Blood Products and IV fluids Flashcards
What is the formula for O2 delivery?
- Oxygen delivery (DO2) is determined by the formula
- DO2 = cardiac output X arterial oxygen content
Transfusion risks
5
- Infection
- Allergic and immune transfusion reaction
- Volume overload
- Hyperkalemia
- Iron Overload
Transfusion Risks
- Who is volume overload a common risk in? 3
- Hyperkalemia is a risk in which populations specifically? 3
- Iron overload more common in what?
- Volume overload
- Elderly,
- children,
- CHF - Hyperkalemia
- Newborns,
- renal failure,
- massive transfusions - Iron overload
- Large number of transfusions ex: chronic anemia
- What is a massive transfusion defined as?
2. Complications? (PATCH) 5
- Defined as replacement of blood volume in a 24 hour period or >50% of blood volume in 4 hours
- Complications (PATCH)
- Platelets decrease, Potassium increase
- ARDS, Acidosis
- Temp decrease
- Citrate intoxication
- Hemolytic reaction
Don’t forget about coagulation factors if replacing blood with PRBCs … may need a unit of what?
FFP
Type and Screen
- Determines what?
- Adverse rxn chance?
- Takes how long?
Type and Crossmatch
- Determines what?
- Adverse rxn risk?
- Takes how long?
Type and screen
- Determines ABO and Rh status and the presnce of most commonly encountered antibodies
- Risk of adverse reaction is 1:1000
- Takes about 5 minutes
Type and crossmatch
- Determines ABO and Rh status as well as adverse reaction to even low incidence antigens
- Risk of adverse reaction is 1:10,000
- Takes about 45 minutes
Depending on the clinical situation and the which society’s guidelines the range for transfusion is anywhere from Hgb of what?
6-10 g/dL
Studies indicate:
1. Target Hgb values of ______ g/dL are associated with equivalent or better outcomes in many patient populations
Compared with a target Hgb of ___ g/dL
- 7 to 8
2. 10
Why not transfuse before Hgb gets so low?
1. The rate of normal O2 delivery exceeds consumption by a factor of what?
- Theoretically (if fluid volume and cardiovascular status is maintained) O2 delivery will be adequate until the Hct reaches what?
- Compensatory mechanism?
3
- 4
- below 10!
- increased cardiac output,
- rightward shift of the oxygen-hemoglobin dissociation curve
- increased oxygen extraction
- Blood Transfusion: Decision to transfuse depends on? 4
- Can check what 15 min post infusion to assess status (if not actively bleeding)?
- If stable, consider transfusing what instead of what?
- Hgb level
- Clinical status
- Co-morbidities
- Patient preference
- Hgb/Hct
- one unit of packed red cells at a time (instead of multiple units in the initial order)
What makes up whole blood? 4
- Red cells
- Granulocytes
- Plasma
- Platelets
What makes up plasma? 2
- Fresh Frozen Plasma
2. Fractionated products
What makes up fractionated products? 5
- F VII
- F VIII
- F IX
- Albumin
- Immune Globin
FFP is made of? 2
- Cryoprecipitate
- Cryo supernatant plasma
(CSP)
- When do you use FFP? 3
2. When do you transfuse platelets? 1
- To replace clotting factors
- Reverse warfarin
- Also when you infuse a lot of packed RBC
- low platelet count that is symptomatic
- Which blood type is the universal donor?
- Which blood type is the rarest?
- Which blood type(s) is/are the most common?
2
Which blood type is the universal donor?
1. O negative
Which blood type is the rarest?
2. AB negative (1% of the population)
Which blood type(s) is/are the most common?
3.
-O positive
-A positive
Crystalloids: 1. What are they? 2. Isotonic solutions: Given when? 3. Hypotonic solutions Given to do what?
- Hypertonic solutions
Given to do what?
- Solutions that contain small molecules and are able to pass through semipermeable membranes
- Given to expand the ECF volume
- reverse dehydration
- increase the ECF volume and decrease cellular swelling
Colloids
- Solutions that contain what? 2
- Describe their movement?
- Pulling fluid out of the what for several days? 2
- high molecular weight proteins or
- starch
- Do not cross the capillary semipermeable membrane and remain in the intravascular space
- intracellular and
- interstitial space
Remember which is a colloid vs. crystalloid:
- D5W, D10W, D50W?
- Albumin?
- Dextran?
- Saline?
- Combo: D5 ½ NS, D5NS, D10NS?
- Hexastarch?
- Ringer’s lactate?
- Crystalloid
- Colloid
- colloid
- Crystalloid
- crystalloid
- Colloid
- Crystalloid
- Intracellular space
- Where is it and how much of the body does it make up? - Extracellular fluid includes
- Which spaces? 2
- Total body fluid?
- Inside the body cells
2/3 of total body water - Intravascular space
- Interstitial space
- 1/3
Signs and symptoms of intravascular depletion? 4
Signs and symptoms of interstitial fluid depletion? 4
Signs and symptoms of intravascular depletion
- Decreased BP,
- flat jugular veins
- Increased HR
- Cool extremities
Signs and symptoms of interstitial fluid depletion
- Decreased skin turgor,
- sunken eyeballs,
- weight
- Can also have hemodynamic effects
Intravascular fluid makes up what portion of the ECF?
1/4 of ECF ~75 ml
1 Liter 0.9% saline: isotonic…distributed in ECF. Why?
since cell membrane not permeable to sodium)
1 liter 5% Albumin and PRBCs: remains where?
Dont give this if what?
remains in intravascular space
Bleeding somewhere
How is ½ normal saline handled?
2
½ as free water
½ as saline
- Which electrolytes are lost in sweat and exhaled water vapor?
- Which electrolytes are lost in the urine?
- Renal failure patients do not need maintenance what? 2
- none
- All of them
- Na or K
- Serum sodium = what? 2
- Sodium is regulated by what? 3
- A disruption in water balance is manifested as an abnormality in what?
- Sodium is a functionally impermeable solute so it contributes to what? How?
- osmolality = water
- thirst,
- ADH, and
- renal water handling
- serum sodium
- tonicity
- and induces water movement across the membranes
Which ways would we get fluid loss?
4
Fluid gain? 4
- Fluid loss
- GI
- Renal
- Vascular
- Skin - Fluid gain
- Iatrogenic
- Heart failure
- Liver failure
- Kidney failure
A 25 year old pt presents with massive hematemesis X 1 hour. He has a hx of peptic ulcer disease. Exam: Diaphoretic, normal skin turgor Supine BP 120/70 HR 100 Sitting BP 90/50 HR 140 Serum sodium 140
- What kind of loss?
- What fluid?
- Mixed
- Intravascular mostly though because he hasnt vomited enough stomach contents to shit the sodium - NS
of lactated ringer
An 18 year old previously healthy male with severe diarrhea and vomiting X 48 hours
Exam: sunken eyeballs, poor skin turgor, dry mucous membranes
BP 80/60 HR 130 supine
Labs: Na 148, K 2.8, HCO3 22
- What kind of loss?
- What would we replace with?
- Extracellular
Hypernatremia
Hypokalemia - Crystalloid
NS + 20K
Lactated Rinegr
An 85 year old female nursing home resident with known dementia presents with worsening confusion. Hx significant for diabetes.
Exam: disoriented, decreased skin turgor
BP 110/70 supine; 90/70 sitting
Labs: Na 150, Hct 45, BUN/Cr 50/1.8, blood glucose 1200
- How would we treat?
- What would K be?
- Insulin drip and massive fluid replacement. NS because you have to give so much
- Hyperkalemia
Rules of Fluid Replacement
- Replace blood with?
- Replace plasma with?
- Resuscitate with? 2
- Replace ECF depletion with?
- Rehydrate withwhat if you want the fliud distributed to all the body compartments?
- Replace blood with blood
- Replace plasma with colloid
- Resuscitate with
- colloid
- Ringer’s - Replace ECF depletion with saline
- Rehydrate with dextrose if you want the fluid distributed to all body compartments
