Blood and Transfusion Exam 3 Flashcards
What is blood comprised of primarily?
Plasma
What percentage of blood volume is made up by plasma?
55%
If we had to pick one thing to transfuse what would it be?
whole blood
What blood type is a universal donor? Universal acceptor?
Donor = O neg
Acceptor = AB +
What are 2 Hb related issues we will see often in clinical settings?
β thalassemia → Hb Barts
α thalassemia → Hb H
What are the possible blood antigen types? What are possible Rh factors?
Antigen → A, B, AB, O
Rh → Rh+ and Rh-
Is the general population primarily Rh+ or Rh-?
Rh+ (85%) and Rh- (15%)
What 4 things can cause a right shift of the OxyHb curve?
↓ pH(↑ acidosis)
↑ CO2
↑ temp
↑ 2,3-DPG
[⇒ ↑unloading or↓affinity]
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)
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
For blood type AB which Antigen is present on erythrocyte and which Antibody is in the serum?
Antigen: A and B
Antibody: none
For blood type B, which Antigen is present on erythrocyte and which Antibody is in the serum?
Antigen: B
Antibody: Anti-A
For blood type A which Antigen is present on erythrocyte and which Antibody is in the serum?
Antigen: A
Antibody: Anti-B
AB donor blood will react with which other blood types?
A, B, and O
B donor blood will react with which blood types?
A & O
A donor blood will react with which blood types?
B & O
O donor blood will react with which blood types?
none
When whole blood is centrifuged what separation products result?
Platelet rich plasma (PRP)
WBC
RBC
What happens if we centrifuge platelet rich plasma (PRP) again?
Separates plasma from platelets
Where is PRP used in surgery?
Surgeon injects locally → ortho, dental, plastics cases commonly (for healthy cell growth)
What are the 5 different blood components we can use for treatments?
RBC
FFP
Cryo
PLT
LTOWB - Low titer Group O Whole Blood
What is the lifespan of WB?
~ 3 wks
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)
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 ↑)
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]
