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Flashcards in Surgery 2.2b - Sheet1 Deck (69):
1

Question

Answer

2

What type of blood is used for emergecy situations?

Type "O" blood

3

If >4 U transfused, what is there increased risk of?

Hemolysis

4

Autologous Transfusion: up to how many U?

Up to 5 U

5

1st U: How many days before?

4 days before

6

Last U: How many days before?

3 days before

7

Blood donors: Hgb > how many g/dL?

Hgb > 11 g/dL or if Hct > 34%

8

How long is the shelf life of banked whole blood?

42 days. Banked whole blood was once the gold standard

9

During storage: reduction of intracellular ADP and 2,3-diphosphoglycerate (2,3-DPG) does what?

Alters oxygen dissociation curve of haemoglobin --> decrease in oxygen transport!

10

What are Stored RBCs?

Acidotic with elevated levels of lactate, potassium, and ammonia

11

What is the product of choice for most clinical situations requiring resuscitation?

Red Blood Cells

12

What product is used for patients who are known to have been previously sensitized (but is not currently available for use in emergencies, as the thawing and preparation time is measured in hours)?

Frozen Red Blood Cells

13

How are leukocyte-reduced/washed red blood cells prepared?

Prepared by filtration that removes about 99.9% of the white blood cells and most of the platelets

14

What do leukocyte-reduced/washed red blood cells do?

Prevents almost all febrile, non-hemolytic reactions, allowing to HLA class I antigens, and platelet transfusion refractoriness and cytomegalovirus transmission

15

What is caused by massive blood loss and replacement with platelet-poor products (inadequate production)?

Thrombocytopenia

16

Platelet concentrates are used for what?

Qualitative platelet disorders

17

What is the shelf life of platelet concentrates?

120 hours from time of donation

18

How much is 1 unit of platelet concentrate?

Approx. 50ml

19

Are platelet concentrates capable of transmitting infectious diseases?

Yes, and they account for allergic reactions

20

What is the therapeutic level?

50,000 to 100,000/uL

21

What are platelet concentrates for?

Chronic anemias, bone marrow, liver failure; Pre-op and post-op surgery; CHF, uremia

22

What is the usual source of vitamin K-dependent factors?

Fresh Frozen Plasma

23

Fresh frozen plasma is the only source of which factor?

Only source of factor V

24

What is the shelf life of fresh frozen plasma?

up to 5 days

25

What is fresh frozen plasma for?

Liver disease, warfarin overdose; DIC, TTP, [down arrow]CF d/t large volume transfusions

26

Name the indications for blood transfusions

Improvement in oxygen-carrying capacity; Treatment anemia; Volume replacement

27

The treatment of anemia

Hgb approaching 9 g/dL

28

Volume replacement

Blood loss can be evaluated by estimation in wound, drapes, sponges, suctioned

29

Describe the study that verified this

A prospective randomized controlled trial in critically ill patients that compared a restrictive transfusion threshold to a more liberal strategy

30

What did the study demonstrate?

It demonstrated that maintaining hemoglobin levels between 7 and 9 g/dL had no adverse effect on mortality. In fact, patients with APACHE II scores of <20 or patients age <55 years actually had a lower mortality.

31

Loss of <20% blood -->

Crystalloid solution

32

Loss of >20% blood -->

Additional packed RBC

33

Massive transfusion -->

Addition of fresh frozen plasma

34

What is the rationale for new concepts in resuscitation?

In civilian trauma systems, nearly half of all deaths happen before a patient reaches the hospital, and many are nonpreventable. Patients who survive to an emergency center have a high incidence of truncal hemorrhage, and deaths in this group of patients may be potentially preventable.

35

Truncal hemorrhage patients in shock often present with what?

The early coagulopathy of trauma in the emergency department. They are at significant risk of dying.

36

What are the three basic components of damage control resuscitation?

Red Blood Cells; Plasma; Platelets

37

In Iraq and Afghanistan, what was the variation of plasma:platelet: red blood cell ratios?

They varied from 1:1:1 to 0.3:0.1:1, with corresponding survival rates ranging from 71% to 41%

38

A recent prospective observational study evaluating current transfusion practice at 10 Level 1 centers documented what?

The wide variability in practice and improved outcomes with earlier use of increased ratios of plasma and platelets

39

79 patients receiving ratios less than 1:2 were how many times more likely to die than patients with ratios of 1:1 or higher?

4 times

40

What are febrile nonhemolytic reactions?

Increase in temp >1degree C associated with a transfusion (1% of transfusions)

41

What are some bacterial contaminations of infused blood?

Yersinia enterocolitica, Pseudomonas

42

What to do in the case of bacterial contamination of infused blood?

Emergency! Discontinue transfusion ASAP; Oxygen, adrenergic blocking agents, antibiotics

43

What percentage of transfusions result in allergic reactions?

1%

44

What are the symptoms of an allergic reaction during transfusion?

Mild rash, urticaria and fever within 60-90 minutes of the start of transfusion

45

What is the treatment for mild allergic reaction?

Antihistamines

46

What is the treatment for severe allergic reaction?

Steroids or epinephrine

47

What are respiratory complications associated with?

Transfusion-associated circulatory overload

48

When do respiratory complications occur?

Occur with rapid infusion of blood, plasma expanders, crystalloids especially in older patients with heart disease

49

What are the symptoms of respiratory complications?

Rise in venous pressure, dyspnea, cough, rales in LLF

50

What is a transfusion-related acute lung injury (TRALI)?

Noncardiogenic pumonary edema related to transfusion

51

When can a TRALI occur?

Occurs with administration of any plasma-containing blood product

52

What are the symptoms of TRALI?

Fever, rigors, bilateral pulmonary infiltrates on CXR

53

When can TRALI occur?

Within 1-2 hours after onset of transfusion (before 6 hours)

54

What is the cause of acute hemolytic?

Administration of ABO-incompatible blood

55

In what percentage of cases is acute hemolytic fatal?

6%

56

What commonly leads to the administration of ABO-incompatible blood?

Technical or clerical errors

57

What are the symptoms of immediate hemolytic?

Intravascular destruction of RBCs and consequent hemoglobinemia and hemoglobinuria; acute renal insufficiency d/t toxicity associated with free Hgb in the plasma; tubular necrosis and precipitation of Hgb in tubules

58

When could delayed hemolytic reaction occur?

Occur 7-20 days after transfusion

59

What are the symptoms of a delayed hemolytic reaction?

Extravascular hemolysis, mild anemia, indirect hyperbilirubinemia; low antibody titer at time of transfusion but titer increases after transfusion; anamnestic response

60

What diseases can be transmitted through transfusion?

Malaria (P. malariae), Chagas' disease, Brucellosis, Syphilis, CMV infection

61

What to look for in careful review of the patient's history?

Abnormal bleeding/bruising, drug use

62

A platelet count > 1 M / uL could lead to what?

Bleeding or thrombotic complications

63

A platelet count < 100 T / uL will require what?

Major surgical procedures

64

A platelet count < 50 T / uL will require what?

Minor surgical procedures

65

A platelet count < 20 T/ uL will result in what?

Spontaneous bleeding

66

PT Column

For: Vit K def; warfarin therapy...VII...X, V, II (prothrombin), Fibrinogen

67

aPTT Column

For: heparin therapy...XII...HMWK...Prekallikrein...XI...IX...VIII...X, V, II (prothrombin), Fibrinogen

68

INR Column

Measured PT divided by Control PT...N:2-3

69

BT Column

Ivy Test...Bleeding must stop in 7 minutes