Blood conservations/transfusion

Question 1

List complications of blood transfusions

Answer 1

Febrile reactions 
Infectious (bacterial, viral, and prions) 
Hemolytic (immune and non-immune) 
Fluid overload
ARDS
Hypothermia 
Hemorrhagic (dilution, DIC) 
Embolic 
electrolyte abnormalities

Question 2

What are current canadian testing standards for products, and what are the infection rates
for Hep B, Hep C, HIV, CJD

Answer 2

Hep B 1 in 82 000
Hep C 1 in 2.8 Million
HIV 1 in 4 Million
CJD 1 in 10 Million

Question 3

What is transmission rate from a needle of an infected pt

Answer 3

HIV 0.5%
HCV 2%
HBV 20%
risk is higher with hollow needle and gross contamination

Question 4

What is retrograde autologous priming

Answer 4

Circuit volume in the CPB that displaces crystalloid solution with autologous blood drained from the arterial cannula and from the venous cannula.

Reduced the amount of crystalloid prime to 200ml

Question 5

What are predictors of needing a blood transfusion

Answer 5

Advanced age
Female
personal or family history of excessive bleeding/bleeding disorder
Lower body weight (70 kg) 
Lower perop hematocrit (< 28%) 
pre-op red cell blood volume
Prolonged CPB time
Lack of institutional guideline for transfusion
Emergent surgery
Renal failure at time of surgery

Question 6

List ways to reduced need for PRBC during cardiac surgery

Answer 6

a. Minimal hemodilution-retrograde autologous prime
b. Heparin coated CPB circuit
c. Intraoperative autologous donation
d. Use of serine protease inhibitors/antifibrinolytics
e. Erythropoietin with iron
f. Preoperative autologous (rare/2 weeks)
g. Surgeon with good technique/anesthiology minimal volume
h. Multidisciplinary approach
I. Stopping ASA/anti-platelet agents at appropriate times
J. Using of topical agents–Tissell/Floseal
K. Return shed blood via cell saver

Question 7

List 4 factors that must be met to do pre operative autologous blood donation

Answer 7

Pt must be able to wait (about 2 weeks) from time of donation to regeneration of red cells
Pt must be healthy enough to undergo donation (no left man, AS, CHF)
Does not have active endocarditis
Pt has an adequate hematocrit and red blood cell mass (HCT > 33%)

Question 8

List 2 Herbs that effect platelets

Answer 8

Thyme

Rosemary

Question 9

List a herb that increases INR (effects warfarin) *will be common in NL

Answer 9

Fish Oil

Omega-3 fatty acids.

Question 10

What is mechanism of action of Factor VIIa

Who was it designed for?

Answer 10

complexes with all available tissue factor to activate factor X directly and induced thrombin generation. This leads to the formation of a tight and stable fibrin plug that is resistant to early fibrinolysis

Originally for Hemophilia A or B

Question 11

What is dose of Factor VIIa

a. What is most common complication?
b. What is the rate of this complication?

Answer 11

Dose between 75- 100 ug/kg. There is a very wide range of efficacy.

Risk of thromboembolic events of 25%..this is really high. I have read other reports showing it to be as low as 4%

Question 12

Limited Blood Transfusion DOES NOT impact survival in octogenerians undergoing cardiac operations

Annals thorac Surg 2012:94;2038-45

James J. Yun et al., Nothern New England Cardiovascular Disease Study Group

Answer 12

Previously reported transfusion of 1 to 2 U of PRBC confers a 16% increased hazard of late death after cardiac surgery.

1, 311 pts that were great then 80 years with about half receiving a transfusion and half not.

3 main findings of this study:

1. Limited 1 to 2 U RBC transfusion is common (50%) of octogenerians
2. This degree of transfusion is associated with increased mortality (to 6 months) for patients younger then 80 years of age
3. Did not appear to increase the risk of early or late death in Octogenerians