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My 2016 RUSVM Anesthesia > Blood loss & Fluid therapy Dr. Ambrisko > Flashcards

Blood loss & Fluid therapy Dr. Ambrisko Flashcards

1
Q

What is a blood transfusion

A

the process of transferring blood or blood-based products from one individual into the cirulatory system of another individual of the same species

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2
Q

Purpose of transfusion

A

incr. Hgb

incr. volume

incr. albumin

provide coagulation factors

provide platelets

loss of 50% circ vol is fatal but loss of 50% of Hgb may not be

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3
Q

Types of blood products

A

Fresh whole blood (PCV ≈ 40%)

Packed RBCs (PCV ≈ 70%)

Fresh frozen plasma (FFP)

cryoprecipitate (contains coag factors)

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4
Q

how to incr Hgb content of blood

A

Whole blood

acute blood loss & TP < 3.5

Packed RBCs

TP >3.5

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5
Q

When should you consider transfusion

A

Acute blood loss > 20% of blood volume

Clinical signs more important than arbitrary values!

  • >10-15 % if loss was perioperative*
  • Acute anemia: PCV <20%*
  • Chronic anemia: PCV <15%*
  • Anemia + Anesthesia: PCV<20%*
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6
Q

CS of blood loss

A

pale MM

incr HR

decr BP

weak pulse

blood in sponges & suction

Caution: acute bloo loss may not change PCV & TP!

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7
Q

How to estimate blood loss

A

surgical sponge holds ≈ 5mL of blood

Blood loss (mL) = PCV of suctioned fluid x Volume in canister (mL)

Preoperative pt PCV

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8
Q

How much blood to give

A

Acute: loss = replacement

General rule: 2ml whole blood / kg BW raises PCV by 1%

  • *Blood to be transfused (ml) =**
  • *[PCV required – PCV recipient] x blood volume of recipient (ml)**
  • *PCV of donor**
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9
Q

How to increase plasma albumin content

A

Will not be effective if using FFP

consider supplementation with concentrated albumin

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10
Q

Providing coagulation factors

A

Best option: cryoprecipitate

Fresh whole blood

Fresh plasma

FFP

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11
Q

Providing functional platelets

A

Use fresh whole blood (plastic container platelets adhere to glass!)

transfuse within 8 hours

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12
Q

considerations for Blood collection

A

Types of anticoagulant

Plasma separation

Storage

Closed collecting systems

Open system: use blood within 12 hours

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13
Q

Transfusion reactions

A

incompatibility

anaphylaxis

  • alteration of immune system:*
  • problems during next transfusion*
  • neonatal isoerythrolysis (equine)*
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14
Q

Possible side effects of transfusion

A

Circulatory overload

Transfusion Related Acute Lung Injury (TRALI)

Citrate induced hypocalcaemia (tetany)

Sepsis (baterial contamination)

Transmission of infectious dz (FIV, FELV, hemobartonella, anaplasma, etc.)

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15
Q

Examining the risk/benefit ratio of transfusions

A

Give only if absolutely necessary to save life!

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16
Q

Reaction types with blood type incompatibility

A

Acute

  • Hemolysis (horses & cattle)
  • agglutination

Slow

Decr RBC life span (few days)

17
Q

Signs of acute reaction

A

incr HR, decr BP, incr RR, dyspnea

tremors, vomiting, wheals, urticaria, fever

Pain @ injection site

Hemolysis, Hemoglobinuria, renal failure, DIC

CV collapse

Signs will be less noticible under anesthesia!

18
Q

Tx of acute reaction

A

Stop tranfusion!

depending on CS:

Epinephrine IV

Antihistamines IV

Fast acting steroids (?)

Fluids (if needed)

O2 supplementation

Analgesia, etc

19
Q

Canine blood groups

A

Dog Erythrocyte Antigen (DEA)

DEA 1.1 & 1.2 incompatibility may cause acute hemolysis

No naturally occurring antibodies, therefore:

1st incompatible transfusion usually uneventful

2nd incompatible transfusion may cause acute transfusion reaction

20
Q

Feline bloo groups

A

A, B & AB

  • A is common, B rare except in certain breeds*
  • naturally occuring antibodies*

1st blood transfusion can be fatal

Blood typing is compulsory!

Mik recently identified 2nd important blood group system in cats

21
Q

Equine blood groups

A

Type Aa & Qa most antigenic

22
Q

Cross matching

A

serological compatibility

agglutination reaction

Major cross-match: donor RBC + recipient plasma

Minor cross-match: recipient RBC + donor plasma

My 2016 RUSVM Anesthesia (22 decks)

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