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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
_______ is the protein fraction taken off the top of FFP when being thawed
Cryoprecipitate
26
Cryoprecipitate contains what?
- Factor VIII: C - Factor VIII: vWF - Factor XIII - Fibrinogen
27
When giving cryoprecipitate, the goal is to maintain a fibrinogen concentration of ____mg/dL. How much cryoprecipitate do you give?
For fibrinogen replacement, two units of cryoprecipitate/10 kg of body weight generally raise fibrinogen concentration by 100 mg/dL
28
What is the downside of giving products to normalize INR?
Can't get below a certain limit - 1.5
29
Can you warm up platelets?
Book answer is no, but in reality it doesn't dec platelets much
30
Why can't you give LR with blood?
calcium causes clotting in line
31
One unit of platelets contains ____mL and inc PLT by ____
250-300mL 5-10k
32
1 unit of whole blood contains ____ mL
400-500
33
What are the s/s of hemolytic transfusion reactions? Which signs can be seen under anesthesia?
Fever, chill, hemoglobinemia, hemoglobinuria, hypotension, dyspnea - hypotension and hemoglobinuria (foley)
34
What are the s/s of nonhemolytic febrile transfusion reactions?
Fever and chills
35
What are the s/s of allergic transfusion reactions? Treatment/prevention?
Urticaria, erythema, itching, anaphylaxis - antihistamines; treat sx, transfuse IgA-deficient components
36
What is the most common transfusion reaction?
allergic
37
What are the s/s of noncardiogenic pulmonary transfusion reactions? How can is be detected under anesthesia?
ARDS, fever, chill, cyanosis, hypotension, noncardiogenic pulmonary edema - pulmonary edema
38
What is the tx for a noncardiac pulmonary transfusion reaction?
vigorous respiratory support (PEEP), steroids
39
What are the mediators of allergic transfusion reactions?
plasma proteins(mild reactions), A/b to IgA(anaphylactic reactions)
40
What are the mediators of noncardiogenic pulmonary transfusion reactions?
donor/recipient WBC A/b
41
What are the mediators of nonhemolytic febrile transfusion reactions? Tx/prevention?
A/b to HLA Class I Ag - antipyretics, leukocyte-reduced
42
What are the mediators of hemolytic transfusion reactions?
IgM A/b (usually ABO), complement
43
Define TRALI
Transfusion Related Acute Lung Injury (TRALI) - an acute lung injury that is temporally related to a blood transfusion
44
TRALI typically occurs after the administration of?
platelets and FFP
45
What are the s/s of leukoagglutination in a TRALI?
S/S: mild dyspnea and pulmonary infiltrates within about 6 hours of transfusion, and spontaneously resolves
46
What are the 7 criteria for TRALI?
- 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
What is the immediate management for TRALI?
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
What are the 3 acute, non-immunologic transfusion effects?
1. Bacterial contamination 2. Transfusion-associated circulatory overload (TACO) 3. Hemolysis d/t physical/chemical means
49
What are the 3 delayed, immunologic transfusion effects?
1. Hemolytic 2. Transfusion-associated Graft-versus-host disease 3. Post-transfusion purpura
50
What are the mediators, s/s, and tx/prevention for bacterial contamination transfusion reactions?
- Mediators: endotoxins produced by GN bact. - S/S: fever, shock, hemoglobinuria. - TX/prevention: IV ABX; treat hypotension & DIC.
51
What are the mediators, s/s, and tx/prevention for Transfusion Associated Circulatory Overload (TACO) transfusion reactions?
- 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
What are the mediators, s/s, and tx/prevention for hemolysis d/t physical/chemical means transfusion reactions?
Mediators: exogenous destruction of RBC. S/S: hemoglobinuria. TX/prevention: document & r/o hemolysis d/t other causes; treat DIC
53
What are the mediators, s/s, and tx/prevention for hemolytic transfusion reactions?
- Mediators: IgG A/b. - S/S: shortened RBC survival, decreased Hb, fever, jaundice, hemoglobinuria. - TX/prevention: Ig-negative blood for further transfusions.
54
What are the mediators, s/s, and tx/prevention for transfusion-associated Graft-versus-host disease transfusion reactions?
- Mediators: viable donor lymphocytes. - S/S: fever, skin rash, desquamation, anorexia, nausea, vomiting, diarrhea, hepatitis, pancytopenia - TX/prevention: gamma irradiation of cellular components.
55
What are the MOA, s/s, and tx/prevention for post-transfusion purpura transfusion reactions?
- MOA: platelet specific A/b. - S/S: thrombocytopenia, clinical bleeding. - TX/prevention: IV Ig, plasma exchange, corticosteroids.
56
How are TRALI and TACO similar and different?
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
Which transfusion reaction is delayed, non-immunologic?
Transfusion-Induced Hemosiderosis.
58
What are the MOA, s/s, and tx/prevention for Transfusion-Induced Hemosiderosis?
- MOA: Iron overload. - S/S: subclinical to death. - TX/prevention: dec transfusion frequency, neocytes, iron chelation therapy
59
Differentiate between blood loss in mL and % for the 4 classes of hemorrhage
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
Differentiate between pulse and BP changes for the 4 classes of hemorrhage
- HR: I < 100, II > 100, III > 120, IV > 140 - BP normal for classes I and II, decreased for classes III and IV
61
Differentiate between pulse pressure and RR changes for the 4 classes of hemorrhage
- 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
Differentiate between urine output and mental status changes for the 4 classes of hemorrhage
- 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
What are the fluids used for replacement in the 4 classes of hemorrhage
Class I and II = crystalloid Class III and IV = crystalloid and blood
64
What is the Massive transfusion protocol (MTP) in adults?
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
What is the Massive transfusion protocol (MTP) in children?
= >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
Differentiate between fibrinogen levels of LTOWB, FFP, and cyro
- LTOWB-1000mg - FFP-400mg - Cryo-2500mg
67
What is the preferred resuscitation product?
Stored whole blood
68
Pedi transfusion recommendations
Age <15 or weight <40 kg → limit WB to 30 mL/kg
69
What is the difference between calcium chloride and calcium gluconate when replacing calcium?
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
What is considered "severe" hypocalcemia? What are the effects related to blood transufion?
<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
What is the lethal triad of trauma? What should be added?
Hypothermia, acidosis, and coagulopathy - hypocalcemia
72
What are the components of TEG interpretation?
R time, K time, MA, LY30, angle
73
Blood products according to TEG interpretation
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
What are the normal values, description, and what TEG-ACT measures?
- normal: 80-140 sec - description: "activated clotting time" to initial fibrin formation - measures: clotting factors (ext/int pathways)
75
What are the normal values, description, and what R-time measures?
- normal: 5-10 min - description: "reaction time" to initial fibrin formation - measures: clotting factors (intrinsic pathway)
76
What are the normal values, description, and what K time measures?
- normal: 1-3 min - description: "kinetic time" for fibrin cross-linkage to reach 20 mm clot strength - measures: fibrinogen, platelet number
77
What are the normal values, description, and what alpha angle measures?
- normal: 53-72 degrees - description: angle from baseline to slope of tracing that represents clot formation - measures: fibrinogen, platelet number
78
What are the normal values, description, and what MA measures?
- normal: 50-70 mm - description: max amplitude of tracing - measures: platelet number and function
79
What are the normal values, description, and what G value measures?
- normal: 5.3-12.4 dynes/cm^2 - description: calculated value of clot strength - measures: entire coagulation cascade
80
What are the normal values, description, and what LY30 measures?
- normal: 0-3% - description: clot lysis at 30 min following MA - measures: fibrinolysis
81
normal
82
heparin/warfarin
83
qualitative/quantitative platelet defect
84
hyperfibrinolysis
85
Hypercoagulable state
86
DIC beginning - intravascular thrombosis with secoundary hyperfibrinolysis
87
DIC late - platelet coagulation factor depletion

Adv. Phys & Health Assessment (21 decks)

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