Blood transfusion and ABG Flashcards
what are the indications for red blood cell transfusion (4)
Hb <70: Target 70 to 90 post transfusion
Hb <80 and symptomatic: Target 80 to 100 post transfusion
Hb<80 in ACS: Target 90-100 post transfusion
Suspected major haemorrhage with signs of shock
samples for blood transfusions go in what colour bottles
pink
antibodies
what does a group and save check
checks ABO group and for anti A and B antibodies
takes 30 mins
uesful for elective surgeries, if unlikely to bleed and will speed up cross match
what is a cross match
same as GandS but donor samples check with patient samples for potential reactions
occurs in 60-90 mins
taken if severe bleeding
how long can blood be out of the fridge before it must be returned
30mins
how long can blood be out the fridge before the transfusion must be completed
4 hours
when do you consider iron replacement
Consider if low MCV and low ferritin
stable post op pt
when is transxaemic acid used
Antifibrinolytic used in bleeding patients (major trauma, PV, epistaxis)
what is in the major haemorrhage protocol two packs
Once major haemorrhage protocol is activated via 2222 the blood bank will continually
supply the major haemorrhage pack. What’s in it?
Pack A:
4 units RBC and 4 units FFP
Pack B:
4 units RBC, 4 units FFP and 1 unit platelets
Pack B is continually replaced until the lab is stood down
when to give platelets (4)
Used in bleeding patients or those undergoing procedures with counts <50
Clinically significant bleeding and platelets <30
Platelets <100 with major haemorrhage or bleeding into CNS or eyes
Consider prophylactic use if having invasive surgery and count <50
FFP is used in bleeding pt what is it
Centrifuged plasma that contains clotting factors and albumin
when do you give FFP
Significant bleeding WITHOUT major haemorrhage AND abnormal coagulation
Consider FFP if abnormal coagulation and having invasive surgery
cryoprecipitate is used in DIC what is in it
Similar to FFP but high levels of factor VIII, fibrinogen and von Willebrand Factor
when to give cryoprecipitate (2)
Significant bleeding AND fibrinogen <1.5g/L
Consider prophylactic cryo if fibrinogen <1 and having invasive surgery
by what age to blood antibodies develop
12months
how long does metbaolic ocmpensation tke
3 days minimum
These can help identify chronicity:
Respiratory acidosis without metabolic compensation has occurred within the past 3 days
causes of resp alkalosis
Hyperventilation
Panic attack
Salicylate poisoning
alitude and preg
causes of metabolic alkalosis
Prolonged vomiting
diuretics
hypokalamia
cushings
Gastrointestinal loss of H+ ions (e.g. vomiting, diarrhoea)
Renal loss of H+ ions (e.g. loop and thiazide diuretics, heart failure, nephrotic syndrome, cirrhosis, Conn’s syndrome)
Iatrogenic (e.g. addition of excess alkali such as milk-alkali syndrome)
metabolic acidosis normal anion gap
gastrointestinal bicarbonate loss:
prolonged diarrhoea: may also result in hypokalaemia
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease
respiratory acidosis causes
Hypoventilation
Asthma
Pneumonia
COPD
CNS depressants - benzos and opiates
Guillain-Barre: paralysis leads to an inability to adequately ventilate
absolute contraindications to doing an ABG
peripheral vascular disease in the limb
cellulitis surrounding the site
arteriovenous fistula
relative : impaired coagulation (e.g. anticoagulation therapy, liver disease, low platelets <50).
raised anion gap metabolic acidosis cx
lactate:shock, sepsis, hypoxia
ketones: DKA , alcohol
urate: renal failure
acid poisoning: salicylates, methanol
normal anion gap
10-18
high base excess idnicates what
A high base excess (> +2mmol/L) indicates that there is a higher than normal amount of HCO3– in the blood, which may be due to a primary metabolic alkalosis or a compensated respiratory acidosis.
low base excess indicates what
A low base excess (< -2mmol/L) indicates that there is a lower than normal amount of HCO3– in the blood, suggesting either a primary metabolic acidosis or a compensated respiratory alkalosis.
what does a mixed resp and metabolic alkalosis caused by
A mixed respiratory and metabolic alkalosis would have the following characteristics on an ABG:
↑ pH
↓ CO2
↑ HCO3–
Causes of mixed respiratory and metabolic alkalosis:
Liver cirrhosis in addition to diuretic use
Hyperemesis gravidarum
Excessive ventilation in COPD
