Spring 2024 (Exam II)-Blood Products and Transfusion Flashcards
(92 cards)
1
Q
What is blood comprised of primarily?
A
Plasma
2
Q
What percentage of blood volume is made up by plasma?
A
55%
3
Q
Which blood product has a ↑ risk of infection and why?
A
- Pooled packs d/t being from multiple donors. (Platelets and Cryo are pooled from multiple donors)
4
Q
If we had to pick one thing to transfuse what would it be?
A
- whole blood
5
Q
What blood type is a universal donor? Universal acceptor?
A
- Donor = O -
- Acceptor = AB +
6
Q
Which patient is the potential exception to accepting blood from an O+ donor?
If we have to, how can we compensate for this?
A
- Pregnant women who are O- (Rh-), may have problems with the fetus
- Rhogam
7
Q
What are 2 Hb related issues we will see often in clinical settings?
A
- β thalassemia → Hb Barts
- α thalassemia → Hb H
8
Q
What are the possible blood antigen types? What are possible Rh factors?
A
- Antigen → A B AB O
- Rh → Rh+ and Rh-
9
Q
What are the different blood types? What antigens are present on erythrocytes? Serum?
A
Blood type; erythrocyte; serum
* O; none; Anti-A, Anti-B
* AB; A and B; none
* B;B; Anti-A
* A; A; Anti-B
10
Q
Is the general population primarily Rh+ or Rh- ?
A
Rh+ (85%) and Rh- (15%)
11
Q
What 4 things can cause a right shift of the OxyHb curve?
A
- ↓ pH
- ↑ CO2
- ↑ temp
- ↑ 2,3-DPG
12
Q
T or F: If our O₂ saturation is good so is our PO₂?
A
- False → O₂sat has nothing to do with PO₂ (could have 1 Hb fully saturated; ex. anemia)
13
Q
AB donor blood will react with which other blood types?
A
- A, B, and O
slide 7
14
Q
B donor blood will react with which blood types?
A
- A
- O
slide 7
15
Q
A-donor blood will react with which blood types?
A
- B
- O
slide 7
16
Q
O donor blood will react with which blood types?
A
- none
slide 7
17
Q
When whole blood is centrifuged what separation products result?
A
- Platelet rich plasma (PRP)
- WBC
- RBC
slide 10
18
Q
Blood component preparation based on different specific gravities?
A
- RBC 1.08-1.09
- Platelet 1.03- 1.04
19
Q
What happens if we centrifuge platelet rich plasma (PRP) again?
A
- Centrifuge PRP again → Separates plasma from platelets
slide 10
20
Q
Where is PRP used in surgery?
A
- Surgeon injects locally → ortho, dental, plastics cases commonly
21
Q
What are the 5 different blood components we can use for treatments?
A
- RBC
- FFP
- Cryo
- PLT
- LTOWB - Low titer Group O Whole Blood
22
Q
What is the lifespan of WB?
A
~ 3 wks
23
Q
What chemicals are added to blood that allows it to be stored?
A
CPDA-1 → Citrate phosphate dextrose adenine
* Citrate → chelates Ca++ to prevent clotting
* Phosphate → used as buffer
* Dextrose → fuel source
* Adenine → to support ATP synthesis (extends storage from 21 to 35 days)
slide 13
24
Q
Due to the chemicals used to allow blood to be stored, what labs do we need to check when transfusing lots of blood?
A
- Ca++ (it will ↓)
- Blood Glucose (it will ↑)
- K(it will ↑)
25
Which electrolyte will stored blood always have ↑ levels of? Why?
* K+ d/t cells lysing as they degrade in the bag
26
What happens to 2,3-DPG in stored blood?
What does this do to the OxyHb association curve?
* ↓ 2,3-DPG
* Left shift → impairs O2 delivery
slide 14
27
PRBCs contain _______ unless they have been specifically ________?
* Leukocytes (WBCs)
* Leukoreduced
28
PRBC facts
* volume 200-350 mL
* no functional platelets/ granulocytes
29
What are PRBCs and how much does 1 unit of PRBCs ↑ H&H level?
* PRBCs are dervied from whole blood from which the plama has been removed
* Hb: ↑ 1 g/dL; Hct: ↑ 3%
slide 14
30
Whichblood product is this?
* volume 200-250 mL
* expires 12 months
* contains proteins which may affect volume distribution or how pts process medications
FFPs
31
Which blood transfusion product is a source of antithrombin III?
FFP
32
What is the dose of FFP?
* 10-15 mL/kg
33
How much will 1 unit of FFP ↑ level of each clotting factor?
* ↑ 2 to 3% for each factor
34
What are the indicated uses of FFP ?
* Correction of inherited factor deficiences
* Correction of aquired multi-factor deficinces with clinical evidence of bleeding or anticipated surgery/ invasive procedure
* Liver dysfunction
* DIC
* Microvascular bleeding with blood loss > 1L
** Reversal of vitamin K agonists (Warfarin)**
* Heparin resistance d/t antithrombin deficiency
* Treat angioedema (also use TXA along with FFP)
35
What is the INR of FFP?
* 1.5 to 1.8
36
What is Cryoprecipitate?
What clotting factors does cryoprecipitate have?
The protein fraction that is taken off the top of the FFP when being thawed.
* Factor VIII: C
* Factor VIII: vWF
* Factor XIII
* Fibrinogen
slide 18
37
What target of fibrinogen are we trying to maintain when using cryo?
100 mg/dL
38
How much will two units of cryo raise fibrinogen levels?
* 2 bags of cryo/10 kg body weight = **100 mg/dL ↑ in fibrinogen**
*except in DIC or continued bleeding with massive transfusion*
39
Clinical indications for use of Cryo?
Which patient population is cryo really important for?
* See chart
* Pregnant women who are bleeding
40
How much will one unit of PLT increase PLT count by?
* 5000 to 10000
41
Are there any contraindications for warming IV-administered fluids and blood products ?
No, it's a common practice.
*Except for platelet- which has no clinical data to support it but is listed as a contraindication in the operator's manual for the Level 1 fluid warmer*
slide 20
42
When platelets are low at what level will we start to spontaneously bleed?
PLT < 30000
43
Indications for Plt transfusions?
* Invasive procedures need >/= 50
* stable pts without evidence of bleeding/ coagulopathy <10
* stable pts with evidence of bleeding/ coagulopathy <50
44
What are the 4 IV solutions we could use with blood transfusions?
* Electrolyte-R (preferred)
* Normosol
* Pasmalyte
* NS 0.9%
45
What is the deadly triad when transfusing a patient?
* Hypothermic
* Coagulopathic
* Acidotic (NS pH is 5.5)
46
When is WB indicated for transfusion?
* To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss )
slide 24
47
What are S/Sx of Hemolytic transfusion reactions?
* fever
* chill
* hemoglobinemia
* **hemoglobinuria (keep an eye on foley bag)**
* **hypotension**
* dyspnea (look for high airway pressure and RR)
48
What are the mediators of Hemolytic transfusion reactions?
IgM antibodies
*This is usually a result of the patient getting incompatible blood.*
49
What are the S/S of nonhemolytic febrile transfusion reactions?
Fever and chills
50
What are the mediators of non-hemolytic febrile transfusion reactions?
HLA Class I Ag antibodies
51
How do we treat Non-hemolytic febrile transfusion reactions?
* Antipyretics
* Use leukocyte reduced products
52
What are some S/S of an allergic transfusion reaction?
* urticaria
* erythema (blotchy red rashes)
* itching
* anaphylaxis.
53
What are the mediators of allergic transfusion reactions?
* plasma proteins
* IgA antibodies
54
How do we treat allergic transfusion reactions?
* antihistamines
* treat symptoms
55
What are S/S of Non-cardiogenic pulmonary transfusion reactions?
* **Noncardiogenic pulmonary edema** - from a minimal amount of blood transfused.
* ARDS
* Fever
* Chill
* Hypotension
* Cyanosis
focus on the pulmonary symptoms
* increases airway pressures
56
What are the mediators for a non-cardiogenic pulmonary transfusion reaction?
Recipient WBC antibodies
57
How do we treat Non-cardiogenic pulmonary transfusion reactions?
* Lots of PEEP (to force fluid back across the membrane)
* Steroids
58
What is TRALI?
**T**ransfusion **R**elated **A**cute **L**ung **I**njury - temporarily r/t to blood transfusion within 1st 6 hrs of a transfusion
slide 31 (read notes section)
59
What types of blood products is TRALI most associated with this?
* Mostly with FFPs and PLTs
* some reports with PRBCs since there is some residual plasma
60
What are the acute nonimmunologic effects of transfusion reaction?
Nonimmunologic
* Bacterial contamination (give abx)
-- s/s fever, shock, hemoglobinuria
* **T**ransfusion **A**ssociated **C**irculatory **O**verload **(TACO)**
--see other card for s/s
--tx administer subsequent Tx slowly & in small volume
* Hemolysis d/t physical /chemical means
--s/s hemoglobinuria
61
What are the delayed immunologic effects of transfusion reaction?
* Hemolytic transfusion reactions (Decrease Hgb value, Ig negative blood for future reactions.)
--s/s shortened RBC survival, decreased Hb, fever, jaundice, hemoglobinuria
* Transfusion-associated Graft-versus-host disease (N/V, Pancytopenia)
--s/s fever, skin rash, desquamation, anorexia, n/v/d, hepatitis, pancytopenia
* Post-transfusion purpura (Oozing--sterioids, IV Ig)
--MOA platelet specific A/b
--s/s thrombocytopenia, clinical bleeding
62
Criteria for TRALI?
* Acute onset hypoxemia
* Ratio of PaO2/ FiO2 <300 or SpO2 <90% on RA
* Occurs within 6 H of transfusion
* B/L diffuse pulmonary infiltrates
* no evidence of LA hypertension (i.e. circulatory overload)
slide 32
63
Transfusion Associated Circulatory Overload (TACO) s/s?
* coughing
* cyanosis
* orthopnea
* severe headache
* peripheral edema
* dyspnea
Symptom based treatments
64
Immediate Management of TRALI?
* Stop the transfusion immediately
* Support the patient
* If intubated, obtain undiluted edema fluid and simultaneous plasma for determination of total protein (within 15 min)
* CBC/ CXR
* Notify blood bank
* may require ECMO
65
What are some quick ways to differentiate between TRALI and TACO? (This is very cut down from the main list)
* TRALI → Fever and ↓BP (Immunologic Response)
* TACO → HTN, ↑JVP, ↓ EF (Fluid Overload)
66
What are the delayed nonimmunologic effects of blood transfusion reactions? MOA, S/S, Tx?
* Transfusion-Induced Hemosiderosis
* MOA: Iron overload
* s/s: subclinical death
* Tx/ Prevention: decreased frequency of transfusion, neocytes, iron chelation therapy
slide 41
67
What classes of hemorrhage are there and what is associated blood loss for each?
* Class 1 = up to 750 mL (< 15%)
* Class 2 = 750 to 1500 mL (15-30%)
* Class 3 = 1500 to 2000 mL (30-40%)
* Class 4 = > 2000 mL (>40%)
68
Which classes of hemorrhage require blood transfusions?
* Class III and Class IV
69
What are 3 definitions of Massive Transfustion Protocol (MTP) in Adults?
* Total blood volume is replaced within 24 hours
* 50% of total blood volume is replaced in 3 hours ← Most common
* Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss
70
What is considered MTP for Kids?
* > 40mL/kg transfusion
71
What is balanced resuscitation?
* 1:1:1 ratio (PLT:Plasma:RBC)
72
What are the fibrinogen levels of Cryo, FFP, and LTOWB?
* Cryo = 2500 mg
* LTOWB = 1000 mg
* FFP = 400 mg
73
What is the difference between stored whole blood (SWB) and LTOWB?
* SWB amount of anticoagulants < LTOWB
* SWB is preffered resuscitation product
* LTOWB is universal donor
74
What are the recommendations for whole blood transfusion in kids?
* If they are <15 yr old or <40 kg then limit WB to 30 mL/kg
* few studies in pediatric pts; no established clinical data
75
Which clotting factors required Ca++ to work?
* 2,7,9,10 as well as proteins C and S
* Ca stabilizes fibrinogen and plateles in the developing thrombus
76
Which drug has more elemental calcium; Ca gluconate or CaCl?
* CaCL 10% contains 270 mg/10mL (vs 90 mg/10ml for gluconate)
*Citrate (additive for stored blood) is processed by the liver; if liver is not functioning properly, increased citrate levels results in slower release of ionized Ca2+*
77
How much will 1, 2, and 5 units of blood decrease iCa?
* 1 unit drops to 1.13 mmol/L
* 2 unit drops to < 1mmol/L
* 5 units drops to < 0.8 mmol/L
78
What is the value for TEG-ACT?
* 80-140 sec
79
What is R and the normal value for R time?
* Reaction time, first significant clot formation
* 5.0 - 10.0 min
80
What is K and the normal value for K time?
* Achievement of certain clot firmness
* 1-3 minutes
81
What is the α angle and the normal value for α angle?
* measures kinetics of clot development
* 53 - 72°
82
What is MA and the normal value for MA?
* Max strength of the clot
* 50-70mm
83
What is G and the normal value for G value?
* Measures entire coagulation cascade
* 5.3-12.4 dynes/cm2
84
What is the LY 30 and the normal value for LY 30?
* Percent lysis 30 min after MA (max strength of clot)
* 0-3%
85
If TEG-ACT is > 140 what do we transfuse?
* FFP
86
If R time is > 10 what do we transfuse?
* FFP
87
If K time is > 3 what do we transfuse?
* Cryo
88
If α angle < 53° what do we transfuse?
* Cryo and platelets
89
If MA < 50 what do we transfuse?
* PLT
90
If LY30 > 3% what do we transfuse?
TXA (Tranexamic Acid)
91
EKG changes with hypocalcemia?
* narrowing QRS
* reduced PR interval
* T-wave flattening and inversion
* QT prolongation
* Prominent U wave
* Prolonged ST and ST-depression
92
EKG changes with hyperkalemia?
* Wide, low amplitude P-waves
* Wide QRS with fusion of QRS-T and loss of ST segment
* Tall tented T-waves
