Anesthesia Buddy: Transfusion Therapy Flashcards
Packed red blood cells (pRBCs) are prepared from whole blood by removing —.
plasma
The most commonly used preservative-anticoagulant solution for RBCs is —.
CPDA1 (citrate, phosphate, dextrose, adenosine)
1 unit of pRBC has a volume of —to—mL and a hematocrit of approximately —to—.
250 to 300ml ; 65% to 80%
Red blood cells are generally stored at —to—°C.
1°C to 6°C
All RBC transfusions must be — compatible with the recipient.
ABO
Do red blood cells provide viable platelets?
No
Do red blood cells provide clinically significant amounts of coagulation factors?
No
In a normovolemic patient, one unit of RBCs in an adult and 10 mL/Kg in a pediatric patient will increase the hematocrit by approximately —% or the hemoglobin by —g/dL.
3% ; 1g/dL
Theoretically, mixing pRBCs with Lactated Ringer’s solution can result in clot formation due to —.
calcium
Intraop blood transfusion should be warmed to prevent —.
hypothermia
With intraop blood transfusion, hypothermia and decreased levels of 2,3 DPG in stored blood can result in — (left shift of oxyhemoglobin curve).
tissue hypoxia
— RBCs should not be given to women of childbearing age because an anti-D antibody may develop (risk of hemolytic disease of the newborn).
O Rh+
ABO compatible platelets are preferred but are they required for transfusion?
No
Platelets are commonly stored at —to—°C for —days.
20°C to 24°C ; 5 days
During the short duration of storage, platelets can become — and lose the ability to —.
activated ; aggregate
A single apheresis unit contains —to—mL and can increase plt count by —/L.
200-400mL ; 50,000 × 10^9/L
What is commonly indicated for thrombocytopenia or dysfunctional platelets
Platelets
Transfused platelets commonly survive —to—days following transfusion.
1 to 7 days
What are the 4 common causes of platelet dysfunction?
- antiplatelet drugs
- cardiopulmonary bypass
- uremia
- liver disease
FFP is plasma that is free of —, —, and —.
red blood cells, leukocytes, and platelets
Group — plasma is suitable for all blood types.
AB
When antithrombin concentrate is unavailable, consider administering — in antithrombin III deficiency (heparin resistance).
FFP
In an average-sized adult, each unit of FFP increases levels of coagulation factors by —to—%.
2% to 3%
FFP contains most — (except —).
coagulation factors (except platelets)
What are the 6 indications for the use of FFP?
- correction of bleeding and elevated INR
- during massive transfusion
- reversal of warfarin
- correction of isolated factor deficiency
- heparin resistance due to antithrombin III deficiency
- coagulopathy associated with liver disease
Prothrombin complex concentrates (PCCs) are formulations containing purified vitamin K-dependent clotting factors and can be used to rapidly reverse — and —.
warfarin and Factor Xa inhibitors
Cryoprecipitate contains —, —, —, —, and —.
fibrinogen, factor VIII, von Willebrand factor, factor XIII, and fibronectin
Is ABO compatibility required for transfusion of cryoprecipitate?
No, but it is preferred
What Changes Occur in Banked/Stored Blood?
• ATP (adenosine triphosphate)
• 2,3-diphosphoglycerate (DPG)
• pH
• Potassium level
• Hemolytic state
• RBC morphology
• Microaggregates
• Proinflammatory cytokines
• Depletion of ATP (adenosine triphosphate)
• Depletion of 2,3-diphosphoglycerate (DPG)
• Acidosis
• Hyperkalemia
• Hemolysis
• Alteration in RBC morphology
• Accumulation of microaggregates
• Accumulation of proinflammatory cytokines
Type and Screen compatibility test is testing and screening what?
ABO-Rh testing and antibody screen
What are the three separate alleles involved in blood typing for type and screen?
A, B, and O
For type and screen, the basis for the Rh factor is the presence or absence of the —.
D antigen
What compatibility test is this: It tests the recipient’s RBCs with serum that contains A and B antibodies. It also determines Rh status by testing recipient’s RBCs with anti D antibodies.
Type: ABO-Rh antigen testing on RBC.
Screen: Assesses for antibodies in recipients serum (indirect — test). When antibodies are present, addition of antiglobulin antibody results in —.
Coomb’s ; agglutination
The most severe transfusion reactions with type and screen are due to — incompatibility
ABO
A crossmatch mimics the transfusion by mixing — cells with — serum (in vitro compatibility).
donor ; recipients
A crossmatch can detect less common (more unique) — not commonly tested in the screen.
antibodies
Blood types with antigens and antibodies for blood genotype of OO? (Blood type, Antigens, Antibodies)
Blood type: O
Antigens: none
Antibodies: anti A and anti B
Blood types with antigens and antibodies for blood genotype of OA or AA? (Blood type, Antigens, Antibodies)
Blood type: A
Antigens: A
Antibodies: anti B
Blood types with antigens and antibodies for blood genotype of OB or BB? (Blood type, Antigens, Antibodies)
Blood type: B
Antigens: B
Antibodies: anti A
Blood types with antigens and antibodies for blood genotype of AB? (Blood type, Antigens, Antibodies)
Blood type: AB
Antigens: A and B
Antibodies: none
Blood therapy ABO compatibility with group O? (Compatible RBCs, Compatible Plasma)
Compatible RBCs: Group O
Compatible Plasma: Group O, A, B, and AB
Blood therapy ABO compatibility with group A? (Compatible RBCs, Compatible Plasma)
Compatible RBCs: Group A and O
Compatible Plasma: Group A and AB
Blood therapy ABO compatibility with group B? (Compatible RBCs, Compatible Plasma)
Compatible RBCs: Group B and O
Compatible Plasma: Group B and AB
Blood therapy ABO compatibility with group AB? (Compatible RBCs, Compatible Plasma)
Compatible RBCs: Group O, A, B, and AB
Compatible Plasma: Group AB
Generally, a fully soaked “4 × 4” is considered to hold —mL of blood.
10 mL
Generally, a soaked laparotomy pad (“lap”) can hold —to—mL of blood.
100 to 150 mL
Hemoglobin/hematocrit are affected by the patient’s — status.
fluid
Tranfusion of — improves oxygen delivery (DO2).
packed red blood cells (pRBCs)
DO2 is dependent on — and —.
cardiac output (CO) and the arterial oxygen content (CaO2)
DO2=
CO x CaO2
CaO2=
1.34 x [Hgb] x SaO2 + 0.003 x [PaO2]
If the Hemoglobin is 15 g/dL, SaO2 is 100%, and PaO2 is 100 mmHg
-What is the arterial O2 content CaO2 in mL/L?
CaO2=20.4mL/dL or 204 mL/L
What is the oxygen delivery (DO2) to tissues if the cardiac output is 5 L/min and CaO2 is 204 mL/L?
DO2=1020 mL/L
Preferably, blood loss should be replaced with — and — initially to maintain
normovolemia.
crystalloids and colloids
Careful not to induce acute normovolemic anemia due to replacement of intraoperative blood loss with — solution.
crystalloid
In patients with chronic anemia, increased —make oxygen transport more efficient.
2,3 DPG levels
Allowable Blood Loss (ABL)=
[starting Hct or Hgb - target Hct or Hgb x EBV] / starting Hct or Hgb
Estimated Blood volume for preterm neonates:
90-100 mL/kg
Estimated Blood volume for full term neonates:
80-90 mL/kg
Estimated Blood volume for infants:
70-80 mL/kg
Estimated Blood volume for adult men:
75 mL/kg
Estimated Blood volume for adult women:
65 mL/kg
What Blood Type Should be Transfused in an Emergency?
Type O, Rh-negative packed RBCs, and type AB plasma
Massive Blood Transfusion definition: Administration of greater than — blood volume (—to—units) in — hours or — of the patient’s total — in — hour.
1 blood volume (10-20 units) in 24 hours or one half of the patient’s total estimated blood volume in 1 hour
What is the lethal triad of trauma?
hypothermia, acidosis, and coagulopathy
Citrate toxicity is when citrate binds calcium and magnesium causing — and —.
hypocalcemia and hypomagnesemia
— is the most common cause of nonsurgical bleeding following massive blood transfusion.
Dilutional thrombocytopenia
Complications of Blood Transfusion:
•Volume status
•Body Temp
•Citrate level
•Coagulopathy
•Potassium level
•Acid base imbalance
•Impaired oxygen delivery capacity
•Volume status: overload
•Body Temp: hypothermia
•Citrate level: citrate toxicity
•Coagulopathy: dilutional
•Potassium level: hyperkalemia
•Acid base imbalance: metabolic acidosis and alkalosis
•Oxygen delivery capacity: impaired
What can occur with hypothermia when considering complications of Blood Transfusion?
It can lead to ventricular arrhythmias and fibrillation. It impairs platelet function and the function of coagulation proteins.
What can occur with citrate toxicity when considering complications of Blood Transfusion?
Calcium binding by the citrate preservative can cause hypocalcemia and myocardial depression. Calcium is a necessary cofactor for several clotting factors. Citrate toxicity is treated with calcium. Hypocalcemia causes QT prolongation on ECG.
What can occur with coagulopathy when considering complications of Blood Transfusion?
Dilutional thrombocytopenia and dilutional coagulopathy (decreased “labile” factors V and VIII)
What can occur with hyperkalemia when considering complications of Blood Transfusion?
K+ moves out of pRBCs during storage.
What can occur with impaired oxygen delivery capacity when considering complications of Blood Transfusion?
Decreased in the 2,3-DPG in store blood and left shift of the oxyhemoglobin dissociation curve
What kind of transfusion reactions occurs due to recipient reaction to residual donor white blood cells, platelets, or plasma proteins?
Febrile non-hemolytic reaction
How does febrile non-hemolytic transfusion reaction presents itself?
Increase in temperature without evidence of hemolysis
How can risk be minimized with febrile non-hemolytic reaction?
Leukoreduced blood products
What kind of transfusion reactions occurs commonly due to ABO incompatibility?
Acute hemolytic reaction (acute intravascular hemolysis)
S/S for acute hemolytic reaction in awake pts?
Chills, fever, nausea, and chest and flank pain
S/S for acute hemolytic reaction in anesthetized pts?
Fever, hypotension, tachycardia, hemoglobinuria, and oozing from surgical site
What 3 things can acute hemolytic reaction result in?
- acute kidney failure
- disseminated intravascular coagulation (DIC)
- shock
What kind of transfusion reaction occurs due to antibodies to non-D antigens of the Rh system or other systems such as Kell, Duffy, or Kidd antigens (not anti-A or anti-B)?
Delayed hemolytic reaction (extravascular hemolysis)
Delayed Hemolytic Reaction (extravascular hemolysis) typically occurs —to—days after transfusion?
2-21 days
S/S for Delayed Hemolytic Reaction (extravascular hemolysis)?
Usually mild: malaise, jaundice, and fever
What is the treatment for Delayed Hemolytic Reaction (extravascular hemolysis)?
Supportive
What kind of transfusion reaction is associated with IgA deficiency (they have IgA antibodies) and receive IgA containing blood transfusions?
Anaphylactic reaction
— decreases risk of anaphylactic reaction by reducing amount of plasma proteins and immunoglobins.
Washed blood products
4 common treatments for anaphylactic transfusion reaction?
- Epinephrine
- Fluids
- Corticosteroids
- H1 and H2 blockers
What kind of transfusion reaction occurs in immunocompromised patients due to lymphocytes immune response?
Graft versus Host disease
What decreases the risk of graft versus host disease?
Irradiation of blood products
What kind of transfusion reactions occurs from excessive and rapid blood product administration (common in massive hemorrhage resuscitation cases).
TACO (transfusion associated circulatory overload)
TACO (transfusion associated circulatory overload) causes —.
Hydrostatic pulmonary edema (too much volume)
What kind of transfusion reaction presents as noncardiac (nonhydrostatic) pulmonary edema inflammatory response associated with acute hypoxia occurring within 6 h of blood product administration?
Transfusion-related acute lung injury (TRALI)
Transfusion-related acute lung injury (TRALI) occurs more frequently with — and —.
Platelets and FFPs
Transfusion-related acute lung injury (TRALI) treatment is supportive care similar to —.
ARDS
What are the 3 transfusion-related infections?
- Viral infections
- Bacterial infections
- Parasitic infections
— contamination is most common with platelets due to their storage in dextrose at room temperature.
Bacterial
What is the diagnosis for major S/S of:
Fever, headache, malaise, nausea
Febrile non-hemolytic reactions
What is the diagnosis for major S/S of:
Fever, hypotension, hemoglobinuria, renal failure, disseminated intravascular coagulation
Hemolytic reactions
What is the diagnosis for major S/S of:
Evidence of hypervolemia, hypertension, respiratory distress, cyanosis, hypoxemia, hydrostatic pulmonary edema
TACO (transfusion associated circulatory overload)
What is the diagnosis for major S/S of:
Noncardiogenic, nonhydrostatic pulmonary edema, respiratory distress, dyspnea, hypoxemia, fever, tachycardia
Transfusion-related acute lung injury (TRALI)
What is the diagnosis for major S/S of:
Most common with platelets ; Fever, rigors, hypotension
Bacterial contamination of blood products
What is the diagnosis for major S/S of: Bronchospasm, hypotension, respiratory distress, erythema, urticaria, mucous membrane edema, anaphylactic shock
Anaphylactic reaction
When managing hemolytic reactions, do you stop transfusion immediately and notify blood bank?
Yes
What are the 6 main steps to managing a hemolytic reaction?
- STOP transfusion immediately & notify blood bank.
- RECHECK pts ID bracelet against blood product slip.
- DRAW blood: Coagulation studies, platelet count, compatibility testing (recipient and donor
specimens), presence of hemoglobin in plasma. - INSERT urinary catheter for strict I&Os. Test urine for presence of hemoglobin.
- TREAT hypotension aggressively: IV fluids & vasopressors
- MAINTAIN urine output (euvolemic state): Mannitol & loop diuretics are used cautiously, bicarbonate to alkalinize urine, IV fluids.
Removes WBCs from RBCs and platelets and reduces the risk of HLA alloimmunization and CMV transmission.
Leukoreduction
It helps prevent Graft Versus Host Disease in immunocompromised patients.
Irradiation
