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NURS 671 - Intro to Anesthesia > Blood Products & Transfusions > Flashcards

Blood Products & Transfusions Flashcards

1
Q

What are the limitations for blood donors?

A

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

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2
Q

What is special about AB blood type?

A
  • universal plasma donor
  • Universal blood recipient
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3
Q

What diseases are required to be tested in blood products?

A

Hep B & C
HIV
Syphilis
human T-lymphotropic virus (HTLV)
West Nile Virus
Zika virus
and Chagas disease for first time donors

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4
Q

What are the biochemical stored in blood?

A

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

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5
Q

What happen to RBC during storage?

A

RBCs metabolized glucose to lactate
Hydrogen ions accumulate
pH decreases
Increases oxidative damage to lipids and proteins

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6
Q

What happen to RBCs as the length of storage increased? (>35 days)

A

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

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7
Q

NS or LR?

A

Lactate is not recommended as diluent or carrier for RBCs due to Calcium in LR can increase clotting

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8
Q

Calculate maximal allowable blood loss (Nagelhout)

A

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%

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9
Q

Estimated volume of blood loss

A

Surgical sponge = 10ml
Laparotomy sponge = 100 -150ml of blood

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10
Q

what is the reason to give RBC?

A

-to increase O2 carrying capacity
-to improve hemoglobin

**Use restrictive strategy Hb <7-8g/dL

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11
Q

what are the key aspects of patient blood management (PBM)?

A

1) optimization of patient’s RBC production
2) minimize blood loss
3) treatment of anemia

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12
Q

How does erythropoietin affect RBCs?

A

-Erythropoietin is a hormone RBCs use in production, excreted by kidneys.
Anemic patients might be benefit from erythropoietin administration pre-op

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13
Q

When to give Tranexamic acid?

A

When significant amount of blood loss is anticipated

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14
Q

What is preop autologous donation?

A

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

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15
Q

What is acute normovolemic hemodilution (ANH)?

A

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

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16
Q

What is cell salvage?

A

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

17
Q

RBCs and recommend replacement

A

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

18
Q

What is the recommended blood products ratio for MTP?

A

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

19
Q

Platelets and transfusion guides

A

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)

20
Q

FFP

A

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)

21
Q

What coagulation factors are contained in FFP?

A

factor 5 and 8

22
Q

what does cryoprecipitate have?

A

Nagelhout: Factor 1 (Fibrinogen), 8, vWF, and fibronectin

Miller: factor 5 and 13 as well

23
Q

What are the treatments for TRALI?

A

D/c transfusion, Ventilatory and hemodynamic support

24
Q

What are the symptoms of TRALI?

A

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)

25
Q

Treatments for TACO

A

-O2
-diuresis
-ventilatory support

26
Q

What are s/sx of TACO?

A

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

27
Q

What are s/sx of hemolytic reactions related to blood product transfusion?

A

-Under anesthesia s/sx: unexplained HypOtension, hemoglobinuria, or tendency to bleed (DIC)

28
Q

what are the treatments for hemolytic reactions related to blood transfusion?

A
  1. D/C transfusion
  2. IV fluids
  3. FP
  4. Platelets
  5. Cryo
29
Q

Who are the most at least for hemolytic reactions related to blood transfusion?

A

-Obstetric patients
-Those who had blood transfusion prior (basically everyone)

30
Q

What are the s/sx of allergic reactions related to blood transfusion?

A

-urticaria
-erythema

31
Q

What is the treatment for allergic reaction?

A

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

32
Q

Recommended dose for cryo

A

1 unit for every 10 kg of body weight
1 unit increased 50mg/dL in plasma fibrinogen

NURS 671 - Intro to Anesthesia (8 decks)

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