Blood Products and IV Fluids

Question 1

Hgb Levels and Oxygen Demands

Answer 1

Can tolerate Hgb dropping below 10 before oxygen supply no longer meets demand

Usually Hgb is carrying 4X the demand of oxygen

Question 2

Transfusion Risks

Answer 2

Infection

Allergic or Immune transfusion reaction

Volume overload (elderly, kids, CHF)

Hyperkalemia (newborns, renal failure, massive transfusion)

Iron overload (large number of transfusions - chronic anemia)

Post-op patients - lower tolerance threshold

Question 3

Massive Transfusion

Answer 3

Replacement of blood volume in a 24 hour period OR

>50% blood volume in 4 hours

Question 4

Massive Transfusion Complications - PATCH

Answer 4

Platelets decrease, Potassium increase

ARDS, Acidosis

Temperature decrease

Citrate intoxication

Hemolytic reaction

Question 5

Type and Screen vs Type and Crossmatch

Answer 5

Type and Screen: Determines ABO, Rh and common antibodies; takes 5 minutes

• 1:1000 risk adverse reaction

Type and Crossmatch: Determines ABO, Rh, and all antigens including low incidence ones; takes 45 minutes

-1:10,000 risk adverse reaction

Question 6

Transfusion Thresholds

Answer 6

Target Hgb 7-8 g/dL associated with better outcomes

May be due to decreased inflammatory reaction

O2 delivery will be adequate until Hct <10

Question 7

Compensatory Mechanisms

Answer 7

Increased cardiac output

Rightward shift of the oxygen-hemoglobin dissociation curve

Increase oxygen extraction

Question 8

Blood Transfusion - Decisions to Transfuse

Answer 8

Hgb levels

Clinical status

Co-morbidities

Patient preference

Can check hbg/hct 15 minutes post-infusion to assess status

If stable, consider transfusion one PRBC at a time

Question 9

Cryoprecipitate

Answer 9

Most concentrated form of fibrinogen

Give if the patient needs a fibrinogen transfusion (DIC)

Also contains vWF, and factor VII

Question 10

Universal Donor

Rarest Blood Type

Most Common Blood Type

Answer 10

Universal Donor: O-

Rarest Blood Type: AB-

Most Common Blood Type: O+ and A+

Question 11

Isotonic Solution

Hypotonic Solution

Hypertonic Solution

Answer 11

Isotonic Solution: Given to expand the ECF volume

Hypotonic Solution: Given to reverse dehydration

Hypertonic Solution: Given to increase the ECF volume and decreases cellular swelling

Question 12

Extracellular fluid

Answer 12

Includes intravascular space and interstitial space

Comprises 1/3 total body water

Question 13

Signs and Symptoms of Intravascular and Interstitial Depletion

Answer 13

Intravascular: decreased BP, flat jugular veins, increased HR, cool extremities

Interstitial: Decreased skin turgor, sunken eyeballs, weight, hemodynamic effects

Question 14

Dextrose

Isotonic Saline

Albumin/PRBCs

1/2 Normal Saline

Answer 14

Dextrose: Diffuses just like free water - goes to all spaces

Isotonic Saline: Distributed in ECF - cell membrane impermeable to sodium

Albumin/PRBCs: Remains in intravascular space

1/2 Normal Saline: handled as 1/2 free water and 1/2 saline

Question 15

Electrolyte Loss

Answer 15

No electrolytes are lost in sweat and exhaled water vapor

All electrolytes are lost in urine

Renal failure patients do not need maintenance sodium or potassium

Question 16

Sodium

Answer 16

Serum sodium = osmolality = water

Regulated by thirst, ADH, renal water handling

Disruption in water balance manifested as serum sodium abnormality

Functionally impermeable - contributes to tonicity and induces water movement across the membranes

Question 17

Disease Fluid Shifts: What causes loss and what causes gain

Answer 17

Loss: GI, Renal, Vascular, Skin

Gain: Iatrogenic; heart, liver, kidney failure

Question 18

Fluid Replacement Rules

Answer 18

Replace blood with blood

Replace plasma with colloid

Resuscitate with colloid or LR

Replace ECF depletion with saline

Rehydrate with dextrose to get fluid to distribute to all body compartments