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Health Assessment > Blood products and transfusions (3) > Flashcards

Blood products and transfusions (3) Flashcards

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1
Q

Blood compositon

A
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2
Q

What percent of blood is plasma?

A

55%

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3
Q

What percent of blood is formed elements?

A

45%

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4
Q

What is the makeup of plasma?

A
  • Proteins 7%
  • Water 92%
  • Other solutes 1%
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5
Q

What is the makeup of formed elements?

A
  • Platelets (140k-340k)
  • Leukocytes (5k-10k)
  • Erythrocytes (4.2-6.2 million)
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6
Q

What proteins are in plasma?

A
  • Albumin
  • Globulins
  • Fibrinogen
  • Prothrombin
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7
Q

What are the “other solutes” in plasma?

A
  • ions
  • nutrients
  • waste products
  • gases
  • regulatory substances
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8
Q

Rh factor percentage:

A
  • Rh+ = ~85%
  • Rh- = ~15%
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9
Q

What can cause a shift to the right on the oxyhemoglobin dissociation curve?

A
  • decreased pH (increased acid)
  • Increased CO2
  • increased temperature
  • increased 2,3 DPG
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10
Q

Blood Typing:

A
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11
Q

Blood compatibility (memorize)

A
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12
Q

Contents and use for whole blood:

A

Contents: all cells, platelets, clotting factors and plasma

Use: replace blood loss from hemorrhage

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13
Q

Contents and use for PRBCs:

A

Contents: red blood cells and some plasma

Use: replace blood cells in anemic patients

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14
Q

Contents and use for platelets:

A

Contents: thrombocytes and some plasma

Use: Replace platelets in a patient with thrombocytopenia

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15
Q

Contents and use for FFP:

A

Contents: plasma, a combination of fluid, clotting factors and protein

Use: replace volume in a burn patient or in hypovolemia secondary to low oncotic pressure

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16
Q

Contents and use for clotting factors:

A

Contents: specific clotting factors needed for coagulation

Use: replace factors missing due to inadequate production as in hemophilia

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17
Q

RBC and platelet specific gravities:

A

RBC: 1.08-10.9
Platelet: 1.03-1.04

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18
Q

Steps for separating a unit of whole blood:

A
  • The centrifuged product settle out into RBC, WBC and PRP
  • After separating PRP from the bag, PRP is centrifuged again for a longer time and is harder to spin
  • Platelets are heavier than plasma and will settle into the bottom of the bag
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19
Q

What is added to blood to help with storage?

What are their uses?

A

Citrate phosphate dextrose adenine

  • Citrate for chelation of calcium to prevent clotting
  • Phosphate as a buffer
  • Dextrose as a fuel source
  • Adenine as a substrate for the synthesis of ATP extending storage time from 21 to 35 days
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20
Q

What effect does blood storage have on oxygen delivery?

A

The longer blood is stored, the lower levels of 2,3 DPG are, which shift the oxyhemoglobin dissociation curve to the left and impairs oxygen delivery

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21
Q

PRBCs contain ____ unless they have been specifically ____.

A

Leukocytes; leukoreduced

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22
Q

How are PRBCs prepared?

A

By removing 200-250 ml of plasma from a unit of whole blood

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23
Q

Characteristics of PRBCs:

A
  • 1 unit = 200-350mL
  • Do not contain functional platelets or granulocytes
  • have the same O2 carrying capacity with whole blood
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24
Q

Why is PRBCs given to anemic patients?

A

Intended to increase the O2 carrying capacity in anemic patients who require an increase in their red cell mass without increasing their blood volume

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25
How much does 1 unit of PRBCs increase hgb and hct?
1 unit = 1g/dL (10g/L) and hct by 3%
26
How is FFP prepared?
Removing plasma from whole blood within 8 hours of collection - one bag is 200-250 mL
27
FFP is a good source of ____
antithrombin III
28
What is the dose for FFP?
10-15 mL/kg
29
Storage for FFP:
- stored at -18C or below - expires 12 months after donation
30
1 unit of FFP increases ____
Level of each clotting factor by 2-3% in adults
31
FFP contains:
Water, carbohydrates, fats, minerals, proteins
32
How is cryo prepared?
- Protein fraction taken off the top of the FFP when being thawed - then refrozen for up to 1 year - stored at -18C and below
33
What is in cryoprecipitate?
- Factor VIII: C - Factor VIII: vWF - Factor XIII - Fibrinogen
34
How much does cryo increase fibrinogen?
Two units of cryo/10 kg of body weight increases fibrinogen concentration by 100 mg/dL (except for DIC or continued bleeding with massive transfusion)
35
Indications for the use of FFP:
36
Indications for use of cryo:
37
Indications for platelets transfusion:
38
How are platelets prepared?
- Cytapheresis - by separating PRP from a unit of whole blood within 8 hours of collection and recentrifuged to remove plasma
39
How much does one unit of platelets increase levels?
one unit = increase platelets by 5-10,000
40
Why do you not want to give LR with blood products?
It has calcium in it so it can cause clotting
41
When would you use warming devices when administering blood products?
- trauma patient receiving 4 or more units in 1 hour - 5 yo patient with a current temp of 98.1 receiving 2 units in 1 hour - a 90 yo patient with a temp of 97.5 receiving any unit
42
Preferred fluid for blood product administration:
- Electrolyte-R pH 7.4 (normosol/plasmalyte) - Normal saline only used for priming blood tubing and flushing before and after
43
Indications for giving whole blood:
To maintain blood volume and O2 carrying capacity in acute or massive blood loss - actively bleeding patient greater than 20% of body blood volume
44
Complications of blood transfusion:
45
Delayed complications of blood transfusion:
46
Mediators for a hemolytic transfusion reaction:
IgM A/b (usually ABO), complement
47
S/S for hemolytic transfusion reactions:
Fever (late), chills, hemoglobinemia, hypotension, dyspnea
48
Treatment and prevention for hemolytic transfusion reactions:
Decrease opportunities for error - treat ARF and DIC
49
Nonhemolytic febrile transfusion reactions:
- Mediators: A/b to HLA class I Ag - S/S: fever, chills - Treatment and prevention: antipyretics, leukocyte reduced
50
What is the most common transfusion reaction?
Allergic transfusion reaction
51
Mediators for allergic transfusion reactions:
- Plasma proteins (mild reactions) - A/b to IgA (anaphylactic reactions)
52
S/S of allergic transfusion reactions:
Urticaria, erythema, itching, anaphylaxis
53
Treatment and prevention for allergic transfusion reactions:
- Antihistamines - treat sx - transfuse IgA deficient components
54
Noncardiogenic pulmonary transfusion reactions:
Mediators: donor/recipient WBC A/b S/S: ARDS, fever, chill, cyanosis, hypotension, noncardiogenic pulmonary edema Treatment and prevention: vigorous respiratory support (PEEP), steroids
55
What is TRALI?
Acute lung injury that is temporally related to a blood transfusion - specifically it occurs within the first 6 hours following a transfusion
56
Incidence and mortality for TRALI:
Incidence: unknown - but estimated to occur in 1:1300-5000 transfusions Mortality: ranges from 5-25% with most patients recovering within 72 hours
57
What is the criteria for TRALI?
* Acute onset hypoxemia (cyanosis common) * P/F ratio <300 or SpO2 <90% on RA * Occurs within 6 hrs of transfusion * Bilat diffuse pulmonary infiltrates * No Left atrial hypertension (circulatory overload) * Fever common * Hypotension
58
What percent of TRALI patients require mechanical ventilation?
70%
59
What might lungs of a patient with TRALI sound like?
Pulmonary crackles (and no signs of CHF/ volume overload)
60
What are priority action if TRALI is suspected?
* Stop transfusion * Support patient * If patient is intubated → obtain undiluted edema fluid ASAP (within 15 min) and plasma to see total protein * CBC/ CXR * Notify blood bank (request different unit and quarantine other units from same donor)
61
What are some other issues that mimic transfusion reactions?
* Sepsis * Hemoglobinuria (trauma, AKI, muscle damage)
62
What are the causes of acute non-immunologic transfusion reactions?
* Bacterial Contamination * Circulatory overload (TACO) * Hemolysis from physical/chemical means
63
What mediators are involved in acute non-immunologic bacterial contamination of blood products?
Endotoxins produced by gram negative bacteria
64
What are s/s of patient with bacterial contamination from blood products?
* Fever * Shock * Hemoglobinuria
65
What is the treatment of bacterial contamination from blood product?
* IV ABX * Treat hypotension * Treat DIC
66
What mediators are involved in transfusion associated circulatory overload (TACO)?
Fluid volume
67
What are s/s or TACO?
*Cough * Cyanosis * Orthopnea * Severe headache * Peripheral edema * Difficulty breathing
68
How can TACO be prevented?
* Give transfusion slowing in a small volume
69
What causes physical/chemical hemolysis following a blood transfusion and what are the S/S?
* Caused by exogenous destruction of RBCs *S/S: Hemoglobinuria
70
What are the delayed immunologic reaction discussed in lecture?
* Hemolytic transfusion reactions * Transfusion associated graft-vs host disease * Post transfusion purpura
70
What is the treatment for physical/chemical hemolysis?
Document and rule out hemolysis d/t other causes Treat DIC
71
What type of blood transfusion reactions are the most common in the operating room?
Delayed complications
72
What mediators are involved in hemolytic transfusion reactions?
IgG A/b
73
What are symptoms of hemolytic transfusion reactions?
* Shortened RBC survival * Decreased Hgb * Fever * Jaundice * Hemoglobinuria
74
How are hemolytic transfusion reactions treated/prevented?
Ig-negative blood for further transfusions
75
What mediators area associated with transfusion related Graft-vs host disease?
Viable donor lymphocytes (pancytopenia and hepatitis)
76
What are S/S of transfusion graft vs host?
* Fever * Skin rash * Desquamation (Skin peeling) * Anorexia * N/V/D * Hepatitis * Pancytopenia
77
What is the treatment for transfusion associated graft vs host?
Gamma irradiation of cellular components
78
What is the MOA of post-transfusion purpura?
* Platelet specific antibody
79
What are S/S of post transfusion purpura?
* Thrombocytopenia * Clinical bleeding
80
What is the treatment for post-transfusion purpura?
* IV Ig * Plasma exchange * Corticosteroids
81
How can we differentiate TRALI and TACO?
TACO→ *no fever*, *HYPERtension*, acute dyspnea, *JVD can be changed*, Rales and *S3*, diffuse b/l infiltrates, *decreased EF*, *improvement with diuretics* TRALI→ *fever*, *HYPOtension*, acute dyspnea, *JVD unchanged*, Rales, diffuse b/l infiltrates, *normal EF*, *No improvement with diuretics*
82
What is a delayed non-immunologic effect associated with blood transfusions?
Transfusion-induced Hemosiderosis (iron deposition)
83
What is the MOA of transfusion-induced hemosiderosis? What are the s/s?
Iron overload * S/S: subclinical to death (usually people who are getting repeated transfusions)
84
What is the treatment for transfusion induced hemosiderosis?
* Decreased frequency of transfusion * Neocytes (young RBC that have longer life than RBC) * Iron chelation therapy
85
What are the steps to follow if suspect blood transfusion reaction?
* Discontinue the transfusion * Keep IV line open * Check all labels, forms, and Pt ID * Report to blood bank * Send requested blood samples
86
What class of hemorrhage starts to affect BP?
Class 3 and 4 (BP starts to drop)
87
What is the blood loss in mL for class 1-4?
Class 1: 750mL Class 2: 750-1500mL Class 3: 1500-2000mL Class 4: >2000mL
88
Which class of hemorrhage do you start giving blood products with crystalloids?
Class 3 and 4
89
What is the purpose of MTP in adults?
* Total blood volume is replaces within 24 hours * 50% of total blood volume replaced in 3 hours * Rapid bleeding rate= 4units RBC transfused w/in 4 hours or 150mL/min blood loss
90
MTP in kids is >____ mL/kg transfusion.
>40mL/kg
91
What blood products are used with MTP? What is the goal of MTP?
Balanced resuscitation→ 1:1:1 ratio of platelets: plasma: RBC Goal is to get all the components back to whole blood
92
What is blood component therapy?
Basically MTP (using multiple blood products to try to get back to whole blood ratios)
93
Why is blood component therapy not as good as whole blood?
Blood component therapy= loss of coagulation factors and platelet function in reconstituted products→ can lead to increased anemia, thrombocytopenia, and coagulopathy Requires multiple products= higher risk of infection from multiple donors Products diluted with anticoagulants and additives
94
Why is whole blood superior for hemostatic potential?
* Less dilution from anticoagulants and additives than combination of 1:1:1 * Higher platelet count in whole blood (200 vs 88) * Higher coagulation factor levels in whole blood (90% vs 65%)
95
What products are given as 1st, 2nd, 3rd choice for low fibrinogen levels?
1) Cryo (2500mg) 2) Whole blood (1000mg) 3) FFP (400mg)
96
How does stored whole blood (SWB) have to be stored/tested?
* Cold: 2-6 degrees C * Storage: 21-35 days * Hemostatic capability: 14-21 days * Testing: same as blood components
97
Which type of whole blood is the universal donor?
Low titer type O whole blood (LTOWB)
98
What is the preferred resuscitation product?
Stored whole blood
99
What is the protocol for trauma patients with unknown blood types?
* Pre-transfusion blood sample (determine blood type * Additional transfusions require LTOWB or group O RBCs for 1month after initial transfusion
100
What is the blood product of choice for males? What is the blood product of choice for females of child bearing years?
Rh positive blood for males Rh negative blood for females of child bearing years
101
Why are there a limited number of centers in the US that provide whole blood transfusion for massive hemorrhage?
*Highly regulated process
102
How long is LTOWB good for?
21 days
103
What is the recommendation for WB in peds?
Few studies on WB In pediatric populations: Age <15 or weight <40kg: Limit WB to 30mL/kg
104
How much calcium gluconate has to be given to get the same effect as calcium chloride?
3x calcium gluconate = calcium chloride
105
What are some clinical usages for calcium chloride?
* Hypocalcemia * Long QTc * Decreased cardiac output * Coagulopathy * Seizures
106
____% of trauma patients are hypocalcemic
97.4%
107
What is associated with sever hypocalcemia?
* More coagulopathy * More blood transfused * Double mortality
108
T/F: One unit of citrated blood product drops iCa?
True: Would be a good idea to replace calcium after one unit is transfused
109
What is the lethal triad?
* Hypothermia * Acidosis * Coagulopathy
110
________ + _______ = decreased citrate metabolism
Hypothermia (caused by hemorrhage) Liver injury *citrate is metabolized in the liver*
111
What are the different components of TEG?
R: reaction time K: time to clot firmness Angle: kinetics of clot development MA: Maximum amplitude (Max clot strength) LY30: Percent lysis 30 min after MA
112
What does TEG stand for?
Thromboelastography
113
What is the treatment for TEG-ACT >140?
FFP
114
What is the treatment for TEG R-time >10?
FFP
115
What is the treatment for TEG K-time >3?
Cryo
116
Treatment for TEG Angle <53?
Cryo +/- Platelets
117
What is the treatment for TEG MA <50?
Platelets
118
What is the treatment for LY30 >3%
TXA

Health Assessment (27 decks)

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