Blood products and Components Flashcards
what do we use for initial critical bleeding
colloids
crystalloids
prbc
what is the problem with crystalloids
does not improve coagulation because these have no coagulation factors
**what treatment will severe bleeding require
FFP
PLTS
CRYO
Factor concentrations (fibrinogen and PT complex concentrates)
**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
*which is tolerated better…chronic or acute anemia
chronic
*in acute anemia, the compensatory mechanism such as increased CO, and improved oxygenation rely on what
the patients cardiac reserve
what could limit compensation during acute anemia
heart failure and or flow restricting lesions
what factors would you consider for a transfusion
intravascular volume
pt actively bleeding
need improve 02 transport
how do you weight the need to transfuse
risk versus benefit
benefit such as the need for increased 02 carrying capability
ASA task force recommends tranfusion in a young healthy patient for a hgb of
less than 6g/dL
it is usually unnecessary to transfuse PRBC when the hgb is greater than
10g/dL
when can the parameters for blood transfusion be altered
in the presence of anticipated blood loss or active critical ischemia or target organ ischemia
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
are transfusion parameters absolute
no
should patients with s/s of inadequate myocardial oxygenation be tranfused
yes
how many days are PRBC stored
42 days
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
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
is there conclusive studies regarding age of stored RBC on patient outcomes?
no
mechanism of TRALI
unclear
TRALI occurs how soon after transfusion begins
minutes to 6 hours
*what three things should be ruled out other than TRALI
sepsis
PNA
aspiration
“ALI = acute lung issues”
is TRALI under diagnosed or over diagnosed
underdiagnosed
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
*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
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
4
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
no
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
no
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).
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
