Flashcards in Blood Conservation- Exam 1 Deck (75)
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1
Blood Transfusion Complications (General)
Post-op infections
Ventilator- acquired pneumonia
Central line sepsis
Increased LOS
Increased mortality rates
2
2 Types of Transfusion Risks
Infectious
Non-infectious
3
Types of Infectious Transfusion Risks
Bacterial
HIV
Hepatitis
4
Types of Non-Infectious Transfusion Risks
Febrile Rxns
Urticarial (Allergic) Rxns
Anaphylactic Rxns
Acute Hemolytic Rxns
Volume Overload
Hypothermia
Citrate Toxicity
Potassium Effects
5
Febrile Reactions
Fever, chills
Antibodies reacting w. white cell antigens or white cell fragments in transfused blood products or due to cytokines which accumulate during storage
Most common with platelet transfusions
6
What non-infectious reaction is most common with platelet transfusions?
Febrile Reactions
7
Urticarial (Allergic) Reactions
1%
urticaria, itching, flushing
caused by foreign proteins
8
Anaphylactic Reactions
Hypotension, tachycardia, cardiac arrythmia, shock, cardiac arrest
caused by patients who have IgA deficiency who have anti-IgA antibodies (require specially washed/tested blood products)
9
Acute Hemolytic Reactions
Caused by transfusions of ABO incompatible blood
Chills, fever, pain, hypotension, dark urine (plasma free hgb) uncontrolled bleeding due to DIC
10
Volume Overload
Not on bypass; big concern in ICU; no where for volume to go
On bypass- can tx a lot of rxns and can prevent volume overload
11
Citrate Toxicity
Metabolized by liver
Rapid transfusion of large quantiity of blood products
Binds calcium and magnesium- depleting stores
Myocardial depression
Coagulopathy
12
Potassium Effects
Stored RBC leak K+
Irradiation increased the rate of leak
Cardiac effects (must give slowly or they could go into cardiac arrest)
13
TRALI
transfusion related acute lung injury
14
TRALI Symptoms
Similar to ARDS
Hypotension, fever, dyspnea, tachycardia
15
What is TRALI?
Non-cardiogenic pulmonary edema with diffuse bilateral pulmonary infiltrates on CXR
16
How fast can TRALI occur?
Occurs within 6 hours of tx
Most cases present within 1-2 hours
17
What are the culprits for causing TRALI?
All blood products
18
How common is TRALI?
1/2000 transfusions
19
TRALI Pathophysiology
Unclear.
Attributed to HLA Antibodies, Granulocyte antibodies and biologically active mediators in the blood
20
What is the Tx for TRALI?
Ventilator support for ~96 hours
21
What ii TRALI mortality?
5-10%
22
Clinically, transfusions are associated with....
Longer hospital stays
Longer time to extubation
Mobidity
Mortality
23
What are some techniques to minimize our impact on blood usage?
Autologous transfusion
Pre-bypass autologous donation
Intraoperative cell saver use
Shed mediastinal blood recovery
Accept lower HCT
RAP
Hemoconcentration
Plasma/Platelet Pheresis
Mini-circuits
24
Bloodless Medicine
Transfusion-free medicine
Multimodality and Multidisciplinary approach to patient care without the use of allogenic blood.
25
Blood Conservation
Global concept aimed at reducing patient exposure to allogenic blood products. Does not exclude use.
26
Jehovah's Witness booklet related to bloodless medicine
Blood, Medicine, and the law of God (1961)
-Transfusion rxns
-Transfusion related syphilis, malaria, hepatitis
27
Which doctor took JW tranfusion requests to heart?
Denton Cooley (1960's)
28
What is Cooley's 1964 publication
Open Heart Surgery in the JW; described techniques for treating these patients
1977- reported experience with 500 JW patients
29
How did the military contribute to blood management?
Did surgery on wounded soldiers before transfusions were even available
confronted with blood loss but not way to replace the blood; stopped bleeding promptly and effectively
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