basics of transfusion therapy resident education lecture series
TRANSCRIPT
![Page 1: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/1.jpg)
Basics of Transfusion Therapy
Resident Education Lecture Series
![Page 2: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/2.jpg)
Hemoglobin Level and Symptoms
HGB (GM%) SYMPTOMS
9-11 MINIMAL
7.5 EXERTIONAL DYSPNEA
6.0 WEAKNESS
3.0 DYSPNEA AT REST
2-2.5 HEART FAILURE
LINMANNEJM 279:812, 1968
![Page 3: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/3.jpg)
RBC Transfusion: Indications
Acute Blood Loss
Symptomatic Anemia
Suboptimal O2 Capacity
Exchange (SS, Co)
![Page 4: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/4.jpg)
RBC Transfusion: The Bathtub Principle
Kidney
Kidney
Kidney
100
30
0
100
40
0
Blood Volume Blood VolumeBlood Volume
100
30
0
![Page 5: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/5.jpg)
Pre-Transfusion Testing
BLOOD TYPING: ABO, D Antigens only
(Other antigens are weak immunogens)
ANTIBODY SCREEN: Patient serum vs. cell panel
CROSSMATCH Major: Patient Serum vs. Donor Cells
![Page 6: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/6.jpg)
RBC Products PRBC MOST TRANSFUSIONS
WHOLE BLOOD ACUTE BLEEDINGEXCHANGEPLASMA NEEDED
WASHED REMOVE PLASMA
FROZEN RARE RBC PHENOTYPE
IRRADIATED IMMUNODEFICIENT CMV NEGATIVE IMMUNODEFICIENT
SERONEGATIVE, NEONATE
![Page 7: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/7.jpg)
RBC Transfusion Volume
Usual: Up to 15cc/Kg in 3-4 hours
Unusual: Acute Hemorrhage: replace ongoing losses
Chronic Anemia, Heart Failure, îBP
2cc/Kg/Gm HGBDiureticExchange
![Page 8: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/8.jpg)
Transfusion Volume
10cc/Kg PRBC 2.4 GM% in HGB
10cc/kg = X cc/kg 2.4 GM% Desired HGB rise
PRBC cc = Blood Volume x (HGBF- HGBI)
HGBT
BV=70cc/KG, 80-90cc/KG newborn
![Page 9: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/9.jpg)
Hemolytic Transfusion Reactions
Acute HTR 1/25,000Fatal Acute HTR 1-4/1,000,000
Delayed HTR 1/5-10,000
![Page 10: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/10.jpg)
Symptoms and Signs of Acute Hemolytic Reactions
Severe Back Pain Substernal Tightness, Dyspnea Hypotension / Circulatory collapse Vomiting, diarrhea Icterus Hemoglobinuria Renal shutdown Diffuse Oozing from
wounds/punctures
![Page 11: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/11.jpg)
Response to Suspected Hemolytic Reaction
Stop Transfusion Hydrate Specimens to Blood Bank
Unit/BagSerumRed cellsUrine
![Page 12: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/12.jpg)
Acute Hemolysis: Diagnosis
Do a direct antiglobulin test on post-transfusion sample
Obtain post-transfusion blood and urine and inspect visually
Recheck paperwork Recheck ABO type of unit and pre-and
post-transfusion specimens Run urinalysis - to check for
hemoglobinuria
![Page 13: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/13.jpg)
Cause of Acute HTR ABO incompatibility:source of error
10% at phlebotomy/labeling23% in Transfusion Lab67% transfusion administration (at the
bedside)
![Page 14: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/14.jpg)
Nonhemolytic Transfusion Reactions
Leukocyte Associated FNHTR Transfusion GVHD Neonatal Neutropenia
Immunoglobulin Associated Urticaria/Fever Ig E TRALI
Platelet Associated Post transfusion Purpura Neonatal
Thrombocytopenia
Metabolic/ Physical Citrate Toxicity Hypothermia Circulatory Overload
Massive Transfusions Haemostatic Abnormalities Metabolic complications Hgb-O2 Curve Shift
![Page 15: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/15.jpg)
TRANSFUSION-RELATED INFECTION
![Page 16: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/16.jpg)
Risk of Transfusion-Transmitted Infection
HIV 1 in 2,000,000Hepatitis C 1 in 2,000,000Hepatitis B 1 in 175,000Hepatitis A RareHTLV I/II 1 in 3,000,000Bacteria 1/3,000 (for platelets)
Malaria, T Cruzi, Babesia, Yersinia, Syphilis, Lyme, CJD, West Nile Virus…??
![Page 17: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/17.jpg)
Post Transfusion HCV
Percent Number
Incidence 5-10 150-300,000Chronic 50 75-150,000Cirrhosis 20 15-30,000
![Page 18: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/18.jpg)
Neonatal Post Transfusion CMV
Incidence:25% of seronegative infantsreceiving >50ml CMVseropositive blood
Severity 50% severe or lethal manifestations
![Page 19: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/19.jpg)
Neonatal Transfusion CMV Prevention by Filtering Blood
Seroconvert/Total
Filtered PRBC: 0/30
Unfiltered PRBC: 9/42
Gilbert, L1:98:228, 1989
![Page 20: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/20.jpg)
Prevention of Post Transfusion Infection
Don’t Transfuse Minimize Transfusion Limited Donors (dedicated units) Autologous Transfusions Erythropoetin Donor Screening: HIV Ab, HIV NAT, HCV Ab,
HCV NAT, HBV Ag, Ab, HBc Ab, VDRL, West Nile NAT, HTLVI/II Ab, CMV Ab, Bacterial Culture (Platelets)
![Page 21: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/21.jpg)
Strategies to Decrease Operative RBC Transfusion
HemostasisHemodilutionCell salvage
DDAVPAutologous Transfusion
Erythropoetin
![Page 22: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/22.jpg)
Neutropenia: infection risk
0
10
20
30
40
50
60
0 1 2 3 4 5
PMNs (/microL)
% p
ati
en
t d
ay
s w
ith
in
fec
tio
n
100 100-500 500-1000 1000
Relapse
Remission
Bodey. Ann Int Med 64:328, 1966.
![Page 23: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/23.jpg)
WBC Indications 2004
PMN:Newborn SepsisCongenital/Acquired
NeutropeniaPMN DysfunctionRefractory Gram Negative
Sepsis Ly: Disseminated Varicella-Zoster
![Page 24: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/24.jpg)
WBC transfusion:Logistics
Donors Receive G-CSF +/- Decadron 2-3 Hour Cytapheresis 1010 Cells by Standards Donors pretested for ID markers Cells decay rapidly: limited value at
> 6 hours post-collection Quantitative impact limited
![Page 25: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/25.jpg)
Fresh Frozen Plasma
200-250 ml of plasma containing all clotting factors, AT III, Protein C & S.
Compatibility Important Can Give: A plasma to A or O patient
B plasma to B or O patientO plasma to O patientAB plasma to anyone
![Page 26: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/26.jpg)
Indications: FFP
Replacement of Coagulation Factors Abnormal Bleeding with coagulopathy
Multiple factor deficiency: Liver disease DIC Reversal of Warfarin Dilutional
Isolated factor deficiency-no concentrate Factor XI, XIII
Replacement of regulatory proteins TTP, Hereditary angioedema
Not indicated for: volume expansion, reversal of Heparin, correction of INR < 1.5
![Page 27: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/27.jpg)
Guidelines: FFP Use
Usual dosing: Adult 10ml/Kg Peds 10-15ml/Kg
15-20% rise in factor levels Usually does not correct laboratory
coagulation status to “normal”
![Page 28: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/28.jpg)
![Page 29: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/29.jpg)
Cryoprecipitate
10-15 ml per unit (bag) Fibrinogen 250 mg Factor VIII80-120 units Von Willebrand Factor 40-70% of FFP Factor XIII 20-30% of FFP Fibronectin 20-40 mg
![Page 30: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/30.jpg)
Cryoprecipitate: Dosing
1-2 Units / 10 Kg Expect 60-100 mg/dl rise in fibrinogen Goal: Fibrinogen 70-100 mg/dl
![Page 31: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/31.jpg)
![Page 32: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/32.jpg)
![Page 33: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/33.jpg)
Platelets: Risk of Spontaneous Hemorrhage
Count Site > 40,000 Minimal20-40,000 GI Mucosa 5-20 Skin, Mucus Membranes < 5 CNS, Lung
![Page 34: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/34.jpg)
![Page 35: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/35.jpg)
0
10
20
30
40
0 50 100 150 200 250 300
Platelets (/microL)
Ble
edin
g t
ime
(min
)
ITP
AA
WAS
ASA
Uremia
vWD
Harker. NEJM 287:155, 1972.
![Page 36: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/36.jpg)
Prophylactic Platelet TX Guidelines
Platelet Count/μl Recommendation
0-5,000 Always 5-10,000 If Febrile of Minor Bleeding 11-20,000 If coagulopathy or minor
procedure >20,000 If Major Bleed or invasive
procedure
![Page 37: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/37.jpg)
Transfused Platelets/Survival 6 units = 1 single donor unit (SDP);
available as ¼, ½ and full SDP Dose: child 1 unit/5-6 kg
adult 1 unit/8-10 kg Lifespan: 7-10 Days Native
2-3 Days Transfused Factors shortening Lifespan:
Fever, Sepsis HLA, Platelet Specific Abs DIC Product Age?
![Page 38: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/38.jpg)
TRAP TrialEffect of Leukodepletion on Alloimmunization
No Rxpooled
FilterPooled
UV-BPooled
FilterSDP
Number 131 137 130 132
LCYTX-AB 45% 18% 21% 17%
LYCTX-ABrefractory
13% 3% 5% 4%
![Page 39: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/39.jpg)
![Page 40: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/40.jpg)
When in Doubt: Call the Transfusion Service!
266-2119
![Page 41: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/41.jpg)
![Page 42: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/42.jpg)
From ABP Certifying Exam Content Outline
2. Transfusion and collection of blood Understand the risk of transmitting infectious
diseases during blood transfusion(s) Recognize that erythrocyte transfusions may be
associated with hemolytic, febrile, and urticarial reactions
Understand the role of erythrocyte transfusions in the management of anemia
![Page 43: Basics of Transfusion Therapy Resident Education Lecture Series](https://reader030.vdocuments.us/reader030/viewer/2022032702/56649cef5503460f949bd077/html5/thumbnails/43.jpg)
Credits
Bruce Camitta MDM W Lankiewicz MD