Blood Components and Sub

Question 1

Antithrombin III deficiency

Answer 1

May give FFP to help get antithrombin III

Question 2

Whole blood

Answer 2

For acute hemorrhage of 25% or more

Question 3

RBC transfusion objective

Answer 3

Improvement of inadequate oxygen delivery

Question 4

Diminished OXygen carrying capacity

Answer 4

Ischemic effects on heart and brain

Question 5

Transfuse patient with HF or with decreased

Answer 5

Higher threshold

Question 6

Patient with those medications are at known risk for decreased CO

Answer 6

Beta blockade

Non DHP CCB

Question 7

Hemoglobin concentration increase will

Answer 7

increase O2 delivery

Question 8

DO2

Answer 8

CaO2 x CO

Question 9

Loss of 15%

Answer 9

Class 1 little hemodynamic effect other than vasoconstriction and mild tachycardia

Question 10

Loss of 15-30%

Answer 10

Class 2 Tachycardia decrease pulse pressure

Question 11

Loss 30-40%

healthy patients give

Answer 11

Class III hemorrhage, signs of hypovolemia, marked tachy, tachypnea
Crystalloids

Question 12

Loss of more than 40%

Answer 12

life threatening, transfused

Question 13

Acute anemia: O2 delivery adequate at hemoglobin concentration

Answer 13

as low as 7g/dl

Question 14

Chronic anemia

Answer 14

better tolerated than acute

Question 15

CO in chronic anemia does not change until

Answer 15

below 7g/dl

Question 16

acute anemia no reductio in arterial O2 because

Answer 16

Well compensate in increased in CO

Question 17

Factors that affect CO

Answer 17

Left Ventricular dysfunction
hypothermia
Vasoactive (BBlockers, CCB, anesthetics)

Question 18

Effective of RBC transfusion

Keyword: NONBLEEDING

Answer 18

NON-bleeding, 1 unit of RBC

1g increase Hct by 3%

Question 19

However, for anemia relationship with

Answer 19

Perioperative anemia with MI

Question 20

Transfusion recommendations

Answer 20

Rarely indicated if hbg more than 10

Less than 6 when the anemia is acute.

Question 21

The determinants of intermediate:

Answer 21

The determination of whether intermediate hemoglobin concentrations (6-10g/dl) justify or require RBC transfusion should be based on the patient’s risk for complications of
inadequate oxygenation

Question 22

Most anesthetics cause

Answer 22

myocardial depression and
decrease arterial BP, cardiac output, stroke volume,
PVR.

Question 23

The use of a single transfusion “trigger”

Answer 23

(i.e.. 10/30 rule) for all patients is not

recommended.

Question 24

Hemoglobin <6 g/dL – T.

Answer 24

Transfusion recommended except in exceptional circumstances.

Question 25

● Hemoglobin 6 to 7 g/dL

Answer 25

– Transfusion generally likely to be indicated

Question 26

● Hemoglobin 7 to 8 g/dL –

Answer 26

Transfusion may be appropriate in patients undergoing orthopedic surgery or cardiac surgery, and in those with stable cardiovascular disease, after evaluating the patient’s clinical status.

Question 27

● Hemoglobin 8 to 10 g/dL

Answer 27

– Transfusion generally not indicated, but should be considered for some populations (eg, those with symptomatic anemia, ongoing bleeding, acute coronary syndrome with ischemia, and hematology/oncology patients with severe thrombocytopenia who are at risk of bleeding).

Question 28

● Hemoglobin >10 g/dL –

Answer 28

Transfusion generally not indicated except in exceptional circumstances.

Question 29

Transfusion reactions, often manifested in awake patients by_____, _____, ______ are the most common adverse reaction of transfusion with CBC's.

Answer 29

fever, chills, or urticaria,

Question 30

The more transfusion

Answer 30

the more risk of Hepatitis C

Question 31

The most common viral agent | Important for type of patients

Answer 31

Cytomegalovirus | HIV, immunosuppressed patients or autoimmune disease

Question 32

Platelets : patients

Answer 32

patients spontaneous bleeding is uncommon with a platelet count greater than 20,000.

Question 33

The probability of clinically significant thrombocytopenia i

Answer 33

Increases in proportion to the number of units of blood transfused because only parts of the blood is given

Question 34

ASA action

Answer 34

Inhibit platelet aggregation

Question 35

Patients with bleeding from ASA

Answer 35

Platelets

Question 36

With HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome associated with

Answer 36

preeclampsia the thrombocytopenia is usually more severe, but spontaneous resolution usually occurs by the 4th postpartum day.

Question 37

Transfusion of one platelet concentrate will increase | the platelet count by approximately

Answer 37

5,000-10,000 in an average adult.

Question 38

The usual therapeutic dose of platelets is

Answer 38

one platelet concentrate per 10kg body weight.

Question 39

Heparin induced thrombocytopenia and ITP

Answer 39

should not receive platelets.

Question 40

To assess risk of HIT

Answer 40

4 Ts

Question 41

Prophylactic platelet transfusion is rarely indicated in surgical patients with thrombocytopenia due to decreased platelet production when the platelet count is greater than_______ and is usually indicated when less than _______

Answer 41

100,000; 50,000.

Question 42

The determination of whether patients with intermediate (50,000-100,000) require therapy should be based on the

Answer 42

risk of bleeding.

Question 43

Platelet transfusions may be indicated despite an apparently adequate platelet count if there is

Answer 43

known platelet dysfunction and microvascular bleeding.

Question 44

Most major surgeries

Answer 44

50000 threshold for platelets tx

Question 45

Epidural anesthesia –plt threshold

Answer 45

80,000/microL

Question 46

Replacement of an entire blood volume leaves the | patient with approximately

Answer 46

1/3 of the original concentration of coagulation factors.

Question 47

Although lab values such as PT and PTT may be abnormal, clinical coagulopathy from dilution usually does not occur until replacement

Answer 47

exceeds one blood volume or when the PT and PTT exceeds 1.5-1.8 times control then start giving FFPs

Question 48

In preoperative patients with no history of bleeding, retrospective studies show that abnormal PT and PTT are

Answer 48

poor predictors of bleeding

Question 49

______is indicated for urgent reversal of warfarin therapy.

Answer 49

FFP

Question 50

FFP should be given in doses calculated to achieve a minimum of ________except for urgent

Answer 50

30% of plasma concentration (10-15ml/kg of FFP), Except for urgent reversal of warfarin anticoagulation, for which (5-8ml/kg of FFP) will usually suffice. 4-5 platelet concentrations, or one unit of whole blood provide a quantity of coagulation factors

Question 51

FFP is contraindicated for

Answer 51

augmentation of plasma volume or albumin concentration.

Question 52

Most patients with factor VIII deficiency will be treated with___________ and patients with some subtypes of vWD respond to DDAVP.

Answer 52

factor VIII concentrates

Question 53

_______ _____________, _____, is used for correction of inherited and acquired coagulopathy.

Answer 53

Cryoprecipitate contains factors VIII, fibrinogen, | fibronectin, von Willibrand’s factor, and factor XIII,

Question 54

Albumin 25g (100ml of 25% solution), is equivalent

Answer 54

osmotically to 500ml of plasma, but contains about 1/7 the amount of sodium present in the same amount of plasma.

Question 55

25% reserved for

Answer 55

Kidney , liver

Question 56

The administration of 25% albumin will draw

Answer 56

3-4ml of fluid from the interstitial space into the vascular space for every 1ml of albumin given.

Question 57

Best way to correct albumin deficiency

Answer 57

by feeding the patient

Question 58

PPF is a 5% pooled solution of stabilized plasma proteins in saline containing at

Answer 58

least 83% albumin and no more than 17% globulins, of which <1% are gamma globulins.

Question 59

● PPF 5% is administered to treat

Answer 59

hypovolemic shock

Question 60

Imnunoglobulin is a concentrated solution of _______ and ________prepared from large pools of ________

Answer 60

Immune globulin is a concentrated solution of | globulins, primarily immunoglobulins, prepared from large pools of human plasma

Question 61

● Immune globulin protects against clinical manifestations of

Answer 61

hepatitis A when given before or within 2 weeks of exposure.

Question 62

● Replacement therapy for patients with | hypogammaglobulinemia is another use of

Answer 62

immune globulin.

Question 63

Immune Globulin SOME indications

Answer 63

``` ● Idiopathic thrombocytopenia purpura (ITP) CLL Myasthenia Gravis SLE ***Guillian barre syndrome ```

Question 64

Prothrombin Complex Concentrate | (Human) Factors

Answer 64

II, VII, IX, X), Protein C, and Protein S];

Question 65

PCC also known as

Answer 65

Kcentra

Question 66

Indications for Kcentra

Answer 66

Indications; Vitamin K antagonist (VKA) reversal in patients with acute major bleeding or need for an urgent surgery/invasive procedure.

Question 67

Increase INR require surgery

Answer 67

Kcentra

Question 68

Patient require emergent surgery with warfarin BETTER AND FASTER

Answer 68

KCENTRA, given faster; but expensive

Question 69

Use Reversal of dabigatran: Reversal of the | anticoagulant effects of

Answer 69

dabigatran for emergency surgery/urgent procedures or in life-threatening or uncontrolled bleeding

Question 70

Dosing Reversal of dabigatran: IV:

Answer 70

5 g (administered as 2 separate 2.5 g doses no more than 15 minutes apart)

Question 71

Xa rivaroxaban, xarelta

Answer 71

REVERSAL KNOW