4 Mar Blood Products and Transfusion (Exam 3) Flashcards
What are the two main components of blood?
45% Elements (white blood cells, platelets, red blood cells) and 55% plasma
What is the primary purpose of type and screen tests?
To identify antigens and antibodies in blood
What are the four blood types?
A, B, AB, O
What is the significance of the Rh factor in blood types?
It indicates whether the blood type is positive or negative
- Rh+ constitutes ~ 85% of the population
- Rh- ~ 15%
What is considered massive transfusion protocol (MTP)?
What is the MTP in children?
- Total blood volume (or more) is replaced within 24hrs
- 50% of blood volume is replaced within 3 hours
- There is a rapid bleeding rate requiring replacement: 4 units PRBCs transfused within 4 hours or >150ml/min blood loss
MTP in children is >40mL/kg transfusion
What does citrate in blood products cause?
Hypocalcemia and impaired clotting
- Citrate chelates Ca++ so you have less ionized to perform work. Citrate is metabolized in the liver (you gotta be mindful of that)
What are the key components measured in viscoelastic testing and what are their values?
- R time (Conventional reaction time, time it takes for initial fibrin formation) 5-10min
- ACT (Rapid activation) 80-140sec
- K time (“Kinetic” clot firmness reaches 20mm strength) 1-3min
- MA (maximum amplitude) 50-70mm
- Ly30 (clot lysis time 30min following MA) 0-3%
What are the risks associated with transfusion reactions?
- TACO (transfusion-associated circulatory overload)
- TRAILI (transfusion-related acute lung injury)
What is the purpose of fresh frozen plasma (FFP) in transfusions?
To increase clotting levels by 2-3%
How much does one unit of packed red blood cells increase hemoglobin?
About 1g/dL
Fill in the blank: Blood type compatibility is crucial for preventing _______.
Transfusion reactions
Whole blood is preferred over components for transfusions due to its __.
ease of administration
It is much easier to hang one line instead of 3+
What is hyperfibrinolysis?
A condition where the clotting process is abnormally accelerated leading to rapid breakdown of clots
What is the role of viscoelastic testing in transfusion management?
Provides real-time analysis of clotting factors for tailored treatment
What is the effect of high cholesterol on blood separation?
It can cause a fat gel level to form on top
What is the history of blood transfusion practices during World War I?
Whole blood was used as the primary resuscitation fluid due to limited resources
What are the implications of using uncross-matched blood in emergencies?
Increases the risk of transfusion reactions
What is the importance of calcium replacement during massive transfusions?
To counteract citrate-induced hypocalcemia
Don’t forget about the Trauma Death Diamond: Hypothermia, coagulopathy, acidosis, hypocalcemia
What are some common symptoms of acute transfusion reactions?
- Fevers
- Chills
- Hemoglobinuria
- Hypotension
- Dyspnea
What can prolonged clotting times indicate? (R-Time)
Need for fresh frozen plasma in treatment
What is the normal value interpretation of TEG/ROTEM parameters critical for?
Tailored transfusion treatments
give them what they’re missing
What can be given if a type and screen is not completed?
Uncrossmatched blood
Uncrossmatched blood is used in emergencies when there’s no time for proper crossmatching.
Why should O positive blood be avoided in females of childbearing age?
Increased risk of fetal incompatibility
Rh incompatibility can occur if a Rh-negative mother receives Rh-positive blood.
What happens to patients’ blood types after receiving large volumes of blood?
Patients may change blood types
This can occur due to the introduction of different blood components and antibodies.
What are the four main blood products?
- Red blood cells
- Fresh frozen plasma (FFP)
- Cryoprecipitate
- Platelets
These components are separated during blood donation and have different uses.
What is the intended use of normal saline?
IV rehydration to treat cholera
Normal saline was originally designed to rehydrate patients, not as a resuscitation fluid.
What is a concern when using crystalloids for resuscitation?
Dilution of blood components
Crystalloids can dilute essential components needed for effective resuscitation.
What is the shelf life of whole blood?
3 to 5 weeks
This varies based on storage conditions and practices.
What is the purpose of separating blood components?
To reduce wastage and target specific deficiencies
This allows for more efficient use of blood products based on patient needs.
What is a walking blood bank?
Utilizing pre-screened donors on-site to provide blood
This approach is often used in military settings to quickly provide blood in emergencies.
How has military conflict influenced blood transfusion practices?
Led to advancements in trauma resuscitation strategies
Historical conflicts have provided valuable data on effective blood transfusion techniques.
What is the advantage of using low titer whole blood?
Lower risk of transfusion reactions
It is screened for specific antibodies to reduce complications.
What happens to patients’ hemodynamics when given crystalloid solutions?
Improved blood pressure but diluted blood components
This can lead to a false sense of stability while not addressing actual blood loss.
What is cryoprecipitate rich in?
Clotting factors
- Factor VIII (C and vWF)
- Factor XIII
- Fibrinogen (Single most important component)
It is used to treat patients with bleeding disorders.
What is the military’s method for blood donation during conflicts?
Fresh whole blood or low titer whole blood from pre-identified donors
This method allows rapid response to casualties in remote areas.
What is the main challenge in blood storage?
Prevention of blood clotting with the use of anticoagulants like citrate.
What does citrate do in blood transfusions?
Chelates calcium, preventing blood from clotting.
What happens to blood stored for longer periods?
It loses functionality, including lower levels of 2,3-DPG.
What are leuco reduced PRBCs?
Packed red blood cells that have had white blood cells removed.
What is the shelf life of frozen plasma (FFP)?
What about after it is thawed?
6 to 12 months.
- 72hrs after thawing
What is the recommended dosing for FFP?
10 to 15 mls per kilogram.
What are the indications for administering cryoprecipitate?
- Massive transfusions * Congenital bleeding disorders * Pregnant women that are bleeding.
What is the typical increase in platelet count from one unit of platelets?
By about 5,000 to 10,000.
What should be avoided when administering platelets?
Warming them, as it causes aggregation.
Why is calcium a concern when using Lactated Ringer’s (LR) with blood products?
Calcium can cause clotting issues.
What is the recommended resuscitation fluid over crystalloid solutions?
FFP.
What is the typical volume of whole blood compared to other blood products?
About 400 to 500 ml.
What are common symptoms of hemolytic transfusion reactions?
- Fevers * Chills * Hemoglobinuria * Hypotension * Dyspnea.
What is the significance of monitoring urine output in patients receiving blood products?
To detect potential hemolytic reactions through hemoglobinuria.
What is the main goal of blood product resuscitation?
To restore blood volume and improve clotting ability.
What is the significance of having a Foley catheter during large volume resuscitation?
It helps monitor urine output and kidney function during resuscitation
A Foley catheter is crucial for patients receiving multiple blood products.
What are common symptoms that a patient may report during a transfusion reaction?
Itching, difficulty breathing, fever, chills
Fever is a late finding in transfusion reactions.
What is the main treatment approach for allergic reactions during blood transfusions?
Symptomatic treatment with antihistamines
Allergic reactions are similar to those seen with other allergens.
How do you detect non-cardiogenic pulmonary edema under anesthesia?
Increased airway pressures, secretions, and color changes in the patient
Hypotension can be a confusing sign.
What is the initial treatment for TACO?
Diuretics and fluid management
Patients may complain of headache and pulmonary complications.
What are the signs of TRALI?
Acute onset of hypoxemia, bilateral infiltrates on chest X-ray, normal ejection fraction
TRALI is an immunologic response and not due to volume overload.
What is the difference in response to diuretics between TACO and TRALI?
TACO responds well to diuretics; TRALI does not
This is due to the underlying causes of each condition.
What should be done if a transfusion reaction is suspected?
Stop the transfusion, notify the blood bank, administer saline, and send specimens
It is important to act quickly to manage the patient’s condition.
What are potential complications of massive transfusions?
Hypothermia, coagulopathy, transfusion reactions, and electrolyte imbalances
Monitoring is crucial to avoid these complications.
What is the one-to-one-to-one ratio in massive transfusion protocols?
A balanced administration of red blood cells, plasma, and platelets
This aims to approximate whole blood.
What are signs that a patient may have developed hemoglobinuria?
Dark urine, possible kidney injury, and muscle damage
Hemoglobinuria can occur from various causes, not just transfusion reactions.
What is transfusion-induced hemosiderosis?
Iron overload due to multiple blood transfusions
- Fun fact: Hemosiderin is a brown, iron-containing pigment that is formed when red blood cells break down.
It is usually a gradual progression and monitored in patients with frequent transfusions.
What are the common symptoms of TACO?
Pulmonary edema, headache, and increased blood pressure
Symptoms arise from volume overload.
True or False: Fever is a common early sign of transfusion reactions.
False
Fever is typically a late finding.
What is the role of Lasix in treating pulmonary complications from transfusions?
It may help in managing fluid overload in TACO
However, its effectiveness in TRALI is limited.
Fill in the blank: TACO stands for _______.
Transfusion Associated Circulatory Overload
It is a common complication associated with blood transfusions.
What laboratory assessment is challenging during massive hemorrhage?
Determining the exact amount of blood loss
Clinical judgment based on suction and patient condition is often used.
What are the potential consequences of bacterial contamination during a transfusion?
Shock, DIC, and rapid clinical deterioration
Proper sterile technique is crucial to prevent contamination.
What are the components that are often lost in patients experiencing significant bleeding?
- RBCs, plasma, clotting factors, platelets
- The patient is losing whole blood, not just inividual components
How does the hemoglobin concentration in whole blood compare to that in components?
The hemoglobin concentration in whole blood is about a third higher than in components.
What is the primary benefit of using whole blood over components?
Whole blood has higher concentrations of hemoglobin, functional platelets, and plasma.
The more you break down whole blood, the more preservatives neededso the less effectiveness overall.
What is the risk associated with using multiple blood component products?
Increased risk of infection due to exposure to multiple donors.
What is the typical shelf life of stored whole blood?
About three weeks.
What is the lethal triad in trauma? What about the 4th component? Death diamond?
- Hypothermia
- Acidosis
- Coagulopathy
hypocalcemia
True or False: Calcium chloride can be safely given through a peripheral IV.
Yes…True and False.
Ideally, a CVL is used D/T the increased risk of tissue necrosis if infiltration occurs. Carefully administer in PIV as long as the line is truly patent.
What is the difference between serum calcium and ionized calcium?
Ionized calcium is not affected by factors like albumin levels and is free to do work (clotting, contraction, etc.).
What is viscoelastic testing used for?
To assess clotting function and tailor transfusion therapy.
What does the R time in viscoelastic testing indicate?
The reaction time from when the clot starts to form.
Normal values are 5-10min
What does a prolonged R time suggest?
The need for treatments like FFP or PCC.
What are some potential complications of a ‘shotgun’ approach to transfusion therapy?
- Transfusion reactions
- Fibrinolytic shutdown
What is the benefit of tailoring transfusion therapy to individual patients?
Reduced chance for reactions and complications.
Fill in the blank: The function of stored platelets is ______ than that in whole blood.
less
What should be monitored to assess calcium levels in patients receiving blood transfusions?
Ionized calcium, not serum calcium.
Serum calcium can be bound to albumin and not contribute to the body.
What is the consequence of severe hypocalcemia in trauma patients?
Low blood pressure and impaired clotting.
What is the significance of cryoprecipitate in transfusion therapy?
It provides specific clotting factors when needed. (VIII and fibrinogen!)
What is the role of TxA in transfusion therapy?
To prevent excessive clot lysis.
- TxA inhibits the conversion of plasminogen to plasmin
What are the components analyzed in viscoelastic testing?
- TEG ACT (80-140sec)
- R time (5-10min)
- K time (1-3min)
- Angle (53-72 degrees)
- MA (50-70mm)
- G Value (53.-12.4 dynes)
- LY30 (0-3%)
What is the risk associated with administering TxA when it’s not needed?
Fibrinolytic shutdown
Fibrinolytic shutdown can lead to excessive clotting and complications.
What is the benefit of tailoring treatment to patients?
Reduces risk of volume overload
Tailored treatments minimize unnecessary complications and focus on the specific needs of the patient.
Based on TEG, when would you give FFP?
ACT too high (>140sec) or reaction time too long (>10min)
Fresh Frozen Plasma (FFP) is often used to correct coagulation factor deficiencies.
Based on TEG, when would you give Cryo?
K-time too high(>3min) or angle too low (<53 degrees)
Cryoprecipitate (cryo) is used to treat deficiencies in fibrinogen and other clotting factors.
Based on TEG, when would you give Platelets?
Alpha angle too low(<53degrees) MA too low (<50mm)
Based on TEG, when would you give TXA?
Ly30 too high (>3%)
What do the terms ly 30, ly 60, and ly 3 refer to?
Duration of clot measurement
These terms indicate the time in minutes for which clotting is monitored.
What does a prolonged reaction time in coagulation tests indicate?
Patient on anticoagulants
Prolonged reaction times can suggest that a patient is receiving anticoagulant therapy, affecting clotting ability.
What condition is indicated by dysfunctional platelets?
Normal clotting time but weak platelet formation
Patients with dysfunctional platelets may form clots at a normal rate but lack clot strength.
What does hyperfibrinolysis result in?
Clots forming but breaking down too quickly
Hyperfibrinolysis can lead to rapid clot degradation despite initial clot formation.
What does a hypercoagulable state indicate?
Normal clotting time but excessive clot formation
In a hypercoagulable state, there is an increased risk of thrombus formation.
What characterizes the initial stage of DIC?
Appropriate clotting followed by hyperfragmentation
In disseminated intravascular coagulation (DIC), initial clotting can be followed by rapid breakdown.
What happens in the late stages of DIC?
Prolonged clotting time and inability to form strong clots
Late-stage DIC results in the exhaustion of clotting factors and poor clot stability.
Fill in the blank: If your reaction time is too long, they need _______.
FFP
Fill in the blank: If your K-Time is too high, they probably need _______.
cryo
Fill in the blank: If your MA is too low, they probably need _______.
platelets
Fill in the blank: If your ly3/30/60 is too high, they probably need _______.
TXA
What is the universal acceptor blood type?
AB positive
What are the blood types based on antigens?
A, B, AB, O
What is the approximate percentage of Rh positive individuals?
0.85
What is the approximate percentage of Rh negative individuals?
0.15
What is the primary function of red blood cells?
Oxygen transport
What does the oxyhemoglobin dissociation curve illustrate?
What shifts this to the right? Left?
The relationship between oxygen saturation and partial pressure of oxygen. Right shifts indicate that O2 is more easily released from Hgb, while left shifts indoicate that Hgb wants to hold onto O2.
- Shifts to the right, think exercising muscles (mostly increases) increased 2,3 DPG, increased CO2 production, increased heat, decreased pH
- Shifts to the left are opposite of the right
What is the role of 2,3-DPG in blood?
Regulates oxygen release from hemoglobin
What does blood typing determine?
The antigens present on erythrocytes and antibodies present in serum
What antibodies are present in blood type A?
Anti-B
What antibodies are present in blood type B?
Anti-A
What antibodies are present in blood type AB?
None
What antibodies are present in blood type O?
Anti-A and Anti-B
In blood compatibility, what does ‘+’ indicate?
Reaction
In blood compatibility, what does ‘-‘ indicate?
No reaction
Memorize this hemorrhage chart, sorry…
What is the specific gravity range for red blood cells?
1.08-1.09
What is the specific gravity range for platelets?
1.03-1.04
What is the purpose of differential centrifugation in blood component preparation?
To separate blood into layers based on specific gravities
What is the typical storage temperature for whole blood?
1-6 °C
What is Fresh Frozen Plasma (FFP) used for?
Source of antithrombin III and clotting factors
What is the therapeutic dose of FFP?
10-15 mL/kg
What does cryoprecipitate contain?
- Factor VIII: C * Factor VIII: vWF * Factor XIII * Fibrinogen
How much does one unit of cryoprecipitate generally raise fibrinogen concentration?
50 mg/dL
What is the main indication for platelet transfusion?
To treat thrombocytopenia
What is the effect of warming blood products during transfusion?
May help maintain normothermia
What is the primary complication of blood transfusion related to immune response?
Hemolytic transfusion reactions
What are common symptoms of hemolytic transfusion reactions?
- Fever * Chills * Hemoglobinemia * Hemoglobinuria * Hypotension * Dyspnea
What is the treatment for nonhemolytic febrile transfusion reactions?
Antipyretics and leukocyte reduced blood products
What are the criteria for diagnosing TRALI?
- Acute onset hypoxemia * Pao2/FiO2 <300 * Occurs during or within 6 hours of transfusion * Bilateral diffuse pulmonary infiltrates * No evidence of left atrial hypertension
What is the management step for suspected TRALI?
Stop the transfusion immediately
What is the main mediator of bacterial contamination in blood transfusions?
Endotoxins produced by Gram-negative bacteria
Fibrinogen levels for different products?
- Cryo-2500mg
- LTOWB-1000mg
- FFP-400mg
What is the fluid replacement rule for blood loss?
3:1 crystalloid to blood ratio
What classifies a patient as Class I hemorrhage?
Up to 750 mL blood loss, up to 15% of total blood volume
What is indicated for a patient with Class III hemorrhage?
Transfusion of crystalloid and blood
What does delayed immunologic effect of blood transfusion include?
- Hemolytic transfusion reactions * Transfusion associated Graft-versus-host disease * Post-transfusion purpura
What mental status is typical for hemorrhage class 2?
Mildly anxious.
What is the fluid replacement rule for massive transfusions?
Fluid Replacement (3:1) rule.
3 part crystalloid to 1 part whole blood
What components are included in the massive transfusion protocol (MTP) for adults?
1) Total blood volume is replaced within 24 hours
2) 50% of total blood volume is replaced in 3 hours
3) Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss.
What is the MTP transfusion volume for children?
≥ 40 mL/kg transfusion.
What is the current standard of care in level 1 trauma centers?
Balanced resuscitation with a 1:1:1 ratio of platelets, plasma, and RBC.
What is meant by ‘reconstituted’ whole blood?
Multiple blood components combined to resemble whole blood.
What are the risks associated with blood component therapy?
Significant losses of coagulation factor and platelet function, more anemic, thrombocytopenic, coagulopathic, requires multiple products, and higher risk of infection.
How does the volume of whole blood compare to component therapy?
Whole Blood ~ 570 mL; Components (1:1:1) ~660 mL.
- Platelet count in WB is 200 vs 88 and coag factors in WB are 90% vs 65%
What is the hemostatic capability of stored whole blood?
Contains all components of blood products, smaller amounts of anticoagulants, and has a hemostatic capability of 14-21 days.
What is the universal donor type for low-titer whole blood?
Low-titer type O whole blood (LTOWB).
What is the expiration time for LTOWB?
21 days.
What is the preferred calcium replacement method in trauma patients receiving massive transfusions?
Calcium replacement after 4 units of blood transfused.
Remember, citrate chelates calcium so if you are replacing citrate-containing blood, you patient needs the calcium too for effective clotting and contraction!
What is the effect of hypocalcemia on trauma patients?
Increased coagulopathy, more blood transfused, and double mortality risk.
What is the preferred IV calcium salt?
Calcium gluconate.
Note that this a 3x less potent than calcium chloride
What is the relationship between citrate metabolism and hypocalcemia?
Hemorrhage leads to hypothermia and decreased ionized calcium levels.
What is the normal range for TEG-ACT?
80 - 140 sec.
What does a prolonged R time in TEG indicate?
Indicates a need for FFP transfusion.
What is the maximum amplitude (MA) normal range in TEG?
50.0 - 70.0 mm.
What does a low MA indicate in TEG results?
Indicates a need for platelet transfusion.
MA tells how strong clot is
What does LY30 indicate in TEG testing?
Clot lysis at 30 minutes following maximum amplitude.
Time to lyse clot
What is the treatment recommendation for a K time >3 in TEG?
Administer cryoprecipitate.
What is the significance of the alpha angle in TEG?
Represents clot formation efficiency.
What are the consequences of citrate accumulation in massive transfusion?
May lead to hypocalcemia and impaired coagulation.
