CHAPTER 9 Blood Com anent Thera
'"
hi.tories of urticari:iJ al""F;ic ",actions to blood tr.u15fu.ioru l1IlIy l><oeIit from administr3:ioo of diphmhy<hmine (BenadtyIJ immedialely pcio< to comm<"",",e,\t of
"'h>eG""'"
t"""fusions to mitigate tb< .. :iJ1e1gi< f1I2IIife>tations.""Infrequ<ntly, allergic "'''''tions to .lIogeneic.lly t",",fu.oo blood <an I>< IgE-medi.ted ond thu. «hibit ., lUI .naph)'lactic t),pe of «action. Thi, type of "'actioo t),pic.lly ocrurs earl)' during the fin' f ... · minute, of tbe tr,nsfu,ion. and the potient
~dly dcterionte. into >n2phylactic .hock unl ... "'pid inte,,'ention. are t»;en.
TIte.e clinicall1lllnife,tion. include the .. me .ign,.nd .ymptom> that are ron.i"ent with an .lIe'llic ",action plu, the following:
Wheezing with ",,,,i"'tO<)' dis ...
ss.
followed by.trim
ond laryngosp1Sms N.u", •.• lxIomin.1 poin •.•• " .."e
<",",pingTachycardi.
Hypoten.ion ,,'ith n.rrowed pulse I"""ure"'"
'" I.V. Therapy Demystified
Palien" with. k""""n hi,IOf)' of he:ort failure .nd woo ore oomidereJ "' risk for C,!culatory
"""load
may benefit from "',inB their blood components admini".red more .Iowly_ In oome il\Sl""""'. it may be advi •• Me to""I"' ''' ,/" "
bkod bank prof...;oo:il. prepare "spli'poc"'" of PRBC. so th .. "",ients with bean failure do 001 r«oj,.., emire un it> of bIoOO prodocts within 4-boorl ime Ii mit>, 0Ihcr prophylactic inte!'lenti"". rruoy re",l", arouoo admini.tering prophylactic LV, loop diu""ic. to the"" "",ien" 50 , .... they """"""i,..,
lmlIimum be""filS of myo,,.rdi.1 OJIygenation from tr2n,fused blood cell. while over:all ,"""',.,., in blood ",10"'" are minimized.thus diminishing myocordial wodloaJ and the likelihood of <,,,,ulatory ",.."Ioad
Bacteremia and Sepsis
Coowninalion of the Ir.Ul>f...m blood ~, ",ith p<IIOOgem. """" COIJVDOrIly bocteria. c'" """'" blood-bome bat-lerial infeetioru (i.e., """",,,,mi.) and 'Y"""'''' infection (i.e" >q>Si». Thi. """ be prevented tbuugh admini.tering the blood 001'
'P""'"
within the specified time limit<. by maintUning the """lity of the LV. adminislr.llion
""up with Luer_locl oonnectK>ns. ood by changi"ll LV, blood admini5lI:ltioo
_"""I)'
4 hours or with the administr>tion of erh ""'" blood OOI''P''"o1 unit. In additK>ri. I. V. odmini.mtion ><u sbookl be changed anytime !hal. oont>rninaboo is suspected • Oinic21 manifo.utiom of bacteremia and
..".u ....
y V2EJ wXkly fromr...wr
and chill!! to manifc.utiom IhaI. are oonsiste.-. ,,'illl><plic shock."'-"General Protocols for Treating Transfusion Reactions ,
\\Ihe . . >", .ny t)'1'" of ,,,,,,,fu,;oo ",,,,,,ion i, ,u'f"'C,ed. there are ... me gener.ol proIocol. that mus' be instituted. Fim of oil. if ,Ile pa,ion, i. still receiving the '''''''fu';oo. i, muot be stopped immedi>toly.
n.e
phy.ici>n i. _ ified . .oo the "oc' clinic.1 ,"""ifest11;oo, that the patien' . . hibi" :ore roporu-d .00 OOcu,"",nted corefully. 11>< po,;'nt identifk .. iOll prooocol i, rope>ted to cn,ure that ,be patient received the right blood rom!"""'nt produc'."'" 11>< I. V. ~ Ii ... i. flu.ned willi 0.9% storile >aline .00 kepll"ton, in the even' ,hat om<rgOfl' LV. push medie .. ions ... indie>ted or in c.", the I"tion' require> cmefgen' fluid ,'olume r<>u",it .. ion.Blood.oo urine specimen ... obt.ined.oo sent '0 the bkod bank fo.-:uWY""
olong willi the originil bkod com!"""'nt infu.;oo "".00 bag wi,h its remaining blood rom!""",n' ronton" ...
S,~Bu.,r
If
Q pali<.' i, ''''put<dof
<xhibiling manifwalion, of Qfry 1)'' ' 'of
lraJufi"iof!mlClion. ,Iu! finl I"aI_nl in,<"".,i"" lhat mu>1 IH i""ilut<d i,
CHAPTER 9 Blood Com anent Thera
Summary
T",nsfu.iom of 'p<"Cific blood components .... y be indicated to corTl"rt orute life-threatening blood component deficieocies, Ahr""'t .ny JJ\lIjo.- blood romponent may be """"fu.oo, 1he ad>ent of rocornbinant J>Iwmacologic blood component colony_stimulating facton ha, ,ul'Pl:urted some indic>tion. fo.-blood t"",,fusion. In addition .• Ileighter>ed .ware ... th:tt tnnsfu.ion with blood components can ltave delet";ou, >IIon_ and long_term .If ... 00 immune fuocti""
ha> fu"her limitoo indication. fo.- blood ",,,ufu,i,,,, •. Nu"". admini.tering t"""fusion. must tboroughly underst.nd the policie. and pcotocols that go>em .. fe and .If ...
i,..,
deli .... y oft"""fu,i"",,. In addition. they must be adept .. recognizing t"",,fusion .. "",i"". "t.en they occur and interyming quickly to pc","ont funbcr morbidity and ... Iity.Quiz
A "","",I ndult male hemoglobin level i.
(oj 15g1dL (b) 45 peJNnt.
(cj 12 gldL
(d) 5.0~ 100cellslmm',
2. Leukopenia may be tre.ted •• rely.nd eff«tively "'ith (oj leukocyte transfu.ions,
(b) whol. blood t",nsfu.ion"
(cj recombinant g""'ulocyte colony_stimulating fartor (G-CSF).
(d) "",ombinant .rythropoietin.
1. 1be ""pi .... ion dale fa- whole blood 0.-parked red blood cell> is approorimalely (oj J(t minute •• r"'r it i. donated.
(b) 9 day •• fter it isdon>too, (oj J(t day •• her it i, doo.",d.
(d) 42 day, .f.er it i, doo.",d.
, .. I.V. Therapy Demystified
4. E.a<h "n'l of
"""ked
red blood""II.
'hOI i., ,,. ,,,fused
should incre ... ,he"'matocrit by (.j 1 !"'fee"'.
<"j
31"'=""
(.j S !"'fee"'.
(" 10 ""'""",.
S. 11>< melhOO of .UI"'rnI>fu.ion ,h .. u ... " blood lhat i. ""thd",,," from !he p",jeDl 4-6 mooth. pleope""i,..,)y .00 stored in c • .., ,be po'ien' require.
blood 'mlSfu,;",," pos""",ratj,..,ly i.
(0)
_",Ii,"
.utologou. blood dorullioo (PAS D).(b) >rute flCfiOO,olemic bemodii",i"" (ANH).
(el in,uo"" ... ,;,.., blood •• Ivage (illS).
(d) "",tope .... i •• blood ")""ge (PBS).
6. Which of the follo ... i"~ type. of modified "ni .. of packed red blood coli. (PRBC.) may be il>dic.l<"d for p>.'ienl>
,,'i'" •
hi.lory of febrileoon/rmol)1io ",,,,,ion.?
(0) Irradiated (h) W.shed
(e) l.eukoctye_redocN (d) CMV ",....,IX"d
7, Tr2Iufu';oo. of pl.telcts are ;Minted for
(0) .11 ",,'ien" who ore lhrombocytope"'" (i .•.. line ""'," than 00fTTIlI1 pb.d .. NUIIU).
(b)
. n ""tiena
with bleeding di.oro.n Of roagul"l"'lhics.(el .11 ",,'ien" with platdet coon .. of I ... than IO.OOOImm'.
(d) .n ""tiena with conwmpli,.., plate"" di50rders weh as >liopathie thromboc)'t"P"ni. PUIJlYr> (ITP).
8. T"""fu';oo. of f~_f,,,,on plasma (1'1'1') ore iodie.too for (0) palien" with hfmop/lili. A and bleedin~ 0< iniuf)'.
(b) palien" with hfmop/lili. 8 and bleeding 0< iniuf)'.
CHAPTER 9 Blood Component Th erapy ".
(e) p.oli.nl< ,,'ith "'" "'"ollcbnnd di ... ",th bi<xdillJ ard injury,
(d) pau ... """"'illJ ..
...t ....
(Coumadin) .. -ho """"~ quICk ~ of il< """",,"«ulaI.,., elf«l.<.9. A pab<1II,,'IIh .. NJ ~ype ,,',11 ~ ... "'~bIood typo?
(a) TypeA (b) Type 8
(e) TypcAB
(d) TypcO
10. _ .. ilh "'b"'" bbld type not " " " " " ... , , _ ' " IJJ>< A. tlpo B.
am
type 0 blood?(a) Typo A (b) Typo 8 (e) TypoAB (d) Typo 0
II. WhICh pat .. nl< with RI>."""""" blood typo mu .. ~ ... ~u ... of Rh-"'Il.ti •• blood 'ype>?
(a) All pat,.nl< "'ho an: Rh.no,,,i ...
(b) Eidorly tn<.
(e) Eldorly"""",o
(d) II-'ornr. of ehildbeorins
Y<'"
12. Which of ,he fol"""iog muO! be ... rift ... prior '0 """'"",""i08 a ... f •• i001
(a) """.ot". ,nf""""" """ .. ., (b) Physic, ... •• onler
(e) Two un"lllt poIiett' .... nufi< ... th .. ~h ard an: r""nd on both tho blood rompone ... And ,he pM;'.,
(d) Alloftho~
B.
n.. ...r"""" ... .,.,
1Il0l io Itre-thruocnll'lll ard tenth 10 mani' ....'P',dJy .. 'heft pol ... _ ... fuS<d ,,·,th lbe """'8 blood type .. 0(_) (a) ..,.lo<moIytlC ... .,.,.
(b) febrile ""' .. ho".,I)'ue ...