Blood and Transfusion Exam 3 Flashcards by Raymond Bas

What is blood comprised of primarily?

Plasma

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What percentage of blood volume is made up by plasma?

55%

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If we had to pick one thing to transfuse what would it be?

whole blood

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What blood type is a universal donor? Universal acceptor?

Donor = O neg
Acceptor = AB +

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What are 2 Hb related issues we will see often in clinical settings?

β thalassemia → Hb Barts
α thalassemia → Hb H

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What are the possible blood antigen types? What are possible Rh factors?

Antigen → A, B, AB, O
Rh → Rh+ and Rh-

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Is the general population primarily Rh+ or Rh-?

Rh+ (85%) and Rh- (15%)

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What 4 things can cause a right shift of the OxyHb curve?

↓ pH(↑ acidosis)
↑ CO2
↑ temp
↑ 2,3-DPG
[⇒ ↑unloading or↓affinity]

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T or F: If our O₂ saturation is good so is our PO₂?

False → O₂sat has nothing to do with PO₂ (could have 1 Hb fully saturated; ex. anemia)

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For blood type O which Antigen is present on erythrocyte and which Antibody is in the serum?

Antigen: none
Antibody: Anti-A and Anti-B

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For blood type AB which Antigen is present on erythrocyte and which Antibody is in the serum?

Antigen: A and B
Antibody: none

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For blood type B, which Antigen is present on erythrocyte and which Antibody is in the serum?

Antigen: B
Antibody: Anti-A

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For blood type A which Antigen is present on erythrocyte and which Antibody is in the serum?

Antigen: A
Antibody: Anti-B

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AB donor blood will react with which other blood types?

A, B, and O

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B donor blood will react with which blood types?

A & O

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A donor blood will react with which blood types?

B & O

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O donor blood will react with which blood types?

none

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When whole blood is centrifuged what separation products result?

Platelet rich plasma (PRP)
WBC
RBC

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What happens if we centrifuge platelet rich plasma (PRP) again?

Separates plasma from platelets

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Where is PRP used in surgery?

Surgeon injects locally → ortho, dental, plastics cases commonly (for healthy cell growth)

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What are the 5 different blood components we can use for treatments?

RBC
FFP
Cryo
PLT
LTOWB - Low titer Group O Whole Blood

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What is the lifespan of WB?

~ 3 wks

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What chemicals are added to blood that allows it to be stored?

CPDA-1 → Citrate phosphate dextrose adenine; chelates Ca++ to prevent clotting
Phosphate → used as buffer
Dextrose → fuel source
Adenine → to support ATP synthesis (extends storage from 21 to 35 days)

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Due to the chemicals used to allow blood to be stored what labs do we need to check when transfusing lots of blood?

Ca⁺⁺ (it will ↓) ⇒ less clotting
Glucose (it will ↑)

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Which electrolyte will stored blood have ↑ levels of? Why?

K⁺ d/t cells lysing as they degrade in the bag

What happens to 2,3-DPG in stored blood? What does this do to the OxyHb association curve?

↓ 2,3-DPG Left shift → impairs O2 delivery

PRBCs contain ______ unless they have been specifically ________?

Leukocytes (WBCs) Leukoreduced

How much does 1 unit of PRBCs ↑ H&H level?

Hb: ↑ 1 g/dL Hct: ↑ 3%

Which blood transfusion product is a source of antithrombin III?

FFP

What is the dose of FFP?

10-15 mL/kg

How much will 1 unit of FFP ↑ level of each clotting factor?

↑ 2 to 3% for each factor

What are two specific uses of FFP Dr. C mentioned in class?

Heparin resistance d/t antithrombin deficiency Treat angioedema (also use TXA along with FFP)

What is the INR of FFP?

~1.5

What clotting factors does cryoprecipitate have?

Factor VIII: C Factor VIII: vWF Factor XIII Fibrinogen

What target of fibrinogen are we trying to maintain when using cryo?

100 mg/dL

Which patient population is cryo really important for?

Pregnant women who are bleeding

How much will one unit of PLT increase PLT count by?

5000 to 10000

Is there any clinical data that says warming platelets is bad?

Not recommended to use on a warming device for now (but studies show no significant impact)

When platelets are low at what level will we start to spontaneously bleed?

PLT < 30000

What is the deadly trauma triad when transfusing a patient?

Hypothermia Coagulopathy Acidosis

When is WB indicated for transfusion?

To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss)

What are S/Sx of Hemolytic transfusion reaction?

fever chill hemoglobinemia hemoglobinuria hypotension dyspnea.

What are mediators of Hemolytic transfusion reactions?

IgM antibodies

What are the S/S of nonhemolytic febrile transfusion reactions?

Fever and chills

What are the mediators of non-hemolytic febrile transfusion reactions?

HLA Class I Ag antibodies

How do we treat Non-hemolytic febrile transfusion reactions?

Antipyretics Use leukocyte reduced products

What are some S/S of an allergic transfusion reaction?

urticaria erythema itching anaphylaxis.

What are the mediators of allergic transfusion reactions?

plasma proteins IgA antibodies

How do we treat allergic transfusion reactions?

antihistamines treat symptoms

What are S/S of Non-cardiogenic pulmonary transfusion reactions?

ARDS Fever Chill Hypotension Cyanosis noncardiac pulmonary edema

What are the mediators for a non-cardiogenic pulmonary transfusion reaction?

donor/recipient WBC antibodies

How do we treat Non-cardiogenic pulmonary transfusion reactions?

Lots of PEEP Steroids

What is TRALI?

Transfusion Related Acute Lung Injury - temporarily r/t to blood transfusion within 1st 6 hrs of a transfusion

What is the mortality rate from TRALI?

5-25% Most pt recovering within 72 hrs -Ecmo good option for tx

What are the 3 acute nonimmunologic effects of transfusion reaction?

Bacterial contamination Circulatory overload (TACO) Hemolysis d/t physical /chemical means

What are the three delayed immunologic effects of transfusion reaction?

Hemolytic transfusion reactions Transfusion associated Graft-versus-host disease Post-transfusion purpura

How can you differentiate between TRALI and TACO?

TRALI → Fever, HoTN TACO → HTN, Signs of circulatory overload

What classes of hemorrhage are there and what is associated blood loss for each?

Class 1 = up to 750 mL (< 15%) Class 2 = 750 to 1500 mL (15-30%) Class 3 = 1500 to 2000 mL (30-40%) Class 4 = > 2000 mL (>40%)

What are 3 definitions of MTP in Adults?

Total blood volume is replaced within 24 hours 50% of total blood volume is replaced in 3 hours ←Most common Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss

What is considered MTP for Kids?

> 40mL/kg transfusion

What is balanced resuscitation?

1:1:1 ratio (PLT:Plasma:RBC)

What are the fibrinogen levels of Cryo, FFP, and LTOWB?

Cryo = 2500 mg LTOWB = 1000 mg FFP = 400 mg

What is the difference between stored whole blood (SWB) and LTOWB?

SWB anticoagulants < LTOWB

What are the recommendations for whole blood transfusion in kids?

If they are <15 yr old or <40 kg then limit WB to 30 mL/kg

Which clotting factors required Ca⁺⁺ to work?

2, 7, 9, 10

Which drug has more elemental calcium; Ca gluconate or CaCl?

Calcium Chloride: 270 mg/10mL (27mg/mL) Calcium Gluconate: 90 mg/10ml (9mg/mL)

How much will 1, 2, and 5 units of blood decrease iCa?

1 unit = drop to 1.13 mmol/L 2 unit = drop to < 1mmol/L 5 units = drop to < 0.8 mmol/L

What is the value for TEG-ACT (rapid)?

Activated Clotting Time 80-140 sec

What is the normal value for R time?

Reaction Time 5.0 - 10.0 min

What is the normal value for K time?

Kinetic time 1-3 minutes

What is the normal value for α angle?

53 - 72°

What is the normal value for MA?

Max Amplitude 50-70mm

What is the normal value for G value?

Clot strength 5.3-12.4 dynes/cm2

What is the normal value for LY 30?

Clot lysis at 30 min 0-3%

If TEG-ACT is > 140 what do we transfuse?

FFP

If R time is > 10 what do we transfuse?

FFP

If K time is > 3 what do we transfuse?

Cryo

If α angle < 53° what do we transfuse?

Cryo and platelets

If MA < 50 what do we transfuse?

PLT

If LY30 > 3% what do we transfuse?

TXA (Tranexamic Acid)

What are the contents of FFP?

plasma clotting factors proteins

What are the criteria for TRALI?

Occuring during or within 6 hrs of transfusion P/F ratio < 300 or SpO2 < 90% Pulmonary infiltrates No evidence of circulatory overload

What 4 things can cause a left shift of the OxyHb curve?

↑ pH (↓acidosis) ↓ CO2 ↓ temp ↓ 2,3-DPG [⇒ ↓unloading or ↑affinity]