Massive Transfusion Protocol Quiz

Cryoprecipitate

• Forms when FFP is thawed slowly at 4°C
• ABO-compatibility not needed
• Viruses can be transmitted
• Contains: FVIII, FXIII, vWF, fibrinogen
• Indications: microvascular bleeding with low fibrinogen, DIC with low fibrinogen and RBCs

Transfusion-Related Mortality

• Leading cause of transfusion-related mortality (5-25%)
• Accounts for 40% of US transfusion-related fatalities
• Activated neutrophils → sequestered in lung
• Donor antibodies (due to alloimmunization) complex with WBC antigens
• Avoid multiparous female donors
• "Two hit model": pre-existing pro-inflammatory state and reactive lipids in stored blood
• Symptoms: dyspnea, fever, pulmonary edema, bilateral infiltrates within 6h of transfusion
• Treatment: supportive ventilator and fluid management
• Prevention: leukocyte reduction, avoid multiparous female donors

Graft-Versus-Host Disease (GVHD)

• Donor lymphocytes establish immune response against the host
• Highest risk: immunocompromised patients, stem-cell or bone-marrow transplants, B-cell malignancies
• Symptoms occur within 4-21 days: fever, rash, diarrhea, liver dysfunction
• Rapidly progresses to pancytopenia, >90% mortality
• Prevent with irradiation – inactivate donor lymphocytes

Transfusion Related Immunomodulation (TRIM)

• Alteration of immune responsiveness and/or pro-inflammatory mechanisms
• Transfused WBCs and other immune mediators
• Effect of transfused RBCs in the microvasculature
• "Two insult" theory: pre-existing trauma/illness is the first "insult"
• Decreased rates of transplant rejection, Crohn’s, and spontaneous abortion
• Increased mortality, accelerated recurrence of malignancy, increased rates of infection, and more rapid progression of HIV/AIDS

Transfusion-Induced Inflammatory Response

• Bioactive substances accumulate during storage
• PRBC age correlates with multi-organ failure and mortality in ICU patients
• May lead to shorter "shelf times," esp. for sickest patients

Other Non-infectious Risks

• Massive Transfusion: hypothermia, TACO, dilutional coagulopathy, decreased 2,3-DPG, acidosis, hyperkalemia, citrate intoxication, iron overload, microaggregates

Transfusion Reactions

• Febrile non-hemolytic transfusion reaction
• Minor allergic reaction
• Anaphylactic reaction – PRBCs
• Anaphylactic reaction – FFP, platelets
• Acute hemolytic transfusion reaction (AHTR)
• Delayed hemolytic transfusion reaction (DHTR)
• Transfusion-related immunomodulation
• Alloimmunization
• Transfusion-related lung injury (TRALI)
• Graft-vs-host disease (GVHD)
• Post-transfusion purpura

Test your knowledge on the validity of data supporting "massive transfusion protocol" packs, particularly focusing on cryoprecipitate. Explore indications, components, and risks associated with the use of cryoprecipitate in transfusions.