Blood - Dr. Reed Final Review

Question 1

What is the transfusion ratio?

Answer 1

1:1or 1:2
PRBC:FFP

Question 2

What can happen when you give a lot of banked blood?

Answer 2

TRALI and TACO (most lethal)
Hypocalcemia

Question 3

What kind of changes can banked PRBCs have?

Answer 3

-Hyperkalemia
-Decreased 2,3 DPG
-Hemolysis or Altered Morphology, which limits the RBCs oxygen carrying capacity
-Acidosis
-Depletion of ATP

Question 4

Once RBCs are collected, how long is it good for?

Answer 4

40-45 days

Question 5

After you transfuse someone, what is the expected change in Hgb and Hct after 1 unit of PRBCs?

Answer 5

1 hgb or 2-3% Hct

Question 6

Hemophilia is an X-Linked Clotting Disorder. How would you treat Hemophilia A?

Answer 6

Hemophilia A: Deficient in Factor 8.
1.*Factor 8 Concentrate (best choice but expensive)
2. Cryoprecipitate - has more Factor 8 than FFP
3. Lastly, FFP (difficult to achieve high enough Factor 8 alone)

Other options, Mild HA: Desmopressin 0.3mcg/kg to inc. vWF and Factor 8. TXA and aminocaproic acid (plasmin inhibitors)

Question 7

Hemophilia is an X-Linked Clotting Disorder. How would you treat Hemophilia B?

Answer 7

Hemophilia B: Deficient in Factor 9
FFP - has all factors but especially 2, 7, 9!, and 10
(desmopressin will not help here)

TXA and Aminocaproic Acid (plasmin inhibitors) are other options.

Question 8

Objective transfusion rationales include:

Answer 8

Active bloodloss - drains, suction, sponges
Organ perfusion - svo2, tachycardia, high lactate (anerobic metabolism), spo2 (late sign)
Labs - H&H, TEGs, PTT, PT/INR, plts, ABG

Question 9

Justification to transfuse people, you have seen it before… ??

Question 10

Universal FFP donor

Answer 10

AB

Question 11

What is the treatment for a patient with DIC for surgery?

Answer 11

1. Identify and treat the underlying cause
2. FFP (all factors), Plts, and sometimes Cryo (Factor 8 and 13, Fibrinogen) and AntiThrombin III

Question 12

What lab values would you expect for DIC?

Answer 12

Increased: PT, PTT, and D-Dimer

Decreased: Plt and Fibrinogen

Question 13

Normal PTT is? It measures what pathway? If prolonged, what factors could be deficient? How would you treat it?

Answer 13

25-32sec
Intrinsic Pathway and Common Pathway
Factors 12, 11, 9, and 8

Tx: FFP (all factors, especially 2, 7, 9, 10), Protamine

(Would expect to be prolonged if on Heparin)

Question 14

Normal PT is? It measures what pathway? If prolonged, what factors could be deficient? How would you treat it?

Answer 14

12-14seconds
Extrinsic and Common Pathway

Tissue Factor and Factor 7

FFP (all factors, especially 2, 7, 9, 10)

Question 15

The patient has Type 1 vWD; how would you treat it?

Answer 15

Desmopressin - can be given 40-60min before surgery. Increases endothelial cell release of Factor 8, VWF, and plasminogen activator.

Question 16

Patient has VWD type 2 or 3. How would you treat?

Answer 16

-vWF concentrate, aka Factor 8 concentrate (first line for type 3, but expensive)
-Cryoprecipitate is next best

Question 17

When a blood vessel is injured, what happens at the cellular level? What is being released?

Answer 17

Tissue Factor,
Thromboxane A2, Serotonin, and ADP for Vasoconstriction

Question 18

What symptoms distinguish TRALI from TACO? What is the treatment for TRALI?

Answer 18

Hypotension and Fever (immune-mediated) distinguish TRALI from TACO.

Hemodynamic support and lung protection strategies.
Maximize PEEP, Low tidal volumes, and avoid overhydration.