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CV Perf Tech II > Blood Conservation- Exam 1 > Flashcards

Blood Conservation- Exam 1 Flashcards

1
Q

Blood Transfusion Complications (General)

A 
Post-op infections
Ventilator- acquired pneumonia
Central line sepsis
Increased LOS
Increased mortality rates
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2
Q

2 Types of Transfusion Risks

A

Infectious

Non-infectious

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3
Q

Types of Infectious Transfusion Risks

A

Bacterial
HIV
Hepatitis

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4
Q

Types of Non-Infectious Transfusion Risks

A 
Febrile Rxns
Urticarial (Allergic) Rxns
Anaphylactic Rxns
Acute Hemolytic Rxns
Volume Overload
Hypothermia
Citrate Toxicity
Potassium Effects
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5
Q

Febrile Reactions

A

Fever, chills
Antibodies reacting w. white cell antigens or white cell fragments in transfused blood products or due to cytokines which accumulate during storage
Most common with platelet transfusions

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6
Q

What non-infectious reaction is most common with platelet transfusions?

A

Febrile Reactions

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7
Q

Urticarial (Allergic) Reactions

A

1%
urticaria, itching, flushing
caused by foreign proteins

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8
Q

Anaphylactic Reactions

A

Hypotension, tachycardia, cardiac arrythmia, shock, cardiac arrest
caused by patients who have IgA deficiency who have anti-IgA antibodies (require specially washed/tested blood products)

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9
Q

Acute Hemolytic Reactions

A

Caused by transfusions of ABO incompatible blood

Chills, fever, pain, hypotension, dark urine (plasma free hgb) uncontrolled bleeding due to DIC

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10
Q

Volume Overload

A

Not on bypass; big concern in ICU; no where for volume to go

On bypass- can tx a lot of rxns and can prevent volume overload

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11
Q

Citrate Toxicity

A

Metabolized by liver
Rapid transfusion of large quantiity of blood products
Binds calcium and magnesium- depleting stores
Myocardial depression
Coagulopathy

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12
Q

Potassium Effects

A

Stored RBC leak K+
Irradiation increased the rate of leak
Cardiac effects (must give slowly or they could go into cardiac arrest)

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13
Q

TRALI

A

transfusion related acute lung injury

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14
Q

TRALI Symptoms

A

Similar to ARDS

Hypotension, fever, dyspnea, tachycardia

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15
Q

What is TRALI?

A

Non-cardiogenic pulmonary edema with diffuse bilateral pulmonary infiltrates on CXR

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16
Q

How fast can TRALI occur?

A

Occurs within 6 hours of tx

Most cases present within 1-2 hours

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17
Q

What are the culprits for causing TRALI?

A

All blood products

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18
Q

How common is TRALI?

A

1/2000 transfusions

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19
Q

TRALI Pathophysiology

A

Unclear.

Attributed to HLA Antibodies, Granulocyte antibodies and biologically active mediators in the blood

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20
Q

What is the Tx for TRALI?

A

Ventilator support for ~96 hours

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21
Q

What ii TRALI mortality?

A

5-10%

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22
Q

Clinically, transfusions are associated with….

A

Longer hospital stays
Longer time to extubation
Mobidity
Mortality

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23
Q

What are some techniques to minimize our impact on blood usage?

A 
Autologous transfusion
Pre-bypass autologous donation
Intraoperative cell saver use
Shed mediastinal blood recovery
Accept lower HCT
RAP
Hemoconcentration
Plasma/Platelet Pheresis
Mini-circuits
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24
Q

Bloodless Medicine

A

Transfusion-free medicine

Multimodality and Multidisciplinary approach to patient care without the use of allogenic blood.

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25
Q

Blood Conservation

A

Global concept aimed at reducing patient exposure to allogenic blood products. Does not exclude use.

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26
Q

Jehovah’s Witness booklet related to bloodless medicine

A

Blood, Medicine, and the law of God (1961)

  • Transfusion rxns
  • Transfusion related syphilis, malaria, hepatitis
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27
Q

Which doctor took JW tranfusion requests to heart?

A

Denton Cooley (1960’s)

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28
Q

What is Cooley’s 1964 publication

A

Open Heart Surgery in the JW; described techniques for treating these patients

1977- reported experience with 500 JW patients

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29
Q

How did the military contribute to blood management?

A

Did surgery on wounded soldiers before transfusions were even available

confronted with blood loss but not way to replace the blood; stopped bleeding promptly and effectively

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30
Q

WWI and Blood Management

A

Blood Anticoagulation
Allowed for transport of blood to the wounded
Problem: Storage!

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31
Q

WWII and Blood Management

A

Storage problem overcome with the advent of blood banks

32
Q

What blood management development occurred in 1953?

A

Use of blood alternatives

Switched from plasma to Dextran (volume expander) deue to incidence of hepatitis transmittal

33
Q

Dextran

A

Sugar substrate, used outside US instead of plasma in 1953

34
Q

What blood management develoment occured in 1985?

A

Started looking into blood subsitutes; military role

Searched for oxygen carrier

35
Q

Who introduced the first cell saver in a military hospital?

A

Surgeon Gerald Klebanoff (Vietnam Vet)

36
Q

What is significant about Recombinant Factor VIIa?

A

Hemopheliacs

Israeli army discovered potential to stop life threatening hemorrhage (used aprotinin before)

37
Q

How many organized bloodless programs are in the US?

A

More than 100

38
Q

What is the major variable related to percent transfusions?

A

Institution physicians (not patients!)

39
Q

What should be obtained in a focused patient Hx pre-op?

A

Age
Gender
Weight/Height
Race/ethnicity/background/religion

40
Q

Why is age important in a focused hx?

A

Tolerance of anemia is age dependent

As age increased, risk of transfusion increases

41
Q

Why is gender important in focused hx?

A

Women more likely than men to get transfused

lower hct; prone to blood loss with menses

42
Q

What size patients are at risk for transfusion?

A

Small patients

Obese patients

43
Q

What patient-related obstacles should be asked about in pre-op?

A 
Anemia
Hemostatic disturbances
Medical conditions increasing perioperative blood loss
Obstacles to surgical hemostasis
Factors decreasing anemia tolerance
44
Q

What lab work should be done pre-op?

A

Hgb
PT/INR/PTT
Platelet count and platelet function tests

45
Q

Drugs that have increased bleeding risk

A

NSAIDs, PCN, NTG, HIgh doses of Vitamin C, St. John’s Wort, Ginger, Garlic, etc.

46
Q

What temperatures optimize clotting?

A

Warm

47
Q

How long before surgery would autologous donation have to be done?

A

At least 2 weeks prior

48
Q

Auto-Donation requires what HCT?

A

33%

49
Q

Contraindications for Autologous Donation

A 
Recent MI
CHF
Aortic Stenosis
Transient Ischemic Attacks
HTN
Unstable Angina
Bacteremia
50
Q

What allows the donation of platelets and plasma?

A

Plateletpheresis and Plasmapheresis

51
Q

Prebypass Autologous Normovolemic Hemodilution

A

Used to remove blood from the patient pre-bypass for transfusion later in the case (spares platelets)

Removed volume replaced with crystalloid

52
Q

Prebypass Autologous Normovolemic Hemodilution HCT requirement

A

AT least 35%

53
Q

How much fluid is removed in prebypass autologous normovolemic hemodilution?

A

500-1000mL (1-3 units)

-Depends on starting HCT, age, BSA, existing conditions

54
Q

When is blood reinfused during PANH?

A

After protamine is administered

55
Q

Contraindications for PANH?

A 
COPD
CHF
CAD
Unstable Angina
Renal insufficiency
Severe aortic stenosis
Coagulopathy
56
Q

How much prime do you remove in RAP?

A

200-600mL of prime

57
Q

Dry Venous Line Technique

A

Venous line emptied prior to connection to venous cannula
Requires VAVD
Volume removed to a big and discarded or sequestered

58
Q

How much fluid does the dry venous line technique remove?

A

400-1000 mL

59
Q

Mini-Circuit Advantages

A

Decreased foreign surface area (less inflammatory)
Decreases prime volume (less hemodilution)
Decreases blood-air contact

60
Q

What does a mini circuit lack?

A

Venous reservoir
Cardiotomy
Often no heat exchange or art line filter

61
Q

What is mini circuit prime volume?

A

500 mL; can be decreased with RAP- ing

62
Q

What procedures use mini circuits usually?

A

Mostly CABGs

Some valves have been done

63
Q

2 types of Mini-circuits

A

Totally Integrated Devices

Combination of Components

64
Q

Totally Integrated Devices (Mini circuit)

A

Include air handling and eliminiation systems, centrifugal pump and membrane oxygantor

ex. CorX (Cardiovention) and Cobe Synergy

65
Q

Combination of Components

A

MECC System (jostra)
MCPB
Deltra Stream ERP(medos)
Resting Heart System (Medtronic)

66
Q

What variables affect the outcomes in mini circuits?

A 
Steroids
Aprotinin
Degree of heparinization
Type of tubing coating
Patient population
67
Q

ERC

A

Electric Remove Clamp

68
Q

APC

A

Air Purge Control

69
Q

Ultrafiltration/Hemoconcentration

A

Filtration of water across a semipermeable membrane via hydrostatic pressure gradient

Water crosses membrane which creates a solute concentration gradient

Solute from blood (high concentration) to water (low concentration)

70
Q

What must you add if you’re Z-BUFing?

A

Add sodium bicarb to the normal saline you’re Z BUFing with to avoid acidosis

71
Q

MUF

A

Modified Ultrafiltration
Withdrawing blood from the patient via the arterial line (post bypass); run blood through hemoconcentrator, pump blood back to patient via venous line

72
Q

What does a cell saver remove?

A

Fat, air, tissue debris, potassium, hormones, bioactivators, etc.

73
Q

Cell Saver Limitations

A 
Delay in processing
Loss of plasma proteins
Loss of coag factors and plts
Expense
Operator attention and time
74
Q

Cardiopat

A

Shed blood collected and processed
Uses dynamic disk to process- processes variable volume of blood
Consistently delivers washed RBCs w/ hct of 70-80%
Processes up to 2 L/hr or as little as 5mL of RBCs

75
Q

What HCT can you tolerate if you are healthy and have good LV function?

A

20-25%

CV Perf Tech II (17 decks)

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