Blood Products & Transfusion Flashcards
Test 3
Whole blood is composed of ____% plasma & ____% formed elements
55%
45%
What percent of whole blood is plasma? What does plasma consist of and its percentages?
55%
-Water 92%
-Proteins 7% (Albumin 57-60%, Globulin 38%, fibrinogen 4%, prothrombin 1%)
-Solutes 1% (ions, nutrients, waste, products, gases, regulatory substances)
What percent of whole blood is formed elements? What does the formed elements consist of and what’s their values?
45%
Platelets: 140,000 - 340,000
Leukocytes: 5000 - 10,000
Erythrocytes: 4.2 - 6.2 million
per cubic mm
What are the different types of leukocytes & their percentages?
Neutrophils 40 - 60%
Lymphocytes 20 - 40%
Monocytes 2 - 8%
Eosinophils 2 - 4%
Basophils 0.5 - 1%
The color of plasma is _______ because it mostly consist of ______
clear
water
What is the largest component of WB?
Plasma
Will plasma sink or rise to the bottom of WB?
Rise
What is the normal adult hemoglobin? Variant?
Hemoglobin A (A2B2)
Hemoglobin A2 (A2D2)
What is the normal fetal hemoglobin?
Hemoglobin F (A2Y2)
What is the sickle cell hemoglobin?
Hemoglobin S (A2BS2)
T/F: there are lots of different hemoglobins, and they will all react differently
T
What are the four different blood types? (Antigens)
A
B
AB
O
___% of people are Rh+ and ___% and Rh-
85%
15%
What causes the oxygen-hemoglobin dissociation curve to shift to the right? (4)
- Decreased pH.
- Increased CO2.
- Increased temperature.
- Increased 2, 3-DPG.
What does type & screening do?
Looks for specific antigens and antibodies
Describe the antibodies present in each blood type.
O: A/B
AB: None
B: A
A: B
T/F: you can change your blood type
T
You can change your blood type/antigen/antibodies with giving large amounts of blood
What do you need to get if you give large amounts of blood? Why?
A new type & screen
Because you can change the blood type/antigen/antibodies with large amounts of blood given
Why is it better to give blood that is more specific to the patient?
Less risk for a reaction
______ is the universal donor and _______ is the universal recipient
O negative
AB positive
We try not to give female ______ blood. Why?
O positive
Increases risk of fetal compatibility
What is the specific gravity of RBC?
1.08 - 1.09
What is the specific gravity of platelets?
1.03 - 1.04
How do we prepare blood components?
It’s separated into layers based on the blood component specific gravity
Will platelets rise or fall in WB?
Fall to the bottom
What are the different blood component therapies?
RBC
FFP
Cryo
Platelets
LTOWB (low titer WB)
Give a BRIEF history description of blood transfusion during these periods: WWI-Vietnam; 1970-1990; Iraq+Afghanistan; Today (current)
WWI-Vietnam: WB primary resusitation fluid in milirary
1970-1990: transition from WB to component therapy
Iraq+Afghanistan: WB & LTOWB
Today (current): Level 1 trauma centers have WB transfusion strategies
It takes crystalloids ______ to re-distribute to ISF
30 minutes
What compound is needed for blood storage? How does this help with the storage of blood?
CPDA – 1
Citrate: chelation of Ca+ prevents clotting
Phosphate: buffer
Dextrose: fuel source
Adenine: synthesis of ATP –> extend storage time from 21 to 35 days
The oxyhemoglobin dissociation curve shifts to the _____ the longer blood is stored
Left
(impaired O2 delivery)
What are PRBCs?
WB without plasma (no clotting factors or functional platelets; has leukocytes/WBC)
What is Leukoreduced or eradicated PRBCs?
WBC taken out and used for immunocompromised
How much is one unit of PRBCs? How much plasma is extracted?
200–350 ml
200-250ml
PRBCs increases Hgb by _____ & Hct by _____
1g/dL or 10g/L
3%
How do you prepare FFP?
Remove plasma from WB w/i 8h of collection
How much is one bag of FFP?
200–250 ml
FFP expires ______ after donation
12 months
What is the dose of FFP?
10–15 ml/kg
FFP & cryoprecipitate has to be stored at what temperature?
-18C or below
FFP is a good source of _________
Antithrombin III
Each unit of FFP increases each clotting factor by _____ an adult
2-3%
FFP requires ______ which takes time
Thawing
The ______ in FFP helps medications work better
Proteins
What is cryoprecipitate? How is it stored?
Protein fraction taken off top of FFP when being thawed
After that, it is refrozen for UP TO 1 YEARS
What does cryoprecipitate consist of?
F VIII: C
F VIII: vWF
F XIII
Fibrinogen
What blood component has the most fibrinogen?
cyro
What is the fibrinogen goal level?
100 mg/dL
____ units of cryo/10 kg of body wt raise fibrinogen by 100 mg/dL
2
(except in DIC or continuous bleeding)
What are indications for FFP?
-PT/PTT >1.5
-acquired multifactor deficiencies w/ evidence of bleeding
-liver dysfunction w/ evidence of bleeding
-DIC w/ bleeding
-massive transfusion
-reversal of vitamin K antagonist (warfarin)
-heparin resistance
-Tx of thrombotic microangiopathies (TTP, HELLP, hemolytic uremic syndrome)
-Tx of hereditary angioedema when C1-esterase inhibitor is not available
What are indications for Cryo?
-DIC w/ fibrinogen <80-100
-hemorrhage/MTP w/ fibrinogen <100-150
-prophylaxis w/ hemophilia A & vWD
-prophylaxis w/ congenital dysfibrinogenemias
-systemic depletion of clotting factors
How are platelets prepared?
cytapheresis by separating PRP from a unit WB w/i 8h of collection
how much is one bag of platelets? pheresis?
Random
250-300 ml
One unit of platelets increases your platelet count by _______
5000 - 10,000
What happens if you warm platelets?
Platelet count decreases
Platelets will aggregate
do not warm platelets
T/F: You warm platelets
F
They become less functional
We do not use ____ to prime blood tubing. Why?
LR
Contains Ca –> clot
What are indications for platelet transfusions?
-stable pts w/o bleeding/coag (<10,000)
-prophylaxis for invasive procedures (<50,000)
-stable pts w bleeding/coag (50,000(
-DIC w/ bleeding (<50,000)
-MTP (<75,000)
-Pts w/ Sx at critical sites like eye/CNS (<100,000)
-Microvascular bleeding dt platelet dysfunction –> uremia, liver disease, CABG
How do we administer blood products?
Through an FDA approved warming device
except platelets
When does blood need to be warmed?
-transfusion rates >100ml/min
-4+ units in one hour
-5yo w/ 98.1 temp getting 2 units in 1hr
-90yo w/ 97.5 temp getting any blood
What are the preferred priming fluids for blood tubing in order?
- Normosol
- plasmalyte
- NS 0.9%
How much is one unit of whole blood?
400–500ml
How do you store WB?
1-6 C
Not frozen –> kept cool
What are the S/S of Acute immunologic hemolytic transfusion reaction? Tx?
S/s: fever, chill, hemoglobinemia, hemoglobinuria, hypotension, dyspnea
Tx: prevention, treat ARF
& DIC
Why do you need to make sure that your pt has a foley if you’re giving a lot of blood products?
Acute immunologic hemolytic transfusion reaction can occur –> s/s his blood in the urine –> can catch this easily with a Foley
What are the S/S of Acute immunologic nonhemolytic febrile transfusion reaction? Tx?
S/s: fever, chill
Tx/prevention: anti-antibiotics, leukocyte reduced blood
What are the S/S of Acute immunologic allergic transfusion reaction? Tx?
S/s: urticaria, erythema, itching, anaphylaxis
Tx/prevention: antihistamines, treat symptoms, transfuse IgA-deficient components
What is the most common blood transfusion reaction?
Acute immunologic allergic transfusion reaction
What are the S/S of Acute immunologic noncardiogenic pulmonary transfusion reaction? Tx?
S/s: ARDS, fever, chills, cyanosis, hypotension, non-cardiogenic, pulmonary edema, increased airway pressures
Tx/prevention: vigorous respiratory support (PEEP), steroids
These are pulmonary signs
What is TRALI?
Transfusion related acute lung injury
(Acute immunologic)
Temporarily related to blood transfusion
-happens within first six hours following transfusion
The mortality of TRALI is ___% to ___%. When do most patients recover?
5 - 25%
Within 72 hours
TRALI is typically associated w/ _______ components. Which types of blood products does this include?
Plasma
platelets
FFP
Cryo
You can get it from PRBCs
There is residual plasma in PRBCs
What is the patho of TRALI?
Leukoagglutination/pooling of granulocytes in lungs –> injury to membrane/endothelial/parenchyma –> mild dyspnea & pulm infiltrates
What is the criteria for TRALI? What are other S/S?
Criteria:
-acute onset hypoxemia
-ratio of PaO2/FiO2 <300 or SpO2 <90% on RA
-occurs during or w/i 6hrs
-bil pulm infiltrates
-No evidence of L atrial HTN or circulatory overload (CHF)
S/S: Cynosis; hypotension; fever; resp distress
What may the CXR present with TRALI after rapid progression?
“White out”: which is indistinguishable from ARDS
T/F: TRALI pts usually require resp support and 70% mechanical ventilation
T
What is the Tx for TRALI?
- Stop infusion
- Support patient.
- Obtain undiluted edema fluid within 15 min.
- CBC & CXR.
- Notify BB.
May require ECMO
What are the S/S of Acute nonimmunologic bacterial contamination transfusion reaction? Tx?
S/S: fever, shock, hemoglobinuria
Tx: Abx, treat hypotension/DIC
What are the S/S of Acute nonimmunologic transfusion related circulatory overload? Tx?
“TACO”
S/S: coughing, cyanosis, orthopedic, severe HA, peripheral edema, diff breathing
Tx: administer subsequent treatment slow & in small volumes
Acute nonimmunologic circulatory overload transfusion reaction =
TACO
What is the mediator with TACO?
Fluid overload
What are the S/S of Acute nonimmunologic hemolysis dt physical/chemical transfusion reaction? Tx?
S/S: hemoglobinuria
Tx: rule out other reasons; Tx DIC
What are the S/S of Delayed immunologic hemolytic transfusion reaction? Tx?
S/S: Shortened RBC lifespan, decreased Hgb, fever, jaundice, hemoglobinuria
Tx: Ig-negative blood for future transfusions
What are the S/S of Delayed immunologic transfusion associated Graft-vs-host disease reaction? Tx?
S/S: fever, skin, rash, desquamation, anorexia, N/V, diarrhea, hepatitis, pancytopenia
Tx: gamma irradiation of cellular components
What are the S/S of Delayed immunologic post-transfusion purpura reaction? Tx?
S/S: Platelet specific A/b; thrombocytopenia; clinical bleeding
Tx: IV Ig; plasma exchange; corticosteroids
What is the main differences between TACO & TRALI?
TRALI: immune –> fever; hypertension; JVP unchanged; EF normal; minimal response to diuretics
TACO: fluid overload –> no fever; HTN; JVP changed; S3 present; decreased EF; significant improvement with diuretics
What is the main similarities between TACO & TRALI?
Acute dyspnea
Rales
bil infiltrates
What are the S/S of Delayed nonimmunologic transfusion-induced hemosiderosis reaction? Tx?
S/S: subclinical to death
Tx: decrease frequency of iron infusions; iron chelation therapy, neocytes
This is iron overload which is not common
Describe Hemorrhage Class I
Blood loss: 750ml/15%
Pulse: <100
BP: Normal
PP: normal/increased
RR: 14–20
UO: >30
Mental: slightly anxious
Fluid replacement: crystalloid
Describe Hemorrhage Class II
Blood loss: 750–1500/15-30%
Pulse: >100
BP: normal
PP: decreased
RR: 20-30
UO: 20–30
Mental: mildly anxious
Fluid replacement: crystalloids
Describe Hemorrhage Class III
Blood loss: 1500–2000/30-40%
Pulse: >120
BP: decreased
PP: decreased
RR: 30–40
UO: 5–15
Mental: anxious, confused
Fluid replacement: blood & crystalloids
Describe Hemorrhage Class IV
Blood loss: >2000 or >40%
Pulse: >140
BP: decreased
PP: decreased
RR: >35
UO: negligible
Mental: confused, lethargic
Fluid replacement: blood & crystalloids
What is the definition of MTP?
Massive transfusion protocol
Adults:
1. Total volume replaced in 24hr.
2. 50% of total blood volume replaced in 3hr.
3. 4u of PRBCs transfused in 4 hrs
4. 150ml/min blood loss
Children: >40ml/kg transfusion
What is the standard of care in MTP? Why?
1:1:1
platelets:plasma:PRBC
Trying to reconstitute WB
With blood component therapy, what are some issues we run into?
-hbg/platelets less functional
-less clotting factors
-multiple donors –> risk for infection/immune response
-dilute blood dt additives for storage
Overall it takes more volume w/ separate components to equate to WB and even then, the components altogether still have less platelets and functionality.
What is a normal Hgb:Hct ratio
1:3
Why is WB superior to component therapy?
-less dilution from additives (1u WB = 570 & 1:1:1= 660)
-higher platelet count (200 vs 88)
-higher coagulation factors (90 vs 65%)
What blood component has the highest fibrinogen level levels? What are the fibrinogen levels in blood components?
Cryo: 2500mg
LTOWB: 1000mg
FFP: 400mg
Stored whole blood contains a ______amount of anticoagulants
smaller
SWB =
Stored whole blood
SWB is stored at a temp of ________ and maintains hemostatic capability for __________
2-6 degrees C
14-21 days
How long can SWB be stored? What happens after this time?
21-35 days
After 5 weeks the functionality decreases (some places will separate the components)
Where were WB programs started?
TX
Rh____ is the product of choice for males
Rh+
With WB programs, how long will units remain as LTOWB? What happens to the units after?
21 days – during this time used for potential MTP
After 21 days – used for other needs
What is the recommendations for WB in pediatrics?
Age <15 or wt <40kg:
limit WB to 30 ml/kg
What pediatric population gets alot of WB?
CV Sx
For blood values we look at _______ Ca. Why?
ionized Ca
Too many other factors affect serum Ca like bone/albumin
We have to give ____Ca++ gluconate to equate to Ca++ chloride. What are the values of this?
3x
Ca++ gluconate 10%: 90mg/10ml
Ca++ chloride 10%: 270mg/10ml
How does Ca++ affect the clotting cascade?
Required by F II, VII, IX, X, and Proteins C & S
Stabilizes Fibrinogen & platelets in forming thrombus
Ca++ ______ myocardial contractility & BP
increases
Ca++ counters the effects of ________ in acidosis
hyperkalemia
When should you start replacing Ca+ when giving blood?
After 1 unit or if you even anticipate MTP
What is the Triad of Death?
Lethal triad in trauma:
1. hypothermia
2. acidosis
3. coagulopathy
Citrate is metabolized in the _____
liver
What is the 1st organ that takes a hit during shock?
liver
Ca++ gluconate is _____ likely to cause tissue necrosis if extravasated vs chloride
less
Hypocalcemia = _______ mortality
Increased
What is viscoelastic testing used for? What are the tests called?
To see pt clotting ability in real time
TEG
ROTEM
TEG interpretion/value: R
Reaction time: 5.0 - 10.0 minutes
Most important
How long the clot is exposed to whatever until it starts forming
What is the most important TEG value?
R
Reaction time
TEG interpretion/value: K
Firmness: 1.0 - 3.0 minutes
How long it takes for clot to reach a certain firmness
TEG interpretion/value: Angle
angle: 53.0 - 72.0 degrees
Kinetics of clot development of that firmness
TEG interpretion/value: MA
Maximum amplitude: 50.0 - 70.0 mm
How strong the clot gets
TEG interpretion/value: LY30
Lysis 30 mins: 0 - 3%
% of clot lysis after 30 minutes
TEG interpretion/Tx: Prolonged R
Give FFP or PCC
TEG interpretion/Tx: low MA
Check FF
If FF low –> give cryo
If FF normal –> give platelets (or platelet mapping low)
TEG interpretion/Tx: LY30/60 high
Give TXA
What is the purpose to TEG and other viscoelascity testing?
Give pt exactly what they need –> decreases volume to prevent overload & decrease risk of infection/immune response
TEG interpretion/value: TEG-ACT
80 - 140 secs
actiavted clottng time
TEG interpretion/value: G
5.3 - 12.4 dynes/cm2
Calculated value of clot strength of the entire clotting cascade
TEG interpretion/Tx: TEG-ACT >140
Give FFP
TEG interpretion/Tx: K >3
Give cryo
TEG interpretion/Tx: Angle <53
Cryo and/or platelets
