrics?

Administer ______ components through filters designed to remove blood colots/debris.

this infusion set has an in-line filter with a 170-260 micron pore size to trap lage clots.

what is the micron pore size of the rapid infusion device?

gravity drip sets are used for what two blood products?

this infusion set is used for small volumes with in line filter.

this infusion set is used for RBC transfusion, has a 20-40 micron pore size, and traps aggregates fo degenerating platelets, white cells, and fibrin strands.

this infusion set reduces risk of HLA alloimmunization, traps leukocytes but not RBCs and platelets.

blood warmers should be used to decrease what two things?

Blood warmers should have a thermometer, audible alarm and must not warm blood past what temp?

These infusion sets have a mechanical pump with controlled delivery rate.

This electromechanical infusion device is used to speed up infusion?

this electromechanical infusion device is used to recover blood during operations.

Compatible I.V. solutions administered with blood products should be approved by who?

Accurate ID of donor with the recipient should be checked at what two times?

If transfusion cannot be started within ____ minutes, blood should be returned to the blood bank for proer storage.

Transusionist should remain with the patients for at least the first ___ minutes of transfusion?

after 15 minutes of transfusion, transfusionist should check what?

Normal transfusion are completed within ____ hours. maximum is ____ hours.

what three factors affect the rate of transfusion?

Any unfavorable patient response to transfusion is called what?

This is a transfusion reaction with red cell destruction due to incompatibility.

how much incompatible blood can cause a hemolytic transfusion reaction?

This transfusion reaction is extremely life threatening.

this transfusion reaction is characterized by fever, chills, pain, nausea, flushing, hypotension, bleeding, shock, and hemoglobinuria.

what is the therapy for hemolytic transfusion reaction.

this transfusion reaction can be prevented with attention to detail.

a temperature change of __ degree celcius indicates a febrile transfusion reaction.

this is the most frequently encountered transfusion reaction.

this transfusion reaction is characterized by fever and chills and should be treated with antipyretics

what blood product should be used to prevent febrile transfusion reactions?

This transfusion reaction is caused by an antibody to plasma proteins and is characterized by itching and hives.

what is the therapy/prevention of mild allergic- urticarial transfusion reactions?

this transfusion reaction is caused by an antibody to IgA and is characterized by urticaria, shock, wheezing, and cardiac arrest.

what is the therapy for anaphylactic transfusion reaction?

what is the preventionof anaphylactic transfusion reactions.

This non immune transfusion reaction is caused by bacterial contamination.

This transfusion reaction is characterized by a rapid onset of chills, high fever, vomiting, diarrhea, hypotension, shock, DIC.

what is the therapy for sepsis?

how is sepsis prevented in transfusion?

This transfusion reaction is caused by fluid administered faster than circulation can accommodate.

this transfusion reaction is characterized by cough, headache, pulmonary congestion, hypertension and tachycardia.

what is the therapy for circulatory overload?

who is at high risk for circulatory overload?

this transfusion reaction is caused by an anamnestic antibody, kidd system is notorious.

delayed hemolytic transfusion reactions usually occur _______ days after transfusion.

This transfusion reaction is characterized by slight fever, mild jaundice, and fall in Hct usually 7-14 days after transfusion.

true or false
treatment is rarely needed for delayed hemolytic transfusion reactions.
True False

this is any adverse symptom occurring during transfusion.

what is the first course of action for suspected transfusion reactions?

medical and nursing presonnel should report suspected reactions to who?

what is the blood bank test used to check for possible transfusion reactions?

absence of hemoglobinemia and a negative DAT suggests ___ acute immune hemolytic reactions.

What three tests should be repeated with pre and post transfusion samples to investigate for possible alloantibodies.

What tests should be performed on donor unit to test for possible bacterial contamination?

who should be notified of transfusion reaction fatalities?

This is an Ab induced hemolytic anemia where mother has IgG antibody and fetus has the corresponding antigen.

HDN begins in ________ and continues after _______.

HDN causes a _______ anemia where hemolytic is maximal at birth and diminishes as concentration of maternal Ab declines in infant circulation.

This is when fetal RBCs enter maternal blood system.

Immunization is possible when fetal cells possess ________ antigen foreign to mother.

highest incidence of maternal immunization is when?

What are three other maternal immunizing events besides delivery?

HDN will causes what two organs to become enlarged in newborn?

this clinical finding of HDN is secondary to anemia prior to brith.

HDN causes this type of edema.

this clinical finding of HDN is associated with deficient glucouronyl transferase.

Brain damage in HDN is caused by Kernicterus with what critical bilirubin level?

what are the six laboratory finding of HDN?

this laboratory finding is specifically indicates ABO HDN.

Subclinical HDN is common in ____ HDN and is detected by a positive DAT.

This is an uncommon form of HDN that is symptomatic and requires treatment.

This form of HDN is usually do to Rh HDN (D antigen)

Clinical HDN severity can vary from a ______ disease to intrauterine ______.

This finding indicates severity of clinical HDN in newborn.

in clinical HDN there is an inverse relationship between cord blood ____ and serum ________ level.

What cord Hgb value indicates mild HDN.

what cord HgB value indicates moderate HDN.

what cord Hgb value indicates severe HDN?

this is the most common form of HDN.

this HDN is mild and usually does not need transfusion/treatment.

ABO HDN is seen with what DAT results?

ABO HDN is seen in group ___ mothers with group ___ or __ infants.

The following eluate reactions indicate what antibody causing HDN?
A cells: +
B cells: =

The following eluate reactions indicate what antibody causing HDN?
A cells: =
B cells: +

The following eluate reactions indicate what antibody causing HDN?
A cells: +
B cells: +

Rh HDN is caused by what maternal antibody?

Rh HDN is seen in Rh ____ mom with Rh ____ fetus.

What DAT result indicates Rh HDN?

This HDN is usually a severe disease which requires treatment.

this HDN is characterized by a rapid increase in bilirubin

treatment in Rh HDN is usually required to correct what?

This uncommon HDN is caused by other antibodies including those of Rh system except anti-D.

This is done to Id women at risk of having HDN baby, ID mom's ABO and Rh, antibody screen.

These two Thiol reagents are sued to differentiate unexpected maternal antibodies.

Antibody titrations are performed on what class of maternal unexpected antibodies?

maternal unexpected antibodies should be titered how often untill delivery?

high titers that are increasing __ tubes or more indicates severe HDN in progress

true or false
titer alaways correlates with severity of HDN.
True False

dilutions greater than ___ or a score change greater than ___ indicates significant change in unexpected maternal antibody titer.

true or false
maternal antibody titer serum should be saved for comparison titer the next month.
True False

What are the two indications for aminocentesis?

amniocentesis is never indicated for what type of HDN.

this is the process by which amniotic fluid is removed from amniotic sac.

amniotic fluid is tested by ___________ for bilirubin like pigments (fetal hgb breakdown).

amniotic fluids become increasingly _________ with HDN.

what is the normal color of amniotic fluid?

this is the best method of determining severity of in-utero hemolysis (HDN) prior to brith.

HDN is also known as what?

Aminocentesis indicates the amount of _______ that fetus is suffering.

Amniotic fluid is tested at what wavelength?

Aminocentesis is plotted on what type of graph?

low zone values on liley graph indicate what?

mid zone values on liley graph indicate what?

top zone values on liley graph indicates what?

if top zone values are indicated on liley graph, deliver infant if L/S ration (lecithin/sphingomyelin) above ___ indicates fetal lung maturity.

intrauterine transfusion is performed with what liley graph values?

this type of transfusion is done prior to brith to treat severe anemia and keep infant alive until delivery is possible.

intrauterine transfusion is injected into where?

this type of transfusion is done after birth to remove sensitized newborn cells and treat high bilirubin and sever anemia.

exchange transfusion reduces the amount of ______ antibody in HDN.

this transfusion is done in HDN with iatrogenic blood loss to mantain Hct above 40%

intrauterine should be done with PRBCs with what HCT?

blood for intrauterine transfusion should be no more than __ days old.

what blood type should be used for intrauterine transfusion?

Intrauterine transfusion donor units should be crossmatched compatible with ________ serum.

Intrauterine transfusion blood units should be irradiated and washed to remove what antibodies?

Exhange transfusion blood should be PRBC units mixed with FFP or 5% albumin to attain whole blood with HCT of what?

true or false
exhange transfusion donor cells should be ABO compatible with mother and infant.
True False

ABO HDN exhange transfusion units should be the ______ group and _____ Rh or group O.

Rh HDN Exchange transfusion units should be _________ Rh, ________ group or group O.

for other HDN exchange transfusion, use the same ABO/Rh as infant or group O. Donor unit must _____ maternal Ab.

this is commercially prepared IgG anti-D which prevents immunization.

RhIg is a standard ____ug dose

RhIg is given within ____ hours

RhIg destroys ___ ml Rh WB or __ ml PRBC

What is the criteria for RhIg?

what are the two contraindications fo RhIg?

RhIg contains trace amounts of what class of antibody?

This is a qualatative fetal bleed screen test.

the Rosette test will detect as little as ____ml or less fetal maternal hemorrhage.

D pos fetal cells + reagent (anti-D) + D pos indicator cells = rosettes, is the principle of what test?

this is a quantitative test that measures the volume of fetal cells in mother's circulation.

this test indicates a need for multiple doses of RhIg

This test is also called the Acid Elution Stain method.

The Kleihauer-Betke test principle is that:
______ Hgb is NOT acid soluble
______ Hgb is acid soluble

normal adult Hgb F value is what?

in Kleihauer-Betke test, a smear of maternal blood is made and fixed in ethanol, then treated with acid buffer, _____ hgb is lost from cells while ____ hgb remain in fetal cells.

in Kleihauer Betke test, the smear is stained with what two stains?

after the smear is stained in Kleihaur-betke test, _______ cells appear as pale ghosts, and ______ cells take stain and appear as bright pink-red cells.

how are test result calculations preformed on the kleihauer-Betke test?

calculate how many RhIg doses to give a patient with 1.3% fetal cells by acid elution

what are the three routine tests performed at the first trimester?

Routine tests at first trimester are to ID who?

For Rh negative mother antibody screen is repated at ___ weeks gestation and give RhIg anternatally.

if IgG antibodies are found in an Rh negative mother what should be done?

This is a semiquantitative method of determining antibody content, used to determine when to monitor fetus for HDN by amniocentesis.

what are errors that affect interpretation of prenatal antibody titration

cord blood in suspected HDN cases should be tested for what three things?

cord blood should be washed how many times?

what ABO testing should be done on cord blood?

when is elution performed on cord blood?

in this specimen, accurate Rh testing is difficult in cells are heavily coated with IgG antibodes.

this is a fast elution test where freezing ruptures cells to release antibody.

After Cord RBC's are washed 6 times this should be saved for later testing?

what quantity of washed cord RBCs are sued to test for Lui Rapid Freeze elution?

how many drops of saline are added to the 0.5 ml washed cord RBC's in lui rapid freeze?

in Lui rapid freeze, cord RBC's and saline are placed horizontally at what temperature for 10 minutes?

in Lui Rapid Freeze, the eluate is tested in paralell with what?

any positive reaction on which Lui Freeze sample indicates an invalid test?

a positve eluate reaction with O cells in Lui Freeze indicates what antibody?

a positive eluate reaction with A cells in Lui Freeze indicates what antibody?

a positive eluate reaction with AB cells in Lui Freeze indicates what antibody?

What can cause a false positve on Cord RBC elution?

False positves on Cord cell elutions will causes what tube to be positive?

Fetal cells heavily coated with mother's antibody (Anit-D), can causes what false result when performing Cord Cell elution?

how is maternal Anti-D removed from cord cells?