Blood products

**** hemolytic reaction due to ABO incompatibility - 1/70,000. number 1 cause is human error.
* Rh incompatibility
* sepsis - blood is contaminated with bacteria - 1/500,000 w/ PRC. w/ platlets 1/50,000
* febrile rx - cytokines in the blood that cause destruction of platlets in patient and cells. transient - 1/100
* TRALI - transfusion related lung injury - antibodies in transfused blood react with antigens in the recipient - 1/5000
* allergic rx - IGE to some protein in transfused blood. Most common in patients with IgA deficiency patients - 1/300
* hypothermia - use a blood warmer

intravascular hemolysis
- fever due to intracellular release

extravascular hemolosis. takes days to happen

washed red blood cells

fluid overload

1/250,000
1/2,000,000
1/2,000,000

1. order blood stopped, and for them to draw a few tubes of blood.
2. unhook blood.
3. check temp
4. quick exam to check for allergic: lungs, bp, skin (hives). if normal, not allergic, trali, or fluid overload.
5. hemolysis - draw blood from patient - all tops. Take a red tube and tape it to the bed to let it settle. the serum will turn pink in 15 minutes if there is major hemolysis. ask blood bank what else they want.
- dip urine for hemoglobin. if pink, then it is hemolysis. if negative then no hemolysis
* CBC, Chem 7, Pt/PTT, bilirubin level
* recheck temp. if normal after 30minutes, then febrile. reaction.

* remove all IVs and tubing that was connected to the contaminated blood
* CXR
* high flow O2
* transfer to ICU/ some place where they can be observed.

1. vitamin K - takes a day to work
2. FFP - replaces coagulation factors - 3 units. every unit increases coagulation by 3-5%. - not FFP is frozen, so it takes 60-90 minutes to thaw. If you suspect that they may be at risk, order FFP at the same time that you order INR

1. order type and cross - cross match for all the major antibodies and test it against the specific patient for 48 hours. takes about 1 hour.
2. order for them to stay two units ahead of us.
3. could also do O negative (woman in child bearing years)/O (man) blood. takes as long as it takes to go to the blood bank and back
* can ask for type specific blood off blood sample. frees up O blood
*type and rh - good for preggers
* if you give a woman O blood, give her rhogam.

type and screen - screen for the major antibodies but do not cross match it to particular patient. does not take blood out of ciruculation.

3 units -> so probably want to give 2-3 units

1. do good neuro exam - why
2. look at the smear - need to rule out TTP - look for schistocytes. wake up path resident/ or get heme onc resident.

* steroids
* 1 unit of plateletss = raises platelets 5-10k -> order a 6 pack

TTP
* plasmaphoresis - take away plasma and give new plasma. Needs renal fellow because similar to dialysis

give protamine