Blood Products and Transfusion (Exam III) 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 a ↑ risk of infection and why?
A
- Pooled packs d/t being from multiple donors. (Platelets and Cryo are pooled 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
Which patient is the potential exception to accepting blood from an O+ donor?
If we have to, how can we compensate for this?
A
- Pregnant women who are O- (Rh-), may have problems with the fetus
- Rhogam
7
Q
What are 2 Hb related issues we will see often in clinical settings?
A
- β thalassemia → Hb Barts
- α thalassemia → Hb H
8
Q
What are the possible blood antigen types? What are possible Rh factors?
A
- Antigen → A B AB O
- Rh → Rh+ and Rh-
9
Q
Is the general population primarily Rh+ or Rh- ?
A
Rh+ (85%) and Rh- (15%)
10
Q
What 4 things can cause a right shift of the OxyHb curve?
A
- ↓ pH
- ↑ CO2
- ↑ temp
- ↑ 2,3-DPG
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)
12
Q
For blood type O which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: n/a (no antigens, blood can go to anyone)
- Antibody: Anti-A and Anti-B
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 (no antibodies, can receive blood from anyone)
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
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
16
Q
AB donor blood will react with which other blood types?
A
- A, B, and O
17
Q
B donor blood will react with which blood types?
A
- A
- O
18
Q
A-type donor blood will react with which blood types?
A
- B
- O
19
Q
O donor blood will react with which blood types?
A
- none
20
Q
When whole blood is centrifuged what separation products result?
A
- Platelet rich plasma (PRP)
- WBC
- RBC
21
Q
What happens if we centrifuge platelet rich plasma (PRP) again?
A
- Centrifuge PRP again → Separates plasma from platelets
22
Q
Where is PRP used in surgery?
A
- Surgeon injects locally → ortho, dental, plastics cases commonly
Example= injected in knee to help healing process
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
24
Q
What is the lifespan of WB?
A
~ 3 wks/ 21 days
25
What chemicals are added to blood that allows it to be stored?
Hint: CPDA
CPDA-1 →
* Citrate —> chelates Ca++ to prevent clotting
* Phosphate → used as buffer
* Dextrose → fuel source
* Adenine → to support ATP synthesis (extends storage from 21 to 35 days)
26
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 ↓from citrate)
* Blood Glucose (it will ↑from dextrose)
27
Which electrolyte will stored blood always have ↑ levels of? Why?
* K+ d/t cells lysing (apoptosis) as they degrade in the bag
(When cells die they release potassium)
28
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
29
PRBCs contain ______ unless they have been specifically ________?
* Leukocytes (WBCs)
* Leukoreduced
30
How much does 1 unit of PRBCs ↑ H&H level?
* Hb: ↑ 1 g/dL
* Hct: ↑ 3%
31
Which blood transfusion product is a source of antithrombin III?
FFP
32
What is the dose of FFP?
* 10-15 mL/kg
33
How much will 1 unit of FFP ↑ level of each clotting factor?
* ↑ 2 to 3% for each factor
34
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)
35
What is the INR of FFP?
* 1.5 to 1.8
36
What is Cryoprecipitate?
What clotting factors does cryoprecipitate have?
The protein fraction that is taken off the top of the FFP when being thawed.
* Factor VIII: C
* Factor VIII: vWF
* Factor XIII
* Fibrinogen
37
What target of fibrinogen are we trying to maintain when using cryo?
100 mg/dL
38
How much will two units of cryo raise fibrinogen levels?
* 2 bags of cryo/10 kg body weight = 100 mg/dL ↑ in fibrinogen
39
Which patient population is cryo really important for?
* Pregnant women who are bleeding
40
How much will one unit of PLT increase PLT count by?
* 5,000 to 10,000
41
Is there any clinical data that says warming platelets is bad?
No, it's a common practice with anesthesia. Only the Belmont manufacturer mentions it in their pamphlet
42
When platelets are low at what level will we start to spontaneously bleed?
PLT < 30000
43
What is the deadly triad when transfusing a patient?
* Hypothermic
* Coagulopathic
* Acidotic (NS pH is 5.5, so you’re making them acidotic with huge bolus’s)
44
When is WB indicated for transfusion?
* To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss )
45
What are S/Sx of Hemolytic transfusion reactions?
* fever
* chill
* hemoglobinemia
* **hemoglobinuria (keep an eye on foley bag)**
* **hypotension**
* dyspnea (look for high airway pressure and RR)
46
What are the mediators of Hemolytic transfusion reactions?
IgM antibodies
*This is usually a result of the patient getting incompatible blood.*
47
What are the S/S of nonhemolytic febrile transfusion reactions?
Fever and chills
48
What are the mediators of non-hemolytic febrile transfusion reactions?
HLA Class Ag antibodies
49
How do we treat Non-hemolytic febrile transfusion reactions?
* Antipyretics
* Use leukocyte reduced products
50
What are some S/S of an allergic transfusion reaction?
* urticaria
* erythema (blotchy red rashes)
* itching
* anaphylaxis.
51
What are the mediators of allergic transfusion reactions?
* plasma proteins
* IgA antibodies
52
How do we treat allergic transfusion reactions?
* STOP TRANSFUSION
* antihistamines
* treat symptoms
53
What are S/S of Non-cardiogenic pulmonary transfusion reactions?
* **Noncardiogenic pulmonary edema** - from a minimal amount of blood transfused.
* ARDS
* Fever
* Chill
* Hypotension
* **Cyanosis
54
What are the mediators for a non-cardiogenic pulmonary transfusion reaction?
Recipient WBC antibodies
55
How do we treat Non-cardiogenic pulmonary transfusion reactions?
* Lots of PEEP (to force fluid back across the membrane)
* Steroids
* Lasix
56
What is TRALI?
Transfusion Related Acute Lung Injury - temporarily r/t to blood transfusion within 1st 6 hrs of a transfusion
57
What types of blood products is TRALI most associated with this?
* FFP
* PLTs
58
What are the 3 acute nonimmunologic effects of transfusion reaction?
* Bacterial contamination (hemoglinuria- give abx) scrub the hub
* Circulatory overload TACO
* Hemolysis d/t physical /chemical means
59
What are the three delayed immunologic effects of transfusion reaction?
* Hemolytic transfusion reactions (Decrease Hgb value, Ig negative blood for future reactions.)
* Transfusion-associated Graft-versus-host disease (N/V, Pancytopenia)
* Post-transfusion purpura (Oozing--sterioids, IV Ig)
60
What are some quick ways to differentiate between TRALI and TACO? (This is very cut down from the main list)
* TRALI → Fever and ↓BP (Immunologic Response)
* TACO → HTN, ↑JVP, ↓ EF (Fluid Overload symptoms)
61
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%)
62
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
63
What is considered MTP for Kids?
* a greater than 40mL/kg transfusion
64
What is balanced resuscitation?
* 1:1:1 ratio (PLT:Plasma:RBC)
65
What are the fibrinogen levels of Cryo, FFP, and LTOWB?
* Cryo = 2500 mg. Best
* LTOWB = 1000 mg. 2nd best
* FFP = 400 mg. 3rd best
66
What is the difference between stored whole blood (SWB) and LTOWB?
* LTOWB has more anticoagulants than Stored Whole Blood
67
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
68
Which clotting factors required Ca++ to work?
2 7 9 10
69
Which drug has more elemental calcium; Ca gluconate or CaCl (Calcium Chloride)
* CaCl (270 mg/10mL vs 90 mg/10ml for gluconate)
70
What is ionized Calcium (iCa++)
How much will 1, 2, and 5 units of blood decrease iCa?
What is the normal iCa++?
Ionized calcium is aka “free calcium” that can participate in physiologic functions
* 1 unit = 1.13 mmol/L
* 2 unit = < 1mmol/L
* 5 units = < 0.8 mmol/L
Normal = 1.15-1.25 mmol/L
71
What is the value for TEG-ACT?
* 80-150 sec
<150sec
72
What is the normal value for R time and what does it represent?
* 5.0 - 10.0 min
It is the time it takes to start forming a clot
73
What is the normal value for K time?
What is the K time?
* 1-3 minutes
It is the time it takes for the tracing to reach 20 mm (but the alpha angle normal is 53-72 degrees: don’t confuse with MA of 50-70mm)
74
What is the normal value for α angle?
What does it represent?
* 53 - 72°
The speed of fibrin accumulation correlates with the angle formed.
75
What is the normal value for MA?
* 50-70mm
A lesser number would show a weak clot
Higher numbers are strong clots that may or may not be hard to lyse
76
What is the normal value for G value?
* 5.3-12.4 dynes/cm2
No clue wtf this means
77
What is the normal value for LY 30?
What does this mean?
What does LY60 mean?
* 0-3%
The percentage of MA (amplitude) drop over 30 mins.
LY60 would mean % over 1 hour. The number after LY is just the amount of time in the test.
78
If TEG-ACT is > 140min what do we transfuse?
* FFP
It is taking too long to clot, so give them more platelets to clot
79
If R time is > 10 min what do we transfuse?
* FFP
It is taking too long to clot, so give them more platelets to clot
80
If K time is > 3min what do we transfuse?
* Cryo bc it is a fibrinogen issue
Cryo #1, whole blood #2, FFP #3
81
If α angle < 53° what do we transfuse?
* Cryo and platelets
82
If MA < 50 mm what do we transfuse?
* PLT
83
If LY30 > 3% what do we transfuse?
TXA (Tranexamic Acid)
Clot is lysing too quick, so get a pro-clot drug like TXA to help
