Blood Component Therapy--when/what to give

Question 1

If there is evidence of rapid acute hemorrhage without immediate control, what do you give?

Answer 1

PRBC

Question 2

If you transfuse PRBC for a rapid acute hemorrhage, it may require _________ or ____ ____ blood.

Answer 2

uncrossmatched

type specific

Question 3

Transfuse PRBC when estimated blood loss > ____ - ____% and there is presence of symptoms of severe blood loss.

Answer 3

30-40

Question 4

KEY TERM

If estimated blood loss <25-30%, what do you give?

Answer 4

crystalloid/colloid resuscitation

Note: Assume this is without uncontrolled hemorrhage.

Question 5

What are the indications for giving FFP? (3)

Answer 5

excess warfarin

vitamin K deficiency

deficiency of multiple coagulation factors

Question 6

What is the first thing you do in response to a hemolytic reaction?

Answer 6

Begin infusion of NS immediately to initiate diuresis and to avoid hypotension!

Question 7

If you are facing a hemolytic reaction, can you give LR?

Answer 7

Avoid using LR because calcium can initiate clotting of blood remaining in the IV line.

Question 8

If you are facing a hemolytic reaction, can you give dextrose-containing solutions?

Answer 8

Avoid dextrose because it may hemolyze any of the remaining red cells in the line.

Question 9

After you begin an infusion of NS following a hemolytic reaction, what do you do next?

Answer 9

Obtain a sample from the other arm for a direct antiglobulin test and repeat type and cross-match.

Question 10

The blood bank should be alerted immediately after a hemolytic reaction. Why?

Answer 10

To evaluate clerical error and to track second patient at risk if there was such an error. (For example, bags of blood accidentally switched.)

Question 11

If blood volume is > 40% loss, what do you proceed to do?

Answer 11

Rapid volume replacement, including RBC transfusion IS REQUIRED.

Question 12

If 30-40% loss (1500 to 2000ml), what do you proceed to do?

Answer 12

Rapid volume replacement with crystalloids or colloids IS REQUIRED

RBC transfusion MAY be required

Question 13

If 15-30% loss (800-1500ml) of lost blood volume, what do you proceed to do?

Answer 13

Need to transfuse crystalloids or colloids

NOT likely to need RBC transfusion unless patient has preexisting anemia, or when patient is unable to compensate due to severe cardiac or respiratory disease

Question 14

Hgb < 7 g/dL, what do you need to proceed to do?

Answer 14

RBC transfusion indicated. If patient is otherwise stable, the patient should receive 2 units of packed RBC

Question 15

If Hgb is 7-10 g/dL, what do you proceed to do?

Answer 15

correct strategy is unclear

Question 16

If Hgb is > 10 g/dL, what do you proceed to do?

Answer 16

RBC transfusion is NOT indicated.

Question 17

For high risk patients (age>65 and or those with cardiovascular or respiratory disease) may tolerate anemia poorly. When do you transfuse these patients?

Answer 17

Hgb < 8 g/dL