Blood Conservation- Exam 1 Flashcards Preview

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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

30

WWI and Blood Management

Blood Anticoagulation
Allowed for transport of blood to the wounded
Problem: Storage!