TRANSFUSION THERAPY (p555-557)

A. Emergency Transfusions
1. Rapid loss of blood can result in hemorrhagic shock.
a. Symptoms: Hypotension, tachycardia, pallor, cyanosis, cold clammy skin,
5 oliguria, decreased hematocrit, decreased central venous pressure (CVP),
CNS depression, and metabolic shock
2. Priorities in acute blood loss
a. Replace and maintain blood volume.
b. Make sure oxygen-carrying capacity is adequate.
10 c. Maintain coagulation system integrity.
d. Correct metabolic imbalances.
e. Maintain colloid osmotic pressure.
3. Massive transfusion: Replacement of a person's entire blood volume
(approximately 10 units) within 24 hours
15 4. Emergency transfusions result from trauma (gunshot wounds, stabbings,
vehicular accidents, etc.) and surgical needs.
5. Emergency release of blood: It is preferable to transfuse type-specific blood.
If time is not available to type the patient, type O, D-negative blood is
transfused into women of childbearing age. Type O, D-positive blood is
20 transfused into men. Physician must request emergency release indicating that
no crossmatch is performed before the blood is transfused. The crossmatch is
performed during or following the transfusion.

B. Neonatal and Pediatric Transfusions

25 1. Smaller blood volume than adults
2. Premature infants may need transfusion to offset the effect of hemoglobin F in
their system. Hemoglobin F does not give up oxygen readily.
3. latrogenic blood loss (blood taken from the neonate or infant for laboratory
tests) causes the neonate or infant to develop an anemia that may be severe
30 enough to transfuse.
4. Neonates and infants do not tolerate hypothermia well, so blood warmers may
be used.
5. Washed or fresh blood is preferred for neonates or infants because of the
liver's inability to metabolize citrate anticoagulants and potassium, which
35 leaks from RBCs in donor units over time.
6. Transfusions are given in small volumes in multiple packs taken from a
normal size blood unit.
7. Infants do not form antibodies for the first 4 months, so no crossmatch is
necessary.
40 8. Transfuse CMV-negative and/or leukoreduced blood.

C. Transplantation
1 . Liver transplant patients require large amounts of blood products (on
average 20 units of RBCs, 25 units of FFP, 17 units of platelets, and 5 units
45 of cryoprecipitate) because the liver produces many coagulation factors and
cholesterol for RBC membranes.
2. ABO compatibility is important in kidney, liver, and heart transplants.
 It is not important in bone, heart valves, skin, and cornea transplants.
3. Progenitor cell transplants
a. Allogeneic or autologous
b. Derived from bone marrow or umbilical cord blood
5 c. Transfusion support with leukocyte-reduced products to prevent
alloimmunization and a greater chance of rejection
d. Conditions treated: Severe combined immunodeficiency disease,
Wiskott-Aldrich syndrome, aplastic anemia, Fanconi anemia, thalassemia,
sickle cell disease, acute leukemia, CML, lymphoma,
10 myelodysplastic/myeloproliferative disorders, multiple myeloma,
neuroblastoma, breast cancer, ovarian cancer, and testicular cancer

D. Therapeutic Hemapheresis
1. Replacement of blood from a patient to improve a patient's health
15 2. Conditions indicated for therapeutic exchanges: Multiple myeloma,
Waldenstrom macroglobulinemia, hyperleukocytosis, TTP/HUS, sickle cell,
myasthenia gravis, acute Guillain-Barre syndrome

E. Oncology
20 1. Chemotherapy drugs kill all cells that are undergoing mitosis: Stem cells,
gastrointestinal epithelial cells, and hair follicles.
2. Action of chemotherapy drugs:
a. Stopping DNA replication
b. Interfering with mRNA production
25
F. Chronic Renal Disease
1. Dialysis patients have an increased uremic (blood urea nitrogen or BUN)
content in blood that alters the RBC shape and causes the cells to be removed
from circulation by the spleen.
30 2. Dialysis itself mechanically destroys RBCs.
3. Nonfunctioning kidneys do not produce erythropoietin to stimulate RBC
production.
4. The use of transfusions in dialysis patients has been dramatically reduced
since erythropoietin therapy was initiated.
35
G. Sickle Cell Anemia
1. An abnormal hemoglobin (e.g., Hgb S) causes cells to be removed from
circulation, resulting in a lowered hematocrit.
2. Because these patients require many transfusions, phenotypically matched
40 units are preferred.
3. Severe cases may be treated by bone marrow transplants.

H. Thalassemia
1. Decreased synthesis of the a- and (3-globin chains
45 2. Hemolytic anemia results
3. Transfusion support necessary
 I. Aplastic Anemia
1. Blood transfusion support is usually needed until bone marrow transplant can
occur.