This information is taken verbatim from the Puget Sound Blood Center’s Website:
Red Blood Cells
One unit of red blood cells (RBC) contains approximately ____ mL red blood cells, ____ mL Optisol AS-5® (a solution added to extend storage life) and ~ ____ mL plasma. All red blood cell transfusions must be _______/Rh compatible with the recipient, so, in dire emergency, type _____ negative can be used for all patients.
RBC do not provide viable _____________, nor do they provide clinically significant amounts of __________ factors. RBC must be stored between __-__° C and have a shelf life of _____ days.
RBC are indicated for patients with symptomatic ________ who are not treatable, within a reasonable amount of time considering their symptoms, with specific therapy such as iron, vitamin B12, folic acid or erythropoietin.
In a 70 kilogram adult, each unit should increase the hematocrit by _____%.
Emergency Red Blood Cell Usage
Many hospitals have a limited supply of _______ matched type __ RBC’s to be used for a bleeding patient in dire emergency. Type ___, Rh-________ RBC’s can be transfused to people of any type with only a slight risk of __________. This risk increases in patients who have previously been ___________ or _________ and may have formed ____________. At most hospitals, a supply of ________ matched type ___, Rh-__________ RBC’s is also available. Type ___, Rh-__________ RBC’s can be used for women who are ________ childbearing age and in males over the age of ___. When Rh-__________ RBC’s are used in an Rh-_________ patient, there is a chance of a ___ immunization, and, therefore, should be used only in life-threatening emergencies. When type ___, Rh- ________ RBC’s are available, the following algorithm should be followed:
1. For all patients under 16, use type O, Rh __________ RBC’s.
2. For females under 50, use type O, Rh __________ RBC’s.
3. For males older than ___ and women _________ childbearing age, use type ___, Rh-_________ RBC’s.
4. If the supply of the __________ Rh type has been exhausted, RBC’s of the other type should be used.
Rhogam®should be given within ___ hours of giving Rh positive blood to an Rh negative woman of childbearing age. If large amounts of Rh positive blood has been given a ___ ______ exchange may be necessary.
Platelets are essential for the initial phase of _________. Platelet concentrates also contain about ___ mL of plasma and small numbers of ___ ___ _____ blood cells. Platelet units must be maintained at ______ temperature and ______ during storage.
Pooled random donor platelet concentrates are prepared from platelets that have been harvested by ________ units of whole blood. Up to __ units of platelets, each from a separate donor, can be pooled into a ______ bag for transfusion. Platelets expire ___ hours after pooling. All units are from the same _____ type. If ____ compatible platelets are unavailable, ____ incompatible platelets can be substituted with very little risk. The usual adult dose is __-__ units of pooled random donor platelets.
Apheresis platelets are collected from a ______ donor and are equivalent to ~___-___ pooled units. An apheresis platelet concentrate contains ____-____ mL of plasma. They may be collected as a random unit (random apheresis platelets) or be obtained for a specific recipient from a family member or a volunteer HLA compatible “directed” donor. Apheresis platelets expire ___ hours after processing for release from the blood center unless incubated storage is available at the local hospital.
1. To prevent bleeding due to thrombocytopenia. The threshold of thrombocytopenia at which bleeding may occur will vary depending on the patient’s clinical condition. In general, spontaneous bleeding does not occur until the platelet count falls below _____-_____/μL. The recommended “trigger” for prophylactic platelet transfusions in patients undergoing chemotherapy or hematopoietic stem cell transplantation is <10,000/μL. Other coexisting clinical conditions may increase this “threshold”.
2. In a bleeding patient a platelet count above ________ should be maintained. In a surgical patient, the necessary platelet count varies depending on the _____________. For most surgeries _______-_______/μL will be adequate. For high risk procedures, such as neurologic or ophthalmologic surgeries, ___________/μL is recommended.
3. Abnormal platelet function may be congenital, or due to medications, sepsis, malignancy, tissue trauma, obstetrical complications, extra corporeal circulation, or organ failure such as liver or kidney disease. Spontaneous bleeding may then occur at __________ platelet counts. If platelet dysfunction is present, the patient with a disrupted vascular system (e.g. trauma or surgery) will require a __________ platelet count to achieve hemostasis.
4. Family donor or HLA matched platelets are indicated when patients have become refractory to random donor platelet transfusions due to alloimmunization.
5. In several situations platelet transfusions may not be indicated unless there is significant bleeding. In autoimmune thrombocytopenias (e.g. ITP) transfusion increments are usually poor and platelet survival is short. Platelet transfusions may be contraindicated in patients with thrombotic thrombocytopenic purpura (TTP) unless there is clinically significant bleeding.
6. In pediatric patients, the usual platelet dose is ___ unit whole blood platelet per ___ kg child, or ___ mL/kg. A ________/ μL rise is expected.
*In a patient with a normal sized spleen and without platelet antibodies.
The survival of transfused platelets averages ___ to ___ days but will decrease if a _______________ process is present. Correction of a prolonged bleeding time in platelet dysfunction will depend on whether a condition exists that will affect the transfused platelets as well (e.g., antiplatelet agents, uremia).
Fresh Frozen Plasma (FFP) and Thawed Plasma
One unit of FFP or thawed plasma is the plasma taken from ___ unit of whole blood. FFP is frozen within ___ hours of collection. FFP contains ____ coagulation factors in _________ concentrations. Thawed plasma may be transfused up to ___ days after thawing and contains slightly decreased levels of Factor ___ (66+/-9%) and decreased Factor ____ levels (41+/-8%). Plasma is free of __________, __________ and __________. One unit is approximately _____ mL and must be ______ compatible. __________ need not be considered. Since there are no viable leukocytes, plasma does not carry a risk of CMV transmission or Graft Vs. Host Disease (GVHD).
Plasma transfusion is indicated in patients with documented _________ _________ deficiencies and _________ bleeding, or who are about to undergo an _________ procedure.
Deficiencies may be _________ or _________ secondary to liver disease, warfarin anticoagulation, disseminated intravascular coagulation, or massive replacement with __________ and _________/_________ solutions. FFP should not be used for Hemophilia B (Factor IX) deficiency unless Factor IX concentrate is not available. FFP, but not thawed plasma, can be used for Factor V deficiency. Recombinant or Factor VIII concentrates should be used to replace Factor VIII.
Usually, there is an increase of at least ____ times the normal PT or PTT, or an INR ≥ ____ before clinically important factor deficiency exists. This corresponds to factor levels <____% of normal.
Reversal of warfarin anticoagulation with plasma is indicated only if significant _________ or _________ is present. Often it will require _________ transfusion to maintain normal factor levels. Otherwise, reversal can be achieved by giving _________ ___ or _________ warfarin two to three days prior to a planned procedure. Rapid reversal for life threatening bleeding may be achieved with recombinant Factor _____ (_________®).
Plasma should not be used for volume expansion unless the patient also has a significant __________ and is bleeding. Pediatric patients dosing is ___-___ mL/kg, to provide ~___-___% rise in factor levels.
Plasma – Dosage
Volume of ___ Unit Plasma: ____-____ mL
___ mL plasma contains ___ u coagulation factors
___ Unit contains ____ u coagulation factors
Factor recovery with transfusion = 40%
1 Unit provides ~80 u coagulation factors (40% of 220 u coagulation factors)
70 kg X .05 = plasma volume of 35 dL (__.__ L)
80 u = __.__ u/dL = __.__% (of normal 100 u/dL) 35 dL
In a 70 kg Patient:
1 Unit Plasma increases most factors ~__.__%
4 Units Plasma increase most factors ~____%
Initial Dose of FFP
___ cc/Kg (round up to nearest ____ cc) = #units FFP / 200 cc/unit FFP
Usually an increase in factor levels of at least 10% will be needed for any significant change in coagulation status, so the usual dose is ____ units, but the amount will vary depending on the patient’s size and clotting factor levels. Hematology consultation is advised concerning the dose of plasma.
* These numbers assume _________ platelet function. Conditions that may affect platelet function include renal failure, medications, leukemias and myelodysplasias, and congenital disorders. Bleeding Time is a _________ predictor of surgical bleeding. The Usefulness of Platelet Function Analysis (PFA) in predicting surgical bleeding is unknown.
Cryoprecipitate is prepared from ________ and contains _________, von Willebrand factor, factor VIII, factor XIII and fibronectin. Cryoprecipitate is the only adequate _________ concentrate available for intravenous use.
Cryoprecipitate is available in pre-pooled concentrates of ____ units. Each unit from a separate donor is suspended in ____ mL plasma prior to pooling. For use in small children, up to 4 single units can be ordered. Each unit provides about _____ mg of fibrinogen.
Indications for Cryoprecipitate
Cryoprecipitate is indicated for bleeding or immediately prior to an invasive procedure in patients with significant ________________ (<____ mg/dL). Cryoprecipitate should not be used for patients with von Willebrand disease or Hemophilia A (Factor VIII deficiency) unless they do not (or are not known to) respond to DDAVP and recombinant and/or virally inactivated preparations are not available. It is not usually given for Factor XIII deficiency, as there are virus-inactivated concentrates of this protein available. Cryoprecipitate is sometimes useful if platelet dysfunction associated with renal failure does not respond to dialysis or DDAVP.
Usage and Therapeutic Effect
Cryoprecipitate – Dosage
___ bag contains ~____ mg Fibrinogen
6 bags (1pool) contains ______ mg Fibrinogen
Recovery with transfusion = ____%
6 bags cryoprecipitate provides _____ mg Fibrinogen
70 kg X .05 = plasma volume of 35 dL (3.5 L)
_____ mg = ____ mg/dL provided by 6 bag pool of cryoprecipitate
In a 70 kg Patient:
6 bags (1 pool) of cryo raises Fibrinogen ____ mg/dL
Fibrinogen replacement: Effect can be monitored by fibrinogen
level assay and clinical response.
Pediatric dosing for cyroprecipitate is ____ unit per ____ kg child,
which should increase fibrinogen by ____ – ____ mg/dL.
To replace factor VIII or von Willebrand factor: When specific factor concentrates are unavailable, the usual adult dose is a pool of 6 – 12 bags. Approximately 150 units of factor VIII and von Willebrand factor are provided per bag. A single donor may be used repeatedly for a young or mildly affected patient to limit donor exposures.
Fibrin glue:Although single units of cryoprecipitate are available for use in the preparation of fibrin glue to be applied locally for surgery, commercially available, virally inactivated concentrates have a higher fibrinogen concentration and are preferred for this purpose (Tisseel®). A patient may donate autologous plasma for processing into cryoprecipitate prior to a planned surgical procedure.