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24 Physical & Health Assessment > Blood Products and Transfusion (Exam III) Stephen's Cards > Flashcards

Blood Products and Transfusion (Exam III) Stephen's Cards 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

Which blood transfusion product is a source of antithrombin III?

A

FFP

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32
Q

What is the dose of FFP?

A
  • 10-15 mL/kg
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33
Q

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

A
  • ↑ 2 to 3% for each factor
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34
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)
35
Q

What is the INR of FFP?

A
  • 1.5 to 1.8
36
Q

What clotting factors does cryoprecipitate have?

A
  • Factor VIII: C
  • Factor VIII: vWF
  • Factor XIII
  • Fibrinogen
37
Q

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

A

100 mg/dL

38
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
39
Q

Which patient population is cryo really important for?

A
  • Pregnant women who are bleeding
40
Q

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

A
  • 5000 to 10000
41
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

42
Q

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

A

PLT < 30000

43
Q

What is the deadly triad when transfusing a patient?

A
  • Hypothermic
  • Coagulopathic
  • Acidotic
44
Q

When is WB indicated for transfusion?

A
  • To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss )
45
Q

What are S/Sx of Hemolytic transfusion reaction?

A
  • fever
  • chill
  • hemoglobinemia
  • hemoglobinuria
  • hypotension
  • dyspnea.
46
Q

What are mediators of (acute immunologic) Hemolytic transfusion reactions?

A

IgM antibodies (ABO), complement

47
Q

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

A

Fever and chills

48
Q

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

A

HLA Class Ag antibodies

49
Q

How do we treat Non-hemolytic febrile transfusion reactions?

A
  • Antipyretics
  • Use leukocyte reduced products
50
Q

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

A
  • urticaria
  • erythema
  • itching
  • anaphylaxis.
51
Q

What are the mediators of (acute) allergic transfusion reactions?

A
  • plasma proteins (mild)
  • IgA antibodies (anaphylaxis)
52
Q

How do we treat allergic transfusion reactions?

A
  • antihistamines
  • treat symptoms
53
Q

What are S/S of Non-cardiogenic pulmonary transfusion reactions?

A
  • ARDS
  • Fever
  • Chill
  • Hypotension
  • Cyanosis
  • noncardiogenic pulmonary edema
54
Q

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

A

Donor/Recipient WBC antibodies

55
Q

How do we treat Non-cardiogenic pulmonary transfusion reactions?

A
  • Lots of PEEP
  • Steroids
56
Q

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

A

Noncardiogenic pulmonary transfusion reaction after blood product administration

57
Q

What is TRALI?

A

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

58
Q

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

A
  • (plasma containing products)
  • FFP, PLTs
59
Q

What are the 3 acute nonimmunologic effects of transfusion reaction?

A
  • Bacterial contamination
  • Circulatory overload (TACO)
  • Hemolysis d/t physical /chemical means
60
Q

What are the three delayed immunologic effects of transfusion reaction?

A
  • Hemolytic transfusion reactions (IgG)
  • Transfusion associated Graft-versus-host disease (lymphocytes)
  • Post-transfusion purpura (plt specific A/b)
61
Q

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

A
  • TRALI → Fever, ↓BP, No JVP or decrease EF
  • TACO → HTN, ↑JVP, ↓ EF, S3, diuretics effective!
62
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%)
63
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
64
Q

What is considered MTP for Kids?

A
  • > 40mL/kg transfusion
65
Q

What is balanced resuscitation?

A
  • 1:1:1 ratio (PLT:Plasma:RBC)
66
Q

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

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

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

A
  • SWB anticoagulants < LTOWB
68
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
69
Q

Which clotting factors required Ca++ to work?

A

II, VII, IX, X (also vit-K dependent)

70
Q

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

A
  • CaCL (270 mg/10mL vs 90 mg/10ml for gluconate)

“3x more in CaCl”

71
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
72
Q

What is the value for TEG-ACT?

A
  • 80-140 sec
73
Q

What is the normal value for R time?

A
  • 5.0 - 10.0 min
74
Q

What is the normal value for K time?

A
  • 1-3 minutes
75
Q

What is the normal value for α angle?

A
  • 53 - 72°
76
Q

What is the normal value for MA?

A
  • 50-70mm
77
Q

What is the normal value for G value?

A
  • 5.3-12.4 dynes/cm2
78
Q

What is the normal value for LY 30?

A
  • 0-3%
79
Q

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

Bonus points! What does TEG stand for?!

A
  • FFP
  • Thromnoelastogram
80
Q

If R time is > 10 what do we transfuse?

A
  • FFP
81
Q

If K time is > 3 what do we transfuse?

A
  • Cryo
82
Q

If α angle < 53° what do we transfuse?

A
  • Cryo and platelets
83
Q

If MA < 50 what do we transfuse?

A
  • PLT
84
Q

If LY30 > 3% what do we transfuse?

A

TXA (Tranexamic Acid)

24 Physical & Health Assessment (33 decks)

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