Blood Flashcards
Earl Malone is a 20 year old passenger on the bus that crashed on Route 91. Upon arrival at the scene, paramedics make the following observations:
Right upper quadrant ( abdominal ) pain
Cyanotic
Cool and clammy skin
Blood pressure 100/60 and falling, pulse 100
Paramedics start an IV to rapidly infuse a 0.9% sodium chloride solution ( normal saline). They transport him to a small rural hospital where Mr Malone’s blood pressure continues to fall and his cyanosis worsens. The local physician begins a transfusing O negative packed red blood cells (PRBCs) and arranges transport by helicopter to a trauma center. She sends additional PRBC units in the helicopter for transfusion en route. After arrival at the trauma center, following notes were added to Mr. Malone’s chart:
Abdomen firm and distended
Blood drawn for typing and cross matching; packed A positive blood cells infused
Emergency FAST (Focused Assessment with Sonography for Trauma) ultrasound is positive for intraperitoneal fluid
A positive FAST scan indicates intra- abdominal bleeding. Mr. Malone s condition continues to deteriorate so he is prepared for surgery which reveals a lacerated liver. The laceration is repaired and Mr Malone’s vital signs stabilised.
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Mr Malone was going into shock because of blood loss, so paramedics infused a saline solution. Why would this help?
Saline infusion temporarily replaces the blood loss volume, thereby helping to restore Mr.Malone’s circulation.
Mr Malone was switched from saline to PRBCs. What problem does infusion of PRBCs address that the saline solution could not?
The PBRCs contain oxygen carrying hemoglobin. While the saline replaces lost blood volume, it can not replace the hemoglobin in the lost RBCs. ( in acute trauma , the rule of thumb is to use no more than 2 litres of normal saline before starting PBRCs, so that the hematocrit does not drop below 30%.
Why was the physician able to use O negative blood before the results of the blood test were obtained?
O negative blood cells bear neither the A nor the B nor the Rh agglutinogens (antigens). People with O negative blood are sometimes called universal donors because there cells lack the antigens responsible for most major transfusion reactions.
Mr Malone’s blood type was determined to be A positive. What plasma antibodies (agglutinins) does he have, and what type of blood can he receive?
Mr Malone’s blood would have anti-B antibodies so he would not be able to receive B or AB blood. He can safely receive A or O blood.
What would happen if doctors had infused type B PRBCs into Mr Malone’s circulation?
If doctors had transfused type B or AB blood into Mr Malone’s circulation, his antibodies would of attacked these foreign cells and caused them to agglutinate cells can clog small vessels. In addition the transfused cells would begin to hemolyze (rupture) or would be destroyed by phagocytes.
