Pediatric Hematology: Transfusion Medicine
Terms
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what is the storage duration for :
whole blood
packed RBCs
Platelets
FFP/cryo frozen
FFP/cryo thawed -
whole blood: 35 days
packed RBCs: 42 days (**in AS**)
Platelets: 5 days
FFP/cryo frozen: one year
FFP/cryo thawed: 24 hours - what is the crit of RBC with AS added?
- goes from HCT of 70% to Hct of 53-61%
- expected Hct rise for 5ml/kg transfusion of AS RBC
- 1.5g/dl
- Two viruses not inactivated in plasma by physical and chemical techniques. Why not?
- parvo b19 and HAV - they are not enveloped
- is DAT positive in allo or auto immune hemolysis
- both
- what is the difference between direct and indirect anti-globulin testing?
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direct: anti human IgG mixed with patient RBC
Indirect: patient serum (with patient IGG) combined with RBC of known specificity - development of which alloantibodies are most common in transfused sickle cell patients
- Anti C, anti- kell, anti-lewis
- why wash platelets or RBCs
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remove plasma proteins that cause allergic reaction
washing may remove high levels of extracellular K from RBC (particularly important in older bags of RBCs) - what percent RBCs are lost in washing?
- 20%
- how long do you have to give washed platetlets or RBCs
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platelets: 4 hours
RBCs: 24 hours - what are the published indications for granulocyte transfusion?
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neonate less than 2 weeks old, bacterial sepsis, ANC < 300
bacterial sepsis, no response to antibiotics, ANC < 500
patients with functional neutrophil defect and documented infection, inresponsive to antibodies - why leukoreduce platelet tansfusion
- decrease HLA antibody alloimmunization
- how does irradiation prevent Transfusion associated GVHD
- makes T cells in product incapable of proliferating
- should blood from relatives be irradiated
- all blood direct donated from relatives should be irradiated
- when does TA GVHD occur? what are the symptoms?
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4-30 days after transfusion
rash, diarrhea, fever, aplastic anemia - what is the effect of irradation of potassium in RBC sample
- accelerated K leak, shortens RBC shelf life to 28 days
- does cryoprecipiate undergo viral inactivation?
- no
- what are the indications for cryo?
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hypofibinogenemia
factor 13 deficiency - most common causes (3) of transfusion related death?
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- error in ABO compatibility
- bacterial contamination
- transfusion related acute lung injury - rate of transmission of parvovirus and t cruzei from transfusion
- 1: 40,000-42,000
- who gets CMV "safe" blood
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LBW infants (<1200 gm)
solid organ transplant patients
BMT patients
other immunodeficienes - what causes acute hemolytic transfusion reactions (AHTR)
- complement mediated, intravascular RBC destruction due to presence of preexisting anti A or anti B antibodies
- when does delayed hemolytic transfusion reaction occur
- days to weeks after transfusion
- what causes TRALI?
- transfusion of antibodies to HLA or neutrophil antigens that result in increased capillary permeability
- when do irradiated RBC units need to be discarded?
- 28 days
- current risk of HIV infection with RBC transfusion
- 1:1.5million
- What is a risk associated with prothrombin complex concentrates
- myocardial infarction
- what is contained in prothrombin complex concentrates
- factors 2,7,9,10