Blood Products Flashcards
Autologous blood donation
- donate every 72 hours up to 72 hours prior to planned surgery
- donate hemoglobin down to 11g/dL
- donate max 2-4 units
Contraindications autologous blood donation
- bacteremia
- ischemic heart disease
- valvular heart disease
- recent seizures
Which blood donation often gets wasted?
autologous
Whole blood can be spun down to get what 3 major products?
PRBC
Platelets
Plasma
Whole blood first spin
PRBC
platelet rich plasma
whole blood 2nd spin
Platelets
Plasma (FFP) –> proteins
t/f whole blood separates within days
false
hours!
What part of blood do you want for plasma donation?
proteins
What part of blood do you want for blood in hospital?
PRBC
Plasma donation
- spin out cells and give back
- 90 mins
- private companies (paid)
Requirements for plasma donation
- > 110lbs
- > 19
- not sick
How often can you give plasma?
2x per week
Types of transfusion medicine
- PRBC
- platelets
- FFP
- PCC
- cryoprecipitate
What is the most common transfusion medicine?
PRBC
1 unit of PRBC
- 250mL
- hematocrit 70-80%
- raises hgb by 1-2 g/dL
How many units of PRBC are given per patient?
2.7
What are PRBC used for?
- treat anemia
- acute blood loss to maintain adequate tissue oxygenation
Treatment of anemia, what do you want to keep hgb at?
ischemic heart disease?
critical level?
> 7
> 8-10
> 5
What could cause acute blood loss and need for PRBC?
massive hemorrhage
surgery
During massive hemorrhage, when would you need PRBC?
30-40% of blood volume lost
Hgb <6
During surgery when would you need PRBC?
general <7
cardiac <8
PRBC storage
fridge (39F, 4C)
frozen (hemolysis)
Shelf life of PRBC
42 days
Risk of PRBC
- immediate transfusion reactions
- inaction
- hemolytic reactions
- transfusion related lung injury
What are immediate transfusion reactions?
- chills
- fever
- urticaria
- tachycardia
- dyspnea
What are platelets used for?
- treat thrombocytopenia
- bleeding
In thrombocytopenia, when would you need platelets?
<20,000/uL
possibly as low as 5,000 to 10,000
Who would you not use platelets in?
TTP (thrombotic thrombocytopenia purport)
HIT (heparin induced thrombocytopenia)
When bleeding, when would you need platelets?
<100,000
consider in massive bleeding once one blood volume has been replaced (10 units PRBC)
1 unit of platelets = ___ mL
200 - 300 mL
each unit of platelets contain ____ per uL
300,000 - 600,000
1 donated unit of whole blood provides about ___mL of platelet concentrate
50mL
T/f you need multiple donors for a therapeutic dose of platelets
true
How many units of platelets are needed for a therapeutic dose?
4-8 units
6 pack of platelets
platelets storage
room temp (68-75F, 20-24C) continuously agitated
Shelf life of platelets
5 days
FFP
fresh frozen plasma
How do you get FFP?
from fresh whole blood or from plasma collected from apheresis
When do you need to freeze FFP?
within 8 hours
Shelf life of FFP
12 months
Risks of FFP
similar to other blood product infusions
PCC
prothrombin complex concentrates
PCC was developed for ____
hemophilia B
Dosing for hemophilia B is based on what?
factor IX
3 factor type of PCC
II
IX
X
4 factor type of PCC
II
IX
X
VII***
Activated PCC (FEIBA)
II
IX
X
VIIa
What is the difference between 3 factor and 4 factor?
factor VII in 4
Concentration of clotting factors are about ____ higher than in human plasma
25x
What is the first available 4 factor PCC in US?
Kcentra
- lyophilized powder
- recon with 20mL diluent
Does FFP or PCC require larger volume to provide same quantity of clotting factors?
FFP
T/F FFP has same risk of allergic reactions and bacterial infection as PCC
false
same as PRBC
T/f FFP undergoes viral inactivation
false
PCC
T/F FFP requires thawing
true (30-45 min)
Is FFP or PCC recommended for reversal of warfarin?
PCC
Cryoprecipitate
- derived by thawing 1 unit of FFP in cold (4C)
Cryoprecipitate is plasma enriched with what?
FVIII vWF FXIII fibronectin fibrinogen
If you want to get fibrinogen what would you use?
cryoprecipitate
What is cryoprecipitate used for?
dysfibrogenemia or if fibrinogen <100 mg/dL
Massive transfusion definition
varies by institution!
Massive transfusion
1:1:1 PRBC, platelets, FFP
Hct 29%
may need cryoprecipitate
clotting factor activity 62%
4 issues with massive transfusion
- dilution thrombocytopenia
- citrate induced hypocalcemia
- hyperkalemia
- acidosis
supportive care in blood transfusions
- mechanical compression
- surgical hemostasis
- fluid resuscitation
- maintenance of renal function
- transfusion of blood products
Vitamin K leads to production of what?
new clotting factors (II, VII, IX, X)
If you want to reverse warfarin what would you use?
vitamin K
Protamine
binds UFH (LMWH to lesser extent) prevent anticoagulant activity
What would you use to reverse heparin?
protamine
Desmopressin
activation of V2 receptors
increase production of FVIII and vWF
reversal of antiplatlet agents
What would you use to reverse aspirin (anti platelets)?
desmopressin
DDAVP
desmopressin
What would you use to reverse fibrinogen?
antifibrinolytic agent
What would you use to reverse dabigatran?
idarucizumab
T/f idarucizumab has Fab portion fully humanized
true
idarucizumab has affinity ____ fold compared to thrombin
350 fold
T/F idarucizumab binds to other thrombin substrates
false!
does not!
Andexanet alfa acts as what?
Fax decoy
retains high affinity for all direct FXa inhibitors
What would you use to reverse rivaroxaban?
andexanet
What is an antidote for Xa drugs?
andexanet
Andexanet used to reverse what?
apixaan
edoxaban
enoxaparin
Standard dose for andexanet
400mg IV bolus; followed by 4mg/min x 2 hours (480mg)
When would you give standard dose of andexanet?
- 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
High dose for andexanet
800mg IV bolus; followed by 8mg/min x 2 hours (960mg)
When would you give high dose of andexanet?
- api last dose 10mg within last 8 hours
- riva last dose 15mg or 20mg within last 8 hours
unapproved uses of andexanet
- high dose for edoxaban and mg/kg doses of enoxaparin
- low dose for enoxaparin prophylaxis
Ciraparantag
- small synthetic, water soluble molecule
- IV antidote
- reversal through strong, non-covalent bonds
Ciraparantag is antidote for what?
DOACs
heparins
T/f ciraparantag is FDA approved
false
