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Health Assessment > Blood Transfusion and Blood Products (Exam 2) > Flashcards

Blood Transfusion and Blood Products (Exam 2) Flashcards

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1
Q

What is the Composition of Blood?

A
  • Plasma 55%
  • Formed Elements 45% ( platelets, leukocytes, erthrocytes)
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2
Q

What Blood type is the Universal Donor? What Blood type is the Universal acceptor/recipient?

A
  • Donor: O negative
  • Recipitent: AB postive
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3
Q

How many varieties of Hemoglobin structures are there?

A
  • Many per Dr Cornelius
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4
Q

Name the Blood Type Antigens.

A
  • Antigens: A, B, AB, O
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5
Q

What are the normal blood type Rh factors and their percentages?

A
  • Rh+ = ~85%
  • Rh- = ~15%
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6
Q

What is the largest component of whole blood?

A

Plasma

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7
Q

What is the Primary job of the Red blood cell?

A
  • Oxygen transportation
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8
Q

What is a common cause of hypoxia?

A
  • Anemia
  • Not enough red blood cells to transport oxygen.
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9
Q

Blood Type O: Erythrocyte Antigens and Serum Antigens

A
  • Erythrocyte: None
  • Serum: Anti A&B
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10
Q

Blood Type AB: Erythrocyte Antigens and Serum Antigens

A
  • Erythrocyte:A&B
  • Serum: none
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11
Q

Blood Type B: Erythrocyte Antigens and Serum Antigens

A
  • Erythrocyte: B
  • Serum: Anti A
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12
Q

Blood Type A: Erythrocyte Antigens and Serum Antigens

A
  • Erythrocyte: A
  • Serum: Anti-B
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13
Q

Blood Compatibility

A
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14
Q

Whole Blood Transfusion: Contents and Uses

A
  • All cells, platelets, clotting factors and plasma
  • Uses: replace blood loss from hemorrhage
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15
Q

Packed Red Blood Cell Transfusion: Content and Uses

A
  • Content: Red blood cells and some plasma
  • Uses: Replace red blood cells in anemic patients.
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16
Q

Platelet Transfusion: Contents and Uses

A
  • Contents: Thrombocytes and some plasma
  • Uses: replace platelets in patients with thrombocytopenia
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17
Q

Fresh Frozen Plasma (FFP) Transfusion: Contents and Use

A
  • Content: plasma, combination of fluids, clotting factors, and proteins
  • Uses: Replace volume in a burn patient or hypovolemic
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18
Q

Clotting Transfusion: Contents and Uses

A
  • Contents: Specific clotting factors needed for coagulation
  • Uses: Replace factors missing due to inadequate production as in hemophilia
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19
Q

What is the specific gravity of RBC?

A

1.08 - 1.09

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20
Q

What is the Specific Gravity of Platelets?

A

1.03 - 1.04

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21
Q

If you centrifuge whole blood what layers will everything settle into (top to bottom)?

A
  • Platelet Rich Plasma
  • WBC
  • RBC
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22
Q

What component of blood is used in localized surgical applications – ortho, dental, plastics?

A
  • Platelet Rich Plasma
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23
Q

What are the (5) Blood Component Therapies?

A
  • RBC
  • FFP
  • Cryo
  • Plt
  • LTOWB - Low Titer O Whole Blood
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24
Q

What was the blood transfusion of choice from WWI –> Vietnam War?

A
  • Whole Blood
  • Primary resuscitation fluid in military settings.
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25
What was the blood transfusion of choice from 1970s --> 1990s?
* Component therapy * Reduced waste + increased storage times * Worried about infectious disease
26
What was the blood transfusion of choice for Iraq and Afghanistan?
* Fresh Whole Blood
27
What is the shelf-life for whole blood?
3 - 5 weeks
28
What is added to blood for shelf storage?
*** Citrated - clotting** * Phosphate - buffer * dextrose - fuel source *** Adenine -- synthesis ATP**
29
What happens to blood the longer it is stored?
* lowers levels of 2,3 -DPG * shifting the oxyhemoglobin dissociation curve to the left * impairs oxygen delivery
30
What is the difference between PRBC and Whole Blood?
* Plasma has been removed in PRBC * PRBC does not contain functional platelets or granulocytes
31
How much Plasma has been removed from Whole Blood to create Packed Red Blood Cell?
* 200 -250 ml of plasma
32
What does 1 unit of PRBC raise your Hgb and Hct? | **
* Hbg: 1 g/dL * Hct: 30%
33
What has a better oxygen carrying capacity: Whole blood or PRBC?
They are the same for oxygen carry capacity.
34
What blood product is a source of antithrombin III?
Fresh Frozen Plasma
35
What does 1 unit of FFP do to your clotting factors?
* Increases each clotting factor by 2-3 % in adults.
36
What is the dose of FFP and what is the volume in a bag of FFP?
* 10 - 15 ml/kg * 200-250 ml/bag
37
What is the storage temperature for FFP and what does it contain?
* -18 C * water, carbohydrates, fat, minerals, * **Proteins (labile and stable clotting factors)**
38
What is used as the guide to infusing FFP?
* INR > 1.5
39
Indications for Use of FFP
* inherited factor deficencies * multifactor deficiencies w/ bleeding * liver dysfunction * DIC * MTP * Reversal of Vitamin K anatagonists
40
Cryprecipitate
* Expensive * Protein fraction taken off the top of FFB when thawed * Refrozen for up to 1 year
41
Cryoprecipitate Contains:
* Factor VIII: C * Factor III: vWF * Factor XIII *** Fibrinogen**
42
Indication for the Use of Cryoprecipitate?
43
How much does 1 unit of Platelets increase platelet count?
* 1 unit increases platelets 5,000-10,000
44
What blood product should you not infuse through a warmer?
Platelets
45
When should blood products be infused through a warmer?
* Transfused at rapid rates > 100 mL/min * MTP/Rapid infusion * When pt is hypothermic or any drop in temp could cause hypothermia.
46
Indications for Platelet infusion.
* < 10,000 - 30,000 * < 50,000 for arterial line * < 70,000 for epidural
47
What is the IV fluid of choice for infusing blood products?
* Normosol * Plasmalyte * Normal Saline 0.9%
48
Indicators for Whole Blood Transfusion.
* maintain blood volume * O2 carrying capacity * acute massive blood loss * active bleeding > 20% of body blood volume
49
Acute Transfusion Complications
* immunologic * febrile nonhemolytic * allergic * non-cardiogenic pulmonary * nonimmunologic * bacterial contamination * circulatory overload * physical/chemical hemolysis
50
Delayed Blood Transfusion Complications
* immunologic * hemolytic * transfusion - associate graft vs Host disease * Post Transfusion Pupura * Transfusion- induced hemosiderosis * disease transfusion
51
Hemolytic Transfusion Reaction
* Mediators: IgM A/b (usually ABO), complement. * S/S: fever, chill, hemoglobinemia, hemoglobinuria, hypotension, dyspnea. * Treatment and Prevention: decrease opportunities for error, treat ARF & DIC. * Make sure right pt gets the right blood! ----> be cautious w blood tubes!
52
Nonhemolytic febrile transfusion reaction
* Mediators: A/b to HLA Class I Ag. * S/S: fever, chill. (rmbr may not be seen under anesthesia!) * Treatment and Prevention: antipyretics, leukocyte reduced.
53
Allergic Transfusion Reactions
* Mediators: plasma proteins (mild), A/B to IgA * S/S: **uticaria, erytherma, itching, anaphylaxis** * Treatment/Prevention: **Antihistamines, transfuse IgA - deficient components**
54
Noncardiogenic Pulmonary Transfusion Reactions | **
* Mediators: donor/recipiet WBC A/B * S/S: **ARDs,** cyanosis, hypotension, **Noncardiac pulmonary edema** * Treatment/Prevention: PEEP, steroids****
55
Transfusion Related Acute Lung Injury (TRALI)
* acute lung injury within 6 hours of transfusion. * difficult to diagnose * 1: 1300/5000 * 5-25% mortality
56
Criteria for TRALI
* Acute onset of hypoxemia * PaO2/FiO2 ratio: <300 or SPO2 <90 RA * B/L diffuse pulmonary infiltrates * no evidence of left atrial hypertension (circulatory overload)
57
Name the Disease
TRALI
58
TRALI Immediate Management
*** STOP THE INFUSION** * support the pt * ***obtain undiluted edema fluid ASAP*** (<15 mins) * CBC and CXR * **Notify Blood bank of possible TRALI**
59
What might TRALI patient require to survive?
ECMO
60
Blood Transfusion: Acute Nonimmunologic Effects
1. Bacterial Contamination 2. Circulatory Overload (TACO) 3. Hemolysis d/t physical/chemical means
61
Blood Transfusion: Bacterial Contamination
* Mediators: Endotoxin produced by Gram Negative Bacteria * S/S: fever, shock, hemoglobinuria * Treatment/Prevention: IV abx, treat hypotension, DIC
62
Blood Transfusion: Circulatory Overload (TACO)
* Mediate: Fluid Volume * S/S: Coughing cyanosis, orthopnea, severe headache, peripheral edema, difficulty breathing * Treatment/Prevention: administer susequent Tx slowly and in small volumes.
63
Blood Transfusion: Hemolysis d/t physical/chemical means
* Mediator: exogenous destruction of RBC *** S/S: hemoglobinuria** * Treatment/Prevention: document and role out hemolysis d/t other causes; treat DIC
64
Delayed Immunologic Effects: Hemolytic Transfusion Rxn
* Mediator: IgG A/B *** S/S: Shortened RBC survival, decreased Hbg, fever, jaundice, hemoglobinuria** * Treatment/Prevention: IG -negative blood for further transfusion
65
Delayed Immunologic Effects: Transfusion Associated Graft v Host Disease
* Mediators: viable donor lymphocytes * S/S: fever, skin rash, desquamation, **anorexia, nausea/vomiting, pancytopenia** * Treatment/Prevention: gamma irradiation of cellular components
66
Delayed Immunologic Effects: Post- transfusion purpura
* Mediators: platelet specific A/B * S/S:**thrombocytopenia, clinical bleeding** * Treatment/Prevention:**IV Ig, plasma exchange, corticosteroids**
67
S/S of TRALI
* Fever * Hypotension * Acute dyspnea * JVP unchanged * Ascultation - RALES * X-ray: diffuse bilateral lower infiltrates * EF Normal * Minimal response to diuretics
68
S/S: TACO
* No fever * Hypertension * Acute dyspnea * JVP can be changes * Rales + S3 * diffuse bilateral lower infiltrates * Decreased EF * Significant improvement with diuretics
69
Delayed Nonimmunologic Effects: Transfusion-Induced Hemosiderosis
* MOA: Iron Overload * S/S/: subclinical to death * Treatment/Prevention: decrease frequency of transfusions, neocytes, iron chelation therapy
70
What Steps do you need to follow if you believe your patient is having a Transfusion Reaction?
1. discontinue the transfusion 2. Keep the IV open 3. Check all labels, forms, and pt identification 4. Report to Blood bank personnel 5. Send requested blood samples
71
Class 1 Hemorrhage
* blood loss: 750 mL (15%) * Fluids: Crystalloid
72
Class 2 Hemorrhage
* blood loss: 750 - 1500 mL (15-30%) * Fluid Replacement: Crystalloid
73
Class 3 Hemorrhage
* Blood Loss: 1500-2000 mL (30-40%) * Fluid Replacement: Crystalloid and blood
74
Class 4 Hemorrhage
* Blood Loss: >2000 (>40%) * Fluid Replacement: Crystalloid and Blood
75
When do we normal start transfusing blood?
* 30% blood loss * ~ 1500 mL
76
What is the definition of MTP
* Total blood volume is replaced within 24 hours
77
What is the definition of MTP for Pediatrics?
* > 40 mL/kg transfusion
78
What is the current standard of care ratio of blood products at level 1 trauma centers?
* 1:1:1 * platelets: plasma: PRB
79
What are the downfalls to Blood component therapy?
* loss of coagulation factor + platelet function * Requires more product * Dilute blood mixtures
80
Whole blood: Hgb, Hct, Plt, fibrinogen/factors
* Hgb: 12-13 * Hct: 35-37 * Plt: 138-165 * F/F: Normal/>50% d7
81
Component blood (1:1:1): hgb,hct,plt, Fibringogen/factor
* Hgb: 9 * Hct: 28 * Plt: 90-120 * F/F: all 62% dilute, loss of F VIII
82
Why is Whole Blood superior?
* less dilution from anticoagulants and additives * Higher platelet count * Easier to store
83
If your fibrinogen levels are low, what should you transfuse?
* LTOWB - 1000mg * FFP- 400mg (longest to absorb) * Cryo - 2500 mg
84
How long can Whole Blood be stored?
21-35 days
85
What is LTOWB?
* Low Titer O Whole Blood * Universal donor
86
What Rh factor do we want to give to females of child bearing age?
* Rh negative
87
Why do we want to avoid given RH postive blood to females of child-bearing age?
* Increases the chance needing RhoGAM in the future
88
When transfusing Whole Blood to someone less than 15 yo or < 40 Kg, what is the transfusion limit?
* 30 mL/kg
89
What is calcium used to treat?
* hypocalcemia * long QTc * decreased Cardiac Output * coagulapathy * seizures
90
What percentage of trauma MTP are hypocalcemic?
* 97.4% * iCAl < 1.12 mmol/L
91
Why is calcium important?
* coagulation * platelet adhesion * contractility of Myocardial and smooth muscle * Required for clotting factors 2, 7, 9, 10
92
Where is Citrate metabolized?
Liver
93
How many grams of Calcium gluconate to equal 1 gram of Calcium Chloride?
* 3 grams gluconate = 1 gram chloride
94
Teg Interpretation: R,K, MA, Angle, Ly30
* R = long * K = firmness * MA = strength * Angle = Kinetics/signicance of clot * Ly30 = time
95
TEG: ACT (rapid)
* Normal: 80 - 140 seconds * Measures: Clotting factors
96
Teg R Time
* Normal: 5.0 - 10.0 * Measures: Clotting factors
97
TEG: K Time
* Normal: 1.0 - 3.0 * Measures: fibrinogen and platelet number
98
TEG: a angle
* Normal: 53- 72 * Measures: fibrinogen and platelet number
99
TEG: MA
Normal: 50 -70 Measures: platelet number and function
100
TEG: G value
* Normal: 5.3 - 12.4 dynes/cm2 * Measure: Entire coagulation cascade
101
TEG: Ly30
* Normal: 0-30% * Measures: Fibrinolysis
102
Treatment for TEG-ACT >140
FFP
103
Treatment for TEG: R time >10
FFP
104
Treatment for TEG: K time>3
Cryoprecipitate
105
106
Treatment for Alpha angel< 53
Cryo and platelets
107
Treatment for TEG MA <50
platelets
108
Treatment for Ly30 > 3%
Tranexamic Acid (TXA)

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