Topic 7 - Blood conversion Flashcards Preview

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Flashcards in Topic 7 - Blood conversion Deck (54):
1

Average units of blood used during heart surgery?

6 units of blood
6 units of platelets

2

Average units of blood used during organ transplant?

40 units of blood
30 units of platelets
20bags of Cryo
25 units FFP

3

% of open heart patients require transfusions

30-70%

Leads to 2-4 donor exposures

4

% of RBC units transfused in US occur during
CABG procedures

10%

5

Blood transfusions can lead to complications?

Lead to complications–post op infections, ventilator-acquired pneumonia, central line sepsis, Increased LOS, mortality rates

6

Blood transfusions Infectious risks (3)

Bacterial
Hepatitis
HIV

7

Blood transfusions non-Infectious risks (8)

-febrile reactions
-uticarial (allergic) reactions
-anaphylactic reactions
-acute hemolytic reactions
-volume overload
-hypothermia
-citrate toxicity
-potassium effects

8

Febrile reactions

-non infectious
-Pt antibodies are reacting with white cell antigens or white cell fragments in the transfused blood products.
OR-due to cytokines which accumulate during storage.
-Most common with platelet transfusions

9

uticarial (allergic) reactions

-non infectious
-1%
-Urticaria, itching , flushing
-Caused by foreign proteins

10

Anaphylactic Reactions

- non infectious
--Hypotension, tachycardia, cardiac arrhythmia, shock, cardiac arrest
--caused by patients who have IgA deficiency who have anti-IgA antibodies.
--Require special washed/ tested blood products

11

Acute Hemolytic Reactions

Symptoms?

-Non infectious
-Caused by transfusion of ABO incompatible blood
-Chills, fever, pain, hypotension, dark urine,
uncontrolled bleeding due to DIC

12

Hypothermia

-non infectious risks
Caused by transfusion of too many cold blood products

13

Citrate Toxicity

-non infectious risks
-Metabolized by liver
-Rapid transfusion of large quantity of blood products
-Binds calcium and magnesium–depleting stores
-Myocardial depression
-Coagulopathy

14

Potassium effects from bagged RBCs

-non infectious risks
-Stored RBC leak K+
-Irradiation increased the rate of leak ( irradiation is
the process or fact of irradiating or being irradiated)
-Cardiac effects

15

TRALI (transfusion related acute lung injury)
-- symptoms

-Similar to ARDS
-Hypotension, Fever, Dyspnea, Tachycardia

16

TRALI occurs within what time frame and how often?

-Occurs within 6 hours of tx
Most cases present w/in 1-2 hours
-Occurs 1/2000 transfusions

17

TRALI (transfusion related acute lung injury)

Non-Cardiogenic pulmonary edema with diffuse bilateral pulmonary infiltrates on CXR

18

TRALI attributed to?

Pathophysiology: Unclear.
Attributed to HLA Antibodies, Granulocyte
antibodies and biologically active mediators in the blood

19

TRALI treatment?

Treatment: Ventilator support for ~96 hours
Mortality: 5-10%

20

MULTIMODALITY and MULTIDISCIPLINARY
approach to patient care without the use of allogenic blood

Bloodless medicine
Transfusion Free

21

Blood conservation

Global concept aimed at reducing patient exposure to allogenic blood products. Does not exclude use

22

Surgeon Gerald Klebanoff (Vietnam Vet) introduced

the first cell saver in a military hospital

23

Recombinant Factor VIIa

For Hemopheliacs
Israeli army discovered potential to stop life
threatening hemorrhage

24

tolerance of anemia is ___ dependent

Age dependent
Elderly don’t tolerate
As age increases, risk of transfusion increases

25

Gender and transfusion

women are more likely than men to get
transfused
Lower hct and prone to blood loss with menses

26

Weight and Height affect on tranfusion?

Small patients and obese patients are at risk for transfusion

27

Pre-Op lab work

Hgb
PT/INR / PTT
Platelet Count and Platelet Function Tests

28

Treat Polycythemia pre-op

Risk of hemorrhage during surgery (hyperviscosity)
Plebotomy

29

Pre-op pharmacological coagulopathies to avoid ? (7 ish)

Drugs (not anticoagulants) than have increased
bleeding risk
NSAIDs, PCN, NTG, High dose Vitamin C, St. John’s Wort, Ginger, Garlic, etc.

30

Fluid administration

Restrict until surgical hemostasis is achieved
Intravascular pressure is not too high

31

Autologous Donation

Donation where the donor and recipient are
identical
-Patient donates blood to be used on themselves during surgery.
-Avoids use/ risks of donor blood
-May not be practical or cost effective for most cardiac surgeries

32

pre-op autologous donation avoided
unless at least ...

2 weeks/unit of blood removed to regenerate lost RBC

33

Autodonation requires a hematocrit of what?

Requires a hematocrit of 33%

34

Autodonation contraindications (7)

Recent MI
CHF
Aortic Stenosis
Transient Ischemic Attacks
Hypertension
Unstable Angina
Bacteremia

35

Plateletpheresis and Plasmapheresis in Autodonation

Allows the donation of platelets and plasma

36

Prebypass autologous normovolemic hemodilution
- hct%

requires a hct of 35%

37

Prebypass autologous normovolemic hemodilution
-- removes how many mls? depending on what?

about 500-1000mL (1-3 units)

Depends on starting hct
Depends on age of patient
Depends on BSA
Depends on coexisting conditions

38

Prebypass autologous normovolemic hemodilution

-Used to remove blood from the patient pre-bypass for transfusion later in the case
-Removed volume is replaced with crystalloid

39

Prebypass autologous normovolemic hemodilution
-- Contraindications (7)

COPD
CHF
CAD
Unstable Angina
Renal Insufficiency
Severe Aortic Stenosis
Coagulopathy

40

Prebypass autologous normovolemic hemodilution
-- reinfused when?

Reinfused after protamine is administered

41

retrograde autologous priming

Performed prior to bypass
Arterial and venous cannula are in place
Use the patient’s blood pressure to displace
prime.

42

retrograde autologous priming
-- Remove prime via: (3)

-Stopcock on ALF
-Arterial sampling manifold
-Y’s in circuit

43

Dry venous line technique
-- how?
-- how much volume?

Venous line is emptied prior to connection to
the venous cannula
Volume is removed to a bag and discarded or
sequestered
Eliminates about 400-1000mL

44

Dry venous line technique
--- Only works if

Only works if patient has adequate volume pre-op

45

Mini Circuits do? (3)

Decreases foreign surface area
Decreases prime volume
Decreases blood-air contact

46

Mini Circuit attempt to ? (3)

Decrease hemodilution
Decrees inflammatory response
Decrease volume shifts

47

Mini Circuits is a ?

Closed A-V Loop with centrifugal pump, membrane oxygenator, coated tubing
- No venous reservoir
- No cardiotomy
- Often no heat exchanger or arterial line filter
Centrifugal pump provides kinetic assisted venous drainage and blood flow

48

Mini Circuits prime volume ?

Prime volume is about 500mL
◦Can be decreased with RAPing

49

Mini Circuits used mostly for what procedures?

CABG

50

Mini Circuits
-- 2 Types

Totally Integrated Devices
Combination of components

51

Mini Circuit: Totally Integrated Devices

Include air handling and elimination systems,
centrifugal pump and membrane oxygenator.
CorX (Cardiovention)
Cobe Synergy

52

Mini circuit: Combination of components

MECC System (Jostra)
MCPB
DeltaStream ERP (Medos)
Resting Heart System (Medtronic)

53

Mini circuit
Benefits: (5)

Less inflammatory reaction
Less activation of coagulation and fibrinolysis
Less hemodilution
Less use of autologous blood
Marginally improved renal and neurological function

54

Mini Circuit
variables impacting outcomes: (5)

steroids
Aprotinin
degree of heparinization
type of tubing coating
patient population