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PT: Hematology & Pulmonary > Blood Products > Flashcards

Blood Products Flashcards

1
Q

Autologous blood donation

A
  • donate every 72 hours up to 72 hours prior to planned surgery
  • donate hemoglobin down to 11g/dL
  • donate max 2-4 units
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2
Q

Contraindications autologous blood donation

A
  • bacteremia
  • ischemic heart disease
  • valvular heart disease
  • recent seizures
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3
Q

Which blood donation often gets wasted?

A

autologous

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4
Q

Whole blood can be spun down to get what 3 major products?

A

PRBC
Platelets
Plasma

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5
Q

Whole blood first spin

A

PRBC

platelet rich plasma

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6
Q

whole blood 2nd spin

A

Platelets

Plasma (FFP) –> proteins

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7
Q

t/f whole blood separates within days

A

false

hours!

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8
Q

What part of blood do you want for plasma donation?

A

proteins

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9
Q

What part of blood do you want for blood in hospital?

A

PRBC

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10
Q

Plasma donation

A
  • spin out cells and give back
  • 90 mins
  • private companies (paid)
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11
Q

Requirements for plasma donation

A
  • > 110lbs
  • > 19
  • not sick
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12
Q

How often can you give plasma?

A

2x per week

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13
Q

Types of transfusion medicine

A
  • PRBC
  • platelets
  • FFP
  • PCC
  • cryoprecipitate
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14
Q

What is the most common transfusion medicine?

A

PRBC

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15
Q

1 unit of PRBC

A
  • 250mL
  • hematocrit 70-80%
  • raises hgb by 1-2 g/dL
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16
Q

How many units of PRBC are given per patient?

A

2.7

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17
Q

What are PRBC used for?

A
  • treat anemia

- acute blood loss to maintain adequate tissue oxygenation

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18
Q

Treatment of anemia, what do you want to keep hgb at?

ischemic heart disease?
critical level?

A

> 7

> 8-10

> 5

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19
Q

What could cause acute blood loss and need for PRBC?

A

massive hemorrhage

surgery

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20
Q

During massive hemorrhage, when would you need PRBC?

A

30-40% of blood volume lost

Hgb <6

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21
Q

During surgery when would you need PRBC?

A

general <7

cardiac <8

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22
Q

PRBC storage

A

fridge (39F, 4C)

frozen (hemolysis)

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23
Q

Shelf life of PRBC

A

42 days

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24
Q

Risk of PRBC

A
  • immediate transfusion reactions
  • inaction
  • hemolytic reactions
  • transfusion related lung injury
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25
Q

What are immediate transfusion reactions?

A
  • chills
  • fever
  • urticaria
  • tachycardia
  • dyspnea
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26
Q

What are platelets used for?

A
  • treat thrombocytopenia

- bleeding

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27
Q

In thrombocytopenia, when would you need platelets?

A

<20,000/uL

possibly as low as 5,000 to 10,000

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28
Q

Who would you not use platelets in?

A

TTP (thrombotic thrombocytopenia purport)

HIT (heparin induced thrombocytopenia)

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29
Q

When bleeding, when would you need platelets?

A

<100,000

consider in massive bleeding once one blood volume has been replaced (10 units PRBC)

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30
Q

1 unit of platelets = ___ mL

A

200 - 300 mL

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31
Q

each unit of platelets contain ____ per uL

A

300,000 - 600,000

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32
Q

1 donated unit of whole blood provides about ___mL of platelet concentrate

A

50mL

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33
Q

T/f you need multiple donors for a therapeutic dose of platelets

A

true

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34
Q

How many units of platelets are needed for a therapeutic dose?

A

4-8 units

6 pack of platelets

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35
Q

platelets storage

A 
room temp (68-75F, 20-24C)
continuously agitated
36
Q

Shelf life of platelets

A

5 days

37
Q

FFP

A

fresh frozen plasma

38
Q

How do you get FFP?

A

from fresh whole blood or from plasma collected from apheresis

39
Q

When do you need to freeze FFP?

A

within 8 hours

40
Q

Shelf life of FFP

A

12 months

41
Q

Risks of FFP

A

similar to other blood product infusions

42
Q

PCC

A

prothrombin complex concentrates

43
Q

PCC was developed for ____

A

hemophilia B

44
Q

Dosing for hemophilia B is based on what?

A

factor IX

45
Q

3 factor type of PCC

A

II
IX
X

46
Q

4 factor type of PCC

A

II
IX
X
VII***

47
Q

Activated PCC (FEIBA)

A

II
IX
X
VIIa

48
Q

What is the difference between 3 factor and 4 factor?

A

factor VII in 4

49
Q

Concentration of clotting factors are about ____ higher than in human plasma

A

25x

50
Q

What is the first available 4 factor PCC in US?

A

Kcentra

  • lyophilized powder
  • recon with 20mL diluent
51
Q

Does FFP or PCC require larger volume to provide same quantity of clotting factors?

A

FFP

52
Q

T/F FFP has same risk of allergic reactions and bacterial infection as PCC

A

false

same as PRBC

53
Q

T/f FFP undergoes viral inactivation

A

false

PCC

54
Q

T/F FFP requires thawing

A

true (30-45 min)

55
Q

Is FFP or PCC recommended for reversal of warfarin?

A

PCC

56
Q

Cryoprecipitate

A
  • derived by thawing 1 unit of FFP in cold (4C)
57
Q

Cryoprecipitate is plasma enriched with what?

A 
FVIII
vWF
FXIII
fibronectin
fibrinogen
58
Q

If you want to get fibrinogen what would you use?

A

cryoprecipitate

59
Q

What is cryoprecipitate used for?

A

dysfibrogenemia or if fibrinogen <100 mg/dL

60
Q

Massive transfusion definition

A

varies by institution!

61
Q

Massive transfusion

A

1:1:1 PRBC, platelets, FFP
Hct 29%
may need cryoprecipitate
clotting factor activity 62%

62
Q

4 issues with massive transfusion

A
  • dilution thrombocytopenia
  • citrate induced hypocalcemia
  • hyperkalemia
  • acidosis
63
Q

supportive care in blood transfusions

A
  • mechanical compression
  • surgical hemostasis
  • fluid resuscitation
  • maintenance of renal function
  • transfusion of blood products
64
Q

Vitamin K leads to production of what?

A

new clotting factors (II, VII, IX, X)

65
Q

If you want to reverse warfarin what would you use?

A

vitamin K

66
Q

Protamine

A 
binds UFH (LMWH to lesser extent) 
prevent anticoagulant activity
67
Q

What would you use to reverse heparin?

A

protamine

68
Q

Desmopressin

A

activation of V2 receptors
increase production of FVIII and vWF
reversal of antiplatlet agents

69
Q

What would you use to reverse aspirin (anti platelets)?

A

desmopressin

70
Q

DDAVP

A

desmopressin

71
Q

What would you use to reverse fibrinogen?

A

antifibrinolytic agent

72
Q

What would you use to reverse dabigatran?

A

idarucizumab

73
Q

T/f idarucizumab has Fab portion fully humanized

A

true

74
Q

idarucizumab has affinity ____ fold compared to thrombin

A

350 fold

75
Q

T/F idarucizumab binds to other thrombin substrates

A

false!

does not!

76
Q

Andexanet alfa acts as what?

A

Fax decoy

retains high affinity for all direct FXa inhibitors

77
Q

What would you use to reverse rivaroxaban?

A

andexanet

78
Q

What is an antidote for Xa drugs?

A

andexanet

79
Q

Andexanet used to reverse what?

A

apixaan
edoxaban
enoxaparin

80
Q

Standard dose for andexanet

A

400mg IV bolus; followed by 4mg/min x 2 hours (480mg)

81
Q

When would you give standard dose of andexanet?

A
  • any dose of apixaban or rivaroxaban >8 hours from last dose
  • last dose of api 5mg or less
  • last dose of riva 10mg or less
82
Q

High dose for andexanet

A

800mg IV bolus; followed by 8mg/min x 2 hours (960mg)

83
Q

When would you give high dose of andexanet?

A
  • api last dose 10mg within last 8 hours

- riva last dose 15mg or 20mg within last 8 hours

84
Q

unapproved uses of andexanet

A
  • high dose for edoxaban and mg/kg doses of enoxaparin

- low dose for enoxaparin prophylaxis

85
Q

Ciraparantag

A
  • small synthetic, water soluble molecule
  • IV antidote
  • reversal through strong, non-covalent bonds
86
Q

Ciraparantag is antidote for what?

A

DOACs

heparins

87
Q

T/f ciraparantag is FDA approved

A

false

PT: Hematology & Pulmonary (8 decks)

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