Blood Component Therapy Part 2 Flashcards
For the average 70 kg patient who has lost approximately ____ - ____ L of blood, send off coagulation studies and start documenting lab values and coagulation status.
1L – 1.5L
Specific types of blood component therapies: (5)
PRBCs
cell saver
platelets
FFP
cryoprecipitate
Indicated for treatment of anemia (often associated with blood loss)
1 unit contains 250-300 mL volume with a hematocrit of -____-____%
PRBCs
70-80
1 unit of PRBCs will increase
Hemoglobin: ___g / dL
Hematocrit: ____%
1
3
How do you administer PRBCs? (3)
- WARM
- NS
- 150 micron filter
Types of PRBCs: (3)
- washed
- leukocyte- reduced
- irradiated
What type of RBCs are centrifuged in saline to remove plasma and cytokines?
Why use this type? (2)
PRBCs can be stored for no longer than ___ hrs after this is done!
washed
older units of blood to remove excess POTASSIUM
patients with a history of transfusion reaction
24
____ days is the most number of days common RBCs are good.
35
Leukocyte-reduced PRBCs can be: (3)
What is the most effective method?
- centrifuged
- washed
- filtered (most effective)
If we want to avoid, use this type of PRBC:
- To avoid nonhemolytic febrile reactions
- To prevent sensitization of patients with aplastic anemia
- To minimize transmission of HIV or CMV
Leukocyte-reduced PRBCs
Cells are exposed to a standard dose of ionizing radiation
In general, it is for people who are not capable of mounting a counterattack and neutralizing transfused lymphocytes
Irradiated PRBCs
Use this type of PRBC for the following patients:
- Stem cell transplant patients (and candidates)
- Chemotherapy patients
- Patients with hematologic malignancies (especially Hodgkin’s Disease)
- Patients with congenital cellular immunity deficits
- ALL premature neonates
irradiated PRBCs
Blood salvaged from the surgical field with ___ ____.
Hematocrit ~___-___%
cell saver
65 - 70
Things to know when administering cell-saver: (4)
- Do not warm
- Use a 40 micron filter
- Do not pressurize a cell saver bag
- Never clamp the delivery line
Note: Do not even decrease the flow by rolling clamp.
Platelet transfusion is indicated when:
platelet count is < ____ cells/mm3
However, there is an exception during _____ ____ surgery!
50k
cardiopulmonary bypbass to restore normal coagulation, platelets are routinely given
How are platelets prepared? (2)
- Centrifuging individual units from multiple whole blood donors (5 x 1010 platelets in 50-70cc of plasma per unit)
- Single donor apheresis (3-5 x 1011 platelets in 200-400cc plasma)
Note: 5 to 10 units of platelets may be pooled together in a single bag
Rough rule of thumb is that a pool of 6-8 units of whole-blood platelets (a “six pack”) or 1 unit of apheresis will raise the patients platelet count by ___-___ x 109 /L
What is the initial dose? ____ cc/kg
30-50
10
When transfusing platelets: (2)
- DO NOT warm or cool platelets
- Use a 150 micron filter when giving platelets.
Note: Microaggregate filters (20-40 micron) should not be used because they will remove most of the platelets.
It is the fluid portion obtained from a single unit of whole blood that is frozen within 6 hours of collection.
(whole blood → RBCs removed → platelet rich plasma → platelets + plasma
Fresh Frozen Plasma (FFP)
When to use _____ blood product:
- Indicated when PT, PTT, or both are at least 1.5 times greater than normal.
- In emergent situations, this may be used to reverse the effects of warfarin prior to surgery.
Fresh Frozen Plasma (FFP)
FFP
___ -___ mL/kg will raise most coagulation proteins by ___-___%
(5-8 ml/kg may be sufficient to reverse warfarin anticoagulation)
FFP
10 to 15
25-30%
FFP should be used as primary therapy for a specific coagulation defect (eg, hemophilia A, hemophilia B, factor VII or XIII deficiency) when specific coagulation factor concentrates are available. True or false?
false
NOT be used, use cryo
The fraction of plasma that precipitates when FFP is thawed
Each bag contains ~____mg of ______and ___ units of Factor____ (80 to 110 IU)
Cryoprecipitate
** 200 **
**fibrinogen **
100
8
When to use ____ blood product:
- Hypofibrinogenemia due to massive hemorrhage or disseminated intravascular coagulopathy (DIC)
- Prophylactically for pts with congenital fibrinogen deficiencies or acquired Factor XIII deficiency.
Cryo
Complications of Blood Transfusion: (5)
- Transfusion reactions
- Febrile
- Allergic
- Hemolytic
- Transmission of disease
- Transfusion-Related Acute Lung Injury
- Suppression of cell-mediated immunity
- Metabolic derangements
What may occur:
- In 0.5-1% of transfusions
- Due to immune reaction between donor antigens on the leukocytes or platelets with recipient antibodies
febrile reaction
What reaction manifests:
- fever
- chills
- mild dyspnea
febrile reaction, which is fairly benign and common. Less febrile reaction with leukocyte reduced blood.
What can occur in blood which has been properly typed and cross-matched?
This results in:
- Increased body temperature
- Pruritis
mild allergic reaction
How do you treat mild allergic reactions? (2)
IV antihistamines
Discontinuation of transfusion if severe
What reaction is this?
- Medical emergency that results from the administration of the ABO incompatible blood
- Caused by the rapid destruction of donor erythrocytes by recipient antibodies
- Most often the result of clerical or procedural error
Hemolytic Reactions
What reaction of blood transfusion do the following describe?
- Hypotension
- Dyspnea
- Fever
- Skin flushing
- Chills
- Lumbar/Substernal
- Pain
Treatment? (2)
Hemolytic Reactions
- Immediate discontinuation of transfusion
- Maintenance of the patient’s airway, blood pressure, heart rate, and urine output
During hemolytic reaction, when you stop the transfusion, do not leave the intravenous line attached. The bag containing the transfused cells, along with all attached labels, should not be discarded, as repeat typing and cross-matching of this unit by the blood bank will most likely be required. True or false?
false
do leave IV attached
What reaction describes:
- Rapid onset
- Shock
- Hypotension
- Angioedema
- Respiratory distress
Anaphylactic Reactions
Anaphylactic Reactions are MOST severe rxns.
Almost always due to the presence of class-specific ____, anti-____ antibodies in patients who are____deficient
IgG
IgA
IgA
May occur within a few seconds to a few minutes following the initiation of a transfusion that contains plasma, such as frozen or liquid plasma, red cells, platelets, granulocytes, cryoprecipitate, or gamma globulin
Not generally seen following the administration of normal _____ _____or ______ factors
Anaphylactic Reactions
serum albumin
coagulation
Anaphylactic reaction treatment: (5)
- Stop the transfusion
- Epinephrine – bolus and possible infusion
- Airway maintenance, oxygenation
- Volume maintenance with saline
- Vasopressors if necessary
Most to least common transmission of disease during blood transfusion: (4)
- CMV (
- Hep B
- Hep C
- HIV
Transfusion Related Acute Lung Injury (TRALI) is characterized by: (5)
- acute respiratory distress
- hypoxemia
- hypotension
- fever
- pulmonary edema, initially without signs of left ventricular failure
Transfusion Related Acute Lung Injury (TRALI)
You will also observe what changes?
increase PAP
Transfusion Related Acute Lung Injury (TRALI)
- Symptoms usually begin within ___-___hours of beginning theblood transfusion.
- Recovery is generally complete within___hours of onset
- Treatment is supportive. High-dose steroid therapy has been used but appears to be ineffective
2-4
96 (8 days)
Stored blood is more acidic the longer it is stored.
Expect the following changes when giving blood:
- _____ Hydrogen
- ______ Potassium
- ______ 2,3-Diphosophoglycerate
- _____ Calcium
- ______-thermia
- increased
- increased
- decreased, because decreased oxygen delivery to RBC
- decreased
- hypothermia, if blood not warmed
Ask during H&P regarding blood products:
- Any history of bleeding disorders, thrombocytopenia, chemotherapy, easy bruising, frequent nose bleeds, gums bleeding easily with brushing teeth.
- Has your patient ever received a blood transfusion, or any other product transfusion, ever had any reaction to blood products, is your patient even willing to receive blood products should their life depend on it?
Physical Exam:
Look for signs of ________in the mouth, under the eye lids. Look for signs of ______, _____. Observe the bleeding while your putting in the IV.
petechiae
bruising
old bruises
