Anesthesia Buddy: Transfusion Therapy Flashcards
Packed red blood cells (pRBCs) are prepared from whole blood by removing —.
plasma
The most commonly used preservative-anticoagulant solution for RBCs is —.
CPDA1 (citrate, phosphate, dextrose, adenosine)
1 unit of pRBC has a volume of —to—mL and a hematocrit of approximately —to—.
250 to 300ml ; 65% to 80%
Red blood cells are generally stored at —to—°C.
1°C to 6°C
All RBC transfusions must be — compatible with the recipient.
ABO
Do red blood cells provide viable platelets?
No
Do red blood cells provide clinically significant amounts of coagulation factors?
No
In a normovolemic patient, one unit of RBCs in an adult and 10 mL/Kg in a pediatric patient will increase the hematocrit by approximately —% or the hemoglobin by —g/dL.
3% ; 1g/dL
Theoretically, mixing pRBCs with Lactated Ringer’s solution can result in clot formation due to —.
calcium
Intraop blood transfusion should be warmed to prevent —.
hypothermia
With intraop blood transfusion, hypothermia and decreased levels of 2,3 DPG in stored blood can result in — (left shift of oxyhemoglobin curve).
tissue hypoxia
— RBCs should not be given to women of childbearing age because an anti-D antibody may develop (risk of hemolytic disease of the newborn).
O Rh+
ABO compatible platelets are preferred but are they required for transfusion?
No
Platelets are commonly stored at —to—°C for —days.
20°C to 24°C ; 5 days
During the short duration of storage, platelets can become — and lose the ability to —.
activated ; aggregate
A single apheresis unit contains —to—mL and can increase plt count by —/L.
200-400mL ; 50,000 × 10^9/L
What is commonly indicated for thrombocytopenia or dysfunctional platelets
Platelets
Transfused platelets commonly survive —to—days following transfusion.
1 to 7 days
What are the 4 common causes of platelet dysfunction?
- antiplatelet drugs
- cardiopulmonary bypass
- uremia
- liver disease
FFP is plasma that is free of —, —, and —.
red blood cells, leukocytes, and platelets
Group — plasma is suitable for all blood types.
AB
When antithrombin concentrate is unavailable, consider administering — in antithrombin III deficiency (heparin resistance).
FFP
In an average-sized adult, each unit of FFP increases levels of coagulation factors by —to—%.
2% to 3%
FFP contains most — (except —).
coagulation factors (except platelets)
What are the 6 indications for the use of FFP?
- correction of bleeding and elevated INR
- during massive transfusion
- reversal of warfarin
- correction of isolated factor deficiency
- heparin resistance due to antithrombin III deficiency
- coagulopathy associated with liver disease
Prothrombin complex concentrates (PCCs) are formulations containing purified vitamin K-dependent clotting factors and can be used to rapidly reverse — and —.
warfarin and Factor Xa inhibitors
Cryoprecipitate contains —, —, —, —, and —.
fibrinogen, factor VIII, von Willebrand factor, factor XIII, and fibronectin
Is ABO compatibility required for transfusion of cryoprecipitate?
No, but it is preferred
What Changes Occur in Banked/Stored Blood?
• ATP (adenosine triphosphate)
• 2,3-diphosphoglycerate (DPG)
• pH
• Potassium level
• Hemolytic state
• RBC morphology
• Microaggregates
• Proinflammatory cytokines
• Depletion of ATP (adenosine triphosphate)
• Depletion of 2,3-diphosphoglycerate (DPG)
• Acidosis
• Hyperkalemia
• Hemolysis
• Alteration in RBC morphology
• Accumulation of microaggregates
• Accumulation of proinflammatory cytokines
Type and Screen compatibility test is testing and screening what?
ABO-Rh testing and antibody screen
What are the three separate alleles involved in blood typing for type and screen?
A, B, and O
For type and screen, the basis for the Rh factor is the presence or absence of the —.
D antigen
What compatibility test is this: It tests the recipient’s RBCs with serum that contains A and B antibodies. It also determines Rh status by testing recipient’s RBCs with anti D antibodies.
Type: ABO-Rh antigen testing on RBC.
Screen: Assesses for antibodies in recipients serum (indirect — test). When antibodies are present, addition of antiglobulin antibody results in —.
Coomb’s ; agglutination
The most severe transfusion reactions with type and screen are due to — incompatibility
ABO
A crossmatch mimics the transfusion by mixing — cells with — serum (in vitro compatibility).
donor ; recipients
A crossmatch can detect less common (more unique) — not commonly tested in the screen.
antibodies
Blood types with antigens and antibodies for blood genotype of OO? (Blood type, Antigens, Antibodies)
Blood type: O
Antigens: none
Antibodies: anti A and anti B
Blood types with antigens and antibodies for blood genotype of OA or AA? (Blood type, Antigens, Antibodies)
Blood type: A
Antigens: A
Antibodies: anti B
Blood types with antigens and antibodies for blood genotype of OB or BB? (Blood type, Antigens, Antibodies)
Blood type: B
Antigens: B
Antibodies: anti A
Blood types with antigens and antibodies for blood genotype of AB? (Blood type, Antigens, Antibodies)
Blood type: AB
Antigens: A and B
Antibodies: none
Blood therapy ABO compatibility with group O? (Compatible RBCs, Compatible Plasma)
Compatible RBCs: Group O
Compatible Plasma: Group O, A, B, and AB
Blood therapy ABO compatibility with group A? (Compatible RBCs, Compatible Plasma)
Compatible RBCs: Group A and O
Compatible Plasma: Group A and AB
Blood therapy ABO compatibility with group B? (Compatible RBCs, Compatible Plasma)
Compatible RBCs: Group B and O
Compatible Plasma: Group B and AB
Blood therapy ABO compatibility with group AB? (Compatible RBCs, Compatible Plasma)
Compatible RBCs: Group O, A, B, and AB
Compatible Plasma: Group AB
Generally, a fully soaked “4 × 4” is considered to hold —mL of blood.
10 mL
Generally, a soaked laparotomy pad (“lap”) can hold —to—mL of blood.
100 to 150 mL
Hemoglobin/hematocrit are affected by the patient’s — status.
fluid
Tranfusion of — improves oxygen delivery (DO2).
packed red blood cells (pRBCs)
DO2 is dependent on — and —.
cardiac output (CO) and the arterial oxygen content (CaO2)
DO2=
CO x CaO2
CaO2=
1.34 x [Hgb] x SaO2 + 0.003 x [PaO2]
If the Hemoglobin is 15 g/dL, SaO2 is 100%, and PaO2 is 100 mmHg
-What is the arterial O2 content CaO2 in mL/L?
CaO2=20.4mL/dL or 204 mL/L
What is the oxygen delivery (DO2) to tissues if the cardiac output is 5 L/min and CaO2 is 204 mL/L?
DO2=1020 mL/L
Preferably, blood loss should be replaced with — and — initially to maintain
normovolemia.
crystalloids and colloids
Careful not to induce acute normovolemic anemia due to replacement of intraoperative blood loss with — solution.
crystalloid
In patients with chronic anemia, increased —make oxygen transport more efficient.
2,3 DPG levels
Allowable Blood Loss (ABL)=
[starting Hct or Hgb - target Hct or Hgb x EBV] / starting Hct or Hgb
Estimated Blood volume for preterm neonates:
90-100 mL/kg
Estimated Blood volume for full term neonates:
80-90 mL/kg
Estimated Blood volume for infants:
70-80 mL/kg
Estimated Blood volume for adult men:
75 mL/kg
Estimated Blood volume for adult women:
65 mL/kg
What Blood Type Should be Transfused in an Emergency?
Type O, Rh-negative packed RBCs, and type AB plasma
Massive Blood Transfusion definition: Administration of greater than — blood volume (—to—units) in — hours or — of the patient’s total — in — hour.
1 blood volume (10-20 units) in 24 hours or one half of the patient’s total estimated blood volume in 1 hour
What is the lethal triad of trauma?
hypothermia, acidosis, and coagulopathy
Citrate toxicity is when citrate binds calcium and magnesium causing — and —.
hypocalcemia and hypomagnesemia
— is the most common cause of nonsurgical bleeding following massive blood transfusion.
Dilutional thrombocytopenia
Complications of Blood Transfusion:
•Volume status
•Body Temp
•Citrate level
•Coagulopathy
•Potassium level
•Acid base imbalance
•Impaired oxygen delivery capacity
•Volume status: overload
•Body Temp: hypothermia
•Citrate level: citrate toxicity
•Coagulopathy: dilutional
•Potassium level: hyperkalemia
•Acid base imbalance: metabolic acidosis and alkalosis
•Oxygen delivery capacity: impaired
What can occur with hypothermia when considering complications of Blood Transfusion?
It can lead to ventricular arrhythmias and fibrillation. It impairs platelet function and the function of coagulation proteins.
What can occur with citrate toxicity when considering complications of Blood Transfusion?
Calcium binding by the citrate preservative can cause hypocalcemia and myocardial depression. Calcium is a necessary cofactor for several clotting factors. Citrate toxicity is treated with calcium. Hypocalcemia causes QT prolongation on ECG.
What can occur with coagulopathy when considering complications of Blood Transfusion?
Dilutional thrombocytopenia and dilutional coagulopathy (decreased “labile” factors V and VIII)
What can occur with hyperkalemia when considering complications of Blood Transfusion?
K+ moves out of pRBCs during storage.
What can occur with impaired oxygen delivery capacity when considering complications of Blood Transfusion?
Decreased in the 2,3-DPG in store blood and left shift of the oxyhemoglobin dissociation curve
What kind of transfusion reactions occurs due to recipient reaction to residual donor white blood cells, platelets, or plasma proteins?
Febrile non-hemolytic reaction
How does febrile non-hemolytic transfusion reaction presents itself?
Increase in temperature without evidence of hemolysis
How can risk be minimized with febrile non-hemolytic reaction?
Leukoreduced blood products
What kind of transfusion reactions occurs commonly due to ABO incompatibility?
Acute hemolytic reaction (acute intravascular hemolysis)
S/S for acute hemolytic reaction in awake pts?
Chills, fever, nausea, and chest and flank pain
S/S for acute hemolytic reaction in anesthetized pts?
Fever, hypotension, tachycardia, hemoglobinuria, and oozing from surgical site
What 3 things can acute hemolytic reaction result in?
- acute kidney failure
- disseminated intravascular coagulation (DIC)
- shock
What kind of transfusion reaction occurs due to antibodies to non-D antigens of the Rh system or other systems such as Kell, Duffy, or Kidd antigens (not anti-A or anti-B)?
Delayed hemolytic reaction (extravascular hemolysis)
Delayed Hemolytic Reaction (extravascular hemolysis) typically occurs —to—days after transfusion?
2-21 days
S/S for Delayed Hemolytic Reaction (extravascular hemolysis)?
Usually mild: malaise, jaundice, and fever
What is the treatment for Delayed Hemolytic Reaction (extravascular hemolysis)?
Supportive
What kind of transfusion reaction is associated with IgA deficiency (they have IgA antibodies) and receive IgA containing blood transfusions?
Anaphylactic reaction
— decreases risk of anaphylactic reaction by reducing amount of plasma proteins and immunoglobins.
Washed blood products
4 common treatments for anaphylactic transfusion reaction?
- Epinephrine
- Fluids
- Corticosteroids
- H1 and H2 blockers
What kind of transfusion reaction occurs in immunocompromised patients due to lymphocytes immune response?
Graft versus Host disease
What decreases the risk of graft versus host disease?
Irradiation of blood products
What kind of transfusion reactions occurs from excessive and rapid blood product administration (common in massive hemorrhage resuscitation cases).
TACO (transfusion associated circulatory overload)
TACO (transfusion associated circulatory overload) causes —.
Hydrostatic pulmonary edema (too much volume)
What kind of transfusion reaction presents as noncardiac (nonhydrostatic) pulmonary edema inflammatory response associated with acute hypoxia occurring within 6 h of blood product administration?
Transfusion-related acute lung injury (TRALI)
Transfusion-related acute lung injury (TRALI) occurs more frequently with — and —.
Platelets and FFPs
Transfusion-related acute lung injury (TRALI) treatment is supportive care similar to —.
ARDS
What are the 3 transfusion-related infections?
- Viral infections
- Bacterial infections
- Parasitic infections
— contamination is most common with platelets due to their storage in dextrose at room temperature.
Bacterial
What is the diagnosis for major S/S of:
Fever, headache, malaise, nausea
Febrile non-hemolytic reactions
What is the diagnosis for major S/S of:
Fever, hypotension, hemoglobinuria, renal failure, disseminated intravascular coagulation
Hemolytic reactions
What is the diagnosis for major S/S of:
Evidence of hypervolemia, hypertension, respiratory distress, cyanosis, hypoxemia, hydrostatic pulmonary edema
TACO (transfusion associated circulatory overload)
What is the diagnosis for major S/S of:
Noncardiogenic, nonhydrostatic pulmonary edema, respiratory distress, dyspnea, hypoxemia, fever, tachycardia
Transfusion-related acute lung injury (TRALI)
What is the diagnosis for major S/S of:
Most common with platelets ; Fever, rigors, hypotension
Bacterial contamination of blood products
What is the diagnosis for major S/S of: Bronchospasm, hypotension, respiratory distress, erythema, urticaria, mucous membrane edema, anaphylactic shock
Anaphylactic reaction
When managing hemolytic reactions, do you stop transfusion immediately and notify blood bank?
Yes
What are the 6 main steps to managing a hemolytic reaction?
- STOP transfusion immediately & notify blood bank.
- RECHECK pts ID bracelet against blood product slip.
- DRAW blood: Coagulation studies, platelet count, compatibility testing (recipient and donor
specimens), presence of hemoglobin in plasma. - INSERT urinary catheter for strict I&Os. Test urine for presence of hemoglobin.
- TREAT hypotension aggressively: IV fluids & vasopressors
- MAINTAIN urine output (euvolemic state): Mannitol & loop diuretics are used cautiously, bicarbonate to alkalinize urine, IV fluids.
Removes WBCs from RBCs and platelets and reduces the risk of HLA alloimmunization and CMV transmission.
Leukoreduction
It helps prevent Graft Versus Host Disease in immunocompromised patients.
Irradiation
Washed blood products decrease risk by reducing amount of plasma proteins and immunoglobins. Beneficial for patients with IgA deficiency.
Washing
Which alternative strategy for management of blood loss is indicated for patients undergoing elective surgery with high probability of transfusion requirement?
Autologous transfusion
Which alternative strategy for management of blood loss is commonly indicated for cardiac, vascular, and orthopedic surgeries for blood losses greater than 1000-1500 mL?
Blood salvage (cell saver)
Which alternative strategy for management of blood loss is when blood can be collected from patient early in the operative course?
Normovolemic hemodilution (rare)
Which alternative blood loss strategy requires the patient to donate their own blood prior to surgery (normally 4-5 weeks before surgery)?
Autologous transfusion
With autologous transfusion, donated blood is stored and may be used preoperatively to treat —.
Anemia
With blood salvage (cell saver), collected blood is — (mixed with —), concentrated (hematocrit of —to—%) and debris is removed.
anticoagulated ; heparin ; 50% to 60%
With blood salvage (cell saver), — and — are moved during filtration process.
Platelets and clotting factors
What are the 2 contract indications for blood salvage (cell saver)?
- Septic contamination
- Malignancy
With normovolemic hemodilution, the withdrawn blood volume is then replaced with —.
crystalloids
With normovolemic hemodilution, this technique relies on the premise that fewer — are lost, and — volume is maintained.
red cells ; intravascular
PRBCs are stored in a Blood Bank refrigerator at a temperature of:
A) -18 ºC
B) 1-6ºC
C) 10-15 ºC
D) 20-25 ºC
B) 1-6ºC
In a normovolemic adult patient, 1 unit of red blood cell transfusion should raise the hematocrit by approximately:
A) 1%
B) 3%
C) 5%
D) 8%
B) 3%
In a normovolemic adult patient, 1 unit of red blood cell transfusion should raise the hemoglobin by approximately:
A) 1 g/dL
B) 2 g/dL
C) 3 g/dL
D) 4 g/dL
A) 1 g/dL
Platelets are stored at a temperature of:
A) 18 ºC
B) 1-6ºC
C) 10-15 ºC
D) 20-24 ºC
D) 20-24 ºC
A patient’s ABO group is O. The patient is compatible with red blood cells from:
A) Group O
B) Group A and O
C) Group B and O
D) Group O, A, B, AB
A) Group O
A patient’s ABO group is AB. The patient is compatible with red blood cells from:
A) Group O
B) Group A and O
C) Group B and O
D) Group O, A, B, AB
D) Group O, A, B, AB
A patient’s ABO group is A. The patient is compatible with red blood cells from:
A) Group O
B) Group A and O
C) Group B and O
D) Group O, A, B, AB
B) Group A and O
In a normovolemic pediatric patient, RBCs 10mL/Kg in a will increase the hematocrit by approximately:
A) 1%
B) 3%
C) 5%
D) 8%
B) 3%
What transfusion therapy is associated with the highest risk of bacterial contamination?
A) Red blood cells
B) Fresh frozen plasma
C) Cryoprecipiate
D) Platelets
D) Platelets
Which is unlikely to occur from massive blood transfusion?
A) Hypothermia
B) Volume overload
C) Dilutional coagulopathy
D) Hypercalcemia
D) Hypercalcemia
All of the following are possible complications of massive blood transfusion EXCEPT:
A) Citrate intoxication
B) Metabolic acidosis
C) Hyperkalemia
D) Right shift of oxyhemoglobin curve
D) Right shift of oxyhemoglobin curve
Which is the universal donor of red blood cells?
A) Type O Rh negative
B) Type O Rh positive
C) Type AB Rh negative
D) Type AB Rh positive
A) Type O Rh negative
The most common cause of nonsurgical bleeding after massive blood transfusion is:
A) Citrate toxicity
B) Hypothermia
C) Dilutional thrombocytopenia
D) Metabolic acidosis
C) Dilutional thrombocytopenia
All these factors can cause symptomatic hypocalcemia EXCEPT:
A) Hyperventilation
B) Administration of bicarbonate
C) Massive blood transfusion
D) Vitamin D intoxication
D) Vitamin D intoxication
Sex-linked inherited bleeding disorder in which factor VIII levels are markedly reduced
A) Hemophilia A
B) Hemophilia B
C) Thalassemia
D) Pernicious anemia
A) Hemophilia A
Which laboratory finding DECREASES with acute disseminated intravascular coagulation (DIC)?
A) PT/INR
B) PTT
C) Bleeding time
D) Platelet count
D) Platelet count
Which of the following factors DECREASES blood viscosity during a transfusion?
A) Raising the height of the bag
B) Pressurizing the bag
C) Utilizing a warming device
D) Decreasing the IV catheter gauge
C) Utilizing a warming device
Which is NOT a component of Poiseuille’s law?
A) Flow
B) Radius
C) Inertia
D) Viscosity
C) Inertia
The solubility coefficient of oxygen in plasma is:
A) 0.003
B) 1.39
C) 26.4
D) 80
A) 0.003
Which blood lacks the A, B, and Rh(D) antigens?
A) A positive
B) AB negative
C) O-negative
D) O-positive
C) O-negative
Metabolic abnormalities that may accompany blood transfusions include all these EXCEPT:
A) Increased levels potassium
B) Decreased 2,3-diphosphoglycerate levels
C) Metabolic alkalosis
D) Hypercalcemia
D) Hypercalcemia
Cryoprecipitate contains all the following EXCEPT:
A) Factor 8
B) Factor 13
C) Factor 7
D) Von Willebrand factor
C) Factor 7
Which is fibrinogen?
A) Factor I
B) Factor II
C) Factor V
D) Factor X
A) Factor I
Physiologic effects of hypothermia include all these EXCEPT:
A) Increased systemic vascular resistance
B) Increased platelet number and function
C) Decreased cerebral blood flow
D) Increased CO2 and O2 solubility
B) Increased platelet number and function
Physiologic effects of hypothermia include all these EXCEPT:
A) Increased pulmonary vascular resistance
B) Left shift of oxyhemoglobin dissociation curve
C) Reduced clotting activity
D) Reduced risk of arrhythmias
D) Reduced risk of arrhythmias
Which of the following factors is prothrombin?
A) II
B) VII
C) IX
D) X
A) II
All of these are Vitamin K dependent coagulation factors EXCEPT:
A) I
B) II
C) VII
D) IX
A) I
Cryoprecipitate contains factor VIII, factor XIII, fibrinogen and:
A) Factor II
B) Factor IV
C) Factor VI
D) Von Willebrand factor
D) Von Willebrand factor
Perioperative hypothermia:
A) Increases drug metabolism
B) Produces vasodilation
C) Can impair coagulation
D) Decreases surgical infections
C) Can impair coagulation
Estimated blood volume of adult men
A) 105 mL/kg
B) 95 mL/kg
C) 85 mL/kg
D) 75 mL/kg
D) 75 mL/kg
Colloid least likely to affect coagulation
A) Albumin
B) Hespan
C) Dextran
D) Hextend
A) Albumin
Most abundant protein in the blood
A) Albumin
B) Lipoprotein
C) Fibrinogen
D) Globulin
A) Albumin
Which electrolyte is a cofactor in blood coagulation?
A) Sodium
B) Potassium
C) Phosphate
D) Calcium
D) Calcium
Hyperventilation during a massive blood transfusion can lead to:
A) Hypokalemia
B) Hypocalcemia
C) Hyponatremia
D) Hypercalcemia
B) Hypocalcemia
All these are side effects of hypothermia EXCEPT:
A) Decreased pulmonary vascular resistance
B) Decreased myocardial contractility
C) Slows intracardiac conduction
D) Increases latency of SSEPs
A) Decreased pulmonary vascular resistance
The amount of oxygen delivered to tissues (DO2) is the arterial O2 content (CaO2) multiplied by the:
A) Heart rate
B) Cardiac output
C) Systemic vascular resistance
D) Hemoglobin saturation
B) Cardiac output
The ECG hallmark of hypocalcemia is:
A) Peaked T wave
B) QTc prolongation
C) Shortened ST segment
D) Flat P waves
B) QTc prolongation
Which blood component is LEAST likely to transmit Hepatitis B?
A) 5% Albumin
B) Packed red blood cells
C) Fresh frozen plasma
D) Cryoprecipiate
A) 5% Albumin
Inherited hypercoagulable conditions include all these EXCEPT:
A) Factor V Leiden
B) Antithrombin deficiency
C) Protein C deficiency
D) Hemophilia B
D) Hemophilia B
Which is NOT a physiologic compensation of anemia?
A) Decreased levels of 2,3-diphosphoglycerate (2,3-DPG)
B) Increased cardiac output
C) Increased oxygen extraction
D) Increased minute alveolar ventilation
A) Decreased levels of 2,3-diphosphoglycerate (2,3-DPG)
Which can reverse the effects of aspirin therapy?
A) Vitamin K
B) Cryoprecipitate
C) Platelets
D) Tranexamic acid
C) Platelets
Mechanism of action: Vitamin K antagonism
A) Argatroban
B) Warfarin
C) Rivoraxaban
D) Bivalrudin
B) Warfarin
Which inhibits cyclooxygenase?
A) Tirofiban
B) Clopidogrel
C) Aspirin
D) Heparin
C) Aspirin
Which of the following can reduce the risk of allergic reactions in IgA deficient patients?
A) Premedication with famotidine
B) Irradiated products
C) Leukoreduced products
D) Washed products
D) Washed products
Which of the following can reduce the risk of transfusion related Graft Versus Host Disease?
A) Addition of citrate to blood products
B) Irradiated products
C) Leukoreduced products
D) Washed products
B) Irradiated products
Which complication is LEAST likely to occur from intraoperative blood salvage (cell saver)?
A) Anaphylactic shock
B) Pulmonary embolism
C) Infection
D) Coagulopathy
A) Anaphylactic shock
What red blood cell therapy is indicated for patients at risk of hyperkalemia?
A) Leukoreduced PRBCs
B) Irradiated PRBCs
C) Washed PRBCs
D) Frozen PRBCs
C) Washed PRBCs
What red blood cell therapy reduces the risk of cytomegalovirus (CMV) infection?
A) Leukoreduced PRBCs
B) Irradiated PRBCs
C) Washed PRBCs
D) Frozen PRBCs
A) Leukoreduced PRBCs
Packed red blood cell contain a hematocrit range of approximately :
A) 15-25%
B) 35-45%
C) 55-70%
D) 70-90%
C) 55-70%
Washed RBC transfusion significantly reduces serum — levels.
potassium
Washing of red cells is also performed to reduce — reactions.
allergic
Leukocyte-reduced (leukoreduction) blood products are used to decrease the risk of transfusion-related febrile reactions, infections, and immunosuppression.
Leukocyte-reduced (leukoreduction)
— reduced units are considered to be cytomegalovirus (CMV) safe.
Leukocyte
pRBCs have a volume of —to—mL and a hematocrit of approximately —to—%.
250 to 300 mL ; 65% to 80%
Cryoprecipitate contains all the following EXCEPT:
A) Fibrinogen
B) von Willebrand factor (vWF)
C) Factor V
D) Factor VIII
C) Factor V
Red blood cells can be frozen in a — solution for up to 10 years (blood with rare phenotypes).
hypertonic glycerol
A patient’s ABO group is O. The patient is compatible with plasma from:
A) Group O, A, B, AB
B) Group A and AB
C) Group B, AB
D) Group AB
A) Group O, A, B, AB
A patient’s ABO group is AB. The patient is compatible with plasma from:
A) Group O, A, B, AB
B) Group A and AB
C) Group B, AB
D) Group AB
D) Group AB
A patient’s hemoglobin is around 7 g/dL. You estimate his hematocrit (Hct) to be:
A) 15%
B) 21%
C) 35%
D) 44%
B) 21%
Normally, the ratio of hematocrit to hemoglobin is —.
three to one
Generally, you can convert the value of hematocrit to hemoglobin by dividing it by —.
3
A preservative–anticoagulant solution is commonly added to collected blood. Which component is NOT part of the solution?
A) Citrate
B) Dextrose
C) Phosphate
D) Alcohol
D) Alcohol
Citrate is an — that binds calcium.
ANTICOAGULANT
Phosphate is a —.
BUFFER
Dextrose is used as a red cell — source.
ENERGY
— is the precursor for adenosine triphosphate (ATP) synthesis.
Adenosine
The most commonly used preservative-anticoagulant solution added to collect blood is —.
CPDA1 (citrate, phosphate, dextrose, adenosine)
What is the most common adverse reaction to blood transfusion?
A) Febrile nonhemolytic reactions
B) Transfusion-Related Acute Lung Injury (TRALI)
C) TACO (Transfusion Associated Circulatory Overload)
D) Acute Hemolytic Reaction (acute intravascular hemolysis)
A) Febrile nonhemolytic reactions
Administration of — blood can considerably reduce the risk of febrile, non hemolytic transfusion reactions complication.
LEUKOREDUCED
All these electrolyte disturbances are associated with QT prolongation EXCEPT:
A) Hypocalcemia
B) Hypokalemia
C) Hypomagnesemia
D) Hyponatremia
D) Hyponatremia
Adverse effects associated with — therapy include hypercapnia, hypokalemia, ionized HYPOCALCEMIA and QTc interval prolongation.
sodium BICARBONATE
— cause result in multiple somatic symptoms due to hypocalcemia induced by respiratory ALKALOSIS
HYPERVENTILATION
Symptomatic — can occur during transfusion of CITRATED blood. Citrate binds to the patient’s endogenous calcium when blood products are administered, rendering calcium inactive
hypocalcemia
The principal biological function of vitamin D is the maintenance of normal levels of serum —
calcium
Disseminated intravascular coagulation (DIC) is a widespread — state that causes microvascular and macrovascular clotting and compromises blood flow, ultimately resulting in multiple organ dysfunction syndrome (MODS).
hypercoagulable
Process consumes clotting factors and platelets. The overall platelet count is —.
reduced
The Hagen– — equation describes the flow through a tube
Poiseuille
Vessel resistance (R) is — proportional to the length (L) of the vessel and the viscosity (η) of the blood
DIRECTLY
Vessel resistance (R) is — proportional to the radius to the fourth power (r4)
INVERSELY
Flow is — proportional to the viscosity of the fluid.
INVERSELY
Electrolyte abnormalities associated with QT prolongation risk include —, —, and —.
hypocalcemia, hypomagnesemia, and hypokalemia
— is NOT a risk factor for QT prolongation.
Hyponatremia
The amount of dissolved oxygen in the blood can be calculated by applying:
A) Henry’s law
B) Boyle’s law
C) Gay-Lussac’s law
D) Charles’s law
A) Henry’s law
Henry’s law is a — law that states that the amount of dissolved gas in a liquid is proportional to its partial pressure.
gas
The amount of oxygen that DISSOLVES into the bloodstream is — proportional to the partial PRESSURE of oxygen in alveolar air.
DIRECTLY
Perioperative hypothermia:
A) Decreases risk of pressure ulcers
B) Decreases surgical bleeding
C) Decreases surgical site infections
D) Decreases drug metabolism
D) Decreases drug metabolism
Hypothermia — drug metabolism, — risk of pressure ulcers, — surgical bleeding, and — risk of surgical site infections.
decreases ; increases ; increases ; increases
The addition of — to the preservative solution of blood allows red blood cells to resynthesize adenosine triphosphate (ATP).
adenine
Concentrations of 2,3-diphosphoglycerate in erythrocytes — with the prolonged storage of blood.
decrease
The infusion of citrate preservative during the transfusion of blood can result in a — and —. The theory is that the metabolic alkalosis results from the metabolism of citrate in the liver to bicarbonate.
metabolic alkalosis and hypocalcemia
Factor I (—)
Fibrinogen
Factor II (—)
Prothrombin
Factor III (—)
Tissue thromboplastin or tissue factor
Factor IV (—)
Ionized calcium
Factor V (—)
Labile factor
Factor VII (—)
Stable factor
Factor VIII (—)
Antihemophilic factor
Factor IX (—)
Christmas factor
Factor X (—)
Stuart-Prower factor
Factor XI (—)
Plasma thromboplastin antecedent
Factor XII (—)
Hageman factor
Factor XIII (—)
Fibrin stabilizing factor
Hypothermia — solubility of O2 and CO2.
increases
The vitamin K-dependent coagulation factors are factors —, —, —, —, proteins — and —.
II, VII, IX, X ; C and S
Calcium chloride is indicated for all these EXCEPT:
A) Hypocalcemia secondary to blood transfusion
B) Hyperkalemia
C) Hypermagnesemia
D) Hypokalemia
D) Hypokalemia
Most of the blood is in the:
A) Arteries
B) Capillaries
C) Veins
D) Pulmonary vasculature
C) Veins
Which causes a LEFT shift in oxyhemoglobin dissociation curve?
A) Hyperthermia
B) Decreased 2,3 diphosphoglycerate
C) Acidosis
D) Hypercarbia
B) Decreased 2,3 diphosphoglycerate
A — is defined as a high molecular weight (MW) substance that largely remains in the intravascular compartment.
colloid
Colloids such as —, —, and — can be associated with coagulation abnormalities (decreased platelet adhesiveness, decreased factor VIII, increased fibrinolysis).
Dextran, Hespan and Hextend
Albumin can inhibit — aggregation but albumin solutions do not appear to directly alter blood coagulation.
platelet
Human serum — is the most abundant plasma protein.
albumin
Clotting factor — is a calcium ion.
IV
Hyperventilation can cause respiratory alkalosis and induce —.
hypocalcemia
— are used to manage hypocalcemia, cardiotoxicity due to hyperkalemia or hypermagnesemia.
Calcium chloride and calcium gluconate
Marked depletion of 2,3 diphosphoglycerate (2, 3-DPG) occurs in banked blood within —to— weeks, this can affect — delivery after massive transfusion.
oxygen
Hypocalcemia prolongs QT interval due to longer phase — of the cardiac action potential.
2
QTc interval prolongation is the hallmark of — (because of lengthening of the ST segment).
hypocalcemia
Inherited — conditions include:
Factor V Leiden
Prothrombin gene mutation
Antithrombin deficiency
Protein C deficiency
Protein S deficiency
Elevated levels of factor VIII
Elevated levels of fibrinogen
HYPERcoagulable
Most common inherited bleeding disorders include which 3 ones?
- Von Willebrand disease
- Hemophilia A (factor VIII deficiency)
- Hemophilia B (factor IX deficiency)
2,3-diphosphoglycerate (2,3-DPG) in red blood cells — in response to anemia and hypoxia
INCREASES
Cardiac output, heart rate, respirations, oxygen extraction and alveolar ventilation are — in response to anemia.
increased
Which is NOT part of the emergent treatment of a hemolytic transfusion reaction?
A) Administration of crystalloid solutions (fluids)
B) Administration of diuretics (furosemide)
C) Administration of alkalinizing agent (sodium bicarbonate)
D) Administration of steroids (prednisone)
D) Administration of steroids (prednisone)
Which clotting factor is Vitamin K dependent?
A) Factor I
B) Factor III
C) Factor X
D) Factor XII
C) Factor X
Which is CORRECT about Von Willebrand disease?
A) Von Willebrand factor is a glycoprotein that plays a part in fibrinolysis
B) It is also known as factor VIII deficiency
C) DDAVP (desmopressin) is most effective in type 1 Von Willebrand disease
D) Least commonly inherited bleeding disorder
C) DDAVP (desmopressin) is most effective in type 1 Von Willebrand disease
Mechanism of action: Direct factor Xa inhibition
A) Rivoraxaban
B) Argatroban
C) Abciximab
D) Tirofiban
A) Rivoraxaban
Mechanism of action: GP IIb-IIIa inhibitor
A) Fondaparinux
B) Bivalrudin
C) Abciximab
D) Argatroban
C) Abciximab
Von Willebrand factor functions as a carrier for factor VIII to maintain its levels and help in — adhesion.
platelet
— is most effective in type 1 Von Willebrand disease.
DDAVP
— is a noncompetitive inhibitor of the COX-enzymes 1 and 2.
Aspirin
— acts on platelets by acetylating the cyclooxygenase enzyme.
Aspirin
Because platelets cannot generate new COX, the effects of aspirin last for the duration of the life of the platelet (— days).
10
The antiplatelet effect of aspirin can be reversed with — transfusions.
platelet
— competitively inhibits the vitamin K epoxide reductase complex 1 (VKORC1). This is an essential enzyme for activating the vitamin K.
Warfarin
— (Xarelto) is a selective inhibitor of factor Xa (FXa).
Rivaroxaban
Factor Xa inhibitors include what 5 meds?
- apixaban (Eliquis)
- fondaparinux (Arixtra)
- edoxaban
- betrixaban
- rivaroxaban (xarelto)
— is a monoclonal antibody directed against the IIb/IIIa complex.
Abciximab
— inhibits platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor, and other adhesive molecules.
Abciximab
— is a second generation thienopyridine antiplatelet drug.
Clopidogrel (Plavix)
— inhibits ADP-dependent activation of the glycoprotein IIb/IIIa complex.
Clopidogrel (Plavix)
ADP receptor inhibitors such as — and — inhibit platelet aggregation by selectively and irreversibly binding the platelet surface receptor P2Y12.
clopidogrel (Plavix) and ticlopidine
Mechanism of action: GP IIb-IIIa inhibitor
A) Fondaparinux
B) Bivalrudin
C) Abciximab
D) Argatroban
C) Abciximab
Mechanism of action: ADP receptor inhibitor
A) Clopidogrel
B) Aspirin
C) Heparin
D) Rivoraxaban
A) Clopidogrel
Which is a synthetic derivative of amino acid lysine?
A) Protamine
B) Tranexamic acid
C) Aspirin
D) Heparin
B) Tranexamic acid
What is the main reason packed red blood cells are stored at a temperature of 1°C to 6 °C?
A) It decreases the risk of hyperkalemia
B) It prevents clotting
C) It reduces the rate of glycolysis
D) It reduces micro-occlusive events
C) It reduces the rate of glycolysis
— is a synthetic derivative of the amino acid lysine that inhibits fibrinolysis.
Tranexamic acid (TXA)
— competitive inhibits the activation of plasminogen to plasmin preventing breakdown of fibrin.
Tranexamic acid (TXA)
Washed blood products decrease risk by reducing amount of — and —.
plasma proteins and immunoglobins
Packed red blood cells are stored at 1°C to 6°C. It reduces the rate of — approximately 40 times the rate at body temperature (helps preserve the RBCs).
glycolysis
Storage at 1°C to 6°C inhibits the — pump, resulting in a loss of potassium ion (K+) from the cells into the plasma.
sodium-potassium
Potential complications of intraoperative blood — include fat embolism, air embolism, pyrexia, infection, microaggregates causing microembolism, salvaged blood syndrome, DIC and ARDS.
salvage
Anaphylactic shock is not a complication of intraoperative blood salvage. It is more common with — blood transfusion.
allogenic
