Blood Products Flashcards
(87 cards)
1
Q
Autologous blood donation
A
- donate every 72 hours up to 72 hours prior to planned surgery
- donate hemoglobin down to 11g/dL
- donate max 2-4 units
2
Q
Contraindications autologous blood donation
A
- bacteremia
- ischemic heart disease
- valvular heart disease
- recent seizures
3
Q
Which blood donation often gets wasted?
A
autologous
4
Q
Whole blood can be spun down to get what 3 major products?
A
PRBC
Platelets
Plasma
5
Q
Whole blood first spin
A
PRBC
platelet rich plasma
6
Q
whole blood 2nd spin
A
Platelets
Plasma (FFP) –> proteins
7
Q
t/f whole blood separates within days
A
false
hours!
8
Q
What part of blood do you want for plasma donation?
A
proteins
9
Q
What part of blood do you want for blood in hospital?
A
PRBC
10
Q
Plasma donation
A
- spin out cells and give back
- 90 mins
- private companies (paid)
11
Q
Requirements for plasma donation
A
- > 110lbs
- > 19
- not sick
12
Q
How often can you give plasma?
A
2x per week
13
Q
Types of transfusion medicine
A
- PRBC
- platelets
- FFP
- PCC
- cryoprecipitate
14
Q
What is the most common transfusion medicine?
A
PRBC
15
Q
1 unit of PRBC
A
- 250mL
- hematocrit 70-80%
- raises hgb by 1-2 g/dL
16
Q
How many units of PRBC are given per patient?
A
2.7
17
Q
What are PRBC used for?
A
- treat anemia
- acute blood loss to maintain adequate tissue oxygenation
18
Q
Treatment of anemia, what do you want to keep hgb at?
ischemic heart disease?
critical level?
A
> 7
> 8-10
> 5
19
Q
What could cause acute blood loss and need for PRBC?
A
massive hemorrhage
surgery
20
Q
During massive hemorrhage, when would you need PRBC?
A
30-40% of blood volume lost
Hgb <6
21
Q
During surgery when would you need PRBC?
A
general <7
cardiac <8
22
Q
PRBC storage
A
fridge (39F, 4C)
frozen (hemolysis)
23
Q
Shelf life of PRBC
A
42 days
24
Q
Risk of PRBC
A
- immediate transfusion reactions
- inaction
- hemolytic reactions
- transfusion related lung injury
25
What are immediate transfusion reactions?
- chills
- fever
- urticaria
- tachycardia
- dyspnea
26
What are platelets used for?
- treat thrombocytopenia
| - bleeding
27
In thrombocytopenia, when would you need platelets?
<20,000/uL
| possibly as low as 5,000 to 10,000
28
Who would you not use platelets in?
TTP (thrombotic thrombocytopenia purport)
| HIT (heparin induced thrombocytopenia)
29
When bleeding, when would you need platelets?
<100,000
| consider in massive bleeding once one blood volume has been replaced (10 units PRBC)
30
1 unit of platelets = ___ mL
200 - 300 mL
31
each unit of platelets contain ____ per uL
300,000 - 600,000
32
1 donated unit of whole blood provides about ___mL of platelet concentrate
50mL
33
T/f you need multiple donors for a therapeutic dose of platelets
true
34
How many units of platelets are needed for a therapeutic dose?
4-8 units
6 pack of platelets
35
platelets storage
```
room temp (68-75F, 20-24C)
continuously agitated
```
36
Shelf life of platelets
5 days
37
FFP
fresh frozen plasma
38
How do you get FFP?
from fresh whole blood or from plasma collected from apheresis
39
When do you need to freeze FFP?
within 8 hours
40
Shelf life of FFP
12 months
41
Risks of FFP
similar to other blood product infusions
42
PCC
prothrombin complex concentrates
43
PCC was developed for ____
hemophilia B
44
Dosing for hemophilia B is based on what?
factor IX
45
3 factor type of PCC
II
IX
X
46
4 factor type of PCC
II
IX
X
VII***
47
Activated PCC (FEIBA)
II
IX
X
VIIa
48
What is the difference between 3 factor and 4 factor?
factor VII in 4
49
Concentration of clotting factors are about ____ higher than in human plasma
25x
50
What is the first available 4 factor PCC in US?
Kcentra
- lyophilized powder
- recon with 20mL diluent
51
Does FFP or PCC require larger volume to provide same quantity of clotting factors?
FFP
52
T/F FFP has same risk of allergic reactions and bacterial infection as PCC
false
same as PRBC
53
T/f FFP undergoes viral inactivation
false
| PCC
54
T/F FFP requires thawing
true (30-45 min)
55
Is FFP or PCC recommended for reversal of warfarin?
PCC
56
Cryoprecipitate
- derived by thawing 1 unit of FFP in cold (4C)
57
Cryoprecipitate is plasma enriched with what?
```
FVIII
vWF
FXIII
fibronectin
fibrinogen
```
58
If you want to get fibrinogen what would you use?
cryoprecipitate
59
What is cryoprecipitate used for?
dysfibrogenemia or if fibrinogen <100 mg/dL
60
Massive transfusion definition
varies by institution!
61
Massive transfusion
1:1:1 PRBC, platelets, FFP
Hct 29%
may need cryoprecipitate
clotting factor activity 62%
62
4 issues with massive transfusion
- dilution thrombocytopenia
- citrate induced hypocalcemia
- hyperkalemia
- acidosis
63
supportive care in blood transfusions
- mechanical compression
- surgical hemostasis
- fluid resuscitation
- maintenance of renal function
- transfusion of blood products
64
Vitamin K leads to production of what?
new clotting factors (II, VII, IX, X)
65
If you want to reverse warfarin what would you use?
vitamin K
66
Protamine
```
binds UFH (LMWH to lesser extent)
prevent anticoagulant activity
```
67
What would you use to reverse heparin?
protamine
68
Desmopressin
activation of V2 receptors
increase production of FVIII and vWF
reversal of antiplatlet agents
69
What would you use to reverse aspirin (anti platelets)?
desmopressin
70
DDAVP
desmopressin
71
What would you use to reverse fibrinogen?
antifibrinolytic agent
72
What would you use to reverse dabigatran?
idarucizumab
73
T/f idarucizumab has Fab portion fully humanized
true
74
idarucizumab has affinity ____ fold compared to thrombin
350 fold
75
T/F idarucizumab binds to other thrombin substrates
false!
| does not!
76
Andexanet alfa acts as what?
Fax decoy
| retains high affinity for all direct FXa inhibitors
77
What would you use to reverse rivaroxaban?
andexanet
78
What is an antidote for Xa drugs?
andexanet
79
Andexanet used to reverse what?
apixaan
edoxaban
enoxaparin
80
Standard dose for andexanet
400mg IV bolus; followed by 4mg/min x 2 hours (480mg)
81
When would you give standard dose of andexanet?
- any dose of apixaban or rivaroxaban >8 hours from last dose
- last dose of api 5mg or less
- last dose of riva 10mg or less
82
High dose for andexanet
800mg IV bolus; followed by 8mg/min x 2 hours (960mg)
83
When would you give high dose of andexanet?
- api last dose 10mg within last 8 hours
| - riva last dose 15mg or 20mg within last 8 hours
84
unapproved uses of andexanet
- high dose for edoxaban and mg/kg doses of enoxaparin
| - low dose for enoxaparin prophylaxis
85
Ciraparantag
- small synthetic, water soluble molecule
- IV antidote
- reversal through strong, non-covalent bonds
86
Ciraparantag is antidote for what?
DOACs
| heparins
87
T/f ciraparantag is FDA approved
false
