Blood Products and Transfusion (Exam II) Flashcards
(93 cards)
1
Q
What is blood comprised of primarily?
A
Plasma
2
Q
What percentage of blood volume is made up by plasma?
A
55%
3
Q
Which blood product has an ↑ risk of infection and why?
A
- Pooled packs d/t being from multiple donors
4
Q
If we had to pick one thing to transfuse what would it be?
A
Whole blood
5
Q
What blood type is a universal donor? Universal acceptor?
A
- Donor = O neg
- Acceptor = AB +
6
Q
Which patient is the potential exception to accepting blood from an O- donor?
If we have to how can we compensate for this?
A
- Pregant women d/t fetus possibly being O+
- Rhogam
7
Q
What are 2 Hb related issues we will see often in clinical settings?
A
- β thalassemia → Hb Barts
- α thalassemia → Hb H
8
Q
What are the possible blood antigen types? What are possible Rh factors?
A
- Antigen → A B AB O
- Rh → Rh+ and Rh-
9
Q
Is the general population primarily Rh+ or Rh- ?
A
Rh+ (85%) and Rh- (15%)
10
Q
What 4 things can cause a right shift of the OxyHb curve?
A
- ↓ pH
- ↑ CO2
- ↑ temp
- ↑ 23-DPG
11
Q
T or F: If our O₂ saturation is good so is our PO₂?
A
- False → O₂sat has nothing to do with PO₂ (could have 1 Hb fully saturated; ex. anemia)
12
Q
For blood type O which antigen is present on erythrocyte and which antibody is in the serum?
A
- Antigen: n/a
- Antibody: Anti-A and Anti-B
13
Q
For blood type AB which antigen is present on erythrocyte and which antibody is in the serum?
A
- Antigen: A and B
- Antibody: none
14
Q
For blood type B, which antigen is present on erythrocyte and which antibody is in the serum?
A
- Antigen: B
- Antibody: Anti-A
15
Q
For blood type A which antigen is present on erythrocyte and which antibody is in the serum?
A
- Antigen: A
- Antibody: Anti-B
16
Q
AB donor blood will react with which other blood types?
A
- A, B, and O
17
Q
B donor blood will react with which blood types?
A
- A
- O
18
Q
A donor blood will react with which blood types?
A
- B
- O
19
Q
O donor blood will react with which blood types?
A
- none
20
Q
When whole blood is centrifuged what separation products result?
A
- Platelet rich plasma (PRP)
- WBC
- RBC
21
Q
What happens if we centrifuge platelet rich plasma (PRP) again?
A
- Centrifuge PRP again → Separates plasma from platelets
22
Q
Where is PRP used in surgery?
A
Surgeon injects locally → ortho, dental, plastics cases commonly
23
Q
What are the 5 different blood components we can use for treatments?
A
- RBC
- FFP
- Cryo
- PLT
- LTOWB - Low titer Group O Whole Blood
24
Q
What is the lifespan of WB?
A
~ 3 wks
25
What chemicals are added to blood that allows it to be stored?
* CPDA-1 → Citrate phosphate dextrose adenine; chelates Ca++ to prevent clotting
* Phosphate → used as buffer
* Dextrose → fuel source
* Adenine → to support ATP synthesis (extends storage from 21 to 35 days)
26
Due to the chemicals used to allow blood to be stored what labs do we need to check when transfusing lots of blood?
* Ca++ (it will ↓)
* BG (it will ↑)
27
Which electrolyte will stored blood always have ↑ levels of? Why?
* K+ d/t cells lysing as they degrade in the bag
28
What happens to 2,3-DPG in stored blood?
What does this do to the OxyHb association curve?
* ↓ 2,3-DPG
* Left shift → impairs O2 delivery
29
PRBCs contain ______ unless they have been specifically ________?
* Leukocytes (WBCs)
* Leukoreduced
30
How much does 1 unit of PRBCs ↑ H&H level?
* Hb: ↑ 1 g/dL
* Hct: ↑ 3%
31
How many mL's are usually in one unit PBRCs?
200-350 mL
32
Which blood transfusion product is a source of antithrombin III?
FFP
33
What is the dose of FFP?
10-15 mL/kg
34
How much will 1 unit of FFP ↑ level of each clotting factor?
↑ 2 to 3% for each factor
35
What are two specific uses of FFP Dr. C mentioned in class?
* Heparin resistance d/t antithrombin deficiency
* Treat angioedema (also use TXA along with FFP)
36
What is the INR of FFP?
* 1.5 to 1.8
37
What clotting factors does cryoprecipitate have?
* Factor VIII: C
* Factor VIII: vWF
* Factor XIII
* Fibrinogen
38
What target fibrinogen concentration are we trying to maintain when using cryo?
100 mg/dL
39
How much will two units of cryo raise fibrinogen levels?
2 bags of cryo/10 kg body weight = 100 mg/dL ↑ in fibrinogen
40
Which patient population is cryo really important for?
Pregnant women who are bleeding
41
How much will one unit of PLT increase PLT count by?
5,000 to 10,000
42
Is there any clinical data that says warming platelets is bad?
No its a common practice → no data to support not warming platelets
43
When platelets are low at what level will we start to spontaneously bleed?
PLT < 30,000
44
What is the deadly triad when transfusing a patient?
* Hypothermic
* Coagulopathic
* Acidotic
45
When is WB indicated for transfusion?
To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss )
46
What are S/Sx of hemolytic transfusion reaction?
* fever
* chill
* hemoglobinemia
* hemoglobinuria
* hypotension
* dyspnea
47
What are mediators of hemolytic transfusion reactions?
IgM antibodies
48
What are the S/S of nonhemolytic febrile transfusion reactions?
Fever and chills
49
What are the mediators of non-hemolytic febrile transfusion reactions?
HLA Class I Ag antibodies
50
How do we treat Non-hemolytic febrile transfusion reactions?
* Antipyretics
* Use leukocyte reduced products
51
What are some S/S of an allergic transfusion reaction?
* urticaria
* erythema
* itching
* anaphylaxis
52
What are the mediators of allergic transfusion reactions?
* plasma proteins
* IgA antibodies
53
How do we treat allergic transfusion reactions?
* antihistamines
* treat symptoms
54
What are S/S of non-cardiogenic pulmonary transfusion reactions?
* ARDS
* Fever
* Chill
* Hypotension
* Cyanosis
* Noncardiogenic pulmonary edema*
55
What are the mediators for a non-cardiogenic pulmonary transfusion reaction?
Recipient WBC antibodies
56
How do we treat non-cardiogenic pulmonary transfusion reactions?
* Lots of PEEP
* Steroids
57
How do we know if we have a TRUE transfusion reaction?
Noncardiogenic pulmonary transfusion reaction after blood product administration
58
What is TRALI?
Transfusion Related Acute Lung Injury - temporarily r/t to blood transfusion within 1st 6 hrs of a transfusion
59
Criteria for TRALI
- acute onset hypoxemia
- ratio PaO2/FiO2 < 300 or <90% on RA
- Within 6hrs of transfusion
- B/L diffuse pulmonary infiltrates (upper)
- No evidence of left atrial hypertension (i.e. circulatory overload)
60
Immediate management for TRALI
1. Stop infusion
2. Intubate if not already intubated
3. Obtain undilute edema fluid and simultaneous plasma
4. Obtain CBC
5. Notify blood bank of possible TRALI
| ...may require ECMO
61
What types of blood products is TRALI most associated with this?
* FFP
* PLTs
62
What are the 3 acute nonimmunologic effects of transfusion reaction?
* Bacterial contamination
* Circulatory overload (TACO)
* Hemolysis d/t physical /chemical means
63
What are delayed immunologic effects of transfusion reaction?
* Hemolytic transfusion reactions
* Transfusion associated Graft-versus-host disease
* Post-transfusion purpura
* Transfusion-induced hemosiderosis (too much iron)
64
What are some quick ways to differentiate between TRALI and TACO? (This is very cut down from the main list)
* TRALI → Fever and ↓BP
* TACO → HTN, ↑JVP, ↓ EF
65
What is TACO?
Transfusion associated circulatory overload
Mediated by fluid volume
Tx: administer treatment slowly and in small volume
66
What classes of hemorrhage are there and what is associated blood loss for each?
* Class 1 = up to 750 mL (< 15%)
* Class 2 = 750 to 1500 mL (15-30%)
* Class 3 = 1500 to 2000 mL (30-40%)
* Class 4 = > 2000 mL (>40%)
67
What are 3 definitions of MTP in Adults?
* Total blood volume is replaced within 24 hours
* 50% of total blood volume is replaced in 3 hours ← Most common
* Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss
68
What is considered MTP for Kids?
> 40mL/kg transfusion
69
What is balanced resuscitation?
* 1:1:1 ratio (PLT:Plasma:RBC)
70
What are the fibrinogen levels of Cryo, FFP, and LTOWB?
* Cryo = 2500 mg
* LTOWB = 1000 mg
* FFP = 400 mg
| *cryo has highest fibrinogen levels
71
What is the difference between stored whole blood (SWB) and LTOWB?
SWB anticoagulants < LTOWB
72
What are the recommendations for whole blood transfusion in kids?
If they are <15 yr old or <40 kg then limit WB to 30 mL/kg
73
Which clotting factors required Ca++ to work?
2 7 9 10 (II, VII, IX, X)
74
Which drug has more elemental calcium; Ca gluconate or CaCl?
* CaCl (270 mg/10mL vs 90 mg/10ml for gluconate)
75
How much will 1, 2, and 5 units of blood decrease iCa?
* 1 unit = 1.12 mmol/L
* 2 unit = < 1mmol/L
* 5 units = < 0.8 mmol/L
| Give calcium every 4 units
76
What is the value for TEG-ACT?
80-140 sec
77
What is the normal value for R time?
5.0 - 10.0 min
78
What is the normal value for K time?
1-3 minutes
79
What is the normal value for α angle?
53 - 72°
80
What is the normal value for MA?
50-70mm
81
What is the normal value for G value?
5.3-12.4 dynes/cm2
82
What is the normal value for LY 30?
0-3%
83
If TEG-ACT is > 140 what do we transfuse?
FFP
84
If R time is > 10 what do we transfuse?
FFP
85
If K time is > 3 what do we transfuse?
Cryo
86
If α angle < 53° what do we transfuse?
Cryo and platelets
87
If MA < 50 what do we transfuse?
PLT
88
If LY30 > 3% what do we transfuse?
TXA (Tranexamic Acid)
89
Indications for PLT transfusion:
90
Rh + or Rh - for
Females of child-bearing age =
Males =
Pregnancy = Rh -
Males = Rh +
91
What two things can decrease the metabolism of citrate?
- Hypothermia
- Liver injury
92
# TEG INTERPRETATION
Angle:
R:
LY30:
MA:
K:
Angle: kinetics of clot development
R: reaction time, first significant clot formation
LY30: percent lysis 30min after MA
MA: maximum amplitude, maximum strength of clot
K: achievement of certain clot firmness
93
Examples of TEG
