Blood Products & Transfusions Flashcards
What are the limitations for blood donors?
In the U.S., age >16 yo, 110lbs
Hb level cut off 13g/dL for men
Hb levels cut off 12.5 g/dL for women
What is special about AB positive blood type?
- universal plasma donor
- Universal blood recipient
What diseases are required to be tested in blood products?
Hep B & C
HIV
Syphilis
human T-lymphotropic virus (HTLV)
West Nile Virus
Zika virus
and Chagas disease for first time donors
What are the biochemical stored in blood?
1) Citrate-binds to calcium to prevent clotting
2) phosphate is a buffer
3) Dextrose is RBC’s energy source-allowing glycolysis and maintain ATP
4) Adenine prolongs RBC’s life span 21-35 days, allowing RBC to resynthesize ATP for fuel use
What happen to RBC during storage?
RBCs metabolized glucose to lactate
Hydrogen ions accumulate
pH decreases
Increases oxidative damage to lipids and proteins
What happen to RBCs as the length of storage increased? (>35 days)
1) elevated potassium
2) decreases in RBCs concentration of ATP
3) Decreases NO
4) decreases 2,3-DPG (oxyhemoglobin association curve shift to the left = love to hold on to O2, less O2 in the tissue)
**Blood can be stored up to 42 days
NS or LR?
Lactate is not recommended as diluent or carrier for RBCs due to Calcium in LR can increase clotting
Calculate maximal allowable blood loss (Nagelhout)
MABL = EBV x (initial Hct/Hb - acceptable Hct/Hb) / Initial Hct
EBV
Premature infant at birth 90-105ml/kg
Full term infant 80-90ml/kg
Infants <3 months 70-75ml/kg
Male 70ml/kg
Female 65ml/kg
Obese lean body wt + 20%
Estimated volume of blood loss
Surgical sponge = 10ml
Laparotomy sponge = 100 -150ml of blood
what is the reason to give RBC?
-to increase O2 carrying capacity
-to improve hemoglobin
**Use restrictive strategy Hb <7-8g/dL
what are the key aspects of patient blood management (PBM)?
1) optimization of patient’s RBC production
2) minimize blood loss
3) treatment of anemia
How does erythropoietin affect RBCs?
-Erythropoietin is a hormone RBCs use in production, excreted by kidneys.
Anemic patients might be benefit from erythropoietin administration pre-op
When to give Tranexamic acid?
When significant amount of blood loss is anticipated
What is preop autologous donation?
Blood collected before surgery, 48-72 hours prior, give iron supplement to maintain erythropoiesis
Contraindicated: preexisting anemia, cyanotic heart disease, ischemic heart disease, aortic stenosis, and uncontrolled HTN
What is acute normovolemic hemodilution (ANH)?
Whole blood is collected and stored in OR
Crystalloid or colloid replaced.
Blood will be returned to the patient when surgery ended
Goal: achieve Hct 20%
Contraindications: MI, organ dysfunction that rely on stable Hb and Hct
What is cell salvage?
Collection of blood from the surgical field via suction or drains that will be filtered, washed, and returned to the patient
Advantages: low cost, acceptable therapy for Jehovah witnesses
Contraindication: sepsis, cancerous surgery
RBCs and recommend replacement
store up to 42 days
1 unit RBCs will increase 1g/dL Hgb and Hct 2-3%
Recommend:
adults: 1 ml for every 2 ml of blood loss
Peds: 10-15ml/kg
infants: 15ml/kg
What is the recommended blood products ratio for MTP?
plasma: RBCs 1:1 or 1:2
Platelet: RBC 1:6
**When pt’s hx of transfusion is unclear and needs emergent transfusion for FEMALE of childbearing years, blood products type 0 Rh (-) will be given to reduce hemolytic reaction
Platelets and transfusion guides
1 unit of PLts increased pLt counts 5000 - 10000mm3
-Recommend 1 unit for every 10 kg of body wt
It does not need to be ABO compatible, but incompatibility reduces life span of platelets due to hemolysis
store at room temperature up to 7 days–> 3rd leading cause of transfusion-related death due to bacterial contamination (Miller)
FFP
1 unit contains 200-250ml, last up to 1 years frozen, have to use within 24hours after thawed, factor 5 and 8 will declined
contains all factors except factor 3 (tissue factor) and 4 (calcium)
What coagulation factors are contained in FFP?
contains all procoagulant factors (except 3 and 4)
what does cryoprecipitate have?
Nagelhout: Factor 1 (Fibrinogen), 8, vWF, and fibronectin
Miller: factor 5 and 13 as well
What are the treatments for TRALI?
D/c transfusion, Ventilatory and hemodynamic support
What are the symptoms of TRALI?
Miller’s
-onset 6 hours after transfusion
-hypoxemia with P/F <300mmHg
-SpO2 <90% on RA
-CXR shows bilateral infiltrates without Left atrial hypertension (circulatory overload)
Nagelhout’s
-acute lung injury within 6 hours after blood transfusion
-hypoxemia/acute respiratory distress
-increased peak airways
-FEVER (different from TACO)
-hypotension (different from TACO)
Treatments for TACO
-Supportive
- d/c transfusion
- supplemental O2
- fluid mobilization with diuresis
-ventilatory support
What are s/sx of TACO?
Miller’s
-New onset within 6 hours after transfusion
-acute respiratory distress
-elevated BNP
-elevated CVP
-LV failure
-CXR shows pulmonary edema
Nagelhout’s
-Hypertension or hypotension and shock
-hypoxia
-tachycardia
-widen pulse pressure
-jugular vein distension
-rales/wheezing
What are s/sx of hemolytic reactions related to blood product transfusion?
-Under anesthesia s/sx: unexplained HypOtension, hemoglobinuria, or tendency to bleed (DIC)
what are the treatments for hemolytic reactions related to blood transfusion?
- D/C transfusion give mannitol, lassie
- IV fluids (NS)
- FFP, PLTs, Cryo - can help counteract coagulopathies
- hemodynamic support
Who are the most at least for hemolytic reactions related to blood transfusion?
-Obstetric patients
-Those who had blood transfusion prior (basically everyone)
What are the s/sx of allergic reactions related to blood transfusion?
-urticaria
-erythema
What is the treatment for allergic reaction?
Benadryl - antihistamine because allergic reactions happen d/t IgE antibodies from patient reacted to donor’s proteins
*If patient had anaphylactic reaction to blood transfusion before, WASHED blood to remove IgA
Recommended dose for cryo
1 unit for every 10 kg of body weight
1 unit increased 50mg/dL in plasma fibrinogen
What is the transfusion threshold?
A) 8 g/dL
B) 7 g/dL
C) 9 g/dL
D) 10 g/dL
B) 7 g/dL (but almost always at 6)
What are key aspects of patient blood managment
- optimization of pt’s RBC production
- minimization of blood loss
- treatment of anemia
We have oxygen in two forms. Dissolved oxygen is in
A) chemical form
B) molecule form
C) physical form
D) none of the above
C) physical form
CaO2 = (SaO2xHbx1.34) + 0.03(PaO2)
where SaO2xhbx1.34 is bound oxygen
0.03(PaO2) is dissolved oxygen
We have oxygen in two forms hemoglobin-bound is in
A) chemical form
B) molecule form
C) physical form
D) none of the above
A) chemical form
Hemoglobin-bound is in chemical form which is most important and significantly more bound than dissolved oxygen.
CaO2 = (SaO2xHbx1.34) + 0.03(PaO2)
where SaO2xhbx1.34 is bound oxygen
0.03(PaO2) is dissolved oxygen
What can you give to reverse anticoagulants (select all that apply)
A) warfarin
B) vit K
C) fibrinogen
D) Heparin
E) Recombinant factor VII
D) prothrombine complex concentrate (PCC)
B, E, D
Vit K, Recombinant factor VII, PCC, and FFP can all be given to reverse anticoagulants
Which are antifibrinolytics (select 2)
A) ADP
B) Transexamic Acid
C) Aminocaproic acid
D) prostacyclin
E) Thrombaxane A2
F) NO
B) Transexamic Acid
C) Aminocaproic acid
In preoperative autologous transfusion (PAD)
A) pt blood is collected after induction and replaced with crystalloids or colloids then rein fused at end of sx or when hemostasis is achieved
B) Collected blood from sx field or drains is filtered/washed and rein fused to patient
C) Pt blood collected prior to sx (48-72 days prior)
D) Donor blood is collected 5 days prior to procedure and saved for pt
A) pt blood is collected after induction and replaced with crystalloids or colloids then rein fused at end of sx or when hemostasis is achieved
In Directed Donor Transfusions
A) pt blood is collected after induction and replaced with crystalloids or colloids then rein fused at end of sx or when hemostasis is achieved
B) Collected blood from sx field or drains is filtered/washed and rein fused to patient
C) Pt blood collected prior to sx (48-72 days prior)
D) Donor blood is collected 5 days prior to procedure and saved for pt
D) Donor blood is collected 5 days prior to procedure and saved for pt
In Intraoperative & Postoperative acute normovolemic hemodilution (ANH)
A) pt blood is collected after induction and replaced with crystalloids or colloids then rein fused at end of sx or when hemostasis is achieved
B) Collected blood from sx field or drains is filtered/washed and rein fused to patient
C) Pt blood collected prior to sx (48-72 days prior)
D) Donor blood is collected 5 days prior to procedure and saved for pt
C) Pt blood collected prior to sx (48-72 days prior)
In cell saver,
A) pt blood is collected after induction and replaced with crystalloids or colloids then rein fused at end of sx or when hemostasis is achieved
B) Collected blood from sx field or drains is filtered/washed and rein fused to patient
C) Pt blood collected prior to sx (48-72 days prior)
D) Donor blood is collected 5 days prior to procedure and saved for pt
B) Collected blood from sx field or drains is filtered/washed and rein fused to patient
When is cell saver contraindicated
Sepsis or cancerous surgical procedures
Prolonged use of cell saver can result in dilution of clotting factors and thrombocytopenia. T/F
True
Define Typing of blood
A) test transfusion for any adverse reaction
B) checks for any other known antibodies
C) determines ABO type
D) entered data for blood bank
C) determines ABO type
Define screening of blood
A) test transfusion for any adverse reaction
B) checks for any other known antibodies
C) determines ABO type
D) entered data for blood bank
B) checks for any other known antibodies
Define Crossmatch of blood
A) test transfusion for any adverse reaction
B) checks for any other known antibodies
C) determines ABO type
D) entered data for blood bank
A) test transfusion for any adverse reaction
During emergency transfusion who can get O + blood?
A) women of childbearing years
B) women and men of non-childbearing years
C) both
D) none
B) women and men of non-childbearing years
During emergency transfusion who can get O - blood?
A) women of childbearing years
B) women and men of non-childbearing years
C) both
D) none
A) women of childbearing years
OR –> if uncertain of pt’s transfusion history
Massive Transfusion is defined as
- 10 units of PRBCs over 24 hrs
- Loss of one blood volume
- Transfusion > 5 units of PRBCs in 4 hours
Which do not contain coagulations factors (select all that apply)
A) cryo
B) FFP
C) PRBc
D) whole blood
E) crystalloids
D) colloids
F) Vlll concentrate
C, E, D
Crystalloids, colloids, and PRBCs do not contain coagulation factors and cause “dilutional coagulopathy”
What is the ratio of RBC/Plasma you can administer to a patient? (select 2)
A) 3:1
B) 1:3
C) 1:1
D) 1:2
C) 1:1
D) 1:2
Note, for every 6 units of RBCs, give 1PLT (single donor or apheresis)
1 unit of PRBCs will increase the HCT and Hgb by what amount?
1 PRBC unit = increase HCT 2-3% and Hgb 1g/dL
Banked blood is good for
A) 4-5 days
B) 1 year
C) 42 days
D) 7-10 days
C) 42 days (can range between 40-45)
Note if frozen, can be good for up to 1 year
PLTs are good for
A) 4-5 days
B) 1 year
C) 42 days
D) 7-10 days
A) 4-5 days and are stored at room temperature
PLTs are highest for risk of infection due to medium at room temperature
FFP is good for
A) 4-5 days
B) 1 year
C) 42 days
D) 7-10 days
B) 1 year frozen
Cryo is good for
A) 4-5 days
B) 1 year
C) 42 days
D) 7-10 days
C) 1 year frozen
PLT transfusion treats
Thrombocytopenia and abnormal function
What is the recommended dose for PLT administration
1 PLT per 10Kg BW
PLT transfusion will increase PLT count by how much
A) 5-10K
B) 10-15K
C) 15-20K
D) 20-25K
B) 10-15K
Note: PLT level increases for 6-7 days and then slightly less than the lifetime of PLTs (which is 10-12 days)
Indications for PLT transfusion
Bleeding due to low PLT
PLT dysfunction
PLT < 20K
Aplasia/Neoplasia resulting in low PLT
TTP, DIC
Increased PLT destruction (ITP, Hypersplenism)
Replacing depleted coag factors
When is FFP not indicated
A) INR < 2
B) INR < 3
C) INR < 4
D) INR < 5
A) INR < 2 (in absence of active bleeding)
T/F. Prior to giving FFP you have to check ABO compatibility and Rh
False.
ABO compatibility is required, but Rh is not required. You can check for Rh, but not really necessary
Major distinction between TACO and TRALI
A) HR and RR
B) HoTN and Fever
C) HTN and Fever
D) Hypoxemia and Edema
B) HotN and Fever
TRALI will always have HYPOTENSION & FEVER.
TRALI occurs WITHIN 6 hrs after admin
TACO is almost always HTN but sometimes can have HoTN.
TACO occurs 6-12hrs after admin
More likely to see TRALI in OR and TACO in ICU
