Blood products and Components Flashcards by Amanda D

what do we use for initial critical bleeding

colloids
crystalloids
prbc

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what is the problem with crystalloids

does not improve coagulation because these have no coagulation factors

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**what treatment will severe bleeding require

FFP
PLTS
CRYO
Factor concentrations (fibrinogen and PT complex concentrates)

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**what is the single minimum acceptable Hgb level used to determine the need for PRBC transfusion in all patients

there is no single minimal acceptable Hgb level

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*which is tolerated better…chronic or acute anemia

chronic

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*in acute anemia, the compensatory mechanism such as increased CO, and improved oxygenation rely on what

the patients cardiac reserve

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what could limit compensation during acute anemia

heart failure and or flow restricting lesions

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what factors would you consider for a transfusion

intravascular volume
pt actively bleeding
need improve 02 transport

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how do you weight the need to transfuse

risk versus benefit

benefit such as the need for increased 02 carrying capability

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ASA task force recommends tranfusion in a young healthy patient for a hgb of

less than 6g/dL

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it is usually unnecessary to transfuse PRBC when the hgb is greater than

10g/dL

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when can the parameters for blood transfusion be altered

in the presence of anticipated blood loss or active critical ischemia or target organ ischemia

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what 5 factors should be considered to determine the need for transfusion for hgb between 6 and 10?

S/S target organ ischemia

Potential or actual bleeding including rate and magnitude

Intravascular volume status

Risk factors for complications of inadequate oxygenation

Low cardiopulmonary reserve and high oxygen consumption

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are transfusion parameters absolute

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should patients with s/s of inadequate myocardial oxygenation be tranfused

yes

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how many days are PRBC stored

42 days

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what is the concern for storing blood longer than 14-21 days

may lead to adverse effects- storage lesions is a term used to describe older PRBC

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changes of PRBC in storage in blood bank

“Storage Lesion”

depletion of ATP or 2,3 DPG

membrane phospholipid vesculation (blistering) and shedding

protein oxidation and lipid per oxidation of cell membrane

RBC shape changes with an increase in fragility which could impair microcirculatory flow.

increased red cell endothelial cell interaction, bioactive lipids and other substances are released that may initiate inflammatory responses leading to TRALI

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is there conclusive studies regarding age of stored RBC on patient outcomes?

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mechanism of TRALI

unclear

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TRALI occurs how soon after transfusion begins

minutes to 6 hours

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*what three things should be ruled out other than TRALI

sepsis
PNA
aspiration

“ALI = acute lung issues”

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is TRALI under diagnosed or over diagnosed

underdiagnosed

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if TRALI is suspected …

stop infusion
obtain WBC and CXR
request blood bank to quarantine other unit from the same donor
request other units to be given if needed

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*what is treatment for TRALI

treatment is supportive

*females who have not been pregnant- their blood has a higher or lower risk of TRALI?

decreased incidence of TRALI

Most widely accepted current concept is that TRALI results from

Neutrophil and/or endothelial activation via multiple mechanisms in the lung

what does TRALI result in

pulmonary vascular injury and pulmonary edema

in its severe form, what is TRALI indistinguishable from

ARDS

*TRALI is characterized by:

Acute Onset bilateral pulmonary infiltrates, hypoxia without evidence of heart failure

Multiple pathogenic transfused factors are associated with TRALI and predisposing events may prime the response

FFP is frozen within how many hours of collection? | Yet in the US, how many hours

8 hours of collection 24 hours of collection

can cryoprecipitate be obtained from FFP (8hours to frozen) or FP24 (24 hours to frozen)

Difference is Cryoprecipitate may be obtained from FFP but not FP24

FFP and FFP24- what is the overarching name we give these two

FFP and FFP24 can be given interchangeable and both may be referred to as just FFP

*plasma /FFP can be used to replace volume and coagulation factors during?

**massive transfusion treat or prevent future bleeding during surgery and invasive procedures treatment of coagulation factors abnormalities

FFP is used to reverse what drug

warfarin

once RBC and platelets are removed what remains

FFP!!

what does FFP contain

blood coagulation factors fibrinogen plasma proteins

FFP can be stored up to

1 year

after FFP is thawed it can be transfused within 24 hours- after that it is relabeled thawed plasma and can be stored additional ___days

``` thawed plasma (after FFP has been thawed for 24 hours) maintains normal levels of all factors except (2) ```

factor V- falls to 80% or normal factor VIII-falls 60% of normal

FFP used for treating bleeding due to *coagulopathies associated with prolonged PTT or PT/INR greater than

1.5 times normal or specific coagulation factor assay of less than 25%

what two situations are FFP used to reverse warfarin

before/during surgery active bleeding episodes

how is FFP dosed

10-15ml/kg dosed to deliver a calculated minimum of 30% of plasma factor concentration

what dose may be adequate to reverse warfarin anticoagulation

5-8ml/kg

what blood product is overused in surgery

plasma

*what is the most common cause of bleeding after surgery

platelet dysfunction

*does PT and PTT reflect the cause of bleeding in surgical patients

can pt/ptt be elevated in patients who are not bleeding

yes | like a heparin GTT

*how is cryoprecipitate formed

when frozen plasma is allowed to thaw slowly at 1C-10C*

what is cryoprecipitate rich in

fibrinogen, factor VIII, factor XIII, von willebrand factor

*Hemophilia A therapy, early on, its major use today is increase fibrinogen levels during coagulopathies

Hemophilia A therapy, early on, its major use today is increase fibrinogen levels during coagulopathies

what is the dose of cryoprecipitate this is roughly = to?

1 unit per 10kg of body weight roughly 50-70mg/dL *in the absence of cont. massive bleeding

*what is the minimum hemostatic level of fibrinogen

100mg/dl

*what is the NORMAL hemostatic level of fibrinogen

200mg/dl

should cryoprecipitate be used to treat DIC? | explain?

no, it lacks factor V

which blood product is thought to be underused in cardiac surgical patients

cryo

*cardiac surgical patients who are refractory to standard FFP and platelets should be administered

Cryo

how many days are platelets stored

Platelets used clinically are either Pooled Random Donor Platelet Concentrates or Single-donor Apheresis and can be stored up to 5 days.

*normal platelet count

150,000-400,000

what is the threshold for prophylactic platelet transfusion

10,000

*when do neurosurgery patients receive platelets

less than 100,000

what is the level of platelets for invasive procedures or trauma

between 50,000-100,000

blood products undergo what process to reduce the "bugs"

leukoreduction to reduce alloimmunization rates, CMV transmission, and febrile transfusion reactions

10 units of platelets used to come from

10 donors

what process allows for a sufficient number of platelets to be collected from a single donor.

apheresis

the process of apheresis has reduced the number of donor exposures thus reducing

transfusion transmitted infection

why do platelets have an increased risk of bacterial growth

being stored at 22c allows the potential for bacterial growth. testing of all platelets products is mandated.

*what are platelets cross matched

to RBC specific antigen

*name the 6 clinical decisions to transfuse platelets for counts between 50,000- 100,000

``` type of surgery trauma rates of bleeding risk of bleeding use of platelet inhibitors coagulation abnormalities. ```

*name the 6 reasons abnormal platelets can arise

``` Multiple medications Malignancy Trauma to tissue Obstetric issues Cardiopulmonary bypass Hepatic or renal failure ```

*Lab test determine PLT

counts not function!!!

what is TACO

volume overload, more volume than patients CV system can handle

what is TACO characterized by

acute onset of dyspnea typically association with HTN, tachypnea, and tachycardia exacerbation of HF

*TACO incidence is what percent of transfusion

1-8%

Taco is reported as a common cause of morbidity and mortality associated with transfusion---especially which blood product

FFP

*which blood transfusion disorder will BNP be elevated

elevated several fold above baseline of 100-200 in patients with TACO

*In TRALI- what is the cause of pulmonary edema

its not volume overload- LV size should be normal or low and often RV is dilated

is von willebrand factor used prophylactically

when is von willebrand factor indicated

Tx of spontaneous and trauma induced bleeding Prevention of excessive bleeding during or after surgery Used for severe VWD; and those whom desmopressin does not or is suspected not to be adequate treatment

what is the problem with von willebrand factor

its rare and expensive

Human ant hemophilic factor/von Willebrand factor complex is commercially available in the US and is indicated for tx and prevention of bleeding in adult patients with hemophilia A (classical hemophilia).

*spectrum of additional antigenic components in PLTS is why

LEUKOREDUCTION is part of an important management strategy

Classical hemophilia is

hemophilia A

TACO has been increasingly reported as a common cause of morbidity and mortality associate with transfusion, ESPECIALLY transfusion of what?

FFP