Blood Product Transfusions

Transfusions

• Red blood cell transfusions are indicated when hemoglobin is less than 7 g/dL, and less than 8g/dL in cardiogenic shock patients
• Transfuse if there is evidence of ischemia due to impaired oxygen transport
• Give transfusions for symptomatic anemia, hypovolemic shock, and/or bleeding
• One unit of transfused red blood cells should increase hemoglobin by 1 g/dL, or hematocrit by 3%

Plasma

• Plasma provides all coagulation factors
• 10-15 ml/kg of plasma replaces about 20% of a patients clotting factors
• Administer plasma in cases of massive hemorrhage
• Administer plasma before surgical procedures when the INR is greater than 1.6
• Administer plasma if specific factor concentrates aren't available and factor replacement is needed
• Plasma exchange is an indication for plasma

Platelets

• One unit of platelets increases the platelet count by 25-50 per unit given
• The platelets only last about 1 week after donation
• Indications for platelet administration include massive hemorrhage
• Administer platelets for a platelet count below 10
• Administer platelets before a procedure with a platelet count below 50k
• Active bleeding requires platelet administration if the platelet count is below 50k
• Central nervous system or intraocular bleeding requires platelets with a platelet count below 50
• Use for Antiplatelet therapy
• Use in cases of Congenital platelet dysfunction and bleeding

Cryoprecipitate

• Cryoprecipitate contains Fibrinogen and von Willebrand Factor (vWF)
• Administer in cases of massive hemorrhage
• Administer for Hemophilia A.
• Administer for vM disease

Transfusion Considerations: ABO Antigens

• ABO antigens have codominant inheritance
• Individuals with codominant inheritance can have blood types A, B, and O, with O signifying a lack of A and B antigens
• If an individual inherits both A and B alleles, they will express both A and B antigens, resulting in blood type AB
• The absence of A and B antigens is signified by "O" blood type
• A and B antigens exhibit codominance
• When an individual inherits both A and B alleles, both A and B antigens are expressed, resulting in blood type AB
• Based on the presence or absence of A and B antigens, there are four blood types: A (only A antigen), B (only B antigen), AB (both A and B antigens), and O (neither A nor B antigen)
• Individuals with O blood type do not express either A or B antigens

Antibodies and Blood Groups

• The body produces antibodies against antigens that are not present on its own red blood cells
• Blood Type A produces anti-B antibodies and reacts with anti-A serum
• Blood Type B produces anti-A antibodies and reacts with anti-B serum
• Blood Type AB has no antibodies present and can receive both A and B blood
• Blood Type O has no antigens present and produces both anti-A and anti-B antibodies
• Agglutinins cause clumping (agglutination) of incompatible red blood cells

Rh Factor

• The D-antigen presence is positive in about 85% of the population
• Rh negative patients develop Anti-D antibodies only after exposure to Rh positive blood
• A mother with Rh negative blood exposed to the fetal blood of a Rh positive fetus may develop Anti-D antibodies, potentially causing hemolytic disease of the fetus and newborn (HDFN)
• Complications from a Rh negative mother carrying a Rh positive fetus can be prevented with Rh immune globulin (RhoGAM)
• RhoGAM contains anti-D IgG antibodies that clear fetal Rh positive cells from the maternal blood stream to prevent the development of maternal Rh antibodies
• There is also a concern for course transfusion reaction

Type and Screen

• Cross matching reduces complications and includes ABO type, Rh type and Screening for other antibodies
• Religious considerations, Jehovah’s Witness: No blood and sanctity of blood (do not assume they will refuse blood)
• In pediatric cases, it is important to know hospital policy via the ethics committee
• Heparin is derived from porcine intestinal mucosa (pork): Consider for patients with dietary restrictions such as vegetarian, vegan, Islam, and Judaism

Thrombosis and Thrombophilia

• A thrombus is an aggregate of coagulated blood that contains platelets, fibrin, and entrapped cellular elements
• Thrombosis is the formation of a thrombus, which can lead to obstruction of a blood vessel
• Arterial thrombosis can lead to MI, stroke, and peripheral arterial thrombosis in the setting of Atrial Fibrillation without anticoagulation
• Venous thrombosis can lead to DVT and pulmonary embolism

Outcomes of Thrombosis

• Lysis occurs when the fibrinolytic system rapidly dissolves recent thrombi, but is ineffective for older, more resistant clots
• Propagation involves the thrombus growing by accumulating platelets and fibrin, potentially leading to vessel occlusion
• Embolization occurs when a portion of the thrombus breaks off and travels through the bloodstream, potentially causing blockages elsewhere
• Inflammation and fibrosis occur, with connective tissue invading the thrombus, making it firm and grayish white during Organization
• Canalization involves a new lumen forming within the organized thrombus, lined by endothelium, allowing partial blood flow restoration
• Thromboembolus is a thrombus formed in one location that detaches from the vessel wall and travels to a distant site
• Venous thromboembolism (VTE) includes DVT, PE, and cerebral venous sinus thrombosis
• Embolus is an intravascular solid, liquid or gaseous mass that is carried by blood to a distant site from its point of origin
• Fat embolus occurs when fractures of long bones, soft tissue trauma, and burns, releasing emboli of fatty marrow or adipose tissue into the circulation

Fat Embolus Symptoms

• In fat embolus, the onset is sudden
• Symptoms can include tachypnea, dyspnea, tachycardia, neurologic symptoms, mental changes that can progress to delirium or coma, diffuse widespread petechia found in 20-50% of cases
• Patients also experience thrombocytopenia due to adherence of platelets to fat globules
• Fat embolus appears 1-3 days after injury
• Fat embolus mostly obstructs microcirculation, arterioles, and capillaries
• Thrombocytopenia often occurs
• Long bone fractures and burns usually occur

Mechanism of Injury

• Fat globules are present in microvasculature of the lungs, ARDS, and the brain, cerebral edema with small hemorrhages
• Free fatty acids from fat globules cause local injury to endothelium, followed by platelet activation and granulocyte recruitment
• Air embolus is a frothy clotty mass with lots of inflammatory response, requiring 100mL
• Pressurized air embolus is defined as deep water scuba diving caused by ascending to quickly, resulting in rapid decompression
• Amniotic fluid embolism is caused by amniotic fluid or tissue fluid and leads to intense inflammatory response, rare and with a very high mortality rate

Hyperhomocysteinemia

• Marked hyperhomocysteinemia means plasma homocysteine levels are greater than 100 µmol/L
• It is caused by homozygous Cystathionine-beta-synthase deficiency
• The impact is severe developmental disability, lens and skeletal defects, atherosclerotic and or thromboembolic disease
• Moderate elevation is considered 16-100 µmol/L and can be caused by Heterozygous enzyme deficiency or, B12, Folic Acid, or Pyridoxine (B6) deficiency
• Homocysteine is normally metabolized through two pathways: Conversion to Methionine – Requires Vitamin B12 and Folate; and Conversion to Cystathionine – Requires Vitamin B6 (Pyridoxine)
• Deficiencies in B6, B12 and folate can lead to elevated homocysteine levels and increase the risk of cardiovascular disease
• Homocysteine toxicity results in direct damage to endothelium, leading to increased platelet adhesion, and loss of thrombolysis
• Mild to moderate hyperhomocysteinemia is considered an independent risk factor for CAD, PVD, and DVT
• Homocsyteine toxicity leads to homocysteinemia, increased platelet adhesion and loss of thrombolysis, and antithrombin deficiecny

Secondary (acquired) disorders

• Secondary (acquired) disorders, such as cancer, pregnancy and estrogen-containing contraceptives, increase the risk for thrombosis

VTE

• VTE is most common in Deep vein thrombosis (DVT); large vessels (popliteal femoral and iliac veins) enter the right side of the heart
• DVT is asymptomatic in 50% of cases, is recognized only after embolization has occurred, leads to Impaired venous valve function and Chronic Deep Venous INsufficiency
• Pulmonary Embolism results from 90% of DVT cases

Deep Vein Thrombosis (DVT)

• Risk factors include Advanced Age,Sickle Cell and Disease,Genetics,Male, Obesity, smoking, immobilization, and Pregnancy
• Flight travel often asymptomatic and occurs after 4 hrs(1 in 4,600) or after 8 hrs (1 in 200)
• Pathogenesis includes Stasis, Injury, and Hypercoagulability
• Estrogen-containing contraceptives increase the risk of oral thrombosis and stroke, late pregnancy can increase the risk by 60 times higher than in the non pregnant patient
• Clinical features include Statistics and common pathway of disease:
• Superficial thrombi is is is Saphenous system and rarely embolize
• Local edema+impaired venous drainage causes varicose ulcers
• Majority (90%) are larger veins (popliteal, femoral, iliac)
• Pulmonary Embolism is dyspnea + tachycardia; MUST r/o PE( pulmonary embolism) and Bilateral lungs, Right lung, Left Lungs

Pulmonary Embolism(PE)

• Clinical syndrome is small, often Asympatomatac and may lead to underoginzaitnnanand becomes integrated within cells
• Group 1 massive: -Sudden hospital death, -Commonly the death is non obstetric -Congestive with lungs Disease
  • Group3 pulmonary hemorrage is no infarction and small and is not fatal if not imediattly The is imparied gas exhange but also with clinical diagnostic considerations -Imaging from xrays CT scan with localized Opacities

Air Embolism

• If Neck wounds, Thoracocentesis has (100ML) can be required and is not ofted to be DVT

DVT (Deep Vein Thrombosis)

• Asymptomatic: Still at risk of PE( pulmonary embolism)
  • Propagation : Proximal -Embolization

Treatment

• 15-30mm Hg with stockings: Reddues discomfort and leg swelling or assymptotic

Diagnosis

• Assessment high Low
• Negative Dopler is difficult to diagnose

Clinical Feartures

• Pulomany embolism, Contrast by the kidneys of patients with renal disease
• D VT from vein is pulmonary in are in the Lugs

Leucokyte(ALL)

1-Stems cells in marrow is and 2 cells with in CNS in body

• Better for Low white count, allogenic and chemotherapy and symptoms can improve The types are are fatigue, LAd, Thrombocytipeni

Non holikin limpima

-System Malignancy and symtpoms are less then not with an acute and chroni progression all in one is long term

HL (Hodgkins)

• Maliint and is more in to B cells, Symptoms come with high al types of progressions and is still a disaease and or type A
• More for lymphnodes and long terms as well

Multiple Myeloma

• More for men with ages and can cause Bone pains
• Also by hyperkalemia

ALL, Hodgkins

• The the last in lymph nodes
• ForHodgkins it has localised -Some ytpomcs

Proliferation

• Proliferation: too much has been made
• Dysplastic, its a high risk situation so not rigth

Treatment

• Acute Lymphoblastic Leukemia and stem cells is not
• The B can e better
• For most ALL is in Bone marrow, but can also travel to other places
• The sympotmcs in acute all is less often
• CLL is increase in cell count also
• Rai is a classification of staging and the Treatment
• Dermatisis The types are are fatigue, LAd, Thrombocytipeni

-If one if a low rate then one also has in Obintuzumab, the last but not least

Overview of blood product transfusions including red blood cells, plasma, and platelets. Details indications for transfusions based on lab values and patient condition. Includes the expected impact of transfusions on lab values.