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Fluids, coags, transfusions > Apex- Transfusions > Flashcards

Apex- Transfusions Flashcards

1
Q

Type A blood can be given to what blood types

Type B?

Type AB?

A

A, AB

B, AB

AB

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2
Q

What blood type is the universal donor?

A

O

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3
Q

Universal Blood donor type
vs universal plasma donor type

A

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

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4
Q

Universal blood type recipient (can receive any type of blood):

Universal plasma type recipent = O negative (opposite blood)

A

AB+ (it’s got it all, so it can recieve it all)

O negative (opposite blood)

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5
Q

T/F- if an antigen is expressed on the erythrocyte, then there will be an antibody agaisnt that specific antigen in the plasma

A

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

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6
Q

fill out ABO chart

A
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7
Q

Label Rh chart

A
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8
Q

What’s the whole thing with Rh negative/postive/needing rhogam bullshit

A
  1. If Rh negative mom gives birth to a Rh positive baby
  2. 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
  3. 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
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9
Q

Why is AB Positive the universal acceptor?

A

Bc AB positive blood has anti-A, anti-B, and Rh antigens - so administering blood types with these antigens wont cause an issue

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10
Q

What does a Type Vs Screen Vs Crossmatch test for?

how long do each take

A

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

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11
Q

If your patient is hemorrhaging and you can’t obtained crossmatched blood quickly enough, what are your options from most favorable to least (3)

A
  1. Type-specific Partially cross matched blood
  2. Type-Specific uncrossmatched blood
  3. Type O Negative Uncrossmatched blood

  1. tests for ABO compatability as well as a few antibodies
  2. tests for ABO compatibility only
  3. universal donor
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12
Q

Can O-Positive be used for emergencies? why or why not

A

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)

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13
Q

T/F- 85% of the population is Rh-D negative

A

false- Rh-D postive - 85% of population

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14
Q

Which blood product contains the HIGHEST concentration of fibrinogen?

A. Cryo
B. FFP
C. Whole Blood
D. PRBC

A

Cryo

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15
Q

How much is a 5 bag pool of cryo expected to increase fibrinogen levels by?

A

50mg/dL

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16
Q

Which blood product carries the highest risk of bacterial contamination (risk of sepsis)

A

Platlets

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17
Q

T/F- platlets need to be administered with a filter

A

FALSE - NO FILTER, NO WARMER !

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18
Q

tranfusion rarely required with hgb greater than what or less than what?

A

> 10
<6

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19
Q

T/F- large transfusions of PRBC can result in dilutional coagulopathy

A

true

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20
Q

FFP dose for warfarin reversal vs coagulopathy

how much does it increase concentration of factors by?

transfusion should be completed within what time period?

A

warfarin reversal = 5-8ml/kg
coagulopathy= 10-20ml/kg

20-30%

24hrs

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21
Q

Dose of Platlets

A

1 pack/10kg

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22
Q

how long can platelets be stored at room temp for?

A

5 days

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23
Q

Fibrinogen levels less than what should be replaced?

A

< 80-100

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24
Q

Cryo should be infused within how many hours of thawing?

compared to FFP?

platlets?

A

6 hours

24hrs with FFP

platelets stored at room temp for 5 days

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25
Q

Pt’s with CAD should be transfused when hematocrit falls below what?

A

28-30%

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26
Q

EBV for :

Premie:
Full term Neonate:
Infant:
Adult:

A

Premie = 90- 100ml/kg
Neonate = 80-90ml/kg
Infant = 75- 80ml/kg
Adult/Child = 70ml/kg

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27
Q

If a 70kg pt has a hgb of 12g/dL and acutely loses 1L of blood, what is the new Hgb level?

A

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.
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28
Q

Match each blood additave with its function:
Adenine, Citrate, Phosphate, Dextrose

Anticoagulant, Substrate for glycolysis, buffer, substrate for ATP synthesis

A

Adenine- Substrate for ATP synthesis
Citrate - anticoagulant
Phosphate- Buffer
Dextrose - Substrate for glycolysis

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29
Q

1 unit of PRBCs contains how many mls and what hct?

A

300mls
70%

(70/30 referene)

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30
Q

Tranfusion of 1 unit PRBC raises hgb and hct by what?

A

hgb by 1g/dL and
hct by 2-3%

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31
Q

What preparation process is done to reduce the risk of HLA sensitization, febrile, non-hemolytic transfusion reactions, and CMV transmission

A

Leukoreduction

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32
Q

What preparation process decreases the risk of Graft-vs-host disease in immunocompromised patients?

A

Irradiation

destroys donor leukocytes

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33
Q

What blood preparation process prevents anaphylaxis in IgA deficent patients?

A

Washing

removes any remaining plasma from donor RBCs

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34
Q

What does leuko-reduced PRBCs mean?

A

it means WBCs have been reomoved from the PRBCs and platelets

decreased risk of HLA sensitization, febrile non-hemolytic reactions, and CMV transmission

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35
Q

What does washing PRBCs do?

why would u do it

A

removed any remaining plasma from donor RBCs

IgA deficient patient (reduces risk of anaphylaxis)

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36
Q

What does irradiaon to PRBCs do?

A

destroys donor leukocytes

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37
Q

What temp is blood stored at and why

A

1-6 degees C

to extend it’s lifespan by slowing the rate of lycolysis

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38
Q

Why don’t erythrocytes contain mitochrondria?

how do they function if they dont have mitochondria?

A

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

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39
Q

T/F- RBC antigens are NOT removed during the washing process

A

True- remaining plasma antigens are removed

40
Q

4 populations that benefit from irradiated cells

A
  1. leukemia
  2. lymphoma
  3. hematopoietic stem cell transplant
  4. DiGeorge Syndome

DiGeorge Syndrome = CATCH 22

Cardiac defects
Abnormal face
Thymic hypoplasia
Cleft palate
Hypocalcemia
22q11.2 gene deletion

41
Q

Citrate binds which coagulation factor?

A

factor 4 – CALCIUM!

42
Q

Which blood additive increases the shelf life of PRBCs and by how much?

A

adenine 21→35 days

43
Q

Rank each infectious complication of transfusion from MOST common to LEAST common:

HIV, HEP C, HEP B, Cytomegalovirus

A
  1. Cytomegalovirus
  2. Hep B
  3. Hep C
  4. HIV
44
Q

Why do platelets have the highest risk of bacterial contamination?

A

bc they are stored at room temp

45
Q

3 main goals for an acute hemolytic reaction

A
  1. stop transfusion
  2. promote renal blood flow
  3. alkalize the urine
46
Q

T/F- hemolytic reactions are the most common adverse reactions associated with transfusions

A

false! - non-hemolytic/febrile transfusion reactions are most common

47
Q

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

A

Acute Hemolytic

*ABO incompatibility is the most lethal

Renal failure, DIC, and hypotension are the most catastrophic complications of intravascular hemolysis

48
Q

You’re giving a blood transfusion, what would you see undder anesthesia if the patient is experiencing an acute hemolytic reaction (3 things)

A
  1. Hemoglobinuria (presenting sign)
  2. hypotension
  3. 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

49
Q

How does an acute hemolytic reaction cause renal failure/ATN?

A

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

50
Q

How does an acute hemolytic reaction cause DIC?

A

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)

51
Q

By what method does an acute hemolytic reaction cause hemodynamic instability?

A

free hgb activates the kallikein system

→ the final product of this pathway is bradykinin → potent vasodilator

52
Q

What would you do if you observed blood in the patients urine after starting a transfusion? (7)

A
  1. stop transfusion
  2. maintain urine output > 75-100mls/hr with:
    →IVF, mannitol, 12.5-25g, lasix 20-40mg if IVF and mannitol not working
  3. alkalaize the urine with sodium bicarb
  4. send urine and plasma hgb samples to blood bank
  5. check platelets, PT, and fibrinogen
  6. send unused blood back to blood bank to double check the cross match
  7. suppport hemodynamics with IVF and vasopressors
53
Q

T/F- febrile reactions are the most common adverse reaction associated with transfusions

A

True

pyrogenic cytokines and other components arre released from leukocytes in the donor blood. Leukoreduction reduces the occurance of these febrile transfusion reactions

54
Q

T/F: leukoreduction reduces the risk of hemolytic reactions

A

false- reduces the risk of febrile/non-hemolytic reactions

bc these reactions are caused by donor leukocytes releasing pyrogenic cytokines and intracellular components

55
Q

presentation of febrile transfusion reaction

treatment

A

less severe- fever/chills/headache/nausea/malaise

supportive + acetaminophen

56
Q

Which one is IgE mediated and which one is not: anaphylactic or anaphylactoid

A

anaphylactic is IgE mediated (anaphylactoid is not)

57
Q

T/F- most allergic reactions to blood transfusions are not serious

presentation

cause and tx

A

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

58
Q

T/F- if pt is having an allergic response to transfusion, you can continue the transfusion if the symptoms are mild

A

True- just give some benadryl

59
Q

T/f- you should give benadryl to someone with a febrile transfusion reaction

A

false- tylenol

allergic reaction (pt itching/rash) would warrant benadryl

why would you give benadryl? your treating pyrogenic cytokines not an allergy

59
Q

T/f- you should give benadryl to someone with a febrile transfusion reaction

A

false- tylenol

allergic reaction (pt itching/rash) would warrant benadryl

why would you give benadryl? your treating pyrogenic cytokines not an allergy

60
Q

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

A

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)

61
Q

What is Creutzfeldt Jakob disease?

A

Mad cow disease

a prion disease (whatever that means) that can be spread through infected blood products

62
Q

What is the most common cause of transfusion-related mortality in the United States?

A

TRALI

Transfusion Related Acute Lung Injury

63
Q

What is the most common cause of transfusion-related mortality in the United States?

A

TRALI

Transfusion Related Acute Lung Injury

64
Q

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?

A

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
65
Q

3 high risk blood donor populations that may provide blood likely to give TRALI to the donor

A
  1. multiparious women (history of multiple births)
  2. history of transfusions
  3. history of organ transplantation
66
Q

3 high risk populations for getting a transfusion-related acute lung injury

A
  1. sepsis
  2. burns
  3. post- CPB
67
Q

Why do platelets and FFPs carry a higher risk of TRALI

A

bc they have the highest concentration of these antibodies

68
Q

How do donor antibodies end up causes TRALI?

A

donor antibodies → neutophil activation in lungs → endothelial injury → capillary leak → pulmonary edema

impaired gas exchange → hypoxemia → acidosis → death

69
Q

Onset of TRALI

A

< 6 hours following transfusion

70
Q

s/s TRALI for diagnosis (3)

A
  1. B/L infiltrates on frontal CXR
  2. PaO2/FiO2 < 300mmHg OR Spo2 < 90% on RA
  3. normal PAOP (no left atrial HTN or volume overload)
71
Q

Treatment of TRALI is suportive and uses a lung-protective strategy…. what 3 things does that entail?

A
  1. maximize PEEP
  2. low tidal volumes
  3. avoid overhydration
72
Q

What happens in the heart with acute blood loss

A

decreased preload, decreased CO

to compensate for this, the veins constrict

73
Q

Consequences of massive transfusion include all of the following EXCEPT:

A. Hyperkalemia
B. Hypercalcemia
C. Hyperglycemia
D. Alkalosis

A

B. Hypercalcemia

citrate binds calcium
→ myocardial depression
→coagulopathy
→ impaired nerve transmission

74
Q

What’s the lethal triad of trauma

A

Acidsis (hypoperfusion)
Hypothermia
Coagulopathy

75
Q

is massive transfusion associated with acidosis or alkalosis

A

alkalosis bc the liver metablizes citrate into bicarb

76
Q

Why can massive transfusion lead to hyperglycemia?

A

bc of the dextrose additive in the blood

helps provide a substrate for RBC glycoysis (or something)

77
Q

Why can massive transfusion lead to hyperglycemia?

A

bc of the dextrose additive in the blood

helps provide a substrate for RBC glycoysis (or something)

78
Q

Risk of giving PRBCs to neonates

how to decrease the risk (2)

A

increased risk of hyperkalemia and cardiac arrest

when RBCs are stored, their membranes→ dysfunctional → K leaks out

  1. giving washed cells
  2. giving cells < 7 days old
79
Q

How does temperature affect coagulation?

A

impairs it → coagulopathy/bleeding → less able to clot

coagulation is an enzymatic process
→all enxymatic processes are highly dependent on temp

80
Q

PT/PTT are prolonged below what temp?

A

34 degrees C

81
Q

Intraoperative blood salvage is MOST approriate for (select 2):
- living donor kidney transplant
- cesarean section
- Whipple procedure
- anterior hip arthroplasty

A

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
82
Q

T/F- due to high likelyhood of blood loss, cell-saver is an attractive option for a Whipple Procedure

A

False- cell savor is absolutely contraindicated in those with neoplastic disease

Whipples are done on patients with pancreatic cancer

83
Q

Intraoperative blood salvage is typically used when blood loss is expected to exceed how many mLs or what % of patient’s blood volume?

A

blood loss > 1,000 mL’s
or 20% of pts blood volume

84
Q

T/F- with intraop blood salvage, platelets and coagulation factors are returned to the patient

A

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

85
Q

T/F - when compared to banked blood, salvaged blood has a higher o2 carrying capacity

A

True!

+ higher concentrations of 2,3-DPG and ATP
+ + better able to maintain a biconcave shape

86
Q

Hct of Salvaged blood

vs banked

A

Salvaged = 60-70%

banked = 70%

but salvaged has a higher o2 carrying capacity

87
Q

Risks of cell saver (4)

A
  1. Contamination by urine, feces, amniotic fluid, malignant cells
  2. fever
  3. non-immunogenic hemolysis
  4. “Salvaged blood syndrome” - dilutional coagulopathy
88
Q

T/F- Salvaged blood syndrome occurs from contamination of collected blood by urine, feces, amniotic fluid, or malignant cells

A

False- it occurs from dilutional coagulopathy as salvaged blood doesn’t have any platlets or factors returned to the patient

89
Q

T/F- intraoperative blood salvage is considered safe for transplant surgery

A

True

90
Q

5 contraindications to cell-saver

A
  1. infected site
  2. oncologic procedures (whipple)
  3. topical drugs in surgical field
  4. sickle cell disease
  5. thalassemia

3 - betadine, chlorhexidine, topical antibiotics

5- an inherited blood disorder that causes your body to have less hemoglobin than normal.

91
Q

What is Thalassemia and what are you considered with?

A

an inherited blood disorder that causes your body to have less hemoglobin than normal

-check hgb , type and cross

92
Q

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

A

AB Positive

93
Q

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

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%)
94
Q

Which blood types can be administered to a patient who is B-positive? (Select 2)

-O positive
-B negative
-AB positive
-A negative

A

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

95
Q

Estimate the blood volume for a neonate born at 34 weeks weighing 2,000g

A

200mls

Fluids, coags, transfusions (5 decks)

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