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Physical & Health Assessment COPY - Grayson > Blood Products and Transfusion (Exam II) > Flashcards

Blood Products and Transfusion (Exam II) Flashcards

1
Q

What is blood comprised of primarily?

A

Plasma

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2
Q

What percentage of blood volume is made up by plasma?

A

55%

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3
Q

Which blood product has an ↑ risk of infection and why?

A
  • Pooled packs d/t being from multiple donors
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4
Q

If we had to pick one thing to transfuse what would it be?

A

Whole blood

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5
Q

What blood type is a universal donor? Universal acceptor?

A
  • Donor = O neg
  • Acceptor = AB +
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6
Q

Which patient is the potential exception to accepting blood from an O- donor?
If we have to how can we compensate for this?

A
  • Pregant women d/t fetus possibly being O+
  • Rhogam
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7
Q

What are 2 Hb related issues we will see often in clinical settings?

A
  • β thalassemia → Hb Barts
  • α thalassemia → Hb H
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8
Q

What are the possible blood antigen types? What are possible Rh factors?

A
  • Antigen → A B AB O
  • Rh → Rh+ and Rh-
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9
Q

Is the general population primarily Rh+ or Rh- ?

A

Rh+ (85%) and Rh- (15%)

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10
Q

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

A
  • ↓ pH
  • ↑ CO2
  • ↑ temp
  • ↑ 23-DPG
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11
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)
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12
Q

For blood type O which antigen is present on erythrocyte and which antibody is in the serum?

A
  • Antigen: n/a
  • Antibody: Anti-A and Anti-B
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13
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
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14
Q

For blood type B, which antigen is present on erythrocyte and which antibody is in the serum?

A
  • Antigen: B
  • Antibody: Anti-A
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15
Q

For blood type A which antigen is present on erythrocyte and which antibody is in the serum?

A
  • Antigen: A
  • Antibody: Anti-B
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16
Q

AB donor blood will react with which other blood types?

A
  • A, B, and O
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17
Q

B donor blood will react with which blood types?

A
  • A
  • O
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18
Q

A donor blood will react with which blood types?

A
  • B
  • O
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19
Q

O donor blood will react with which blood types?

A
  • none
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20
Q

When whole blood is centrifuged what separation products result?

A
  • Platelet rich plasma (PRP)
  • WBC
  • RBC
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21
Q

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

A
  • Centrifuge PRP again → Separates plasma from platelets
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22
Q

Where is PRP used in surgery?

A

Surgeon injects locally → ortho, dental, plastics cases commonly

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23
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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24
Q

What is the lifespan of WB?

A

~ 3 wks

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25
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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26
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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27
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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28
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
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29
Q

PRBCs contain ______ unless they have been specifically ________?

A
  • Leukocytes (WBCs)
  • Leukoreduced
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30
Q

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

A
  • Hb: ↑ 1 g/dL
  • Hct: ↑ 3%
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31
Q

How many mL’s are usually in one unit PBRCs?

A

200-350 mL

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32
Q

Which blood transfusion product is a source of antithrombin III?

A

FFP

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33
Q

What is the dose of FFP?

A

10-15 mL/kg

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34
Q

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

A

↑ 2 to 3% for each factor

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35
Q

What are two specific uses of FFP Dr. C mentioned in class?

A
  • Heparin resistance d/t antithrombin deficiency
  • Treat angioedema (also use TXA along with FFP)
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36
Q

What is the INR of FFP?

A
  • 1.5 to 1.8
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37
Q

What clotting factors does cryoprecipitate have?

A
  • Factor VIII: C
  • Factor VIII: vWF
  • Factor XIII
  • Fibrinogen
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38
Q

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

A

100 mg/dL

39
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

40
Q

Which patient population is cryo really important for?

A

Pregnant women who are bleeding

41
Q

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

A

5,000 to 10,000

42
Q

Is there any clinical data that says warming platelets is bad?

A

No its a common practice → no data to support not warming platelets

43
Q

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

A

PLT < 30,000

44
Q

What is the deadly triad when transfusing a patient?

A
  • Hypothermic
  • Coagulopathic
  • Acidotic
45
Q

When is WB indicated for transfusion?

A

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

46
Q

What are S/Sx of hemolytic transfusion reaction?

A
  • fever
  • chill
  • hemoglobinemia
  • hemoglobinuria
  • hypotension
  • dyspnea
47
Q

What are mediators ofhemolytic transfusion reactions?

A

IgM antibodies

48
Q

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

A

Fever and chills

49
Q

What are the mediators of non-hemolytic febrile transfusion reactions?

A

HLA Class I Ag antibodies

50
Q

How do we treat Non-hemolytic febrile transfusion reactions?

A
  • Antipyretics
  • Use leukocyte reduced products
51
Q

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

A
  • urticaria
  • erythema
  • itching
  • anaphylaxis
52
Q

What are the mediators of allergic transfusion reactions?

A
  • plasma proteins
  • IgA antibodies
53
Q

How do we treat allergic transfusion reactions?

A
  • antihistamines
  • treat symptoms
54
Q

What are S/S ofnon-cardiogenic pulmonary transfusion reactions?

A
  • ARDS
  • Fever
  • Chill
  • Hypotension
  • Cyanosis
  • Noncardiogenic pulmonary edema*
55
Q

What are the mediators for a non-cardiogenic pulmonary transfusion reaction?

A

Recipient WBC antibodies

56
Q

How do we treatnon-cardiogenic pulmonary transfusion reactions?

A
  • Lots of PEEP
  • Steroids
57
Q

How do we know if we have a TRUE transfusion reaction?

A

Noncardiogenic pulmonary transfusion reaction after blood product administration

58
Q

What is TRALI?

A

Transfusion Related Acute Lung Injury - temporarily r/t to blood transfusion within 1st 6 hrs of a transfusion

59
Q

Criteria for TRALI

A
  • acute onset hypoxemia
  • ratio PaO2/FiO2 < 300 or <90% on RA
  • Within 6hrs of transfusion
  • B/L diffuse pulmonary infiltrates (upper)
  • No evidence of left atrial hypertension (i.e. circulatory overload)
60
Q

Immediate management for TRALI

A
  1. Stop infusion
  2. Intubate if not already intubated
  3. Obtain undilute edema fluid and simultaneous plasma
  4. Obtain CBC
  5. Notify blood bank of possible TRALI

…may require ECMO

61
Q

What types of blood products is TRALI most associated with this?

A
  • FFP
  • PLTs
62
Q

What are the 3 acute nonimmunologic effects of transfusion reaction?

A
  • Bacterial contamination
  • Circulatory overload (TACO)
  • Hemolysis d/t physical /chemical means
63
Q

What are delayed immunologic effects of transfusion reaction?

A
  • Hemolytic transfusion reactions
  • Transfusion associated Graft-versus-host disease
  • Post-transfusion purpura
  • Transfusion-induced hemosiderosis (too much iron)
64
Q

What are some quick ways to differentiate between TRALI and TACO? (This is very cut down from the main list)

A
  • TRALI → Fever and ↓BP
  • TACO → HTN, ↑JVP, ↓ EF
65
Q

What is TACO?

A

Transfusion associated circulatory overload
Mediated by fluid volume
Tx: administer treatment slowly and in small volume

66
Q

What classes of hemorrhage are there and what is associated blood loss for each?

A
  • 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%)
67
Q

What are 3 definitions of MTP in Adults?

A
  • 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
68
Q

What is considered MTP for Kids?

A

> 40mL/kg transfusion

69
Q

What is balanced resuscitation?

A
  • 1:1:1 ratio (PLT:Plasma:RBC)
70
Q

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

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

*cryo has highest fibrinogen levels

71
Q

What is the difference between stored whole blood (SWB) and LTOWB?

A

SWB anticoagulants < LTOWB

72
Q

What are the recommendations for whole blood transfusion in kids?

A

If they are <15 yr old or <40 kg then limit WB to 30 mL/kg

73
Q

Which clotting factors required Ca++ to work?

A

2 7 9 10 (II, VII, IX, X)

74
Q

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

A
  • CaCl (270 mg/10mL vs 90 mg/10ml for gluconate)
75
Q

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

A
  • 1 unit = 1.12 mmol/L
  • 2 unit = < 1mmol/L
  • 5 units = < 0.8 mmol/L

Give calcium every 4 units

76
Q

What is the value for TEG-ACT?

A

80-140 sec

77
Q

What is the normal value for R time?

A

5.0 - 10.0 min

78
Q

What is the normal value for K time?

A

1-3 minutes

79
Q

What is the normal value for α angle?

A

53 - 72°

80
Q

What is the normal value for MA?

A

50-70mm

81
Q

What is the normal value for G value?

A

5.3-12.4 dynes/cm2

82
Q

What is the normal value for LY 30?

A

0-3%

83
Q

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

A

FFP

84
Q

If R time is > 10 what do we transfuse?

A

FFP

85
Q

If K time is > 3 what do we transfuse?

A

Cryo

86
Q

If α angle < 53° what do we transfuse?

A

Cryo and platelets

87
Q

If MA < 50 what do we transfuse?

A

PLT

88
Q

If LY30 > 3% what do we transfuse?

A

TXA (Tranexamic Acid)

89
Q

Indications for PLT transfusion:

A
90
Q

Rh + or Rh - for
Females of child-bearing age =
Males =

A

Pregnancy = Rh -
Males = Rh +

91
Q

What two things can decrease the metabolism of citrate?

A
  • Hypothermia
  • Liver injury
92
Q

TEG INTERPRETATION

Angle:
R:
LY30:
MA:
K:

A

Angle: kinetics of clot development
R: reaction time, first significant clot formation
LY30: percent lysis 30min after MA
MA: maximum amplitude, maximum strength of clot
K: achievement of certain clot firmness

93
Q

Examples of TEG

A

Physical & Health Assessment COPY - Grayson (24 decks)

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