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Mar: prep for clinicals > Blood Products and Transfusion > Flashcards

Blood Products and Transfusion Flashcards

1
Q

What is blood comprised of primarily?

A

Plasma (55%)

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2
Q

What 4 things can cause a right shift of the OxyHb curve?

A
  • ↓ pH
  • ↑ CO2
  • ↑ temp
  • ↑ 23-DPG

Right shift = increased wall tension from O2 unloading (increase PO2)

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3
Q

When whole blood is centrifuged what separation products result?

A
  • Platelet rich plasma (PRP)
  • WBC
  • RBC
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4
Q

What happens if we centrifuge platelet rich plasma (PRP) again?

A
  • Centrifuge PRP again → Separates plasma from platelets
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5
Q

Where is PRP used in surgery?

A
  • Surgeon injects locally → ortho, dental, plastics cases commonly
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6
Q

What are the 5 different blood components we can use for treatments?

A
  • RBC
  • FFP
  • Cryo
  • PLT
  • LTOWB - Low titer Group O Whole Blood
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7
Q

What chemicals are added to blood that allows it to be stored?

A
  • CPDA-1 → Citrate phosphate dextrose adenine; chelates Ca++ to prevent clotting
  • Phosphate → used as buffer
  • Dextrose → fuel source
  • Adenine → to support ATP synthesis (extends storage from 21 to 35 days)
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8
Q

Due to the chemicals used to allow blood to be stored what labs do we need to check when transfusing lots of blood?

A
  • Ca++ (it will ↓)
  • BG (it will ↑)
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9
Q

Which electrolyte will stored blood always have ↑ levels of? Why?

A
  • K+ d/t cells lysing as they degrade in the bag
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10
Q

What happens to 2,3-DPG in stored blood?
What does this do to the OxyHb association curve?

A
  • ↓ 2,3-DPG
  • Left shift → impairs O2 delivery

Left shifts = greater affinity for Hgb, so less O2 is dropped off

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11
Q

How much does 1 unit of PRBCs ↑ H&H level?

A
  • Hb: ↑ 1 g/dL
  • Hct: ↑ 3%
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12
Q

Which blood transfusion product is a source of antithrombin III?

A

FFP

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13
Q

What is the dose of FFP?

A
  • 10-15 mL/kg
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14
Q

How much will 1 unit of FFP ↑ level of each clotting factor?

A
  • ↑ 2 to 3% for each factor
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15
Q

What clotting factors does cryoprecipitate have?

A
  • Factor VIII: C
  • Factor VIII: vWF
  • Factor XIII
  • Fibrinogen
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16
Q

What target of fibrinogen are we trying to maintain when using cryo?

A

100 mg/dL

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17
Q

How much will two units of cryo raise fibrinogen levels?

A
  • 2 bags of cryo/10 kg body weight = 100 mg/dL ↑ in fibrinogen
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18
Q

Which patient population is cryo really important for?

A
  • Pregnant women who are bleeding
19
Q

How much will one unit of PLT increase PLT count by?

A
  • 5000 to 10000
20
Q

When platelets are low at what level will we start to spontaneously bleed?

A

PLT < 30000

21
Q

What is the deadly triad when transfusing a patient?

A
  • Hypothermic
  • Coagulopathic
  • Acidotic
22
Q

When is WB indicated for transfusion?

A
  • To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss )
23
Q

What are S/Sx of Hemolytic transfusion reaction?

A
  • fever
  • chill
  • hemoglobinemia
  • hemoglobinuria
  • hypotension
  • dyspnea.
24
Q

What are some S/S of an allergic transfusion reaction?

A
  • urticaria
  • erythema
  • itching
  • anaphylaxis.
25
Q

What are the fibrinogen levels of Cryo, FFP, and LTOWB?

A
  • Cryo = 2500 mg
  • LTOWB = 1000 mg
  • FFP = 400 mg
26
Q

Which clotting factors required Ca++ to work?

A

2 7 9 10, protein C and S.
Ca plays a role in stabilizing fibrinogen and platelets in developing thrombus

27
Q

Which drug has more elemental calcium; Ca gluconate or CaCl?

A
  • CaCl: 270 mg/10mL
    vs
    90 mg/10ml for gluconate
28
Q

How much will 1, 2, and 5 units of blood decrease iCa?

A
  • 1 unit drops iCal to 1.13 mmol/L
  • 2 unit drops iCal to < 1mmol/L
  • 5 units drops iCal to < 0.8 mmol/L
29
Q

TEG flow chart- when to give which component of blood!

30
Q

What is the value for TEG-ACT?

A
  • 80-140 sec
    this is our normal activated clotting time (ACT)
    measures clotting factors (extrinsic/intrinsic)
31
Q

What is the normal value for R time?

A
  • 5.0 - 10.0 min
    reaction time to initial fibrin formation
    clotting factors (intrinsic pathway)
32
Q

What is the normal value for K time?

A
  • 1-3 minutes
    “kinetic time” for fibrin cross linkage to reach 20mm clot strength
    measures fibrinogen, platelet #
33
Q

What is the normal value for α angle?

34
Q

What is the normal value for MA?

35
Q

What is the normal value for G value?

A
  • 5.3-12.4 dynes/cm2
36
Q

What is the normal value for LY 30?

A
  • 0-3%
    Clot “Lysis” at 30 minutes following MA
37
Q

If TEG-ACT is > 140 what do we transfuse?

38
Q

If R time is > 10 what do we transfuse?

39
Q

If K time is > 3 what do we transfuse?

40
Q

If α angle < 53° what do we transfuse?

A
  • Cryo and platelets
41
Q

If MA < 50 what do we transfuse?

42
Q

If LY30 > 3% what do we transfuse?

A

TXA (Tranexamic Acid)

43
Q

Examples of TEGS

Mar: prep for clinicals (19 decks)

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