Blood products/haemostasis Flashcards
components of packed red cells 5
red cells saline adeninine glucose mannitol citrate
voluem of prc and shelf life
230-340ml
35 day shelf life
at 4 degrees
how blood donation is processed
filter to remove leucocytes
process into red cells
pooled platelets
FFP
how blood donation is processed
filter to remove leucocytes
process into red cells
pooled platelets
FFP
tests run on donar blood 7
hiv hep b and c htlv syphylis abo and rhD other pehnotypes red cell antibodies CMV, HBS, Malaria
platelets storage temp and days
22 degrees
5 days
FFP storage temp and days
minus 25 and 36 months
what does FFP contain 5
clotting factors fibrinogen plasma proteins particuarly albumin electrolytes physiological anticoagulants - protein c, protein s, anti thrombin, tissue factor pathway inhibitor
when to use FFP -2
clinically singifcant bleeding without major haemorrhage if they have abnormal coag tests eg PT or APTT above 1.5
prophylactic for proceudres with abnormal coag with sig risk bleeding
reversal agents warfarin warfarin with bleeding heparin NOAC
vitamin K
beryplex, prothrombin complex concentrate
protamine , binds heparin, replenishes factor Xa
idarucizumab - praxbind for dagibatran, andexanet alpha
IDARUCIZUMAB · Drug action. Idarucizumab is a humanised monoclonal antibody fragment that binds specifically to dabigatran and its metabolites,
Praxbind
Andexanet alfa is a recombinant form of human factor Xa protein which binds specifically to apixaban or rivaroxaban, thereby reversing their anticoagulant
Andexxa
cryoprecipitate 5
fibrinogen vWF factor VIII factor XIII fibronectin
when to use cryo
consider if NO major haemorrhage and clinically significant bleeding and fibrinogen level below 1.5g/l
do not give if not bleeding and no procedure with risk of bleeding
massive transfusion protocol - baseline bloods 5
take baseline blood samples before transfusion for
massive transfusion protocol tranexamic how to manage team group o in females and males until lab results available what to give 4 if lab results available 4 situations
trauma and less than 3h from injury give tranexamic acid 1g bolus over 10 min followed by IV infusion 1g over 8 hours
state patient unique identifier and location
nominate person to liase with blood bank
group o neg in females and o pos in males
group specific blood when known
send porter to lab
until lab results available
giver further FFP 1L 4 units per 6 units red cells
consider cryo 2 pools
consider platelets 1 adult theraputic dose ATD
if lab results available falling Hb give red cells PT ratio >1.5 FFP 15-20ml/kg fibrinogen <1.5g/l - cryo 2 pools platelets less than 75 x 10 to 9 give platelets 1 ATD
continue cycle of clinical and lab monitoring and admin to goal directed therapy until bleeding stops
definition massive transfusion 3
transfusion 10 or more rbc which approximates to TBV of average patient within 24 hours
transfusion of more than 4 RBC with anticipated need continued blood
replacement of >50% of TBV by blood products within 3 hours
transfusion complications - 3 categories
non immunological
immunological
metabolic
non immunological -4 complications transfusion
fluid overload
infection
air embolus
coagulopathy
immunological -4
TRALI
allergy
ABO incompatibility
graft vs host
metabolic 5
hypothermia hyperkalaemia / hypokalaemia hypocalcaemia hypomag met alkalosis
alternatives to blood tranfusion 2
EPO if anaemia and needs transfusion but refuses for religion
IV iron - irone def aneamia, cannot tolerate oral iron, diagnosed with functional irone def, surgery too soon for oral iron to be ffective
cell salvage
diagram of cell salvage
dual lumen catheter suction from patient via heparinised saline to reservoir into cell salvage machin saline for washing into machine washed blood out of machine back to patient for autologous transfusion
why use cell salvage 6
consider if expected blood loss more than 1L Jehovah's witness reduce risks allogenic transfusion reduce infective components higher erythrocyte viability decreased risk post op CVD complications
types of haemostatic agents
gelatin based
gelatin combined with clotting factors - floseal
collagen based
cellulose based - surgicel, fibrillar
how does floseal work
gelatin based with clotting factors
bovine origin
all actions gelatin prodcues
additional thrombin
how does surgicell work
cellulose based
swells on contact with fluid to provide tamponade
contact activation
acid environment
provides scaffold for platelets and clotting factors
needs normal clotting cascade
made from wood pulp
how does gelatin haemostatic agents work
where from
how long reabsorb
whats needed to work
gelatin purified from porcine skin
can absorb large amounts of blood
thereby swelling to produce tamponade
concentrates plasma proteins and clotting agents
only be effective if patient clotting normal
reabsorb within 4-6 weeks
bovine origin
fibrin sealants tisseel
haemostatic, sealant, adhesive
activate clotting cascade by two components mixed together
component 1 contains thrombin and calcium
component 2 contains fibrinogen fibronectin and factor XIII
thrombin converts factor XIII to activated form
activated factor XIII converts fibrin monomers into fibrin polymer
need dry stationary surface
combination collagen and fibrin sealant
tachosil
same mechanism as fibrin sealant
how does collagen agetns work
actifoam
initiates clotting cascade via contact activation
platelets aggregrate in the collegn matrix
platelets initiate clotting cascade via contact activation
beryplex constituents
Beriplex is made from human plasma (this is the liquid part of the blood) and it contains the human coagulation factors II, VII, IX and X. Concentrates including these coagulation factors are called prothrombin complex products.
