Blood Components and Sub Flashcards
Antithrombin III deficiency
May give FFP to help get antithrombin III
Whole blood
For acute hemorrhage of 25% or more
RBC transfusion objective
Improvement of inadequate oxygen delivery
Diminished OXygen carrying capacity
Ischemic effects on heart and brain
Transfuse patient with HF or with decreased
Higher threshold
Patient with those medications are at known risk for decreased CO
Beta blockade
Non DHP CCB
Hemoglobin concentration increase will
increase O2 delivery
DO2
CaO2 x CO
Loss of 15%
Class 1 little hemodynamic effect other than vasoconstriction and mild tachycardia
Loss of 15-30%
Class 2 Tachycardia decrease pulse pressure
Loss 30-40%
healthy patients give
Class III hemorrhage, signs of hypovolemia, marked tachy, tachypnea
Crystalloids
Loss of more than 40%
life threatening, transfused
Acute anemia: O2 delivery adequate at hemoglobin concentration
as low as 7g/dl
Chronic anemia
better tolerated than acute
CO in chronic anemia does not change until
below 7g/dl
acute anemia no reductio in arterial O2 because
Well compensate in increased in CO
Factors that affect CO
Left Ventricular dysfunction
hypothermia
Vasoactive (BBlockers, CCB, anesthetics)
Effective of RBC transfusion
Keyword: NONBLEEDING
NON-bleeding, 1 unit of RBC
1g increase Hct by 3%
However, for anemia relationship with
Perioperative anemia with MI
Transfusion recommendations
Rarely indicated if hbg more than 10
Less than 6 when the anemia is acute.
The determinants of intermediate:
The determination of whether intermediate hemoglobin concentrations (6-10g/dl) justify or require RBC transfusion should be based on the patient’s risk for complications of
inadequate oxygenation
Most anesthetics cause
myocardial depression and
decrease arterial BP, cardiac output, stroke volume,
PVR.
The use of a single transfusion “trigger”
(i.e.. 10/30 rule) for all patients is not
recommended.
Hemoglobin <6 g/dL – T.
Transfusion recommended except in exceptional circumstances.
● Hemoglobin 6 to 7 g/dL
– Transfusion generally likely to be indicated
● Hemoglobin 7 to 8 g/dL –
Transfusion may be appropriate in patients undergoing orthopedic surgery or cardiac surgery, and in those with
stable cardiovascular disease, after evaluating the patient’s clinical status.
● Hemoglobin 8 to 10 g/dL
– Transfusion generally not indicated, but should be considered for some populations (eg, those with
symptomatic anemia, ongoing bleeding, acute coronary syndrome with ischemia, and hematology/oncology patients with severe thrombocytopenia who are at risk of bleeding).
● Hemoglobin >10 g/dL –
Transfusion generally not indicated except in exceptional circumstances.
Transfusion reactions, often manifested in
awake patients by_____, _____, ______
are the most common adverse reaction of
transfusion with CBC’s.
fever, chills, or urticaria,
The more transfusion
the more risk of Hepatitis C
The most common viral agent
Important for type of patients
Cytomegalovirus
HIV, immunosuppressed patients or autoimmune disease
Platelets : patients
patients spontaneous bleeding is uncommon with a platelet count greater than 20,000.
The probability of clinically significant thrombocytopenia i
Increases in proportion to the number of units of blood transfused because only parts of the blood is given
ASA action
Inhibit platelet aggregation
Patients with bleeding from ASA
Platelets
With HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome associated with
preeclampsia the thrombocytopenia is usually more severe, but spontaneous resolution usually occurs by the
4th postpartum day.
Transfusion of one platelet concentrate will increase
the platelet count by approximately
5,000-10,000 in an average adult.
The usual therapeutic dose of platelets is
one platelet concentrate per 10kg body weight.
Heparin induced thrombocytopenia and ITP
should not receive platelets.
To assess risk of HIT
4 Ts
Prophylactic platelet transfusion is rarely indicated in surgical patients with thrombocytopenia due to decreased platelet production when the platelet count is greater
than_______ and is usually indicated when less than _______
100,000; 50,000.
The determination of whether patients with intermediate (50,000-100,000) require therapy should be based on the
risk of bleeding.
Platelet transfusions may be indicated despite an apparently adequate platelet count if there is
known platelet dysfunction and microvascular bleeding.
Most major surgeries
50000 threshold for platelets tx
Epidural anesthesia –plt threshold
80,000/microL
Replacement of an entire blood volume leaves the
patient with approximately
1/3 of the original concentration of coagulation factors.
Although lab values such as PT and PTT may be
abnormal, clinical coagulopathy from dilution usually
does not occur until replacement
exceeds one blood volume or when the PT and PTT exceeds 1.5-1.8 times control then start giving FFPs
In preoperative patients with no history of bleeding,
retrospective studies show that abnormal PT and PTT
are
poor predictors of bleeding
______is indicated for urgent reversal of warfarin therapy.
FFP
FFP should be given in doses calculated
to achieve a minimum of ________except
for urgent
30% of plasma concentration (10-15ml/kg of FFP),
Except for urgent reversal of warfarin anticoagulation, for which (5-8ml/kg of FFP) will usually suffice. 4-5 platelet
concentrations, or one unit of whole blood provide a quantity of coagulation factors
FFP is contraindicated for
augmentation of plasma volume or albumin concentration.
Most patients with factor VIII deficiency will be treated with___________ and patients with some subtypes of vWD respond to DDAVP.
factor VIII concentrates
_______ _____________, _____, is
used for correction of inherited and acquired
coagulopathy.
Cryoprecipitate contains factors VIII, fibrinogen,
fibronectin, von Willibrand’s factor, and factor XIII,
Albumin 25g (100ml of 25% solution), is equivalent
osmotically to 500ml of plasma, but contains about 1/7 the amount of sodium present in the same amount of plasma.
25% reserved for
Kidney , liver
The administration of 25% albumin will draw
3-4ml of fluid from the interstitial space into
the vascular space for every 1ml of albumin
given.
Best way to correct albumin deficiency
by feeding the patient
PPF is a 5% pooled solution of stabilized plasma proteins in saline containing at
least 83% albumin and no
more than 17% globulins, of which <1%
are gamma globulins.
● PPF 5% is administered to treat
hypovolemic shock
Imnunoglobulin is a concentrated solution of _______ and ________prepared from large pools of ________
Immune globulin is a concentrated solution of
globulins, primarily immunoglobulins, prepared from large pools of human plasma
● Immune globulin protects against clinical manifestations of
hepatitis A when given before or within 2 weeks of exposure.
● Replacement therapy for patients with
hypogammaglobulinemia is another use of
immune globulin.
Immune Globulin SOME indications
● Idiopathic thrombocytopenia purpura (ITP) CLL Myasthenia Gravis SLE ***Guillian barre syndrome
Prothrombin Complex Concentrate
(Human) Factors
II, VII, IX, X), Protein C, and Protein S];
PCC also known as
Kcentra
Indications for Kcentra
Indications; Vitamin K antagonist (VKA) reversal in patients with acute major bleeding or need for an urgent
surgery/invasive procedure.
Increase INR require surgery
Kcentra
Patient require emergent surgery with warfarin BETTER AND FASTER
KCENTRA, given faster; but expensive
Use Reversal of dabigatran: Reversal of the
anticoagulant effects of
dabigatran for emergency surgery/urgent procedures or in life-threatening or uncontrolled bleeding
Dosing Reversal of dabigatran: IV:
5 g
(administered as 2 separate 2.5 g doses no
more than 15 minutes apart)
Xa rivaroxaban, xarelta
REVERSAL KNOW
