Blood Products & CPR Flashcards
Maddie is a 12 y/o FS Lab presenting for weight loss, hyporexia, lethargy and vomiting. She has non-regenerative anemia (HCT 33%) and a visible cranial abdominal mass on thoracic radiographs. There are also expected senior kidney and liver changes.
The plan is to perform a partial or total liver lobectomy. What are the main anesthetic concerns?
- new or worsening hemorrhage
- hypotension due to hypovolemia
- hypothermia - CT, then prep for surgery
- hypoventilation
- bradycardia and/or tachyarrhythmias
- maintaining renal and hepatic perfusion
- remaining stable during an extensive abdominal explore
What 2 things should be done when planning for a blood transfusion?
- blood typing
- cross-match to available blood
What are the major canine blood groups? Which is considered the universal donor?
DEA 1.1, 1.3, 1.5, 1.7, 1.4, and DAL
DEA 1.1 - for unknown blood types, give DEA 1.1 negative blood
What are the 3 major feline blood groups?
A - most commonly seen in DSH, DMH, and DLH, has small quantities of anti-B antibodies
B - most commonly seen in Abyssinians, Devon Rex, Persian, Somali, and British shorthair, has large quantities of anti-A antibodies
AB - most commonly seen in Abyssinians, Devon Rex, Persian, British shorthair, Scottish Fold, and Norwegian Forest, no naturally occuring antibodies
Why are all cats ideally blood types and cross-matched prior to infusions?
even though there are established blood types, there are inconsistent differences between breeds
Why is it important to crossmatch donor blood?
- reduces the risk of transfusion reaction and sensitization
- better improves PCV in cats
- reactions are common if there is a history of plasma or RBC transfusion within 3-4 days
What is the difference between major and minor crossmatch?
MAJOR - response of recipient to donor blood = donor RBCs + recipient plasma
MINOR - response of donor blood to recipient = recipient RBCs + donor plasma
Why should IV fluids be carefully given in patients requiring transfusions?
in dogs, IV fluids at 5 mL/kg/her with a max of 2 boluses of 5 mL/kg
can dilute given RBCs
How is blood pressure typically affected by hemorrhage?
drops
How is whole blood calculated? Volume to administer in dogs and cats?
20 mL/kg required to increase PCV by 10%
DOGS = BW x 90
CATS = 70 x [(desired PCV-recipient PCV)/donor PCV]
What is the goal PCV to attain in dogs and cats requiring transfusions?
DOGS - 30%
CATS - 20%
What is the usual PCV of packed RBCs? How much is needed to increase PCV by 10%?
70-80% —> diluted with NaCl to run smoothly through the catheter
10 mL/kg
In what 2 situations is fresh frozen plasma typically given? How much is typically required?
- hypoproteinemia
- coagulation disorders
5-20 mL/kg
In what 3 situations is cryoprecipitate given? How much is typically required?
- clotting factor VIII deficiency
- von Willebrand’s
- fibrinogen deficiency
1 unit/10 kg
Why is platelet-rich plasma not commonly used in a transfusion? How much is required to improve PLT count?
only has a 24-48 shelf life at room temperature, typically requiring a donor present at the moment
1 unit/10 kgs increases PLT 10,000 /uL
How often should a patient be monitored when given a transfusion? What material is required? What is avoided?
check TPR q 15 mins for the first hour, then q 30 mins to ensure there is no reaction
170 um in line filter to keep out clots
roller fluid pump —> damages RBCs
What transfusion rates are required for dogs and cats?
DOGS = 0.25 mL/kg
CATS = 1-3 mL/5 mins
- if there is no reaction, set the rate to give the remainder over 4 hours
What is a major exception to typical transfusion rates?
acute massive hemorrhage —> after the initial rate and no reaction, increase the rate as needed to stabilize the patient
What causes acute immune reactions to transfusions? What is the most common sign?
recipient has antibodies to the donor RBCs —> seen in major crossmatch
rapid hemolysis
What are 2 major causes of acute non-immune transfusion reactions?
- clots, air
- hypocalcemia
What are causes of delayed immune and non-immune transfusion reactions?
IMMUNE - antibody development reduces RBC life
NON-IMMUNE - viral disease
What are the major clinical signs associated with transfusion reactions?
- pyrexia, chills, tremor
- urticaria
- salivation
- nausea, vomiting
- tachycardia, respiratory distress
- hypotension, weakness
- collapse, seizures
How are transfusion reactions treated?
- Epinephrine
- Dexamethasone SP
- Diphenhydramine
Maddie’s current PCV and weight are 20% and 25 kgs respectively. What quantity of packed RBCs are required fo improve her PCV to 30%? What rate is required?
10 mL/kg x 25 kg = 250 mL + 100 mL NaCl for dilution
0.25 mL/kg x 25 kg = 6.25 mL/hr, monitor for reaction, then increase rate to give over 1 hr
What are some signs that a patient under monitoring is going into arrest?
- drop in ETCO2 and HR over the same time frame
- pulse oximeter quits reading SpO2
- intra-arterial BP drops, typically with no visible pulse wave
What sequence of events should occur when a patient is going into arrest?
- start external compressions at 100-120 bpm
- administer IV Atropine + Epinephrine
- if there is no response, repeat epinephrine
- wait for return of spontaneous circulation (ROSC)
What causes electrical activity with no pulse (PEA)? How does treatment differ?
hypovolemia
non-shockable, no medical management
