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
Which blood product has an ↑ risk of infection and why?
A
- Pooled packs d/t being from multiple donors
4
Q
If we had to pick one thing to transfuse what would it be?
A
- whole blood
5
Q
What blood type is a universal donor? Universal acceptor?
A
- Donor = O neg
- Acceptor = AB +
6
Q
What are 2 Hb related issues we will see often in clinical settings?
A
- β thalassemia → Hb Barts
- α thalassemia → Hb H
7
Q
What are the possible blood antigen types? What are possible Rh factors?
A
- Antigen → A B AB O
- Rh → Rh+ and Rh-
8
Q
Is the general population primarily Rh+ or Rh- ?
A
Rh+ (85%) and Rh- (15%)
9
Q
What 4 things can cause a right shift of the OxyHb curve?
A
- ↓ pH
- ↑ CO2
- ↑ temp
- ↑ 23-DPG
10
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)
11
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
12
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
13
Q
For blood type B, which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: B
- Antibody: Anti-A
14
Q
For blood type A which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: A
- Antibody: Anti-B
15
Q
AB donor blood will react with which other blood types?
A
- A, B, and O
16
Q
B donor blood will react with which blood types?
A
- A
- O
17
Q
A donor blood will react with which blood types?
A
- B
- O
18
Q
O donor blood will react with which blood types?
A
- none
19
Q
When whole blood is centrifuged what separation products result?
A
- Platelet rich plasma (PRP)
- WBC
- RBC
20
Q
What happens if we centrifuge platelet rich plasma (PRP) again?
A
- Centrifuge PRP again → Separates plasma from platelets
21
Q
Where is PRP used in surgery?
A
- Surgeon injects locally → ortho, dental, plastics cases commonly
22
Q
from WWI–>Vietnam war what was preferred blood product?
A
whole blood for bleeding intra-op, major trauma, and primary resuscitation fluid in military settings
23
Q
From 1970-1990 what blood products were preferred and why?
A
component therapy- preferred b/c it reduced waste, increased storage time, and targeted specific deficiencies
24
Q
In iraq and Afghanistan what is the cornerstone of resuscitation?
A
fresh whole blood
25
Is whole blood still used today?
Level I trauma centers have WB strategies
26
What are the 5 different blood components we can use for treatments?
* RBC
* FFP
* Cryo
* PLT
* LTOWB - Low titer Group O Whole Blood
27
Is plasma present in PRBC's?
No plasma!!
28
What is the lifespan of WB?
~ 3 wks
29
What chemicals are added to blood that allows it to be stored?
* 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)
30
Due to the chemicals used to allow blood to be stored what labs do we need to check when transfusing lots of blood?
* Ca++ (it will ↓)
* BG (it will ↑)
31
Which electrolyte will stored blood always have ↑ levels of? Why?
* K+ d/t cells lysing as they degrade in the bag
32
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
33
PRBCs contain ______ unless they have been specifically ________?
* Leukocytes (WBCs)
* Leukoreduced
34
How are PRBC's prepared?
remove 200-250mL of plasma from WB
PRBC's will be left with 200-350mL
does not contain functional platelets or granulocytes
has same O2 carrying capacity as WB
intended to increase O2 carrying capacity (good for anemic patients who do not need increased volume, just increased o2 carrying capacity)
35
How much does 1 unit of PRBCs ↑ H&H level?
* Hb: ↑ 1 g/dL
* Hct: ↑ 3%
36
How is FFP prepared?
remove plasma from WB within 8 hours of collection-->leaves us with 200-250mL blood
37
Which blood transfusion product is a source of antithrombin III?
FFP
38
What is the dose of FFP?
* 10-15 mL/kg
39
At what temperature is FFP stored?
-18C or below
Re-thawing takes times
some centers have liquid plasma available, freeze dried plasma is on the horizon
40
How much will 1 unit of FFP ↑ level of each clotting factor?
* ↑ 2 to 3% for each factor
41
What are two specific uses of FFP Dr. C mentioned in class?
* Heparin resistance d/t antithrombin deficiency
* Treat hereditary angioedema (also use TXA along with FFP)
42
What is the INR of FFP?
* 1.5 to 1.8
43
How is cryo prepared?
protein fraction taken off the top of the FFP when being thawed (then refrozen up to 1yr) (still stored at -18C)
44
What clotting factors does cryoprecipitate have?
* Factor VIII: C
* Factor VIII: vWF
* Factor XIII
* Fibrinogen
45
What target of fibrinogen are we trying to maintain when using cryo?
100 mg/dL
46
How much will two units of cryo raise fibrinogen levels?
* 2 bags of cryo/10 kg body weight = 100 mg/dL ↑ in fibrinogen
47
Which patient population is cryo really important for?
* Pregnant women who are bleeding
48
How are platelets prepared?
cytapheresis/separating PRP from a unit of WB within 8hrs of collection and re-centrifuged to remove plasma
49
How much will one unit of PLT increase PLT count by?
* 5000 to 10000
50
Is there any clinical data that says warming platelets is bad?
No its a common practice → no data to support not warming platelets
51
What is the AABB recommendation for warming platelets?
Do not warm platelets
52
When platelets are low at what level will we start to spontaneously bleed?
PLT < 30000
53
What is the deadly triad when transfusing a patient?
* Hypothermic
* Coagulopathic
* Acidotic
54
When is WB indicated for transfusion?
* To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss )
55
What is the storage temperature for whole blood?
1-6C
56
What are S/Sx of Hemolytic transfusion reaction?
* fever
* chill
* hemoglobinemia
* hemoglobinuria
* hypotension
* dyspnea.
57
What are mediators of Hemolytic transfusion reactions?
IgM antibodies
58
What are the S/S of nonhemolytic febrile transfusion reactions?
Fever and chills
59
What are the mediators of non-hemolytic febrile transfusion reactions?
HLA Class 1 Ag antibodies
60
How do we treat Non-hemolytic febrile transfusion reactions?
* Antipyretics
* Use leukocyte reduced products
61
What are some S/S of an allergic transfusion reaction?
* urticaria
* erythema
* itching
* anaphylaxis.
62
What are the mediators of allergic transfusion reactions?
* plasma proteins
* IgA antibodies
63
How do we treat allergic transfusion reactions?
* antihistamines
* treat symptoms, transfuse IgA-deficient components
64
What are S/S of Non-cardiogenic pulmonary transfusion reactions?
* ARDS
* Fever
* Chill
* Hypotension
* Cyanosis
***NONCARDIOGENIC PULMONARY EDEMA
65
What are the mediators for a non-cardiogenic pulmonary transfusion reaction?
Recipient WBC antibodies
66
How do we treat Non-cardiogenic pulmonary transfusion reactions?
* Lots of PEEP
* Steroids
67
How do we know if we have a TRUE transfusion reaction?
Noncardiogenic pulmonary transfusion reaction after blood product administration
68
What is TRALI?
Transfusion Related Acute Lung Injury - temporarily r/t to blood transfusion within 1st 6 hrs of a transfusion
69
What is the mortality rate associated with TRALI?
5%-25%, most recover within 72hrs
70
What types of blood products is TRALI most associated with this?
* FFP
* PLTs
71
What are the 3 acute nonimmunologic effects of transfusion reaction?
* Bacterial contamination
* Circulatory overload (TACO)
* Hemolysis d/t physical /chemical means
72
mediators, s/s, treatment of bacterial contamination
mediators: endotoxins produced by GI bacteria
S/S: fever, sepsis, hemoglobinuria
Tx: IV ABX, treat hypotension and DIC
73
mediators, S/S, Tx of TACO (circulatory overload)
mediator: fluid volume
S/S: coughing, cyanosis, orthopnea, severe headache, peripheral edema, diff breathing.
Treatment and Prevention: administer subsequent Tx slowly & in a small volume.
74
Mediators, S/S, Tx d/t physical/chemical means
M: exogenous destruction of RBC
S/S: hemoglobinuria
Tx: document and rule out hemolysis d/t other causes, treat DIC
75
What are the three delayed immunologic effects of transfusion reaction?
* Hemolytic transfusion reactions
* Transfusion associated Graft-versus-host disease
* Post-transfusion purpura
76
Mediators, S/S and Tx of delayed hemolytic transfusion reactions
Mediators : IgG A/b.
S/S: shortened RBC survival, decreased Hb, fever, jaundice, hemoglobinuria.
Treatment and Prevention: Ig-negative blood for further transfusions.
77
Mediators, S/s. treatment of transfusion associated graft v host disease
Mediators : viable donor lymphocytes.
S/S: fever, skin rash, desquamation, anorexia, nausea, vomiting, diarrhea, hepatitis, pancytopenia
Treatment and Prevention: gamma irradiation of cellular components.
78
Mediators, S/S, treatment of post-transfusion purpura
MOA: platelet specific A/b.
S/S: thrombocytopenia, clinical bleeding.
Treatment and Prevention: IV Ig, plasma exchange, corticosteroids.
79
Criteria for TRALI
acute onset hypoxemia
ratio of PaO2/FiO2<300 or SpO2 <90% on RA
occur during or within 6hrs of transfusion
bilateral diffuse pulmonary infiltrates
no evidence of LA HTN (circulatory overload)
80
immediate management of TRALI
STOP transfusion!
support pt
if intubated, obtain undulated edema fluid ASAP and simultaneous plasma for determination of total protein
obtain CBC and CXR
notify blood bank and request a different until and quarantine other unit from same donor
81
What are some quick ways to differentiate between TRALI and TACO?
* TRALI → Fever and ↓BP, no response to diuretic
* TACO → HTN, ↑JVP, ↓ EF, significant response to diuretic, S3 Heart sound
both: acute dyspnea, auscultation: rales, diffuse bilateral infiltrates
82
mediators, S/S, and treatment of Transfusion induced hemosiderosis
MOA : Iron overload.
S/S: subclinical to death.
Treatment and Prevention: decrease frequency of transfusion, neocytes, iron chelation therapy.
83
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%)
84
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
85
What is considered MTP for Kids?
* > 40mL/kg transfusion
86
What is balanced resuscitation?
* 1:1:1 ratio (PLT:Plasma:RBC)
87
What are the fibrinogen levels of Cryo, FFP, and LTOWB?
* Cryo = 2500 mg
* LTOWB = 1000 mg
* FFP = 400 mg
88
What is the difference between stored whole blood (SWB) and LTOWB?
* SWB anticoagulants < LTOWB
89
What type of blood is preferred for men? women of child-bearing age?
men: Rh + blood
Women: Rh - blood
90
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
91
side effects of hypocalcemia
Long QTc, decreased CO, coagulopathy, SZ
92
Which clotting factors required Ca++ to work?
2 7 9 10, protein C and S.
Ca plays a role in stabilizing fibrinogen and platelets in developing thrombus
93
Which drug has more elemental calcium; Ca gluconate or CaCl?
* CaCL (270 mg/10mL vs 90 mg/10ml for gluconate)
94
How much will 1, 2, and 5 units of blood decrease iCa?
* 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
95
In a study as Western Australia University, what was the most critical variable in determining mortality associated with blood transfusions?
hypocalcemia!!!
more specific than fibrinogen or acidosis levels!
96
TEG flow chart- when to give which component of blood!
97
What is the value for TEG-ACT?
* 80-140 sec
this is our normal activated clotting time (ACT)
measures clotting factors (extrinsic/intrinsic)
98
What is the normal value for R time?
* 5.0 - 10.0 min
reaction time to initial fibrin formation
clotting factors (intrinsic pathway)
99
What is the normal value for K time?
* 1-3 minutes
"kinetic time" for fibrin cross linkage to reach 20mm clot strength
measures fibrinogen, platelet #
100
What is the normal value for α angle?
* 53 - 72°
101
What is the normal value for MA?
* 50-70mm
102
What is the normal value for G value?
* 5.3-12.4 dynes/cm2
103
What is the normal value for LY 30?
* 0-3%
Clot "Lysis" at 30 minutes following MA
104
If TEG-ACT is > 140 what do we transfuse?
* FFP
105
If R time is > 10 what do we transfuse?
* FFP
106
If K time is > 3 what do we transfuse?
* Cryo
107
If α angle < 53° what do we transfuse?
* Cryo and platelets
108
If MA < 50 what do we transfuse?
* PLT
109
If LY30 > 3% what do we transfuse?
TXA (Tranexamic Acid)
110
Examples of TEGS
