Blood Products and Transfusion (Exam II) Flashcards
1
Q
What is blood comprised of primarily?
A
Plasma
2
Q
What percentage of blood volume is made up by plasma?
A
55%
3
Q
If we had to pick one thing to transfuse what would it be?
A
- whole blood
4
Q
What blood type is a universal donor? Universal acceptor?
A
- Donor = O neg
- Acceptor = AB +
5
Q
What are 2 Hb related issues we will see often in clinical settings?
A
- β thalassemia → Hb Barts
- α thalassemia → Hb H
6
Q
What are the possible blood antigen types? What are possible Rh factors?
A
- Antigen → A, B, AB, O
- Rh → Rh+ and Rh-
7
Q
Is the general population primarily Rh+ or Rh-?
A
Rh+ (85%) and Rh- (15%)
8
Q
What 4 things can cause a right shift of the OxyHb curve?
A
- ↓ pH(↑ acidosis)
- ↑ CO2
- ↑ temp
- ↑ 2,3-DPG
[⇒ ↑unloading or↓affinity]
9
Q
T or F: If our O₂ saturation is good so is our PO₂?
A
- False → O₂sat has nothing to do with PO₂ (could have 1 Hb fully saturated; ex. anemia)
10
Q
For blood type O which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: none
- Antibody: Anti-A and Anti-B
11
Q
For blood type AB which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: A and B
- Antibody: none
12
Q
For blood type B, which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: B
- Antibody: Anti-A
13
Q
For blood type A which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: A
- Antibody: Anti-B
14
Q
AB donor blood will react with which other blood types?
A
- A, B, and O
15
Q
B donor blood will react with which blood types?
A
A & O
16
Q
A donor blood will react with which blood types?
A
B & O
17
Q
O donor blood will react with which blood types?
A
- none
18
Q
When whole blood is centrifuged what separation products result?
A
- Platelet rich plasma (PRP)
- WBC
- RBC
19
Q
What happens if we centrifuge platelet rich plasma (PRP) again?
A
- Separates plasma from platelets
20
Q
Where is PRP used in surgery?
A
- Surgeon injects locally → ortho, dental, plastics cases commonly (for healthy cell growth)
21
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
22
Q
What is the lifespan of WB?
A
~ 3 wks
23
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)
24
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 ↓) ⇒ less clotting
- Glucose (it will ↑)
25
Which electrolyte will stored blood have ↑ levels of? Why?
* K⁺ d/t cells lysing as they degrade in the bag
26
What happens to 2,3-DPG in stored blood?
What does this do to the OxyHb association curve?
* ↓ 2,3-DPG
* Left shift → impairs O2 delivery
27
PRBCs contain ______ unless they have been specifically ________?
* Leukocytes (WBCs)
* Leukoreduced
28
How much does 1 unit of PRBCs ↑ H&H level?
* Hb: ↑ 1 g/dL
* Hct: ↑ 3%
29
Which blood transfusion product is a source of antithrombin III?
FFP
30
What is the dose of FFP?
* 10-15 mL/kg
31
How much will 1 unit of FFP ↑ level of each clotting factor?
* ↑ 2 to 3% for each factor
32
What are two specific uses of FFP Dr. C mentioned in class?
* Heparin resistance d/t antithrombin deficiency
* Treat angioedema (also use TXA along with FFP)
33
What is the INR of FFP?
* ~1.5
34
What clotting factors does cryoprecipitate have?
* Factor VIII: C
* Factor VIII: vWF
* Factor XIII
* Fibrinogen
35
What target of fibrinogen are we trying to maintain when using cryo?
100 mg/dL
36
Which patient population is cryo really important for?
* Pregnant women who are bleeding
37
How much will one unit of PLT increase PLT count by?
* 5000 to 10000
38
Is there any clinical data that says warming platelets is bad?
Not recommended to use on a warming device for now (but studies show no significant impact)
39
When platelets are low at what level will we start to spontaneously bleed?
PLT < 30000
40
What is the deadly trauma triad when transfusing a patient?
* Hypothermia
* Coagulopathy
* Acidosis
41
When is WB indicated for transfusion?
* To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss )
42
What are S/Sx of Hemolytic transfusion reaction?
* fever
* chill
* hemoglobinemia
* **hemoglobinuria**
* hypotension
* dyspnea.
43
What are mediators of Hemolytic transfusion reactions?
IgM antibodies
44
What are the S/S of nonhemolytic febrile transfusion reactions?
Fever and chills
45
What are the mediators of non-hemolytic febrile transfusion reactions?
HLA Class I Ag antibodies
46
How do we treat Non-hemolytic febrile transfusion reactions?
* Antipyretics
* Use leukocyte reduced products
47
What are some S/S of an allergic transfusion reaction?
* urticaria
* erythema
* itching
* anaphylaxis.
48
What are the mediators of allergic transfusion reactions?
* plasma proteins
* IgA antibodies
49
How do we treat allergic transfusion reactions?
* antihistamines
* treat symptoms
50
What are S/S of Non-cardiogenic pulmonary transfusion reactions?
* ARDS
* *Fever*
* *Chill*
* *Hypotension*
* Cyanosis
* **noncardiac pulmonary edema**
51
What are the mediators for a non-cardiogenic pulmonary transfusion reaction?
donor/recipient WBC antibodies
52
How do we treat Non-cardiogenic pulmonary transfusion reactions?
* Lots of PEEP
* Steroids
53
What is TRALI?
Transfusion Related Acute Lung Injury - temporarily r/t to blood transfusion within 1st 6 hrs of a transfusion
54
What is the mortality rate from TRALI?
5-25%
Most pt recovering within 72 hrs
-Ecmo good option for tx
55
What are the 3 acute nonimmunologic effects of transfusion reaction?
* Bacterial contamination
* Circulatory overload (TACO)
* Hemolysis d/t physical /chemical means
56
What are the three delayed immunologic effects of transfusion reaction?
* Hemolytic transfusion reactions
* Transfusion associated Graft-versus-host disease
* Post-transfusion purpura
57
How can you differentiate between TRALI and TACO?
* TRALI → Fever, HoTN
* TACO → HTN, Signs of circulatory overload
58
What classes of hemorrhage are there and what is associated blood loss for each?
* Class 1 = up to 750 mL (< 15%)
* Class 2 = 750 to 1500 mL (15-30%)
* Class 3 = 1500 to 2000 mL (30-40%)
* Class 4 = > 2000 mL (>40%)
59
What are 3 definitions of MTP in Adults?
* Total blood volume is replaced within 24 hours
* 50% of total blood volume is replaced in 3 hours ← Most common
* Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss
60
What is considered MTP for Kids?
* > 40mL/kg transfusion
61
What is balanced resuscitation?
* 1:1:1 ratio (PLT:Plasma:RBC)
62
What are the fibrinogen levels of Cryo, FFP, and LTOWB?
* Cryo = 2500 mg
* LTOWB = 1000 mg
* FFP = 400 mg
63
What is the difference between stored whole blood (SWB) and LTOWB?
* SWB anticoagulants < LTOWB
64
What are the recommendations for whole blood transfusion in kids?
* If they are **<15 yr old** or **<40 kg** then limit WB to 30 mL/kg
65
Which clotting factors required Ca⁺⁺ to work?
2, 7, 9, 10
66
Which drug has more elemental calcium; Ca gluconate or CaCl?
* Calcium Chloride: 270 mg/10mL (27mg/mL)
* Calcium Gluconate: 90 mg/10ml (9mg/mL)
67
How much will 1, 2, and 5 units of blood decrease iCa?
* 1 unit = drop to 1.13 mmol/L
* 2 unit = drop to < 1mmol/L
* 5 units = drop to < 0.8 mmol/L
68
What is the value for TEG-ACT (rapid)?
* Activated Clotting Time
* 80-140 sec
69
What is the normal value for R time?
* Reaction Time
* 5.0 - 10.0 min
70
What is the normal value for K time?
* Kinetic time
* 1-3 minutes
71
What is the normal value for α angle?
* 53 - 72°
72
What is the normal value for MA?
* Max Amplitude
* 50-70mm
73
What is the normal value for G value?
* Clot strength
* 5.3-12.4 dynes/cm2
74
What is the normal value for LY 30?
* Clot lysis at 30 min
* 0-3%
75
If TEG-ACT is > 140 what do we transfuse?
* FFP
76
If R time is > 10 what do we transfuse?
* FFP
77
If K time is > 3 what do we transfuse?
* Cryo
78
If α angle < 53° what do we transfuse?
* Cryo and platelets
79
If MA < 50 what do we transfuse?
* PLT
80
If LY30 > 3% what do we transfuse?
TXA (Tranexamic Acid)
81
What are the contents of FFP?
* plasma
* clotting factors
* proteins
82
What are the criteria for TRALI?
* Occuring during or within 6 hrs of transfusion
* P/F ratio < 300 or SpO2 < 90%
* Pulmonary infiltrates
* No evidence of circulatory overload
83
What 4 things can cause a left shift of the OxyHb curve?
* ↑ pH (↓acidosis)
* ↓ CO2
* ↓ temp
* ↓ 2,3-DPG
[⇒ ↓unloading or ↑affinity]
