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Adv. Phys & Health Assessment > Blood Products and Transfusion > Flashcards

Blood Products and Transfusion Flashcards

Exam 3

1
Q

What are the universal blood donors and acceptors?

A

Universal donor – O negative
Universal acceptor/recipient – AB positive

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2
Q

An oxyhemoglobin dissociation curve shifted to the right causes what 4 things?

A
  1. dec pH
  2. inc CO2
  3. inc temp
  4. inc 2,3-DPG
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3
Q

Avoid giving females of child-bearing age what type of blood?

A

O positive

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4
Q

What percentage of TBW is blood?

A

8%

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5
Q

How much of whole blood is plasma vs formed elements?

A

plasma - 55%
formed elements - 45%

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6
Q

What are the components of plasma?

A

7% proteins
92% water
1% other solutes

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7
Q

What are the components of formed elements?

A

platelets - 140-340k
leukocytes - 5-10k
erthrocytes - 4.2-6.2mil

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8
Q

Blood type O antigens present on erythrocyte vs antibody present in serum?

A

Antigens present on erythrocyte - none
Antibody present in serum - anti-A and anti-B

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9
Q

Blood type A antigens present on erythrocyte vs antibody present in serum?

A

Antigens present on erythrocyte - A
Antibody present in serum - anti-B

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10
Q

Blood type AB antigens present on erythrocyte vs antibody present in serum?

A

Antigens present on erythrocyte - A and B
Antibody present in serum - none

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11
Q

Blood type B antigens present on erythrocyte vs antibody present in serum?

A

Antigens present on erythrocyte - B
Antibody present in serum - anti-A

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12
Q

Specific gravities of RBCs vs platelets

A
  • RBC : 1.08-1.09
  • Platelet : 1.03-1.04
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13
Q

WWI to Vietnam War blood transfusion

A

Whole blood fresh from donor

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14
Q

What years did transfusion shift from whole blood to component therapy?

A

1970s-1990s

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15
Q

NS was made to treat ______

A

cholera

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16
Q

What is the shelf-life of whole blood?

A

3-5 weeks

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17
Q

What product is added to blood for storage? How does it work?

A

Citrate phosphate dextrose adenine (CPDA-1) - citrate for chelation of calcium to prevent clothing, phosphate as a buffer, dextrose as a fuel source, and adenine as a substrate for ATP synthesis (ext storage time from 21 to 35 days)

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18
Q

1 unit of PRBCs contains ______mL and increases Hgb level by _____ and HCT by ____

A

200-350mL
Hgb 1g/dL (10g/L) & Hct by 3%.

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19
Q

Why are PRBCs given?

A

Intended to increase the O2 carrying capacity in anemic pt who require an increase in their red cell mass w/out increase in their blood volume.

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20
Q

The longer blood is stored, the lower are the levels of _______, shifting the oxyhemoglobin dissociation curve to the _____, which impairs _________

A

2,3-DPG, left, oxygen delivery

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21
Q

What is the biggest reason to give FFP?

A

Bleeding! and liver issues, also hereditary angioedema

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22
Q

FFP is a source of _______. It contains what?

A

antithrombin III
- Water, carbohydrates, fats, minerals
- Proteins (all labile & stable clotting fx)

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23
Q

There are ____mL of FFP in one bag. The dose is _____ mL/kg

A

200-250mL
10-15 mL/kg

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24
Q

Each unit of FFP increases the level of each clotting fx by ____% in adults.

A

2-3

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25
Q

_______ is the protein fraction taken off the top of FFP when being thawed

A

Cryoprecipitate

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26
Q

Cryoprecipitate contains what?

A
  • Factor VIII: C
  • Factor VIII: vWF
  • Factor XIII
  • Fibrinogen
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27
Q

When giving cryoprecipitate, the goal is to maintain a fibrinogen concentration of ____mg/dL. How much cryoprecipitate do you give?

A

For fibrinogen replacement, two units of cryoprecipitate/10 kg of body weight generally raise fibrinogen concentration by 100 mg/dL

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28
Q

What is the downside of giving products to normalize INR?

A

Can’t get below a certain limit - 1.5

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29
Q

Can you warm up platelets?

A

Book answer is no, but in reality it doesn’t dec platelets much

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30
Q

Why can’t you give LR with blood?

A

calcium causes clotting in line

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31
Q

One unit of platelets contains ____mL and inc PLT by ____

A

250-300mL
5-10k

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32
Q

1 unit of whole blood contains ____ mL

A

400-500

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33
Q

What are the s/s of hemolytic transfusion reactions? Which signs can be seen under anesthesia?

A

Fever, chill, hemoglobinemia, hemoglobinuria, hypotension, dyspnea
- hypotension and hemoglobinuria (foley)

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34
Q

What are the s/s of nonhemolytic febrile transfusion reactions?

A

Fever and chills

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35
Q

What are the s/s of allergic transfusion reactions? Treatment/prevention?

A

Urticaria, erythema, itching, anaphylaxis
- antihistamines; treat sx, transfuse IgA-deficient components

36
Q

What is the most common transfusion reaction?

37
Q

What are the s/s of noncardiogenic pulmonary transfusion reactions? How can is be detected under anesthesia?

A

ARDS, fever, chill, cyanosis, hypotension, noncardiogenic pulmonary edema
- pulmonary edema

38
Q

What is the tx for a noncardiac pulmonary transfusion reaction?

A

vigorous respiratory support (PEEP), steroids

39
Q

What are the mediators of allergic transfusion reactions?

A

plasma proteins(mild reactions), A/b to IgA(anaphylactic reactions)

40
Q

What are the mediators of noncardiogenic pulmonary transfusion reactions?

A

donor/recipient WBC A/b

41
Q

What are the mediators of nonhemolytic febrile transfusion reactions? Tx/prevention?

A

A/b to HLA Class I Ag
- antipyretics, leukocyte-reduced

42
Q

What are the mediators of hemolytic transfusion reactions?

A

IgM A/b (usually ABO), complement

43
Q

Define TRALI

A

Transfusion Related Acute Lung Injury (TRALI) - an acute lung injury that is temporally related to a blood transfusion

44
Q

TRALI typically occurs after the administration of?

A

platelets and FFP

45
Q

What are the s/s of leukoagglutination in a TRALI?

A

S/S: mild dyspnea and pulmonary infiltrates within about 6 hours of transfusion, and spontaneously resolves

46
Q

What are the 7 criteria for TRALI?

A
  • Acute onset hypoxemia
  • Dyspnea/respiratory distress requiring o2 support (Requiring mechanical ventilation-70%)
  • Ratio of Pao2/FiO2 <300 or SpO2 <90% on room air.
  • Cyanosis, fever, hypotension
  • Occur during or within 6 hours of transfusion.
  • B/L diffuse pulmonary edema, infiltrates, crackles, CXR ARDS
  • No evidence of left atrial hypertension (i.e. circulatory overload).
47
Q

What is the immediate management for TRALI?

A
  1. Stop the transfusion immediately
  2. Support the patient
  3. If the patient is intubated, obtain undiluted edema fluid ASAP (within 15 min) and simultaneous plasma for determination of total protein
  4. Obtain CBC and chest radiography
  5. Notify the blood bank of possible TRALI, request a different unit, and quarantine other units from the same donor
  6. May Require ECMO
48
Q

What are the 3 acute, non-immunologic transfusion effects?

A
  1. Bacterial contamination
  2. Transfusion-associated circulatory overload (TACO)
  3. Hemolysis d/t physical/chemical means
49
Q

What are the 3 delayed, immunologic transfusion effects?

A
  1. Hemolytic
  2. Transfusion-associated Graft-versus-host disease
  3. Post-transfusion purpura
50
Q

What are the mediators, s/s, and tx/prevention for bacterial contamination transfusion reactions?

A
  • Mediators: endotoxins produced by GN bact.
  • S/S: fever, shock, hemoglobinuria.
  • TX/prevention: IV ABX; treat hypotension & DIC.
51
Q

What are the mediators, s/s, and tx/prevention for Transfusion Associated Circulatory Overload (TACO) transfusion reactions?

A
  • Mediators: fluid volume.
  • S/S: coughing, cyanosis, orthopnea, severe HA, peripheral edema, diff breathing.
  • TX/prevention: administer subsequent Tx slowly & in a small volume.
52
Q

What are the mediators, s/s, and tx/prevention for hemolysis d/t physical/chemical means
transfusion reactions?

A

Mediators: exogenous destruction of RBC.
S/S: hemoglobinuria.
TX/prevention: document & r/o hemolysis d/t other causes; treat DIC

53
Q

What are the mediators, s/s, and tx/prevention for hemolytic
transfusion reactions?

A
  • Mediators: IgG A/b.
  • S/S: shortened RBC survival, decreased Hb, fever, jaundice, hemoglobinuria.
  • TX/prevention: Ig-negative blood for further transfusions.
54
Q

What are the mediators, s/s, and tx/prevention for transfusion-associated Graft-versus-host disease transfusion reactions?

A
  • Mediators: viable donor lymphocytes.
  • S/S: fever, skin rash, desquamation, anorexia, nausea, vomiting, diarrhea, hepatitis, pancytopenia
  • TX/prevention: gamma irradiation of cellular components.
55
Q

What are the MOA, s/s, and tx/prevention for post-transfusion purpura transfusion reactions?

A
  • MOA: platelet specific A/b.
  • S/S: thrombocytopenia, clinical bleeding.
  • TX/prevention: IV Ig, plasma exchange, corticosteroids.
56
Q

How are TRALI and TACO similar and different?

A

Both: acute dyspnea, rales, x-ray with diffuse b/I infiltrates
TRALI: fever, hypotension
TACO: hypertension, changed JVP, decreased EF, and significant improvement in response to diuretics

57
Q

Which transfusion reaction is delayed, non-immunologic?

A

Transfusion-Induced Hemosiderosis.

58
Q

What are the MOA, s/s, and tx/prevention for Transfusion-Induced Hemosiderosis?

A
  • MOA: Iron overload.
  • S/S: subclinical to death.
  • TX/prevention: dec transfusion frequency, neocytes, iron chelation therapy
59
Q

Differentiate between blood loss in mL and % for the 4 classes of hemorrhage

A

Class I: up to 750 mL or 15%
Class II: 750-1500 mL or 15-30%
Class III: 1500-2000mL or 30-40%
Class IV: >2000mL or 40%

60
Q

Differentiate between pulse and BP changes for the 4 classes of hemorrhage

A
  • HR: I < 100, II > 100, III > 120, IV > 140
  • BP normal for classes I and II, decreased for classes III and IV
61
Q

Differentiate between pulse pressure and RR changes for the 4 classes of hemorrhage

A
  • Pulse pressure: class I is normal or inc, classes II-IV dec
  • RR: class I 14-20 (normal), class II 20-30, class III 30-40, class IV > 35
62
Q

Differentiate between urine output and mental status changes for the 4 classes of hemorrhage

A
  • Urine output (mL/hr): class I > 30, class II 20-30, class III 5-15, class IV negligible
  • mental status: class I slightly anxious, class II mildly anxious, class III anxious/confused, class IV confused/lethargic
63
Q

What are the fluids used for replacement in the 4 classes of hemorrhage

A

Class I and II = crystalloid
Class III and IV = crystalloid and blood

64
Q

What is the Massive transfusion protocol (MTP) in adults?

A
  1. Total blood volume is replaced within 24 hours
  2. 50% of total blood volume is replaced in 3 hours
  3. Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss
65
Q

What is the Massive transfusion protocol (MTP) in children?

A

= >40 mL/kg transfusion

  • Current standard of care in level 1 trauma centers = balanced resuscitation
    • 1:1:1 ratio (platelets:plasma:RBC)
    • Multiple blood components ”reconstituted” whole blood
66
Q

Differentiate between fibrinogen levels of LTOWB, FFP, and cyro

A
  • LTOWB-1000mg
  • FFP-400mg
  • Cryo-2500mg
67
Q

What is the preferred resuscitation product?

A

Stored whole blood

68
Q

Pedi transfusion recommendations

A

Age <15 or weight <40 kg → limit WB to 30 mL/kg

69
Q

What is the difference between calcium chloride and calcium gluconate when replacing calcium?

A

Have to give 3x as much gluconate
(10% calcium gluconate contains 90 mg of elemental calcium per 10 mL, while 10% calcium chloride contains 270 mg of elemental calcium per 10 mL)

70
Q

What is considered “severe” hypocalcemia? What are the effects related to blood transufion?

A

<0.8-0.9mmol/L
- More coagulopathy
- More blood transfused
- Double mortality (49% vs. 24%)
- Calcium replacement after 4U, but never resolved (still <1.12mmol/L)
- One unit of citrated blood product drops iCa

71
Q

What is the lethal triad of trauma? What should be added?

A

Hypothermia, acidosis, and coagulopathy
- hypocalcemia

72
Q

What are the components of TEG interpretation?

A

R time, K time, MA, LY30, angle

73
Q

Blood products according to TEG interpretation

A

TEG-ACT > 140 → FFP
R time > 10 → FFP
K time > 3 → cryo
alpha angle < 53 → cryo and/or platelets
MA < 50 → platelets
LY30 > 3% → TXA

74
Q

What are the normal values, description, and what TEG-ACT measures?

A
  • normal: 80-140 sec
  • description: “activated clotting time” to initial fibrin formation
  • measures: clotting factors (ext/int pathways)
75
Q

What are the normal values, description, and what R-time measures?

A
  • normal: 5-10 min
  • description: “reaction time” to initial fibrin formation
  • measures: clotting factors (intrinsic pathway)
76
Q

What are the normal values, description, and what K time measures?

A
  • normal: 1-3 min
  • description: “kinetic time” for fibrin cross-linkage to reach 20 mm clot strength
  • measures: fibrinogen, platelet number
77
Q

What are the normal values, description, and what alpha angle measures?

A
  • normal: 53-72 degrees
  • description: angle from baseline to slope of tracing that represents clot formation
  • measures: fibrinogen, platelet number
78
Q

What are the normal values, description, and what MA measures?

A
  • normal: 50-70 mm
  • description: max amplitude of tracing
  • measures: platelet number and function
79
Q

What are the normal values, description, and what G value measures?

A
  • normal: 5.3-12.4 dynes/cm^2
  • description: calculated value of clot strength
  • measures: entire coagulation cascade
80
Q

What are the normal values, description, and what LY30 measures?

A
  • normal: 0-3%
  • description: clot lysis at 30 min following MA
  • measures: fibrinolysis
81
Q
82
Q
A

heparin/warfarin

83
Q
A

qualitative/quantitative platelet defect

84
Q
A

hyperfibrinolysis

85
Q
A

Hypercoagulable state

86
Q
A

DIC beginning - intravascular thrombosis with secoundary hyperfibrinolysis

87
Q
A

DIC late - platelet coagulation factor depletion

Adv. Phys & Health Assessment (18 decks)

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