107 Flashcards
List and describe the components of blood - what percentage is what?
1) Erythrocytes - RBC, oxygen carrying (45%)
2) Leukocytes - WBC, several types that are part of immune response (< 1 %)
3) Thrombocytes - Platelets, initiating clot as part of clotting cascade
4) Plasma - Yellow liquid portion of blood (55%)
Describe the makeup, origin and the role of erythrocytes regarding oxygen supply and demand
Erythrocytes are formed in red bone marrow of large bones (7 days) and last for 120 days.
Erythrocytes contain molecures of hemoglobin which contains iron. Hemoblobin binds oxygen thus making erythrocytes oxygen carriers.
Each gram of hemoglobin can carry 1.34 ml of O2.
Describe the different types of leukocytes, their origin and role in the immune system
There are 5 types of leukocytes. Most are formed in bone marrow:
1) Neutrophils - Most common, first on scene of infection, phagocytose bacteria, form pus
2) Lymphocytes - Contain B cells which generate antibodies, and T cells which help moderate B cell activity
3) Monocytes - Slower to respond than neutrophils, but larger and longer laster phagocyting
4) Eosinophils - Mostly related to helminths/parasites and release chemicals as part of defense
5) Basophils - Sort of like circulating mast cells that initiate inflammatory response - Release histamine and heparin
NEVER LET MONKEYS EAT BANANAS (How common in order)
Describe the origin and the role of thrombocytes in blood clotting
Thrombocytes or platelets are formed in bone marrow. They circulate in the blood along the walls of blood vessels and when they encount damage vessel, platelets interact with collagen which causes platelets to aggregate and form a platelet plug in the hole. Fibrin strands are then infused into the plug strengthening the clot.
Describe the makeup of plasma and when is it indicated for transfusion
Plasma (which makes up 55% of whole blood) is 95% water with the remaining 5% containing proteins, clotting factors, electrolytes.
Plasma transfusion is Indicated for INR/PT/PTT greater than 1.8 with multiple coagulation factor deficiencies and when no coag factor concentrations are available or when coagulation studies are delayed.
Describe the role of plasma in blood clotting
Plasma contains the clotting factors in the clotting cascade which start the formation of fibrin in a blood clot
Describe the makeup and functions (8) of blood
1) Supplies oxygen to tissues
2) Removes waste (Co2) to lungs
3) Acid base buffer
4) Coagulation factor transport
5) Transportation of immune cells
6) Transportation of hormones
7) Transportation of nutrients
8) Temperature regulation
Discuss blood group identification
Blood type refers to the antigens presented on the surface of RBC - can we no antigen (type O), A, B, or both (AB). If no antigen, then blood contains antibody for the antigen (So, type O blood has both A and B antibodies, while type AB blood has no antibodies).In addition, there is a RH factor (+ means the antigen is present, - means it is not).
First 40 mls of a blood donation is used to identify blood type.
Discuss RH factor in the setting of blood transfusion - is there a treatment option?
We are concerned about giving Rh+ blood to a Rh- patient in the setting of a woman in child bearing years because she would develop RH+ antibodies which could cause a hemolytic reaction in a newborn if the baby has Rh+ blood.
Patient can be given RHOGAM which “cloaks” the RH+ blood in the mother’s bloodstream preventing it from forming antibodies - can be given 96 hours to 28 days after blood transfusion.
Discuss human leukocyte antigen in the setting of blood product administration
HLA antigen is found on platelets and WBCs - if recipient receives platelets from multiple donors, that could cause febrile antibody/antigen reaction that destroys the platelet and lessens the effectiveness of the transfusion
Describe PRBCs
Packed red blood cells - contains RBCs. 1 unit has a variance in volume, but average is 250 mls
Describe platelets (in context of transfusion) -
What forms does it come in?
What temperature is it stored at?
Can platelets be heated by enflow?
3 forms - Platelets can be either aphoresis (single donor), pooled (from 4 buffy coat donors + male plasma) or hLA matched single donor
It is stored at room temperature.
Platelets can not be heated by enflow.
Describe fresh frozen plasma - what does it contain?
Fresh frozen plasma is plasma that has been frozen! it contains coagulation factors and fibrinogen
Describe cryoprecipitate
Cryoprecipitate is formed from male plasma and contained mostly fibrinogen, VIII, XIII and von Willebrand factor
Describe albumin
Formed from female plasma - used as volume replacement (increased oncotic pull)
Describe plasma protein fractions
Contain 83% albumin and 17% globulin and indicated for volume expansion.
List and describe the indications for blood or blood product administration in shock, anemia or coagulopathies
PRBC if Hgb < 70, Hgb < 80 with cardiac ischemia, active bleeding
FFP - INR/PTT/PT 1.8 x normal, results of INR/PTT/PT delayed, thrombotic thrombocytopenic purpora (TTP)
Platelets Plt < 10 x 10^9 (thrombocytopenia) (other thresholds in bloody easy)
Cryoprecipiate - Bleeding with Fibronogen < 1.0
Albumin - Hypoalbumenia, distributive pts
Describe the process for consent to receive blood products
Physician obtains consent unless patient unconscious, life in danger and no documentation indicates no consent authorized can be found and no substitute decision maker exists
Describe the process for patient identification and verification prior to the administration of blood products
Confirm with 2 pieces of ID matching the blood bag, ideally with verbal confirmation from the patient and a second person must also verify this information
Describe the patient assessment required to establish a base line prior to blood or blood product administration
Baseline set of vital signs including temperature are conducted:
1) at the start of infusion
2) 15 minutes into infusion
3) during any reactions
4) end of infusion
List and describe the equipment required for blood and blood product administration
Blood administration set with 200 micron filter,
IV access 16-18 for rapid, 20-22 for routine PRBCs or CVC
Enflow warmer for anything but platelets
List and describre the complications associated with blood product administartion including anaphylaxis, hemolytic reactions, DIC, transfusion reaction and infection
1) Anaphylaxis - typical signs caused by allergens in donor blood
2) hemolytic reaction - incompatible ABO/RH group mistake
3) DIC - Clotting factors used up
4) Transfusion reactions that are delayed due to low levels of detectable antibodies
5) Infection - non-sterile technique
List and describe acute transfusion reaction (immune vs non-immune)
Immune:
Anaphylaxis
TRALI - tranfusion related acute lung injury caused by transfusion - unknown cause
Allergic - donor antigen reaction
Febrile non-hemolytic - reaction to donor wbc hemolytic - ABO/RH imcompatibilty
Non-immune
TACO - Circulatory overload from too fast transfusion or/and impaired cardiac function
Bacteremia
Describe the documentation required for the administration of blood or blood products
Informed consent document
Start time
stop time
vitals (temp!)
Transfusion reaction documentation if required
How long after PRBCs have been issued from the blood bank can it still be transfused?
PRBCs should be transfused within 4 hours of issuance from blood bank.
How much would you expect hemoglobin to rise after transfusion of 1 unit of PRBCs?
10 g/L in a non-bleeding patient
