6/18 - Operational Transfusion Medicine

Question 1

Most casualties who DO require a transfusion only need

_____ units of blood

Answer 1

Most casualties who DO require a transfusion only need

1-4 units of blood

Question 2

Massive transfusion leading to Hyperkalemia will precipitate with what finding?

Answer 2

– Early EKG changes : Peaked T-waves, short QT, and ST-depression
– Later EKG changes bundle-branch blocks, increased PR, decreased
amplitude of the P wave, widened QRS  sine wave
– Ventricular fibrillation, Asystole / Cardiac standstill

Question 3

Massive transfusion leading to Hypocalcemia will precipitate with what finding?

Answer 3

Signs/symptoms:
– Perioral or digital numbness/tingling in conscious patient
– Decreased myocardial contractility
– Prolonged QT interval on EKG
– More susceptible to arrhythmias (e.g. hyperkalemia, hypothermia)

Question 4

Acidosis will present how?

Answer 4

Signs:
– Coagulopathy – platelet/coagulation enzyme dysfunction
– Dysrhythmias, decreased cardiac contractility/responsiveness to catecholamines

Question 5

When do we typically see transfusion induced hypocalcemia?

Answer 5

Seen primarily with plasma-containing components (FFP & platelets)
transfused at a rate of >100 ml/min

Question 6

What do we give Hypocalcemic patients s/p transfusion?

Answer 6

CaCl

Question 7

Treating hypokalemia from transfusion error

Answer 7

CaCl, bicarb/THAM, 1 amp D50 / 10u Reg Insulin

Question 8

How do we treat/prevent hypothermia from transfusions

Answer 8

– With non-exsanguinating patients, slower rate of infusion
– Convective warmers (Bair Huggers), Reflective Blankets
– Warmed trauma/surgical suites
– Blood warmers (Belmonts/Level 1 infusers)

Question 9

Hypothermia contributes to coagulopathy

How?

Answer 9

Platelet activation by
vWF pathway profoundly reduced at 30°C

PT and PTT rise when
T

Question 10

What causes the acidemia in transfusion therapy

Answer 10

Generally due to Shock state/underlying acidosis – though can be exacerbated by rapid infusion of aged RBCs (or with neonates)

Question 11

Best way to prevent acidemia with transfusions

Answer 11

• Prevention

– Use fresher blood in MT (

Question 12

What plasma do we give an O patient?

Answer 12

Any plasma! Think about it…

Question 13

B blood patient gets what plasma?

Answer 13

B or AB plasma

Question 14

Who can we give O whole blood to?

Answer 14

O Whole blood is not universal.

Reall should only give it to O patients.

Question 15

Best type of donor that can donate in general:

Answer 15

Donors pre-screened within the last 90 days by a CLIA-certified lab using all the current FDArequired
tests