Blood Products & CPR

Question 1

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?

Answer 1

• 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

Question 2

What 2 things should be done when planning for a blood transfusion?

Answer 2

1. blood typing
2. cross-match to available blood

Question 3

What are the major canine blood groups? Which is considered the universal donor?

Answer 3

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

Question 4

What are the 3 major feline blood groups?

Answer 4

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

Question 5

Why are all cats ideally blood types and cross-matched prior to infusions?

Answer 5

even though there are established blood types, there are inconsistent differences between breeds

Question 6

Why is it important to crossmatch donor blood?

Answer 6

• 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

Question 7

What is the difference between major and minor crossmatch?

Answer 7

MAJOR - response of recipient to donor blood = donor RBCs + recipient plasma

MINOR - response of donor blood to recipient = recipient RBCs + donor plasma

Question 8

Why should IV fluids be carefully given in patients requiring transfusions?

Answer 8

in dogs, IV fluids at 5 mL/kg/her with a max of 2 boluses of 5 mL/kg

can dilute given RBCs

Question 9

How is blood pressure typically affected by hemorrhage?

Answer 9

drops

Question 10

How is whole blood calculated? Volume to administer in dogs and cats?

Answer 10

20 mL/kg required to increase PCV by 10%

DOGS = BW x 90
CATS = 70 x [(desired PCV-recipient PCV)/donor PCV]

Question 11

What is the goal PCV to attain in dogs and cats requiring transfusions?

Answer 11

DOGS - 30%

CATS - 20%

Question 12

What is the usual PCV of packed RBCs? How much is needed to increase PCV by 10%?

Answer 12

70-80% —> diluted with NaCl to run smoothly through the catheter

10 mL/kg

Question 13

In what 2 situations is fresh frozen plasma typically given? How much is typically required?

Answer 13

1. hypoproteinemia
2. coagulation disorders

5-20 mL/kg

Question 14

In what 3 situations is cryoprecipitate given? How much is typically required?

Answer 14

1. clotting factor VIII deficiency
2. von Willebrand’s
3. fibrinogen deficiency

1 unit/10 kg

Question 15

Why is platelet-rich plasma not commonly used in a transfusion? How much is required to improve PLT count?

Answer 15

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

Question 16

How often should a patient be monitored when given a transfusion? What material is required? What is avoided?

Answer 16

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

Question 17

What transfusion rates are required for dogs and cats?

Answer 17

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

Question 18

What is a major exception to typical transfusion rates?

Answer 18

acute massive hemorrhage —> after the initial rate and no reaction, increase the rate as needed to stabilize the patient

Question 19

What causes acute immune reactions to transfusions? What is the most common sign?

Answer 19

recipient has antibodies to the donor RBCs —> seen in major crossmatch

rapid hemolysis

Question 20

What are 2 major causes of acute non-immune transfusion reactions?

Answer 20

1. clots, air
2. hypocalcemia

Question 21

What are causes of delayed immune and non-immune transfusion reactions?

Answer 21

IMMUNE - antibody development reduces RBC life

NON-IMMUNE - viral disease

Question 22

What are the major clinical signs associated with transfusion reactions?

Answer 22

• pyrexia, chills, tremor
• urticaria
• salivation
• nausea, vomiting
• tachycardia, respiratory distress
• hypotension, weakness
• collapse, seizures

Question 23

How are transfusion reactions treated?

Answer 23

• Epinephrine
• Dexamethasone SP
• Diphenhydramine

Question 24

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?

Answer 24

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

Question 25

What are some signs that a patient under monitoring is going into arrest?

Answer 25

• 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

Question 26

What sequence of events should occur when a patient is going into arrest?

Answer 26

• 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)

Question 27

What causes electrical activity with no pulse (PEA)? How does treatment differ?

Answer 27

hypovolemia

non-shockable, no medical management