Flashcards in Blood Conservation- Exam 1 Deck (75)
Blood Transfusion Complications (General)
Ventilator- acquired pneumonia
Central line sepsis
Increased mortality rates
2 Types of Transfusion Risks
Types of Infectious Transfusion Risks
Types of Non-Infectious Transfusion Risks
Urticarial (Allergic) Rxns
Acute Hemolytic Rxns
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
What non-infectious reaction is most common with platelet transfusions?
Urticarial (Allergic) Reactions
urticaria, itching, flushing
caused by foreign proteins
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)
Acute Hemolytic Reactions
Caused by transfusions of ABO incompatible blood
Chills, fever, pain, hypotension, dark urine (plasma free hgb) uncontrolled bleeding due to DIC
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
Metabolized by liver
Rapid transfusion of large quantiity of blood products
Binds calcium and magnesium- depleting stores
Stored RBC leak K+
Irradiation increased the rate of leak
Cardiac effects (must give slowly or they could go into cardiac arrest)
transfusion related acute lung injury
Similar to ARDS
Hypotension, fever, dyspnea, tachycardia
What is TRALI?
Non-cardiogenic pulmonary edema with diffuse bilateral pulmonary infiltrates on CXR
How fast can TRALI occur?
Occurs within 6 hours of tx
Most cases present within 1-2 hours
What are the culprits for causing TRALI?
All blood products
How common is TRALI?
Attributed to HLA Antibodies, Granulocyte antibodies and biologically active mediators in the blood
What is the Tx for TRALI?
Ventilator support for ~96 hours
What ii TRALI mortality?
Clinically, transfusions are associated with....
Longer hospital stays
Longer time to extubation
What are some techniques to minimize our impact on blood usage?
Pre-bypass autologous donation
Intraoperative cell saver use
Shed mediastinal blood recovery
Accept lower HCT
Multimodality and Multidisciplinary approach to patient care without the use of allogenic blood.
Global concept aimed at reducing patient exposure to allogenic blood products. Does not exclude use.
Jehovah's Witness booklet related to bloodless medicine
Blood, Medicine, and the law of God (1961)
-Transfusion related syphilis, malaria, hepatitis
Which doctor took JW tranfusion requests to heart?
Denton Cooley (1960's)
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
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