Ch. 8 - Blood management

Question 1

What is the average cost of an RBC unit transfusion?

Answer 1

$225

Question 2

What percentage of RBC transfusions are inappropriate?

Answer 2

50%

Question 3

What is the most common cause of anemia?

Answer 3

Iron deficiency.

Question 4

What is the significance of preoperative anemia?

Answer 4

It is a major predictor of postoperative mortality and the single biggest predictor of perioperative transfusion.

Question 5

Compare the efficacy of oral and IV iron therapy.

Answer 5

Enteric iron therapy is poorly tolerated and has many harmful side effects when compared to IV iron. IV iron is also preferred when treating patients with erythropoiesis stimulating agents.

Question 6

What are the elements of informed consent prior to blood transfusion?

Answer 6

1. A description of the risks, benefits, and alternatives.
2. The opportunity to ask and receive answers to questions.
3. The right to accept or refuse the treatment.

Question 7

Name four formulations of IV iron.

Answer 7

Iron dextran
Iron sucrose
Sodium ferric gluconate
Ferumoxytol

Question 8

What history is important in managing coagulation risk?

Answer 8

Spontaneous bruising and bleeding, medication use, family history.

Question 9

When should antiplatelet drugs be stopped before surgery? Warfarin? Heparins?

Answer 9

ASA: 7-10 days
Clopidogrel/Tiagrelor: 5 days
Warfarin: 1-8 days, depending on INR
UFH: Hours.
LMWH: 1 day

Question 10

Numerous studies have supported transfusion threshold at __g/dL.

Answer 10

7-8g/dL

Question 11

Name three techniques aimed at reducing intraoperative blood loss.

Answer 11

Preoperative autologous donation
Acute normovolemic hemodilution
Cell salvage

Question 12

How effective is preoperative autologous blood donation?

Answer 12

Not very; intraop blood loss is unpredictable and half of units are discarded.

Question 13

How is acute normovolemic hemodilution meant to reduce intraoperative blood loss?

Answer 13

Removal of whole blood prior to surgery means that fewer red cells are lost in hemorrhage. The whole blood is returned after surgery.

Question 14

How is cell salvage performed?

Answer 14

Blood is washed and/or filtered, and must be reinfused within 6hrs of collection.

Question 15

How much blood is drawn in ICU patients for lab tests alone? How much of a Hb drop does this constitute?

Answer 15

An average of 40-70mL per day. 100mL constitutes an average drop of 0.7g/dL, so this means around -0.4g/dL daily for lab tests alone.

Question 16

What are the three types of performance or blood utilization review required by AABB of all facilities?

Answer 16

Prospective (real-time) review
Concurrent review
Retrospective review

Question 17

What is prospective (real-time) review of blood utilization?

Answer 17

Real-time review of requests, which allows for the chance to intervene or stop inappropriate transfusion requests.

Question 18

What is concurrent review of blood utilization?

Answer 18

Review that occurs 12-24hrs following the transfusion episode.

Question 19

What is retrospective review of blood utilization?

Answer 19

Review of aggregate transfusion data and trend in transfusion utilization. This is generally done by transfusion medicine committee.

Question 20

What certification is offered by the AABB, and how is it administered?

Answer 20

Patient Blood Management Certification; voluntary certification offered via AABB & Joint Commission.