Blood Replacement Therapy Flashcards
What is MBOS and what does it help
Maximum surgical blood ordering schedule
*helps simplify blood bank orders before elective surgeries
What happens if any emergency transfusion is needed
- Type-specific blood (ABO and Rh matched only)
*available in 10 min - If the delay is too long type O, Rh-negative PRBC can be used
- Support BP with colloid or crystalloid until properly cross-matched blood is available
What are the blood banking procedures (type and screen)
- Types pts bloods (ABO and Rh)
- Screens for antibodies
- Holds the blood
What are the blood banking procedures (type and cross)
- T&S on pts blood
- Cross match
*testing the recipients serum against donor blood cells
<1 hr to perform
What is the blood component therapy
- Whole blood
- RBC
- Platelets
- FFP (fresh frozen plasma)
- Cryoprecipitate
What is whole composed of
450-500ml of donor blood
1. Contains RBC, plasma, clotting factors (reduced levels of V, and VIII), and anticoagulant
*platelets and granulocytes are not functional
What are the indications for whole blood
- Red cell replacement in massive blood loos with pronounced hypovolemia
How is PRBC obtained
- Apheresis
- Prepared from whole blood
*centrifuged and plasma, WBC and platelets are removed
What are the indications for PRBC
- Increase oxygen carrying capacity in anemic pts
*hemoglobin of 7 in stable / asymptomatic pts is threshold
What is the therapeutic effect of PRBC
70 kg pt = transfusion of 1 unit of PRBC should increase HgB by 1g/dL (HCT 3%)
How to raise Hct of a 70kg man from 15% to 40% (step 1)
- Calculate the total blood volume
*BV = 7% of body weight (KG)
*0.07 X 70 = 4.9 liters of blood
How to raise Hct of a 70kg man from 15% to 40% (step 2)
1 unit of PRBC contains 200ml of RBC
*4.9 L
*200/4900=4%
How to raise Hct of a 70kg man from 15% to 40% (step 3)
Need a 25% increase from 15% to 40%
*25/4=6.25 or 7 units of PRBC
How much will Hct raise if Hgb is raised by 1g/dL
3%
What is the protocol for massive transfusion protocol
- Monitor coagulation tests, platelets, Mg2+, ca+, and lactate levels
- Transfuse plasma and platelets (in massively hemorrhagic pt)
- PRBC:Plasma units of 1:1
- Citrate is used as a calcium binder
- Warm blood to prevent hypothermia
How are the platelets obtain for blood transfusion
- Apheresis (single donor)
- Random donor pooled (whole blood units)
- Issued one unit at a time
One unit of platelets should increase count by how much
30,000-50,000mm
*within 1 hr of transfusion
What are the indications for transfusion platelets
- Decreased production of destruction (aplastic anemia, acute leukemia)
- Count <5,000-10,000 (risk of hemorrhage must transfuse)
- Count <50,000 if life-threatening bleeding
When is prophylactic transfusion used for platelets
- <50,000 line placement, minor surgery
- <50-75,000 major surgery
How is fresh frozen plasmas obtained by
- Apheresis or centrifuged from whole blood
*frozen within 8 hours of collection - Contains normal levels of all clotting factors, albumin, and fibrinogen
What are the indications for fresh frozen plasma
- Emergency reversal of warfarin if Kcentra is unavailable
- Replacement of coagulation factor in patients with deficiencies of multiple clotting factors
What is cryoprecipitate
Cold-insoluble precipitate formed when FFP is thawed
1. Contains more fibrinogen, factors VIII, vWF, and XIII than initial FFP
What are the indications for cryoprecipitate
- Correction of hypofibrinogenemia and dysfibrinogenemia of liver disease
- DIC
- Massive blood loss
What are the indications of blood component therapy
- Decrease in RBC mass compromising tissue perfusion and O2 delivery
- Transfusion done to maintain RBC mass
- Goal = minimum HgB of 10 and Hct of 30
