Apex- Transfusions Flashcards
Type A blood can be given to what blood types
Type B?
Type AB?
A, AB
B, AB
AB
What blood type is the universal donor?
O
Universal Blood donor type
vs universal plasma donor type
universal blood donor = O negative
universal plasma donor = AB positive
*opposite
erythrocytes contain antigeic glycoprotiens on their cell membranes which determine blood type
The plasma contains the opposite antibodies
universal acceptors are opposite:
universaral PRBC acceptor is AB positve
univerasal plasma receptor is O negative
Universal blood type recipient (can receive any type of blood):
Universal plasma type recipent = O negative (opposite blood)
AB+ (it’s got it all, so it can recieve it all)
O negative (opposite blood)
T/F- if an antigen is expressed on the erythrocyte, then there will be an antibody agaisnt that specific antigen in the plasma
FALSE - there will NOT be
just think, if there was an antibody agaisnt it, it would attack the antigen
so if there is NOT an antigen epxressed on the erythrocyte, then there WILL be an antibody agaisnt that specific antigen in the plasma
fill out ABO chart
Label Rh chart
What’s the whole thing with Rh negative/postive/needing rhogam bullshit
- If Rh negative mom gives birth to a Rh positive baby
- during delivery, Rh antigen can cross placenta into moms blood stream - mom will create antibodies to it over several days so that pregnancy isn’t affected
- if a subsequent pregnancy is with a Rh positive baby, the mom will have to get Rhogam (Rh immune globulin) starting @ 28 weeks to prevent sensitization - so the moms antibodies wont attack the fetus during delivery
Why is AB Positive the universal acceptor?
Bc AB positive blood has anti-A, anti-B, and Rh antigens - so administering blood types with these antigens wont cause an issue
What does a Type Vs Screen Vs Crossmatch test for?
how long do each take
Type → tests for ABO & Rh-D antigens
Screen → tests for most clinically significant antibodies
Crossmatch → tests for compatability between recipient plasma and the actual blood unit to be transfused
5 min for type ; 45 min for sceen and cross
If your patient is hemorrhaging and you can’t obtained crossmatched blood quickly enough, what are your options from most favorable to least (3)
- Type-specific Partially cross matched blood
- Type-Specific uncrossmatched blood
- Type O Negative Uncrossmatched blood
- tests for ABO compatability as well as a few antibodies
- tests for ABO compatibility only
- universal donor
Can O-Positive be used for emergencies? why or why not
Yes if the patient is not of child-bearing age and hasn’t recieved a prior transfusion (prob hard to figure out in emergent times)
T/F- 85% of the population is Rh-D negative
false- Rh-D postive - 85% of population
Which blood product contains the HIGHEST concentration of fibrinogen?
A. Cryo
B. FFP
C. Whole Blood
D. PRBC
Cryo
How much is a 5 bag pool of cryo expected to increase fibrinogen levels by?
50mg/dL
Which blood product carries the highest risk of bacterial contamination (risk of sepsis)
Platlets
T/F- platlets need to be administered with a filter
FALSE - NO FILTER, NO WARMER !
tranfusion rarely required with hgb greater than what or less than what?
> 10
<6
T/F- large transfusions of PRBC can result in dilutional coagulopathy
true
FFP dose for warfarin reversal vs coagulopathy
how much does it increase concentration of factors by?
transfusion should be completed within what time period?
warfarin reversal = 5-8ml/kg
coagulopathy= 10-20ml/kg
20-30%
24hrs
Dose of Platlets
1 pack/10kg
how long can platelets be stored at room temp for?
5 days
Fibrinogen levels less than what should be replaced?
< 80-100
Cryo should be infused within how many hours of thawing?
compared to FFP?
platlets?
6 hours
24hrs with FFP
platelets stored at room temp for 5 days
Pt’s with CAD should be transfused when hematocrit falls below what?
28-30%
EBV for :
Premie:
Full term Neonate:
Infant:
Adult:
Premie = 90- 100ml/kg
Neonate = 80-90ml/kg
Infant = 75- 80ml/kg
Adult/Child = 70ml/kg
If a 70kg pt has a hgb of 12g/dL and acutely loses 1L of blood, what is the new Hgb level?
12g/dL
Even though the patient has lost 1/5 of his blood volume, the amount of hgb per deciliter of blood has not changed.
- if resussitated with crystalloid or colloid- the hemoglobin will drop as a result of dilution.
Match each blood additave with its function:
Adenine, Citrate, Phosphate, Dextrose
Anticoagulant, Substrate for glycolysis, buffer, substrate for ATP synthesis
Adenine- Substrate for ATP synthesis
Citrate - anticoagulant
Phosphate- Buffer
Dextrose - Substrate for glycolysis
1 unit of PRBCs contains how many mls and what hct?
300mls
70%
(70/30 referene)
Tranfusion of 1 unit PRBC raises hgb and hct by what?
hgb by 1g/dL and
hct by 2-3%
What preparation process is done to reduce the risk of HLA sensitization, febrile, non-hemolytic transfusion reactions, and CMV transmission
Leukoreduction
What preparation process decreases the risk of Graft-vs-host disease in immunocompromised patients?
Irradiation
destroys donor leukocytes
What blood preparation process prevents anaphylaxis in IgA deficent patients?
Washing
removes any remaining plasma from donor RBCs
What does leuko-reduced PRBCs mean?
it means WBCs have been reomoved from the PRBCs and platelets
decreased risk of HLA sensitization, febrile non-hemolytic reactions, and CMV transmission
What does washing PRBCs do?
why would u do it
removed any remaining plasma from donor RBCs
IgA deficient patient (reduces risk of anaphylaxis)
What does irradiaon to PRBCs do?
destroys donor leukocytes
What temp is blood stored at and why
1-6 degees C
to extend it’s lifespan by slowing the rate of lycolysis
Why don’t erythrocytes contain mitochrondria?
how do they function if they dont have mitochondria?
so the RBC’s don’t consume the o2 they are carrying to the tissues
they rely on glycolysis and the lactic acid pathway t oconvert glucose to ATP
T/F- RBC antigens are NOT removed during the washing process
True- remaining plasma antigens are removed
4 populations that benefit from irradiated cells
- leukemia
- lymphoma
- hematopoietic stem cell transplant
- DiGeorge Syndome
DiGeorge Syndrome = CATCH 22
Cardiac defects
Abnormal face
Thymic hypoplasia
Cleft palate
Hypocalcemia
22q11.2 gene deletion
Citrate binds which coagulation factor?
factor 4 – CALCIUM!
Which blood additive increases the shelf life of PRBCs and by how much?
adenine 21→35 days
Rank each infectious complication of transfusion from MOST common to LEAST common:
HIV, HEP C, HEP B, Cytomegalovirus
- Cytomegalovirus
- Hep B
- Hep C
- HIV
Why do platelets have the highest risk of bacterial contamination?
bc they are stored at room temp
3 main goals for an acute hemolytic reaction
- stop transfusion
- promote renal blood flow
- alkalize the urine
T/F- hemolytic reactions are the most common adverse reactions associated with transfusions
false! - non-hemolytic/febrile transfusion reactions are most common
what kind of reaction describes when the complement system is activated in the recipients blood and plasama antibodies attack the antigens present on the donor blood cell membranes
Acute Hemolytic
*ABO incompatibility is the most lethal
Renal failure, DIC, and hypotension are the most catastrophic complications of intravascular hemolysis
You’re giving a blood transfusion, what would you see undder anesthesia if the patient is experiencing an acute hemolytic reaction (3 things)
- Hemoglobinuria (presenting sign)
- hypotension
- bleeding
Fever, chills, sob, chest pain, nausea, flushing - are said all to be masked by anesthesia
I would think you could see flushing, increased inspiratory pressures, and fevers? but okay
How does an acute hemolytic reaction cause renal failure/ATN?
bc free hgb precipitates inside the renal tubules causing a mechanical obstruction
(free hgb in the form of acid hematin)
the aciditic urine then increases precipitation and worsens the situation
How does an acute hemolytic reaction cause DIC?
bc the RBC releases erythrocyin which activates the intrinsic clotting system
→ leads to uncontrolled fibrin formation
→ body cunsumes it’s own supply of platelets and factors (1,2,5, 7)
By what method does an acute hemolytic reaction cause hemodynamic instability?
free hgb activates the kallikein system
→ the final product of this pathway is bradykinin → potent vasodilator
What would you do if you observed blood in the patients urine after starting a transfusion? (7)
- stop transfusion
- maintain urine output > 75-100mls/hr with:
→IVF, mannitol, 12.5-25g, lasix 20-40mg if IVF and mannitol not working - alkalaize the urine with sodium bicarb
- send urine and plasma hgb samples to blood bank
- check platelets, PT, and fibrinogen
- send unused blood back to blood bank to double check the cross match
- suppport hemodynamics with IVF and vasopressors
T/F- febrile reactions are the most common adverse reaction associated with transfusions
True
pyrogenic cytokines and other components arre released from leukocytes in the donor blood. Leukoreduction reduces the occurance of these febrile transfusion reactions
T/F: leukoreduction reduces the risk of hemolytic reactions
false- reduces the risk of febrile/non-hemolytic reactions
bc these reactions are caused by donor leukocytes releasing pyrogenic cytokines and intracellular components
presentation of febrile transfusion reaction
treatment
less severe- fever/chills/headache/nausea/malaise
supportive + acetaminophen
Which one is IgE mediated and which one is not: anaphylactic or anaphylactoid
anaphylactic is IgE mediated (anaphylactoid is not)
T/F- most allergic reactions to blood transfusions are not serious
presentation
cause and tx
True
Urticaria with itching (most common) & facial swelling
cause: foreign proteins in the donor blood
treatment: supportive + antihistimines
→minor reaction - continue infusion
→major reaction (dyspnea, laryngeal edema, hemodynamic instability) - stop and treat as anaphylaxis
T/F- if pt is having an allergic response to transfusion, you can continue the transfusion if the symptoms are mild
True- just give some benadryl
T/f- you should give benadryl to someone with a febrile transfusion reaction
false- tylenol
allergic reaction (pt itching/rash) would warrant benadryl
why would you give benadryl? your treating pyrogenic cytokines not an allergy
T/f- you should give benadryl to someone with a febrile transfusion reaction
false- tylenol
allergic reaction (pt itching/rash) would warrant benadryl
why would you give benadryl? your treating pyrogenic cytokines not an allergy
FFP from which donor population imparts the HIGHEST risk of transfusion-related acute lung injury?
A. Jehovah’s witness
B. Organ recipient
C. Multiparous female
D. Creutzfeldt Jakob
C. Multiparous women
*TRALI results from HLA and neutrophil antibodies present in DONOR plasma.
-some donor populations have higher concentrations of antibodies
→ blood products from these populations increase the likelihood that the recipent will develop TRALI
Creutzfeldt Jakob disease is mad cow disease (Prion disease that can be spread through infected blood products)
What is Creutzfeldt Jakob disease?
Mad cow disease
a prion disease (whatever that means) that can be spread through infected blood products
What is the most common cause of transfusion-related mortality in the United States?
TRALI
Transfusion Related Acute Lung Injury
What is the most common cause of transfusion-related mortality in the United States?
TRALI
Transfusion Related Acute Lung Injury
What kind of reaction is caused by human leukocyte antigens (HLA) and neutrophils present in the donor plasma
what kind of products impart the highest risk?
TRALI
FFP & Platelets
- hemolytic reaction is caused by → incompatible RBCs
- febrile reaction is caused by → pyrogenic cytokines and intracellular components released from donor leukocytes
- -alergc tranfsusion reactions are caused by → foreign p ptroteins in the donor blood
3 high risk blood donor populations that may provide blood likely to give TRALI to the donor
- multiparious women (history of multiple births)
- history of transfusions
- history of organ transplantation
3 high risk populations for getting a transfusion-related acute lung injury
- sepsis
- burns
- post- CPB
Why do platelets and FFPs carry a higher risk of TRALI
bc they have the highest concentration of these antibodies
How do donor antibodies end up causes TRALI?
donor antibodies → neutophil activation in lungs → endothelial injury → capillary leak → pulmonary edema
impaired gas exchange → hypoxemia → acidosis → death
Onset of TRALI
< 6 hours following transfusion
s/s TRALI for diagnosis (3)
- B/L infiltrates on frontal CXR
- PaO2/FiO2 < 300mmHg OR Spo2 < 90% on RA
- normal PAOP (no left atrial HTN or volume overload)
Treatment of TRALI is suportive and uses a lung-protective strategy…. what 3 things does that entail?
- maximize PEEP
- low tidal volumes
- avoid overhydration
What happens in the heart with acute blood loss
decreased preload, decreased CO
to compensate for this, the veins constrict
Consequences of massive transfusion include all of the following EXCEPT:
A. Hyperkalemia
B. Hypercalcemia
C. Hyperglycemia
D. Alkalosis
B. Hypercalcemia
citrate binds calcium
→ myocardial depression
→coagulopathy
→ impaired nerve transmission
What’s the lethal triad of trauma
Acidsis (hypoperfusion)
Hypothermia
Coagulopathy
is massive transfusion associated with acidosis or alkalosis
alkalosis bc the liver metablizes citrate into bicarb
Why can massive transfusion lead to hyperglycemia?
bc of the dextrose additive in the blood
helps provide a substrate for RBC glycoysis (or something)
Why can massive transfusion lead to hyperglycemia?
bc of the dextrose additive in the blood
helps provide a substrate for RBC glycoysis (or something)
Risk of giving PRBCs to neonates
how to decrease the risk (2)
increased risk of hyperkalemia and cardiac arrest
when RBCs are stored, their membranes→ dysfunctional → K leaks out
- giving washed cells
- giving cells < 7 days old
How does temperature affect coagulation?
impairs it → coagulopathy/bleeding → less able to clot
coagulation is an enzymatic process
→all enxymatic processes are highly dependent on temp
PT/PTT are prolonged below what temp?
34 degrees C
Intraoperative blood salvage is MOST approriate for (select 2):
- living donor kidney transplant
- cesarean section
- Whipple procedure
- anterior hip arthroplasty
living donor kidney transplant and anterior hip arthroplasty
- cell saver with c/s is controversial due to risk of amniotic fluid embolism (despite 2 systematic reviews that failed to show any increase in M&M when it was used)
- cell saver is absolutely contraindicated in neoplastic disease → Whipple is done on patients with pancreatic cancer
T/F- due to high likelyhood of blood loss, cell-saver is an attractive option for a Whipple Procedure
False- cell savor is absolutely contraindicated in those with neoplastic disease
Whipples are done on patients with pancreatic cancer
Intraoperative blood salvage is typically used when blood loss is expected to exceed how many mLs or what % of patient’s blood volume?
blood loss > 1,000 mL’s
or 20% of pts blood volume
T/F- with intraop blood salvage, platelets and coagulation factors are returned to the patient
false- they are not- this can result in a dilutional coagulopathy
so when that surgeon said not to give any more cell-savor since you already gave protamine and that the cell savor blood has heparin in it …..
-no, it’s washed of heparin
-BUT if your giving a lot it can result in a diluational coagulopathy
T/F - when compared to banked blood, salvaged blood has a higher o2 carrying capacity
True!
+ higher concentrations of 2,3-DPG and ATP
+ + better able to maintain a biconcave shape
Hct of Salvaged blood
vs banked
Salvaged = 60-70%
banked = 70%
but salvaged has a higher o2 carrying capacity
Risks of cell saver (4)
- Contamination by urine, feces, amniotic fluid, malignant cells
- fever
- non-immunogenic hemolysis
- “Salvaged blood syndrome” - dilutional coagulopathy
T/F- Salvaged blood syndrome occurs from contamination of collected blood by urine, feces, amniotic fluid, or malignant cells
False- it occurs from dilutional coagulopathy as salvaged blood doesn’t have any platlets or factors returned to the patient
T/F- intraoperative blood salvage is considered safe for transplant surgery
True
5 contraindications to cell-saver
- infected site
- oncologic procedures (whipple)
- topical drugs in surgical field
- sickle cell disease
- thalassemia
3 - betadine, chlorhexidine, topical antibiotics
5- an inherited blood disorder that causes your body to have less hemoglobin than normal.
What is Thalassemia and what are you considered with?
an inherited blood disorder that causes your body to have less hemoglobin than normal
-check hgb , type and cross
During an erythrocyte transfusion, a patient with which blood type is LEAST likely to experience a hemolytic transfusion reaction?
A. AB positive
B. O-negative
C. AB negative
D. O-positive
AB Positive
What is the likelihood of a sucessful transfusion following blood typing WITHOUT crossmatch?
A. 99.8%
B. 95.7%
C. 97.4%
D. 98.5%
A. 99.8%
- blood typing involves mixing the recipeient blood with anti-A, anti-B, and anti-Rh-D antibodies
- there is a 0.2% chance of an incompatability reaction if blood typing is done without crossmatching
- although not idea, proceeding with a transfusion without a crossmatch is a consideration for the acutely hemorrhaging patient
- cross match takes 45mins and only reduces the risk to 0.15% instead of 0.2% (0.05%)
Which blood types can be administered to a patient who is B-positive? (Select 2)
-O positive
-B negative
-AB positive
-A negative
O positive and B negative
a B+ patient can safely receive: B or O blood
because the pt is Rh positive, they can receive Rh positive or negative blood
Estimate the blood volume for a neonate born at 34 weeks weighing 2,000g
200mls
