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Surgery M4 part 1 > blood transfusion > Flashcards

blood transfusion Flashcards

1
Q

What does a blood collection bag contain?

A
  • 70-100mL citrate anticoagulant solution
  • dextrose to preserve viability of RBCs
  • 400 - 450mL of blood

STORED AT 2-6C

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2
Q

What physiological changes will occur during blood storage?

A
  • gradual decrease in % of viable RBCs
  • platelets drop to zero rapidly
  • coagulation factors V & XIII markedly drops
  • potassium content increases due to RBC breakdown leading to hyperkalemia
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3
Q

What is shown on a blood bag?

A
  • blood group
  • Rh
  • expiry date
  • date of collection
  • components inside
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4
Q

Which patients should receive only packed red cells?

A
  • ANEMIC
  • ELDERLY
  • CARDIAC patients
  • RENAL patients

to increase hemoglobin content without overloading circulation

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5
Q

What is a useful method of correcting hemophilia & liver cell failure?

A

FRESH FROZEN PLASMA

  • stored at -40
  • good source of all the coagulation factors
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6
Q

What are the components of fresh plasma?

A

coagulation factors & platelets

given in hypoproteinemia

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7
Q

What is a useful method of managing thrombocytopenia?

A

giving PLATELET CONCENTRATES

  • should be freshly prepared
  • increases platelet number by 10 000 to 15 000
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8
Q

How is cryoprecipitate prepared?

A
  • prepared from fresh frozen plasma
  • stored at -40C
  • rich in factor VIII & fibrinogen
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9
Q

What are the indications for a blood transfusion?

A
  • decreased blood volume (hemorrhage)
  • decreased RBCs (anemia)
  • decreased WBCs (leucopenia, agranulocytosis, & severe infections)
  • decreased platelets (thrombocytopenic purpura)
  • decreased plasma proteins (burns, ascites, hepatic dysfunction)
  • decreased coagulation factors (hemophilia A&B)
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10
Q

What is the most common complication of a blood transfusion?

A

PYROGENIC REACTION

  • chills & fever
  • headache, nausea, & vomiting

STOP TRANSFUSION + IV ANTIHISTAMINES + HYDROCORTISONE + ANTIPYRETIC

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11
Q

What are the causes of a pyrogenic reaction in blood transfusions?

A
  • minor bacterial contamination
  • donor’s white blood cells or platelets
  • pyrogens in transfusion apparatus

if patient has >38C fever do not give blood transfusion

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12
Q

What complication of blood transfusion is more liable to occur in elderly patients?

A

CONGESTIVE CARDIAC FAILURE due to volume overload

  • could occur in cardiac & renal patients as well
  • transfuse packed red cells instead

STOP TRANSFUSION + GIVE DIURETICS + DIGOXIN

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13
Q

When should blood transfusions be given?

A

early in the morning

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14
Q

What causes an allergic reaction to a blood transfusion?

A
  • due to recipient’s response to allergens in donor’s blood
  • common in patients who received many transfusions in the past

STOP TRANSFUSION + IV ANTIHISTAMINES & HYDROCORTISONE

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15
Q

What is the cause of hemolytic reactions?

A

incompatible blood transfusion

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16
Q

What does a hemolytic reaction present as & when?

A 
- presents after transfusion of less than 50mL
fever, chills 
chest pain
dyspnea 
pain in flanks

serious life threatening condition

17
Q

What will examining a person getting a hemolytic reactions reveal?

A

tachycardia
hypotension
hemoglobinuria
jaundice & acute renal failure due to acute tubular necrosis

18
Q

How does a hemolytic reaction present in an anesthetized patient?

A

sudden tachycardia
hypotension
bleeding tendency

NEVER GIVE BLOOD UNDER ANESTHESIA

19
Q

how should a hemolytic reaction be managed?

A
  • stop infusion immediately
  • send donor’s blood & sample of patients blood for repeat typing
  • correct shock by infusion of crystalloid solution & i.v corticosteroids
  • foley’s catheter check urine output
  • mannitol may be needed (osmotic diuretic)
  • dialysis if acute renal failure occurs
20
Q

What are the most common infection transmitted through blood transfusions?

A

Hepatitis B or C
AIDS (HIV)
Malaria (only by RBCs)
septicemia if blood is allowed to warm

21
Q

What causes hyperkalemia during a blood transfusion?

A
  • prolonged storage of blood leading to progressive blood loss of potassium from erythrocytes into plasma

may produce cardiac arrhythmias or arrest

22
Q

escape of air into the circulation during a blood transfusion will lead to?

A

air embolism

23
Q

When does citrate intoxication occur during a blood transfusion?

A
  • excess citrate if patient takes more than 1 unit of blood
24
Q

What does citrate intoxication lead to & how is it managed?

A
  • hypocalcemia
  • tetany
  • augments effects of hyperkalemia on myocardium

GIVE 10mL of 10% calcium gluconate for each 2 units of blood

25
Q

what are the complications of MASSIVE blood transfusions?

A

transfusion of 2500ml of blood at once or 5000ml over 24hrs

  • hypothermia
    • reduced cardiac, hepatic & renal functions
    • difficult O2 delivery
    • impaired blood coagulation
  • citrate toxicity (hypocalcemia)
  • hyperkalemia
  • volume overload
  • deficient oxygen transport
  • thrombocytopenia & coagulation failure (due to dilution of clotting factors & platelets)
  • pulmonary insufficiency (multiple small emboli produced by platelet aggregations & cellular debris in aged blood)
26
Q

What are substitutes for blood?

A

HUMAN ALBUMIN 4.5% (plasma expander)
- no risk of hepatitis transmission

DEXTRANS (improves plasma volume)

  • improve plasma volumes
  • low molecular weight dextran
  • high molecular weight dextran (less effective but long acting)
  • Gelatin
27
Q

What precautions should be made before giving dextrans?

A
  • blood samples for blood group & cross matching because it interferes with rouleaux formations of red cells
  • interfere with platelet function so it may precipitate abnormal bleeding
  • total volume of dextrans should not exceed 1000mL
28
Q

What are different types of blood given in transfusions?

A

AUTOLOGOUS BLOOD TRANSFUSION

  • from same patient to himself
  • in elective surgery

RECYCLED BLOOD
- blood sucked through sterile system & filtered & reused again in patient

ARTIFICIAL BLOOD

  • Perfluorocarbon (Fluosoleda): synthetic oxygen carrier
  • Stroma free haemoglobin

ERYTHROPOIETIN

  • injection 1000-3500 units preoperatively
  • increase RBC count
  • used in chronic renal failure patient who are on hemodialysis
  • given twice weekly but costly

Surgery M4 part 1 (47 decks)

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