Exam 3- Blood Therapy/Blood Transfusion Flashcards
(122 cards)
1
Q
What are the 4 components of blood:
A
Plasma
RBCs
WBCs
Platelets
2
Q
What makes up plasma?
A
Clotting factors
3
Q
What makes up platelets?
A
Thrombocytes
4
Q
What makes up the Buffy coat?
A
WBCs and Platelets
5
Q
Lifetime of RBC
A
100-120days
6
Q
Men WBC
A
5,000-10,000
7
Q
Women WBC
A
4,500-11,000
8
Q
Children WBC
A
5,500-15,500
9
Q
Newborn WBC
A
9,000-35,000
10
Q
Men Hb
A
14-18
11
Q
Women Hb
A
12-16
12
Q
Children Hb
A
9.5-15.5
13
Q
Newborn Hb
A
14-24
14
Q
Men Hct
A
42-52
15
Q
Women Hct
A
37-47
16
Q
Children Hct
A
32-44
17
Q
Newborn Hct
A
44-64
18
Q
Comparing Hb and Hct:
A
Hct is 3x Hb
19
Q
Men PLT
A
140,000-450,000
20
Q
Women PLT
A
140,000-450,000
21
Q
Children PLT
A
150,000-45,000
22
Q
Newborn PLT
A
150,000-450,000
23
Q
3 primary phases to create clot:
A
- Vascular spasm
- Formation of platelet plug (vWF)
- Coagulation (fibrin mesh creation)
24
Q
What is fibrinolysis?
A
Destroys the blood clot
25
What factors are NOT produced by liver:
8 and vWF
26
Genetic causes of hypo coagulation:
Hemophilia
| vWF disease
27
Genetic causes for hyper coagulation:
Factor 5 Leiden
| AT 3 deficiency
28
Platelet lifespan:
7-10 days
29
Dual Antiplatelet therapy (DAPT)
Aspirin + ADP/P2Y12 inhibitor
30
Prothrombin time (PT)
Reflects extrinsic pathway
31
Normal time for PT
11.5-14.5sec
32
What is INR?
Standardizes PT results
33
Normal INR time:
.8-1.2 sec
34
Partial Prothrombin Time (PTT)
Reflects intrinsic pathway
35
Normal time for PTT
24.5-35.2sec
36
Normal time for Thrombin time
22.1-31.2sec
37
Normal fibrinogen levels in plasma:
175-433 mg/dL
38
Normal time for activated clotting time:
70-180sec
39
Antibodies react against foreign antigens:
Compatibility test
40
Two main labs for compatibility testing:
1. Type and screen
| 2. Type and cross match
41
ABO-Rh type + antibody screen:
Type and screen
42
ABO-Rh type + cross match (mimics transfusion)
Type and cross match
43
How long does type and screen take:
45min
44
How long does type and cross match take:
1hr
45
Phase 1 of type and cross match:
Immediate phase (1-5min)
- ABO incompatibility
- AB
46
Phase 2 of type and cross match:
Incubation phase (30-45min)
- incomplete Ab that are bale to attach to Ag
- Ab from Rh system
47
Phase 3 of type and cross match:
```
Antiglobulin phase (60-90min)
-performed on blood with + Ab screen
```
48
EBV preterm neonate:
95ml/kg
49
EBV full-term neonate:
85ml/kg
50
EBV infant (1-12month):
80mg/kg
51
EBV men:
75ml/kg
52
EBV women:
65ml/kg
53
Allowable blood loss equation:
ABL= [EBV x (Hctinitial - Hcttarget)]/Hctinitial
| -vise versa for Hgb
54
What are the 5 blood products:
1. Whole blood
2. Packed RBCs
3. Platelets
4. Fresh Frozen Plasma
5. Cryoprecipitate
55
How much of PRBCs is in centrifuge:
250ml
56
How much of PLTs in centrifuge:
50-70ml
57
How long can PLTs be stored:
20-25*C for 5 days
58
What is frozen to create FFP?
Plasma
59
How is cryo created?
Slowly thaw FFP
60
After donation anticoagulation: CPDA-1
Citrate binds Ca
Phosphate is a buffer
Dextrose gives RBCs energy
Adenosine is precursor for ATP synthesis
61
Shelf life for whole blood:
35 days
62
4 risks with PRBCs:
1. Citrate toxicity
2. Hypothermia
3. Hyperkalemia
4. Decreased 2,3-DPG
63
When should RBCs be administered:
Hgb is < 6g/dL
| Blood loss is acute
64
What is FFP separated from ?
PRBCs/PLTs
65
How much does 1 unit of FFP increase clotting factors?
2-3%
66
Does FFP need ABO and Rh compatibility?
YES ABO
| NO Rh
67
4 indications for FFP:
1. Factor deficiencies
2. Reversal of warfarin therapy
3. Coagulopathy due to liver disease
4. Massive blood loss
68
FFP should be given in doses calculated to achieve a minimum of what?
30% of plasma clotting factor concentration
| -10-15ml/kg
69
3 indications for FFP:
1. Antithrombin III deficiency
2. Treat immunodeficiency’s
3. Treat thrombotic thrombocytopenia purpura
70
What is PLTs centrifuged from:
PRBCs/plasma
71
One unit of PLT increases PLTs by:
5,000-10,000/mm3
72
Is ABO compatibility needed for PLTs:
NO
73
2 indications for PLTs:
1. Thrombocytopenia
| 2. Dysfunctional PLTs
74
How is cryoprecipitate received?
After FFP is thawed slowly
75
Volume approx of cryo:
10-20ml
76
What does cryo have:
Factors 8,13, vWF, fibrinogen
77
One unit of cryo increases fibrinogen by:
5-7mg/dL
78
3 indications for cryo:
1. Factor 8 deficiency
2. Hemophilia A
3. Fibrinogen deficiencies
79
When is cryo indicated because of fibrinogen concentration:
Less than 80-100mg/dL
80
What 5 things are checked before blood administration:
1. Name
2. Hospital ID number
3. Blood type
4. Expiration date
5. Product number
81
What type of fluid is used for blood administration:
Normal saline
82
Why not LR for blood administration:
Ca binds citrate leading to blood clotting
83
What guage is used for adults and peds in blood administration:
Adult: 20ga
Peds: 24ga
84
If blood type is unknown and is emergency transfusion what should be given until cross match complete:
O- PRBCs
85
What labs show DIC (3):
1. Decreased PLTs/fibrinogen
2. Prolonged PT/PTT/INR
3. Increased D-dimer
86
How to begin treating DIC:
1st treat underlying disease process
87
Most concerned hepatitis viral infections:
Hep b
| Hep c
88
Hep B exposure:
1 in 200,000
89
Hep C exposure:
1 in 1,900,000
90
HIV exposure:
1 in 1,900,000
91
HTLV exposure:
1 in 2,900,000
92
Bacterial rxns from RBC exposure:
1 in 250,000
93
Bacterial rnx from PLTs exposure:
1 in 25,000
94
What is acute destruction of tranfused RBCs (3):
1. Occur within 24 hr
2. Intravascular
3. ABO incompatibility
95
What is delayed destruction of tranfused RBCs (3):
1. Occur after 24 hrs
2. Extra vascular
3. Rh incompatibility
96
What does acute hemolytic rxns lead to (3)
1. Renal damage
2. DIC
3. Death
97
5 signs in acute hemolytic rxns anesthetize pt:
1. Tachycardia
2. Hypotension
3. Increased temp
4. Hemoglobinuria
5. Diffuse oozing
98
4 symptoms for delayed hemolytic rxn:
1. Malaise
2. Jaundice
3. Fever
4. Decreased Hgb
99
How is delayed hemolytic rxn diagnosed?
Coombs test
100
Febrile rxn characterized by:
Increase of >1*C within 4 hrs
101
Anaphylactic rxn cause by:
Typically in IgA-deficient pts with anti-IgA Abs
102
5 symptoms for anaphylactic rxns:
1. Hypotension
2. Tachycardia
3. Bronchospasm
4. Swelling
5. Hives
103
3 treatments for anaphylactic rxn:
1. Epi
2. Fluids
3. Steroids
104
What presents as non cardiac pulmonary edema similar to ARDS:
TRALI
105
Leading cause of transfusion-related mortality:
TACO
106
Blood products administered faster than CO
| -occur when source of bleeding controlled and provider continues to give blood products
TACO
107
Class 1 hemorrhage:
Loss of 5% of blood volume or less
108
Class 2 hemorrhage
15-30% blood volume loss
| -sympathetic; HR and DBP increase
109
Class 3 hemorrhage
30-40% loss of blood volume
110
Class 4 hemorrhage
>40% loss
| -needs blood now or will die
111
How much blood loss needs a massive transfusion:
>150ml/hr
112
4 variables for assessment of blood consumption score:
HR >120 BPM
SBP <90mmHg
Positive FAST (fast assessment with sonography)
Penetrating injury
113
How many pt scores is need to have massive blood transfusion:
Two or greater
114
When does tranexamic acid need to be given:
Early, within 3hrs of injury
115
Goals for SBP:
80-100
116
Goals for temp:
>35*C
117
Goals for Hb:
>7
118
Goals for pH:
>7.2
119
Goals for BE:
>-6
120
Point of care test that can assess whole blood coagulation time:
Thromboelastography (TEG)
121
5 complications of massive transfusion:
1. Hyperkalemia
2. Coagulopathy
3. Citrate toxicity
4. Hypothermia
5. Acid-base balance
122
Pt donates own blood prior to surgery
Autologous transfusion
