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APA Fundamentals > Blood Therapy > Flashcards

Blood Therapy Flashcards

1
Q

What is considered adequate urine output to assess intravascular fluid volume?

A

0.5-1ml/kg/hr.

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2
Q

List some clinical assessments for intraoperative blood loss?

A 
Tachycardia.
Hypotension.
Oliguria.
Decrease CVP.
Decrease mixed venous oxygen.
Large variation of systolic BP with RR
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3
Q

What is normal systolic BP variation with inspiration?

A

8-10mmHg

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4
Q

How much blood volume can a young healthy patient lose before demonstrating any clinical signs?

A

20%

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5
Q

What is a physiologic response to acute blood loss?

A

Vasoconstriction of splanchnic and venous capacitance vessels

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6
Q

What is the primary indication for blood transfusion?

A

To increase Oxygen carrying capacity

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7
Q

Transfusion is rarely justified with Hgb is greater than ___ and Hct is greater than ___?

A

Hgb>10g/dl

Hct>30%

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8
Q

Transfusion is almost always justified with Hgb is less than ___ and Hct is less than ___?

A

Hgb<6g/dl

Hct<18%

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9
Q

What is a rough estimate of Hct based on a Hgb value?

A

Hct is 3x Hgb

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10
Q

What blood product is preferred when blood loss leads to hypovolemic shock?

A

Whole Blood

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11
Q

How is crossmatching different than blood typing?

A

Typing checks for antibodies in the patient’s blood.

Crossing (crossmatching) tests the patients blood with the donor’s blood

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12
Q

What is crossmatching and how long does it take?

A

Three step process of testing patient blood with donor blood in an incubator. Takes approx 45mins

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13
Q

Which blood type is considered the universal donor?

A

O Negative

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14
Q

Which blood type is considered the universal recipient?

A

AB+

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15
Q

Which methods allows for a unit of blood to be available for more than one patient?

A

Type and Screen

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16
Q

What is a type and cross?

A

Specific unit(s) of blood are typed, tested, and set aside directly for a specific patient.

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17
Q

What is the chance of significant hemolytic reaction with typed and screened blood?

A

1:10,000

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18
Q

Which is ordered for a surgical procedure when the risk of transfusion is remote?
Risk of transfusion is very high/likely?

A

Remote risk= Type and Screen.

Likely risk= Type and Cross

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19
Q

How long can blood be stored?

A

21-35 days

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20
Q

What is the determining quality of why blood cannot be stored longer?

A

Must have at least 70% of the RBC be viable for more than 24 hours after transfusion

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21
Q

What is the average Hct of whole blood?

A

40%

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22
Q

What preservatives are used in donated blood?

A

Phosphate-acts as buffer.
Dextrose- provides energy to RBC.
Adenine-resynthesized ATP to fuel metabolic requirements

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23
Q

What is the volume and Hct of Packed Red Blood Cell (PRBC) unit?

A

300ml and 70% Hct

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24
Q

How much will one unit of PRBCs effect Hemoglobin concentration?

A

Increase by 1g/dl per unit

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25
Q

What would a hypotonic solution do to RBCs if it were to be mixed with blood product?

A

The cells would swell and and cell lysis would occur.

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26
Q

Which has a higher risk of citrate toxicity- whole blood or PRBC?

A

Whole blood

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27
Q

Which has high risk of allergic reaction-whole blood or PRBC?

A

Whole blood

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28
Q

What is the threshold for platelet replacement?

A

<50,000

29
Q

How much will the platelet count go up per unit in 70kg patient?

A

Increase by 5,000-10,000 cells/mm3 per unit

30
Q

What are some risks with platelet administration?

A

Transmission of viral diseases.
Bacterial infection 1 in 12,000.
Small risk of platelet related sepsis

31
Q

What is a symptom of platelet sepsis after platelet administration?

A

Fever

32
Q

FFP administration is specific indicated for what clinical factor?

A

Prothrombin time and/or Partial Thromboplastin time are greater than 1.5 times normal.

33
Q

What are two other indications for FFP administration?

A
  1. Reversal of warfarin therapy.

2. Known factor deficiencies.

34
Q

What is cryoprecipitate?

A

Basically concentrated FFP with high concentrations of Factor VIII, Factor XIII, Von Willebrand Factor, Fibrinogen, Fibronectin.

35
Q

How is blood product administration determined based on coagulation studies? how many PRBCs:how many FFP: how many platelets, etc?

A

TEG

36
Q

What are the 3 types of transfusion reactions?

A
  1. Febrile transfusion reaction.
  2. Allergic transfusion reaction.
  3. Hemolytic transfusion reaction.
37
Q

What is the most frequently occurring transfusion reaction?

A

Febrile transfusion reaction.

38
Q

How do you differentiate between hemolytic transfusion reaction, and the other two types?

A

Hemolytic transfusion reaction can be confirmed by patients serum and urine hemolysis. Free Hemoglobin in urine is a sign.

39
Q

What are the three main signs of allergic transfusion reaction?

A

Urticaria.
Pruritus.
Occasional facial swelling

40
Q

What causes an allergic transfusion reaction?

A

Due to presence of incompatible plasma proteins in the donor blood.

41
Q

What is treatment for allergic transfusion reaction?

A

Stop infusion.

Benadryl.

42
Q

What causes a hemolytic transfusion reaction?

A

Administration of erroneous unit of blood to a patient

43
Q

How much blood can potentially cause a hemolytic transfusion reaction?

A

As little as 10ml of blood; however, severity of reaction is proportional to the volume of erroneous blood administered.

44
Q

Ultimately, what two things can happen with hemolytic transfusion reaction?

A

Renal failure and DIC

45
Q

Why does renal failure occur with hemolytic transfusion reactions?

A

Precipitates accumulate in the renal tubules.

46
Q

What is preventative treatment for renal failure in the presence of hemolytic transfusion reaction?

A

Maintain 100ml/hr urine output with administration of LR and mannitol/furosemide

47
Q

What are some metabolic complications of blood therapy?

A

Metabolic alkalosis.
Hypocalcemia.
Decreased 2,3 diphosphoglycerate levels.
Increased serum hydrogen and K+

48
Q

Stored blood becomes more acidic or more alkaline as time goes on?

A

More acidic.

49
Q

Does blood administration make the patient’s blood more acidic or more alkaline?

A

More alkaline.

50
Q

Why does blood product make patient’s blood more alkaline even though the product itself is acidic?

A

Citrate being broken down into HCO3.

51
Q

Left shift on hemoglobin/oxygenation curve causes what? Right shift?

A

Left shift=Greater O2 Affinity.

Right shift=Lesser O2 Affinity.

52
Q

Is decreased concentration of 2,3 diphosphoglycerate associated with left or right shift?

A

Left shift=Increased Affinity of O2

53
Q

What are complications of blood therapy related to transmission of viral disease?

A

HIV 1:1,000,000.

Hepatitis 1:60,000

54
Q

Why is a filter used on blood products?

A

Mircoaggregates- mostly leukocytes and platelet clots can cause accumulation in lungs and contribute to ARDS

55
Q

What is the standard filter for blood product and preferred filter?

A

Standard=170um diameter

Preferred=10-40 um diameter

56
Q

What is DIC?

A

Patient’s coagulation and fibrinolytic systems become uncontrollably activated. Leads to platelet consumption and clotting factors.

57
Q

What is treatment for DIC?

A

Treat underlying cause.

Administer platelet and FFP

58
Q

What is TRALI?

A

Transfusion Related Acute Lung Injury

59
Q

What is the only treatment for TRALI?

A

Supportive therapy

60
Q

What are contraindications of intraoperative blood salvage?

A

Open bowel surgery, Septic/infected surgical site, malignancies, blood-borne pathogens.

61
Q

What patient population is intraoperative salvage/autologous blood transfusion used in?

A

Jehovah’s Witnesses.

62
Q

What is therapeutic hemodilution?

A

Removal or blood before induction and restored with crystalloid or colloid.
Then given back to the patient after blood loss has occurred. Form of autologous transfusion

63
Q

Is patient consent required for hemodilution technique?

A

No

64
Q

What is the threshold for FFP administration?

A

INR>2.0

PT/aPTT >1.5x normal

65
Q

How is Allowable Blood Loss (ABL) calculated?

A

[EBV x (Hct-target Hct)] / Hct

66
Q

What is average EBV for Male? Female? Obese?

A

Male=70-75ml/kg
Female=65-70ml/kg
Obese=55ml/kg

67
Q

How to calculate fluid deficit?

A

4:2:1 method x # hours NPO

68
Q

What is best way to replace fluid deficit via the traditional method?

A

Half of fluid deficit in first hour of surgery. Quarter in 2nd hour. Quarter in 3rd hour

APA Fundamentals (10 decks)

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