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Anes 507 > Blood Products > Flashcards

Blood Products Flashcards

1
Q

What are the five main components of blood?

A

Red Blood Cells, White Blood Cells, Platelets, Coagulation factors, Plasma

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2
Q

Blood Type A

A

Red Cell Type: A
Antigens: A-Antigens
Antibodies: Anti-B

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3
Q

Blood Type B

A

Red Cell Type: B
Antigens: B-Antigens
Antibodies: Anti-A

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4
Q

Blood Type AB

A

Red Cell Type: AB
Antigens: AB-Antigens
Antibodies: N/A

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5
Q

Blood Type O

A

Red Cell Type: O
Antigens: N/A
Antibodies: Anti-AB

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6
Q

Coagulation type and pathways

A

Coagulation is a cell based process that occurs via a cascade. Its pathways are intrinsic (12,11,9,8), extrinsic (7,3), and common (10)

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7
Q

Platelet Count Levels

A

Normal: 150,000-400,000/mm3
Thrombocytopenia: 400,000/mm3

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8
Q

Activated Clotting Time (ACT)

A

Measures the amount of time required for whole blood to clot in a test tube

Used to monitor heparin therapy in the OR

Normal – 70-180 seconds
Sufficient for CPB –> 400 seconds

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9
Q

Prothrombin Time (PT)

A

Normal 10-14s or 30-40s (depending on reagent used)

PT test varies in sensitivity among laboratories

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10
Q

Partial Thromboplastin Time (PTT)

A

Normal 25-38s

Can be used to monitor anticoagulation therapy

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11
Q

International Normalized Ratio (INR)

A

developed to standardize PT values to better monitor oral anticoagulation therapy

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12
Q

Type and Screen

A

Recipient’s blood has been typed for A, B, and Rh antigens and screened for common antibodies

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13
Q

Type and Cross-Match

A

Recipient’s blood is incubated with the donor blood product

Clumping occurs if the cross-match is incompatible

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14
Q

Factors that determine when to transfuse

A

Extensive blood loss
Inadequate perfusion
Low hemoglobin concentration
Poor coagulation

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15
Q

When do you know if you need to give blood products?

A

For the average 70 kg patient who has lost ~1L – 1.5L of blood, send off coagulation studies and start documenting lab values and coagulation status

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16
Q

Packed Red Blood Cell Therapy

A

Indicated for treatment of anemia (often associated with blood loss)
1 unit contains 250-300 mL volume with a hematocrit of 70-80%

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17
Q

When to give PRBC’s

A

Evidence of Rapid Acute Hemorrhage w/o immediate control

Estimated blood loss >30-40%, presence of symptoms of severe blood loss

18
Q

When to use crystalloid/colloid resuscitation

A

Estimated blood loss 20-30%

19
Q

How much does 1 unit of PRBC increase hemoglobin and hematocrit

A

Hemoglobin: 1 g/dL
Hematocrit: 3%

20
Q

Washed PRBC’s

A

Centrifuged in saline to remove plasma and cytokines

Once washed, PRBCs can be stored for no longer than 24 hrs

21
Q

Leukocyte-reduced PRBCs

A

Centrifuged, washed, or filtered

  • To avoid nonhemolytic febrile reactions
  • To prevent sensitization of patients with aplastic anemia
  • To minimize transmission of HIV or CMV
22
Q

Irradiated PRBCs

A

Cells are exposed to a standard dose of ionizing radiation

Irradiated blood is for people who are not capable of mounting a counterattack and neutralizing transfused lymphocytes

23
Q

Cell Saver

A

Blood salvaged from the surgical field

Hematocrit ~ 65-70%

24
Q

When to give a platelet transfusion

A

Usually not indicated during surgery unless the platelet count is less than 50,000/mm^3

25
Q

How are platelets prepared

A
  • Centrifuging individual units from multiple whole blood donors (5 x 10^10 platelets in 50-70cc of plasma per unit) – 5 to 10 units of platelets may be pooled together in a single bag
  • Single donor apheresis (3-5 x 10^11 platelets in 200-400cc plasma)
26
Q

Platelet Transfusion level increase

A

Rough rule of thumb is that a pool of 6-8 units of whole-blood platelets (a “six pack”) or 1 unit of apheresis will raise the patients platelet count by 30-50 x 109 /L
Initial dose = 10 cc/kg

27
Q

Things to Know about Platelet Transfusion

A
  • DO NOT warm or cool platelets
  • Use a 150 micron filter when giving platelets. Microaggregate filters (20-40 micron) should not be used because they will remove most of the platelets.
28
Q

Fresh Frozen Plasma (FFP)

A

the FLUID portion obtained from a single unit of whole blood that is frozen within 6 hours of collection (whole blood → platelet rich plasma → platelets + plasma)

29
Q

When should FFP be transfused

A

Indicated when PT, PTT, or both are at least 1.5 times greater than normal.
In emergent situations, FFP may be used to reverse the effects of warfarin prior to surgery

30
Q

How much FFP to give

A

10 to 15 mL/kg will raise most coagulation proteins by 25-30% (5-8 ml/kg may be sufficient to reverse warfarin anticoagulation)

31
Q

Cryoprecipitate (Cryo)

A
  • The fraction of plasma that precipitates when FFP is thawed
  • Each bag of Cryo contains ~ 200 mg of fibrinogen and 100 units of Factor VIII (80 to 110 IU)
32
Q

Complications of Blood Transfusion

A
  • Transfusion reactions
  • Transmission of disease
  • Transfusion-Related Acute Lung Injury
  • Suppression of cell-mediated immunity
  • Metabolic derangements
33
Q

Febrile Reactions (FNHTR)

A

Occur in 0.5-1% of transfusions
Due to immune reaction between cytokines (released by leukocytes) or platelets with recipient antibodies (from previous transfusions or pregnancy)

34
Q

Mild Allergic Reactions

A
  • Can occur in blood which has been properly typed and cross-matched
  • Clinical manifestations
  • –Increased body temperature
  • –Pruritis
  • Treatment
  • –IV antihistamines
  • –Discontinuation of transfusion if severe
35
Q

Hemolytic Reactions

A
  • Medical emergency that results from the administration of the ABO incompatible blood
  • Caused by the rapid destruction of donor erythrocytes by recipient antibodies
  • Most often the result of clerical or procedural error
36
Q

Hemolytic Reactions

A

Hypotension -Dyspnea
Fever -Skin flushing
Chills
Lumbar/Substernal Pain

37
Q

Anaphylactic Reactions

A 
Rapid onset
Shock
Hypotension
Angioedema
Respiratory distress
38
Q

Treatment of Anaphylactic Reactions

A 
Stop the transfusion
Epinephrine – bolus and possible infusion
Airway maintenance, oxygenation
Volume maintenance with saline
Vasopressors if necessary
39
Q

Transfusion Related Acute Lung Injury (TRALI)

A

Characterized by acute respiratory distress, hypoxemia, hypotension, fever, and pulmonary edema, initially without signs of left ventricular failure.
Symptoms usually begin within two to four hours of beginning the transfusion

40
Q

How to treat Transfusion Related Acute Lung Injury

A

Steroid therapy for 96 hours

Anes 507 (9 decks)

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