Week 2- Fluid Management and Blood Flashcards
(186 cards)
1
Q
What are the goals of perioperative fluid management?
A
Maintain sufficient circulating volume, prevent dehydration, avoid inadequate tissue perfusion
These goals are essential for patient safety and recovery.
2
Q
What percentage of the human body is made up of fluid?
A
46-80%
The percentage varies based on age, gender, and composition of muscle to fat.
3
Q
what are three variables that determine fluid compostion?
A
age
gender
composition of muscle to fat
4
Q
What is the ratio of intracellular water volume to extracellular water volume?
A
2:1
This ratio indicates that there is typically more intracellular fluid than extracellular fluid.
5
Q
What percentage of total body weight is water?
A
60%
This percentage varies with age, gender, and physical stature.
6
Q
What are the 2 components and sub-componets of TBW
A
Intracellular Volume
Extracellular Volume
* Intravascular Volume
* Interstitial Volume
Total Body Water also includes intravascular fluid (IVF) and interstitial fluid (ISF).
7
Q
How do you calculate total body water (TBW) for a male?
A
60% x weight in kilograms
For example, for a 70 kg male: 0.60 x 70 kg = 42 liters.
8
Q
What is the TBW % of
male
female
neonate
A
male- 60%
Female- 50%
Neonate- 75%
9
Q
What separates the fluid compartments in the body?
A
Water-permeable membranes
The cell membrane separates intracellular space from extracellular space, while capillary membranes separate intravascular from interstitial space.
10
Q
Fill in the blank: Total body water for females is _______.
A
50%
This percentage is lower than that for males.
11
Q
Fill in the blank: Total body water for neonates is _______.
A
75%
Neonates have a higher percentage of body water compared to adults.
12
Q
What separates the intracellular space from the extracellular space?
A
Cell membrane
The cell membrane is a water-permeable membrane that defines the boundaries of the cell.
13
Q
What further separates the extracellular space?
A
Capillary membrane
The capillary membrane divides the extracellular space into intravascular and interstitial spaces.
14
Q
What percentage of total body water is contained in the intracellular volume?
A
Two-thirds
Intracellular volume holds a substantial portion of the body’s water.
15
Q
What are the primary cation and anion found in the intracellular volume?
A
- Cation: Potassium (K+)
- Anion: Phosphate (PO4-)
These ions are crucial for various cellular functions.
16
Q
What drives the sodium-potassium pump?
A
Adenosine triphosphatase (ATPase)
ATPase is an enzyme that provides the energy for the pump’s activity.
17
Q
What does the sodium-potassium pump exchange?
A
Three sodium ions for two potassium ions
This exchange is essential for maintaining the high concentration of potassium in the intracellular fluid.
18
Q
What is the primary cation and anion found in the extracellular volume?
A
- Cation: Sodium (Na+)
- Anion: Chloride (Cl-)
These ions are key components of extracellular fluid balance.
19
Q
What are the two compartments of extracellular volume (ECV)?
A
- Intravascular compartment (plasma)
- Interstitial compartment (extravascular fluid)
The interstitial compartment contains fluid in tissue spaces.
20
Q
What fraction of ECV is the intravascular compartment?
A
One-fourth
The intravascular compartment is a smaller portion of the total extracellular volume.
21
Q
What fraction of ECV is the interstitial compartment?
A
Three-fourths
The interstitial compartment holds the majority of the extracellular fluid.
22
Q
What type of fluid does the transcellular fluid include?
A
- Intraocular fluid
- GI secretions
- Synovial fluid
- Cerebrospinal fluid (CSF)
Transcellular fluid is anatomically isolated from other extracellular fluid.
23
Q
What factors influence the movement of fluid between compartments?
A
- Membrane properties
- Concentration of substances
These factors determine how fluids distribute across compartments.
24
Q
How much does the extracellular volume account for TBW
A
1/3 of TBW
25
What percentage of total body water is intracellular?
55%
## Footnote
This represents the fluid contained within cells.
26
What percentage of total body water is extracellular?
45% total
27.5% is function ECF
* Intravascular: 7.5%
* Plasma: 5.5%
* Sub-glycocalyceal layer: 2%
* Interstitial: 20%
## Footnote
This includes all body fluids outside of cells.
27
What percentage of total body water is sequestered?
17.5%
divided into
* Bone and dense connective tissue: 15%
* Transcellular: 2.5%
## Footnote
Sequestered fluid refers to fluid trapped in compartments.
28
What is the main factor determining the movement of fluids across the capillary membrane?
what pressures do they include?
Starling Forces
## Footnote
These forces include capillary pressure, ISF pressure, ISF colloid osmotic pressure, and plasma colloid osmotic pressure.
29
What parameters are evaluated to assess intravascular volume?
* Patient history
* Physical exam
* Lab Values
* Hemodynamic Measurements
## Footnote
These assessments help determine the appropriate fluid therapy.
30
True or False: Intravascular space is the target of fluid therapy.
True
## Footnote
Clinicians alter this space during treatment.
31
Factors that affect intravascular volume that you should include in pt history
Factors that affect intravascular volume:
* Vomiting
* Diarrhea
* Oral intake
* Blood loss
* Wound drainage
* Gastric output via suctioning or NG tube
* IV fluids
* Dialysis
* Blood replacement
32
Factors that affect fluid balance
Affected by:
* NPO
* Vomiting
* Diarrhea
* Gastric suctioning
* Fever
* Lost by the GI tract
* Can lead to changes in electrolyte balance
* Ideal to correct before surgery
33
What is 3rd spacing
mvmt of fluid from intravascular to the interstitial space
can be from manipulation of tissue
34
Fluid Volume disorders are affected by the ________ of body fluids and ____________ of body fluids
volume
Concentration
35
Physical Exam of the hypovolemic patient..... what do they look like?
Thready peripheral pulses
* Dry mucous membranes
* Increased resting heart rate
* Decreased blood pressure
* Orthostatic hypotension
* Decreased urinary output
36
What is the difference between osmoLARITY and osmoLALITY
Osmolarity – “an expression of the number of osmoles of solute in a **liter of solution**”
* Osmolality – “Expresses the number of osmoles of solute in a **kilogram of solvent**”
37
Define Tonicity
how a solution affects the cell volume
38
Tell me what a hypertonic, isotonic, and hypotonic solution would do your cells
hypertonic- shrivel them and cause H20 to leave the cell
isotonic keeps them normal
Hypotonic- causes fluid to enter the cell and swell- can cause cell lysis
39
T/F: hypovolemia and dehydration is the same thing
False
Hypovolemia – loss of extracellular fluid
* Dehydration – insufficient water in relation to sodium
level
40
causes of hypovolemia
loss of fluid from the body
redistribution of water
41
examples of absolute and relative fluid loss....
Absolute fluid loss:
* Diaphoresis
* Increased urinary output
* GI tract
* NPO
* Relative fluid loss:
* Burns
* Third-spacing
42
what is hypervolemia and what are some possible causes of it
Excess of fluid
* Possible causes
* Disease:
* Cirrhosis of the liver, renal failure, CHF
* Iatrogenic (causes by medical treatment):
* Excessive IV fluids
* Steroids
* Patient: Increased sodium intak
43
how do you treat hypervolemia
diuretics
restrict the Na+
HD in the renal failure pt
44
what does the hypervolemic pt look like?
* Increased urine output
* Edema
* Congestive heart failure
* Jugular vein distension
* Tachycardia
* Wheezing, crackles, and/or rales
* Frothy, pink pulmonary secretions
* Cyanosis
45
What is the impact of mechanical ventilation on fluid balance?
Mechanical ventilation causes loss of water from evaporation.
46
What happens to atrial natriuretic peptide during mechanical ventilation?
There is a decreased release of atrial natriuretic peptide.
47
How do the kidneys respond to decreased atrial natriuretic peptide?
The kidneys conserve sodium.
48
What occurs on post-op day three regarding fluid balance?
Third-spaced fluid returns to the intravascular space. leading to potential volume overload, CHF, and pulmonary edema
49
Fill in the blank: Mechanical ventilation leads to loss of water from _______.
evaporation
50
True or False: Atrial natriuretic peptide release increases during mechanical ventilation.
False
it decreases and leads to sodium retention
51
how is atrial natriuretic peptide released
it is in the walls of the
cardiac atria- responds to the stretching of atrial wall d/t atrial blood volume
when stretched more ANP is released and promotes Na exretion (and more urine)
52
Patients with renal disorders should have what tested before surgery
GFR and renal tubular function
test BUN/CR and Cr. clearance for GFR
test Urine specific gravity, osmolality, and na concentration for renal tubular fxn
53
54
What does central venous pressure (CVP) assess?
Volume status when difficult to assess by other measurements
## Footnote
CVP is particularly useful during surgery when significant changes in volume status are expected.
55
In what situations is pulmonary artery pressure (PAP) used?
For patients with primary or secondary right ventricular dysfunction
## Footnote
PAP is utilized when CVP does not match the clinical picture.
56
What is pulmonary artery occlusion pressure (PAOP) also known as?
Wedge pressure
## Footnote
Cardiac echo is considered a more reliable method than PAOP.
57
What PAOP reading indicates hypovolemia with clinical signs?
< 8 mm Hg
## Footnote
Clinical signs may include bleeding.
58
What PAOP reading may indicate that hypovolemia could be present in patients?
< 15 mm Hg
## Footnote
This may occur in patients with poor ventricular compliance.
59
What PAOP reading may indicate left ventricular overload?
> 18 mm Hg
## Footnote
This reading suggests potential issues with the left ventricle.
60
When should PAOP pressures be obtained?
At end expiration
## Footnote
This timing is crucial for accurate readings.
61
Sodium concentration is higher in the _____ than in the ______
higher in **ECF** than in **ICF**
## Footnote
also most abundant electrolyte in yo body
62
Sodium can affect a _______________'s water content
Sodium can affect a brain cell’s water content
The blood-brain barrier is different than peripheral capillary beds
* Limited permeability of ions prevents equilibration
between intravascular and interstitial spaces of osmotically active ionic solutes
osmotic gradient is changed between compartments due to lack of equilibrium
63
64
What are the treatment options for sodium imbalance?
• More water or restricted water volume
• Sodium supplementation
• Enhanced excretion of sodium
## Footnote
Treatment approaches may vary depending on the specific condition and patient needs.
65
What is the intra-operative cause of hyponatremia related to SIADH?
SIADH: syndrome of inappropriate secretion of antidiuretic hormone
## Footnote
This condition can lead to excess water absorption during certain surgical procedures.
66
What can occur during procedures using irrigation solutions that do not contain electrolytes?
Water is absorbed resulting in an excess of water, not an excess of sodium
## Footnote
This is particularly relevant in surgeries like endometrial ablation and TURP and lipo
67
What is the most common electrolyte imbalance in hospitalized patients?
Hyponatremia
## Footnote
It is critical to monitor and manage this condition to prevent complications.
68
What is hypervolemic hyponatremia and its associated risks?
Increased risk of death in patients with cirrhosis or CHF
## Footnote
Understanding fluid balance is essential in managing patients with these conditions.
69
What are potential effects of even mild hyponatremia?
Gait disturbances and cognitive deficits
## Footnote
These symptoms can significantly affect patient mobility and safety.
70
What is a serious risk of treating chronic hyponatremia too quickly?
Myelinolysis
## Footnote
Rapid correction can lead to severe neurological disorders.
71
What are the consequences of myelinolysis?
Mental disorders, pseudobulbar palsy, disorders of the upper neurons, spastic quadriparesis, and/or death
## Footnote
These conditions highlight the importance of careful management of sodium levels.
72
What is the recommended rate for increasing serum sodium in hyponatremia treatment?
1 to 2 mEq/L/hr
## Footnote
This **gradual **correction helps to minimize the risk of complications.
73
What should be administered if a patient with hyponatremia is symptomatic?
3% saline at 1 to 2 mL/kg/hr
## Footnote
Symptomatic treatment requires immediate attention to restore sodium levels.
74
What is the goal for increasing serum sodium in patients with hyponatremia when they are no longer symptomatic?
Increase serum sodium no more than 10 to 15 mmol/L in 24 hr
## Footnote
This limit is crucial to avoiding rapid fluctuations.
75
What is the formula to calculate sodium deficit?****
[Na] deficit (mEq) = ([Na] goal – [Na] plasma) x TBW
## Footnote
Accurate calculations are essential for proper treatment.
76
What does 2% saline equal in mg/mL?
20 mg/mL
## Footnote
Understanding medication concentrations is important for correct dosing.
77
What does 3% equal in mg/mL?
how many mg would be in 1L
30 mg/mL
30mg/mL x 1000 mL = 30000mg = 30g
## Footnote
This concentration is commonly used in clinical settings for sodium supplementation.
78
What does 10% saline equal in mg/mL?
100 mg/mL
## Footnote
This higher concentration is less commonly used but important to know.
79
What is hypernatremia usually due to?
Decreased water intake
## Footnote
Hypernatremia can occur with slow onset, leading to brain conservation of intracellular solutes.
80
What happens during slow onset hypernatremia?
The brain conserves intracellular solutes, maintaining normal intracellular volume.
81
What is the consequence of rapid onset hypernatremia?
Brain cells will shrink rapidly, causing traction on intracranial veins leading to intracranial hemorrhage.
82
What occurs if serum sodium is reversed too quickly in hypernatremia?
Cerebral edema.
83
What is the treatment for acute hypernatremia (<24hrs)?
Hypotonic solutions can be given quickly.
84
What is chronic hypernatremia d/t and what is the treatment?
Volume deficiency: isotonic crystalloids; Water deficit: hypotonic solutions.
decrease by 1-2 mEq/hr
85
What are the neurologic symptoms associated with osmolality of 350-375 mOsm/kg in hypernatremia?
376-400?
401-430?
>430?
Confusion, restlessness, agitation, headache.
376-400- ataxia tremors weakness
401-430- cramps/hyperreflexia/twitches/spasms
>430 = coma/seizure/death
86
How is free water deficit calculated?
Free water deficit = ([pt's Na/140]– 1) x TBW.
87
Where is 98% of potassium located?
what are the numbers for ICF and ECF
Intracellular fluid (ICF). - 150-160 mEq/L
Extracellular- 3.5-5 mEq/L
88
What defines hypokalemia?
K+ less than 3.5 mEq/L.
89
What can cause loss of potassium?
* Decreased potassium intake
* GI loss
* Renal loss.
90
What can shift potassium into the intracellular space?
* Insulin
* Alkalosis
* β-adrenergic stimulation.
91
What is the treatment for cardiac dysrhythmias due to hypokalemia?
Potassium IV at 10 to 20 mEq/hr.
can give oral once symptoms are resolved
92
In what solution should IV potassium be administered?
Dextrose-free solution.
so insulin isn't stimulated which could eff everything up
93
What causes hyperkalemia?
* Impaired excretion by the kidneys
* Increased potassium intake
* A shift from the intracellular space to the extracellular space.
*this shift can cause Lysis of the cell.
94
EKG signs of Hyper K and Hypo K
hyperK- peaked T, P wave flattening, PR prolongs, widen QRS
HypoK- T wave inversion, ST depression, Prominent U wave
95
Treatments for HyperK
calcium-10mL chloride or 10%gluconate- IV- onset-1-3min
Insulin-10 units- IV- onset 20 min
Albuterol 10-20mg - inhaled - 30 min
Lasix- 40-80mg - IV - 15 min
sodium polystryene sulfonate and patiromer ?
96
What does the QU interval represent in the context of hypokalemia?
The apparent pseudo-prolonged QT interval, which is actually the QU interval with an absent T wave
## Footnote
This reflects alterations in the cardiac repolarization process due to hypokalemia.
97
What percentage of calcium is found in bones?
99%
## Footnote
This highlights the significant role of calcium in skeletal structure.
98
List important functions of calcium.
* Acts as a second messenger
*`Muscle contraction
* Release of neurotransmitters and hormones
* Coagulation of blood
* Muscle function
## Footnote
Calcium is essential for many physiological processes.
99
100
What are the three different fractions of calcium in the extracellular fluid (ECF)?
* Ionized calcium: 50% of calcium in the ECF
* Bound to plasma proteins (mostly albumin): 40%
* Bound to anions: 10%
## Footnote
Ionized calcium is the active portion of circulating calcium
101
How does pH affect extracellular calcium?
Extracellular calcium is altered by pH
## Footnote
Acidemia decreases the protein-bound fraction and increases the ionized fraction of calcium
102
2 signs of hypocalcemia
chvostek's twiching of the corner of the mouth when you tap the facial nerve anterior to the earlobe
Trousseau- spasm adduction of the thumb
103
What are intra-operative causes of hypocalcemia?
* Hyperventilation
* Massive transfusion of citrated blood- the citrate binds to the Ca+
## Footnote
Hyperventilation leads to increased pH and increases the protein bound fraction of calcium
104
What is the most bioavailable preparation of calcium for treating hypocalcemia?
Calcium chloride- quicker correction but a vesicant
## Footnote
Calcium chloride is irritating to the vein but allows quicker correction of hypocalcemia
105
What is a common treatment for hypocalcemia?
* Calcium chloride
* Calcium gluconate
106
What are the causes of hypercalcemia?
* Impaired excretion of calcium by the kidneys
* Primary hyperparathyroidism
* Malignancy
## Footnote
These conditions lead to increased levels of calcium in the blood
107
What treatments are used for hypercalcemia?
* Normal saline for volume expansion
* Loop diuretic
## Footnote
Both treatments increase the excretion of calcium
108
What is the second most abundant intracellular cation?
Magnesium
## Footnote
Magnesium is important for the function of the Na-K-ATPase pump and energy metabolism
109
What are the causes of hypomagnesemia?
* Inadequate intake of magnesium
* Loss from GI or renal
## Footnote
Both factors can lead to lower levels of magnesium in the body
110
What is the treatment for hypomagnesemia?
1 to 2 g of magnesium sulfate over 5 minutes, then 1 to 2 g/hr
## Footnote
It is also important to correct any other electrolyte abnormalities
111
causes and tx of hypermagnesia
result from tx of
preterm labor
preeclampsia
cardiac dysrhytmias
ischemic cardiac disease
Treatment- stop giving mag
112
What are crystalloids?
Aqueous solutions of ions, some containing glucose.
## Footnote
Crystalloids equilibrate with the extracellular fluid space.
113
What is the intravascular half-life of crystalloids?
20-30 minutes.
## Footnote
Crystalloids are considered the first-line fluid.
114
How do crystalloids compare to colloids in maintaining intravascular volume?
Crystalloids are just as effective as colloids in restoring intravascular volume.
## Footnote
However, 3 to 4 times as much crystalloids are needed to produce the same effect as colloids.
115
In what scenario can colloids correct fluid deficits more quickly than crystalloids?
In cases of severe intravascular fluid deficit.
colloids help maintain plasma oncotic pressure and you need less to produce the same effect as crystalloids
## Footnote
Tissue edema is more frequently associated with rapid infusion of crystalloids.
116
What is Lactated Ringer’s solution (LR)?
The most commonly used isotonic crystalloid in the OR.
## Footnote
It is the most physiologic IV solution and is slightly hypotonic.
117
What is the composition of Lactated Ringer’s in terms of electrolytes (mEq/liter)?
* Na+: 130
* K+: 4
* Ca++: 3
* Cl-: 110
* Lactate: 28
## Footnote
The lactate is converted to bicarbonate in the liver.
118
What are some examples of isotonic crystalloids?
* Normal saline (0.9% NS)
* Lactated Ringer’s (LR)
* 5% Dextrose in Water (D5W)
* Plasmalyte
* Normosol
## Footnote
Isotonic crystalloids have electrolyte concentrations similar to extracellular fluid.
119
What is a disadvantage of using Normal Saline (0.9% NSS)?
Hyperchloremic acidosis.
120
What is the pH and osmolarity of Normal Saline (0.9% NSS)?
pH: 5.0, Osmolarity: 308 mOsmol/L.
## Footnote
It is also used to dilute packed red blood cells.
121
What is the purpose of 5% Dextrose in Water (D5W)?
Provides free water after metabolism of dextrose.
## Footnote
It is not frequently used in the OR due to hyperglycemia risk.
122
When is 5% Dextrose useful?
* Neonates
* Diabetic patients at risk for hypoglycemia
* Patients with sodium restriction
## Footnote
It is useful for patients with limited glycogen stores.
123
What are hypertonic crystalloids?
Hypertonic saline solutions such as 3% NaCl and 5% NaCl.
## Footnote
They are used for low volume fluid resuscitation and draw water into the vascular space.
124
What negative effects can hypertonic crystalloids cause?
* Hyperchloremia
* Hypernatremia
* Cellular dehydration
## Footnote
They are used for patients with severe symptomatic hyponatremia.
125
What is an example of a hypotonic crystalloid?
0.45% Sodium chloride (0.45% NaCl or ½ NSS).
## Footnote
Another example is 2.5% Dextrose in water.
126
What are colloids?
High-molecular-weight substances that help preserve plasma colloid oncotic pressure
## Footnote
Colloids remain intravascular and have an intravascular half-life of 3-6 hours.
127
What are the characteristics of colloids?
Osmotically active, high molecular weight, and draw fluid into the intravascular space
## Footnote
This leads to increased circulating volume.
128
What are the indications for using colloids?
Synthetic glucose polymers or plasma proteins for conditions like:
* Hemorrhagic shock
* Severe hypoalbuminemia
* Large protein losses such as burns
## Footnote
Colloids can be derived from human blood or nonanimal substances.
129
What are the derived colloids from blood?
Albumin and plasma protein fraction
## Footnote
Albumin can be 5% or 25% and contains α- and β-globulins.
130
What is the effect of Albumin 5%?
Given at a 1:1 replacement ratio and stays in the intravascular space longer
## Footnote
This is due to protein molecules with a high molecular weight.
131
What is the effect of Albumin 25%?
Expands intravascular volume five times the infused volume
## Footnote
It is derived from pooled donor plasma.
132
What are examples of synthetic colloids?
Gelatins, Dextran, Hetastarch
## Footnote
Gelatins are not available in the US- becasue allergic rxns
133
What are the negative effects of synthetic colloids?
Can cause anticoagulation and anaphylaxis
## Footnote
This is particularly noted with Dextrans.
134
What is Dextran 70?
A synthetic colloid with an average molecular weight of 70,000, better volume expander than Dextran 40
## Footnote
Should not exceed 20 mL/kg/day.
135
What is the average molecular weight of Dextran 40?
40,000
## Footnote
It enhances blood flow through the microvasculature.
136
What is Hetastarch?
A synthetic colloid derived from plant starch, less expensive than albumin
## Footnote
It disrupts the clotting cascade and inhibits clot formation.
137
What are the contraindications for using Hetastarch?
Do not use in septic and critically ill patients due to increased risk of:
* Mortality
* Renal replacement therapy (RRT)
## Footnote
This is due to its negative coagulation effects.
138
What are the characteristics of Hetastarch?
Available in various formulas, very effective plasma expander, and anaphylactoid reactions are rare
## Footnote
Usually does not affect bleeding times and coagulation studies.
139
What is the recommended replacement volume for crystalloids after blood loss?
3 – 4 x volume of blood loss
## Footnote
Crystalloids are solutions that contain water, electrolytes, and nutrients.
140
What is the recommended replacement volume for colloids after blood loss?
1:1 replacement
## Footnote
Colloids are larger molecules that help to expand blood volume.
141
When should transfusion typically be initiated based on blood volume loss?
After loss is > 10%-20% of blood volume
## Footnote
This threshold is based on starting with a normal hematocrit.
142
What is the average blood volume for neonates (full-term)?
85 mL/kg
143
What is the average blood volume for adult men?
75 mL/kg
144
What is the average blood volume for adult women?
65 mL/kg
145
What is the first step in estimating allowable blood loss?
Estimate the blood volume from the previous table.
146
How is the red blood cell volume (RBCV) calculated at preoperative hematocrit?
RBCVpreop = Estimated blood volume x preop hematocrit
147
How is the red blood cell volume (RBCV) calculated at a hematocrit of 30%?
RBCV30% = Estimated blood volume x 30%
148
What is the formula to calculate RBCV lost when hematocrit is at 30%?
RBCVlost = RBCVpreop – RBCV30%
149
How is allowable blood loss calculated?
Allowable blood loss = RBCVlost x 3
150
What is the estimated blood volume for a 70 kg male?
5250 mL
151
How much blood loss will decrease a 70 kg male's hematocrit from 35% to 30%?
789 mL
152
What is the estimated blood volume for a 55 kg female?
3575 mL
153
How much blood loss will decrease a 55 kg female's hematocrit from 33% to 30%?
321 mL
154
What is the formula for estimating blood loss using a suction canister?
Total volume in canister – irrigation = Estimated blood loss (EBL)
155
How much blood does a 4x4 sponge approximately hold?
10 mL
156
What is the estimated blood loss for Raytec sponges?
10-20 mL
157
What is the estimated blood loss for lap sponges?
100 mL
158
What is the quick calculation formula for estimating blood loss based on hemoglobin?
EBV/Hgb = mLs of blood/gram of Hgb
159
What is the estimated blood volume for an adult male weighing 70 kg with a hemoglobin of 14 g/dL?
5250 mL
160
What is the allowable blood loss for a patient with a preoperative hematocrit of 30%?
RBCVlost x 3
## Footnote
The calculation will vary based on the individual's blood volume.
161
What blood group is considered a universal recipient?
Group AB
162
What blood group is considered a universal donor?
Group O
163
What does 'typed' mean in blood compatibility testing?
Determine ABO and Rh status
164
What is the purpose of a type and crossmatch?
Recipient blood and donor blood are mixed to check for compatibility.
165
Which blood type can be given to men and women of non-childbearing years in an emergency?
O+
166
What type of blood should be saved for women of childbearing years?
O-
167
What does a type and screen test for?
ABO and Rh antigens, screened for common antibodies
168
What does a type and cross test involve?
Type and screen; gets blood ready for transfusion
169
What are Packed Red Blood Cells (PRBCs)?
Improve O2 delivery to tissues and treat hemorrhage
## Footnote
PRBCs are used in cases of acute blood loss greater than 30% of blood volume or in hemodynamically unstable patients.
170
What are potential complications of the Massive Transfusion Protocol (MTP)?
* Metabolic alkalosis
* Hypocalcemia
* Hypothermia
* Hyperkalemia
## Footnote
Non-fatal complications have been seen in over 50% of patients when more than 5 units of blood products are transfused.
171
What causes metabolic alkalosis during massive transfusion?
Sodium citrate and citric acid added to blood products in storage
## Footnote
These compounds prevent coagulation but can lead to bicarbonate generation.
172
What can rapid infusion of cold blood lead to?
Hypothermia
## Footnote
Blood products are stored at 4° C, and rapid infusion can lower core body temperatures.
173
What is hyperkalemia in the context of blood transfusion?
Increase in potassium in blood during long-term storage of blood products
## Footnote
Typically occurs with high-speed infusion through central access.
174
What is the expected increase in hemoglobin and hematocrit from one unit of PRBCs?
* Hemoglobin: increased 1 g/dL
* Hematocrit: increased 2-3%
## Footnote
This is important for assessing the effectiveness of the transfusion.
175
What is Fresh Frozen Plasma (FFP) used for?
Reverse anticoagulant effects and contains all plasma proteins
## Footnote
FFP increases coagulation levels by 20-30%.
176
What is the platelet count increase expected from a single unit of platelets?
Increases by 5,000-10,000
## Footnote
Platelets are available as concentrates from whole blood or apheresis platelets.
177
What does cryoprecipitate contain?
* Factor VIII
* von Willebrand factor
* Fibrinogen
## Footnote
It is given for hypofibrinogenemia or to patients with von Willebrand disease.
178
Which surgical procedures have a higher likelihood of needing transfusion?
* Orthopedic (hip, knee)
* Cardiac
* Vascular
* Colorectal
* Liver transplant
* Trauma
## Footnote
These procedures typically involve significant blood loss.
179
What is a common cause of acute hemolytic reactions during transfusion?
ABO blood incompatibility
## Footnote
This can lead to severe complications, including death.
180
What is TRALI?
Transfusion-related acute lung injury occurring within 6 hours of transfusion
## Footnote
It is the leading cause of transfusion-related deaths.
181
What are the symptoms of a hemolytic reaction?
* Fever
* Hypotension
* Hemoglobinuria
* Oozing at the surgical site
## Footnote
Can lead to DIC, kidney failure, and shock.
182
What is the treatment for a hemolytic reaction?
* Stop transfusion
* Re-check unit
* Draw blood for compatibility testing
* Monitor urine for hemoglobin
* Administer IV fluids and mannitol
## Footnote
These steps are crucial for patient safety.
183
What is a febrile reaction in blood transfusion?
Increase in temperature without evidence of hemolysis
## Footnote
It occurs in 1-3% of transfusion episodes and is due to antibody-antigen interactions.
184
What is the incidence of anaphylactic reactions in blood transfusions?
1:150,000 transfusions
## Footnote
Often occurs in IgA-deficient patients with anti-IgA antibodies.
185
What are the infectious complications associated with blood transfusions?
* Hepatitis B: 1:200,000
* Hepatitis C: 1:1,900,000
* HIV: 1:1,900,000
## Footnote
Awareness of these risks is essential for safe transfusion practices.
186
What is autologous blood donation?
Preoperative blood donation with Hgb > 11 g/dL and Hct > 34%
## Footnote
Blood is collected 4-5 weeks pre-op and can be returned to the patient during surgery.
