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Basics > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

Blood contains

A

RBC, WBC, and platelets suspended in plasma

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2
Q

Plasma

A

contains proteins such as albumin, globulin, and fibrinogen

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3
Q

Fractionation of blood

A

process by which the blood is separated into compartments

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4
Q

Changes in banked blood

A 
depletion of 2,3 DPG
acidosis
altered RBC morphology
hyperkalemia
absence of viable platelets 
absence of facots 5 and 8 (clotting factors)
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5
Q

blood is how many times more viscous than H2O

A

3x due to RNC conc.

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6
Q

increase in Hct btw 60-70% =

A

10 fold increase in viscosity

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7
Q

changes in P50 and Sa O2

A

dont alter viscosity

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8
Q

1 unit whole blood or RBC will raise Hgb

A

1g/dL

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9
Q

Transfusion indicated when

A

Hgb 10 - rarely indicated

btw 6-10 look at other factors

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10
Q

antigens

A
  • in RBC membrane
  • determine blood type
  • Specific RBC antigens are inherited and used for ABO and RH compatibility
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11
Q

Antibodies

A
  • may occur naturally or in response to sensitization

- found in serum

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12
Q

Rh positive

A

has the D antigen

- in cell membrane

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13
Q

Universal recipient

A

AB

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14
Q

Universal donor

A

O

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15
Q

ABO/Rh typing

A

most important test.

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16
Q

Type and screen

A

recipient and donor blood is typed and screened for major antibodies
- 99.94% reliable

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17
Q

type and crossmatch

A

a trial transfusion

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18
Q

blood compatibility

- Type A

A
  • antigen on RBC - A
  • antibodies in serum- Anti B
  • blood group compatibility- A, O
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19
Q

blood compatibility

- TYpe B

A
  • antigen on RBC - B
  • antibodies in serum- Anti A
  • blood group compatibility- B. O
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20
Q

blood compatibility

- Type AB

A
  • antigen on RBC - A and B
  • antibodies in serum- none
  • blood group compatibility- AB, A, B, O
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21
Q

blood compatibility

- Type O

A
  • antigen on RBC - none
  • antibodies in serum- Anti A and Anti B
  • blood group compatibility- O
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22
Q

blood compatibility

- Rh positive

A
  • antigen on RBC - D
  • antibodies in serum- none
  • blood group compatibility- Rh positive and Rh negative
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23
Q

blood compatibility

- Rh negative

A
  • antigen on RBC - none
  • antibodies in serum- Anti D if sensitized
  • blood group compatibility- Rh negative
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24
Q

MTP

A

replacement of estimated blood volume in 24 hours, 50% in 3 hours or 10 units of blood

25
Q

problems with MTP

A
  • dilutional coagulopathy - most common
  • dilutional thrombocytopenia
  • citrate intoxification
26
Q

most commonly used blood preservative/ anticoagulant?

A

citrate - binds to Ca

  • phosphate - buffer
  • dextrose - energy source
  • adenine - precursor for ATP
27
Q

FFP indicated for reversal of.

A

warfarin

28
Q

Cryo

A

contains factor 8, fibrinogen, fibrinonectin, von willebrands factor and factor 13
- indicated with hemophilia A

29
Q

Cryo is derived from

A

a fraction of plasma that precipitates when FFP is thawed at 4 degrees C

30
Q

All blood should be administered

A

through micron filter. changed Q2-4 units

- 170 micron filter allows platelets to pass.

31
Q

Microaggregate filter

A

have 40 micron pore and will remove platelets, small aggregates and fibrin strands

32
Q

Microaggregates of platelets and leukocytes

A

accumulate in whole blood after 3-5 days storage.

33
Q

RBC reconstituted with

A

NS - No Calcium to cause coagulation

34
Q

COmplications of transfusion

A
  • procedural or admin error
  • transfusion related acute lung injury (TRALI)
  • Immuno- suppression (TRIM)
  • bacterial contamination - plt store at room temp
  • viral infection
35
Q

TRALI

A

leading cause of morbidity and mortaility

  • occurs within 6 hours of transfusion
  • Antibodies nad white cells cause capillary membrane to leak into alveoli
36
Q

TRIM

A

ppl have increased risk of infection and CA. WBC in donor causes immune suppression
- decrease by washing an filtering. Leukocyte reduced.

37
Q

Viral infections

A

look for antibodies, blood may be infectious but no antibodies formed yet. made in 8-11 days

38
Q

Alternatives to homologous blood transfusion

A
  • autologous
  • blood salvage and reinfusion
  • designated donor
  • acute normovolemic hemodilution
39
Q

autologous

A

take blood from pt preop, store and have for surgery.

  • can have clerigical error and get wrong blood
  • contaminated while stored
40
Q

blood salvage and reinfusion

A

cell saver - filter blood platelets and proteins and pt gets RBC back

41
Q

Designated donor

A

not common

- friend or family donates, no advantage blood can still be contaminated

42
Q
  • acute normovolemic hemodilution
A
  • withdrawl of blood immediately before or after induction with volume replacement
  • HCt maintained 21-25%
  • blood can remain at room temp for 6 hours before re-infusion
  • advantage- includes no biochemical changes associated with storage
  • considered in pts expected to lose > 2units
43
Q

Advantages of ANH

A
  • no transmission of disease
  • no transfusion reaction
  • avoidance of immunomodulatory effects
  • preservation of platelet function
  • avoidance of hypothermia
  • potential for improved perfusion due to low HCT
  • said to be simpler, less risk of bacteremia than pre donation
44
Q

ANH is contraindicated in…

A
  • anemia
  • poor renal function
  • CAD
  • Carotid disease
  • pulmonary disease
  • liver disease
  • poor vascular access
45
Q

ANH main complications

A

MI and cerebral hypoxia

46
Q

estimating blood loss

A
  • volume in suction minus irrigation
  • volume on drapes
  • sponges
  • observed volume on floor
47
Q

Blood loss

4x4 sponges

A

10cc blood if fully soaked

48
Q

Blood loss

large laparotomy sponges

A

100-150cc blood if fully soaked

49
Q

blood volume =

A

70ml/kg in adults

50
Q

calculation of MABL

A

( Hct start - Hct allowed) x BV

divided by HCt start

51
Q

Blood volume replacements

crystalloids

A

3cc/1cc EBL

52
Q

Blood volume replacements

colloid

A

1cc/1cc EBL

53
Q

Blood volume replacements

whole blood

A

1cc/1cc EBL

54
Q

Blood volume replacements

PRBC

A

0.5cc/1cc EBL

55
Q

Whole blood

A

good for OB hemorrhage

56
Q

2 stages resuscitation and treatment

A
  • resuscitation, transfuse per clinical signs

- treatment- DIC, tranfuse per lab parameters

57
Q

Supportive measures

A
  • bair hugger

- correct metabolic acidosis

58
Q

Recombinant activated factor VII

A

approved for DIC

  • dangerous but potentially life saving
  • massive thrombotic event could happen and kill pt

Basics (9 decks)

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