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SUM '20 - Pharm II > Blood products and Components > Flashcards

Blood products and Components Flashcards

1
Q

what do we use for initial critical bleeding

A

colloids
crystalloids
prbc

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2
Q

what is the problem with crystalloids

A

does not improve coagulation because these have no coagulation factors

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3
Q

**what treatment will severe bleeding require

A

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

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4
Q

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

A

there is no single minimal acceptable Hgb level

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5
Q

*which is tolerated better…chronic or acute anemia

A

chronic

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6
Q

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

A

the patients cardiac reserve

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7
Q

what could limit compensation during acute anemia

A

heart failure and or flow restricting lesions

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8
Q

what factors would you consider for a transfusion

A

intravascular volume
pt actively bleeding
need improve 02 transport

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9
Q

how do you weight the need to transfuse

A

risk versus benefit

benefit such as the need for increased 02 carrying capability

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10
Q

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

A

less than 6g/dL

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11
Q

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

A

10g/dL

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12
Q

when can the parameters for blood transfusion be altered

A

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

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13
Q

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

A

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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14
Q

are transfusion parameters absolute

A

no

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15
Q

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

A

yes

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16
Q

how many days are PRBC stored

A

42 days

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17
Q

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

A

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

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18
Q

changes of PRBC in storage in blood bank

A

“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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19
Q

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

A

no

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20
Q

mechanism of TRALI

A

unclear

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21
Q

TRALI occurs how soon after transfusion begins

A

minutes to 6 hours

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22
Q

*what three things should be ruled out other than TRALI

A

sepsis
PNA
aspiration

“ALI = acute lung issues”

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23
Q

is TRALI under diagnosed or over diagnosed

A

underdiagnosed

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24
Q

if TRALI is suspected …

A

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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25
Q

*what is treatment for TRALI

A

treatment is supportive

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26
Q

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

A

decreased incidence of TRALI

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27
Q

Most widely accepted current concept is that TRALI results from

A

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

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28
Q

what does TRALI result in

A

pulmonary vascular injury and pulmonary edema

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29
Q

in its severe form, what is TRALI indistinguishable from

A

ARDS

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30
Q

*TRALI is characterized by:

A

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

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31
Q

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

A

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

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32
Q

FFP is frozen within how many hours of collection?

Yet in the US, how many hours

A

8 hours of collection

24 hours of collection

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33
Q

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

A

Difference is Cryoprecipitate may be obtained from FFP but not FP24

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34
Q

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

A

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

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35
Q

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

A

**massive transfusion

treat or prevent future bleeding during surgery and invasive procedures

treatment of coagulation factors abnormalities

36
Q

FFP is used to reverse what drug

A

warfarin

37
Q

once RBC and platelets are removed what remains

A

FFP!!

38
Q

what does FFP contain

A

blood coagulation factors

fibrinogen

plasma proteins

39
Q

FFP can be stored up to

A

1 year

40
Q

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

A

4

41
Q 
thawed plasma (after FFP has been thawed for 24 hours) maintains normal levels of all factors 
except (2)
A

factor V- falls to 80% or normal

factor VIII-falls 60% of normal

42
Q

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

A

1.5 times normal

or

specific coagulation factor assay of less than 25%

43
Q

what two situations are FFP used to reverse warfarin

A

before/during surgery

active bleeding episodes

44
Q

how is FFP dosed

A

10-15ml/kg

dosed to deliver a calculated minimum of 30% of plasma factor concentration

45
Q

what dose may be adequate to reverse warfarin anticoagulation

A

5-8ml/kg

46
Q

what blood product is overused in surgery

A

plasma

47
Q

*what is the most common cause of bleeding after surgery

A

platelet dysfunction

48
Q

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

A

no

49
Q

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

A

yes

like a heparin GTT

50
Q

*how is cryoprecipitate formed

A

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

51
Q

what is cryoprecipitate rich in

A

fibrinogen, factor VIII, factor XIII, von willebrand factor

52
Q

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

A

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

53
Q

what is the dose of cryoprecipitate

this is roughly = to?

A

1 unit per 10kg of body weight

roughly 50-70mg/dL
*in the absence of cont. massive bleeding

54
Q

*what is the minimum hemostatic level of fibrinogen

A

100mg/dl

55
Q

*what is the NORMAL hemostatic level of fibrinogen

A

200mg/dl

56
Q

should cryoprecipitate be used to treat DIC?

explain?

A

no, it lacks factor V

57
Q

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

A

cryo

58
Q

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

A

Cryo

59
Q

how many days are platelets stored

A

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

60
Q

*normal platelet count

A

150,000-400,000

61
Q

what is the threshold for prophylactic platelet transfusion

A

10,000

62
Q

*when do neurosurgery patients receive platelets

A

less than 100,000

63
Q

what is the level of platelets for invasive procedures or trauma

A

between 50,000-100,000

64
Q

blood products undergo what process to reduce the “bugs”

A

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

65
Q

10 units of platelets used to come from

A

10 donors

66
Q

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

A

apheresis

67
Q

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

A

transfusion transmitted infection

68
Q

why do platelets have an increased risk of bacterial growth

A

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

69
Q

*what are platelets cross matched

A

to RBC specific antigen

70
Q

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

A 
type of surgery
trauma
rates of bleeding
risk of bleeding
use of platelet inhibitors 
coagulation abnormalities.
71
Q

*name the 6 reasons abnormal platelets can arise

A 
Multiple medications
Malignancy
Trauma to tissue
Obstetric issues
Cardiopulmonary bypass
Hepatic or renal failure
72
Q

*Lab test determine PLT

A

counts not function!!!

73
Q

what is TACO

A

volume overload, more volume than patients CV system can handle

74
Q

what is TACO characterized by

A

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

75
Q

*TACO incidence is what percent of transfusion

A

1-8%

76
Q

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

A

FFP

77
Q

*which blood transfusion disorder will BNP be elevated

A

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

78
Q

*In TRALI- what is the cause of pulmonary edema

A

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

79
Q

is von willebrand factor used prophylactically

A

no

80
Q

when is von willebrand factor indicated

A

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

81
Q

what is the problem with von willebrand factor

A

its rare and expensive

82
Q

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).

A

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).

83
Q

*spectrum of additional antigenic components in PLTS is why

A

LEUKOREDUCTION is part of an important management strategy

84
Q

Classical hemophilia is

A

hemophilia A

85
Q

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

A

FFP

SUM '20 - Pharm II (30 decks)

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