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Health Assessment > Blood Transfusion and Blood Products (Exam 2) > Flashcards

Blood Transfusion and Blood Products (Exam 2) Flashcards

1
Q

What is the Composition of Blood?

A
  • Plasma 55%
  • Formed Elements 45% ( platelets, leukocytes, erthrocytes)
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2
Q

What Blood type is the Universal Donor? What Blood type is the Universal acceptor/recipient?

A
  • Donor: O negative
  • Recipitent: AB postive
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3
Q

How many varieties of Hemoglobin structures are there?

A
  • Many per Dr Cornelius
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4
Q

Name the Blood Type Antigens.

A
  • Antigens: A, B, AB, O
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5
Q

What are the normal blood type Rh factors and their percentages?

A
  • Rh+ = ~85%
  • Rh- = ~15%
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6
Q

What is the largest component of whole blood?

A

Plasma

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7
Q

What is the Primary job of the Red blood cell?

A
  • Oxygen transportation
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8
Q

What is a common cause of hypoxia?

A
  • Anemia
  • Not enough red blood cells to transport oxygen.
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9
Q

Blood Type O: Erythrocyte Antigens and Serum Antigens

A
  • Erythrocyte: None
  • Serum: Anti A&B
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10
Q

Blood Type AB: Erythrocyte Antigens and Serum Antigens

A
  • Erythrocyte:A&B
  • Serum: none
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11
Q

Blood Type B: Erythrocyte Antigens and Serum Antigens

A
  • Erythrocyte: B
  • Serum: Anti A
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12
Q

Blood Type A: Erythrocyte Antigens and Serum Antigens

A
  • Erythrocyte: A
  • Serum: Anti-B
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13
Q

Blood Compatibility

A
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14
Q

Whole Blood Transfusion: Contents and Uses

A
  • All cells, platelets, clotting factors and plasma
  • Uses: replace blood loss from hemorrhage
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15
Q

Packed Red Blood Cell Transfusion: Content and Uses

A
  • Content: Red blood cells and some plasma
  • Uses: Replace red blood cells in anemic patients.
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16
Q

Platelet Transfusion: Contents and Uses

A
  • Contents: Thrombocytes and some plasma
  • Uses: replace platelets in patients with thrombocytopenia
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17
Q

Fresh Frozen Plasma (FFP) Transfusion: Contents and Use

A
  • Content: plasma, combination of fluids, clotting factors, and proteins
  • Uses: Replace volume in a burn patient or hypovolemic
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18
Q

Clotting Transfusion: Contents and Uses

A
  • Contents: Specific clotting factors needed for coagulation
  • Uses: Replace factors missing due to inadequate production as in hemophilia
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19
Q

What is the specific gravity of RBC?

A

1.08 - 1.09

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20
Q

What is the Specific Gravity of Platelets?

A

1.03 - 1.04

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21
Q

If you centrifuge whole blood what layers will everything settle into (top to bottom)?

A
  • Platelet Rich Plasma
  • WBC
  • RBC
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22
Q

What component of blood is used in localized surgical applications – ortho, dental, plastics?

A
  • Platelet Rich Plasma
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23
Q

What are the (5) Blood Component Therapies?

A
  • RBC
  • FFP
  • Cryo
  • Plt
  • LTOWB - Low Titer O Whole Blood
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24
Q

What was the blood transfusion of choice from WWI –> Vietnam War?

A
  • Whole Blood
  • Primary resuscitation fluid in military settings.
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25
Q

What was the blood transfusion of choice from 1970s –> 1990s?

A
  • Component therapy
  • Reduced waste + increased storage times
  • Worried about infectious disease
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26
Q

What was the blood transfusion of choice for Iraq and Afghanistan?

A
  • Fresh Whole Blood
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27
Q

What is the shelf-life for whole blood?

A

3 - 5 weeks

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28
Q

What is added to blood for shelf storage?

A

* Citrated - clotting
* Phosphate - buffer
* dextrose - fuel source
* Adenine – synthesis ATP

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29
Q

What happens to blood the longer it is stored?

A
  • lowers levels of 2,3 -DPG
  • shifting the oxyhemoglobin dissociation curve to the left
  • impairs oxygen delivery
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30
Q

What is the difference between PRBC and Whole Blood?

A
  • Plasma has been removed in PRBC
  • PRBC does not contain functional platelets or granulocytes
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31
Q

How much Plasma has been removed from Whole Blood to create Packed Red Blood Cell?

A
  • 200 -250 ml of plasma
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32
Q

What does 1 unit of PRBC raise your Hgb and Hct?

**

A
  • Hbg: 1 g/dL
  • Hct: 30%
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33
Q

What has a better oxygen carrying capacity: Whole blood or PRBC?

A

They are the same for oxygen carry capacity.

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34
Q

What blood product is a source of antithrombin III?

A

Fresh Frozen Plasma

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35
Q

What does 1 unit of FFP do to your clotting factors?

A
  • Increases each clotting factor by 2-3 % in adults.
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36
Q

What is the dose of FFP and what is the volume in a bag of FFP?

A
  • 10 - 15 ml/kg
  • 200-250 ml/bag
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37
Q

What is the storage temperature for FFP and what does it contain?

A
  • -18 C
  • water, carbohydrates, fat, minerals,
  • Proteins (labile and stable clotting factors)
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38
Q

What is used as the guide to infusing FFP?

A
  • INR > 1.5
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39
Q

Indications for Use of FFP

A
  • inherited factor deficencies
  • multifactor deficiencies w/ bleeding
  • liver dysfunction
  • DIC
  • MTP
  • Reversal of Vitamin K anatagonists
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40
Q

Cryprecipitate

A
  • Expensive
  • Protein fraction taken off the top of FFB when thawed
  • Refrozen for up to 1 year
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41
Q

Cryoprecipitate Contains:

A
  • Factor VIII: C
  • Factor III: vWF
  • Factor XIII
    * Fibrinogen
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42
Q

Indication for the Use of Cryoprecipitate?

A
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43
Q

How much does 1 unit of Platelets increase platelet count?

A
  • 1 unit increases platelets 5,000-10,000
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44
Q

What blood product should you not infuse through a warmer?

A

Platelets

45
Q

When should blood products be infused through a warmer?

A
  • Transfused at rapid rates > 100 mL/min
  • MTP/Rapid infusion
  • When pt is hypothermic or any drop in temp could cause hypothermia.
46
Q

Indications for Platelet infusion.

A
  • < 10,000 - 30,000
  • < 50,000 for arterial line
  • < 70,000 for epidural
47
Q

What is the IV fluid of choice for infusing blood products?

A
  • Normosol
  • Plasmalyte
  • Normal Saline 0.9%
48
Q

Indicators for Whole Blood Transfusion.

A
  • maintain blood volume
  • O2 carrying capacity
  • acute massive blood loss
  • active bleeding > 20% of body blood volume
49
Q

Acute Transfusion Complications

A
  • immunologic
  • febrile nonhemolytic
  • allergic
  • non-cardiogenic pulmonary
  • nonimmunologic
  • bacterial contamination
  • circulatory overload
  • physical/chemical hemolysis
50
Q

Delayed Blood Transfusion Complications

A
  • immunologic
  • hemolytic
  • transfusion - associate graft vs Host disease
  • Post Transfusion Pupura
  • Transfusion- induced hemosiderosis
  • disease transfusion
51
Q

Hemolytic Transfusion Reaction

A
  • Mediators: IgM A/b (usually ABO), complement.
  • S/S: fever, chill, hemoglobinemia, hemoglobinuria, hypotension, dyspnea.
  • Treatment and Prevention: decrease opportunities for error, treat ARF & DIC.
  • Make sure right pt gets the right blood! —-> be cautious w blood tubes!
52
Q

Nonhemolytic febrile transfusion reaction

A
  • Mediators: A/b to HLA Class I Ag.
  • S/S: fever, chill. (rmbr may not be seen under anesthesia!)
  • Treatment and Prevention: antipyretics, leukocyte reduced.
53
Q

Allergic Transfusion Reactions

A
  • Mediators: plasma proteins (mild), A/B to IgA
  • S/S: uticaria, erytherma, itching, anaphylaxis
  • Treatment/Prevention: Antihistamines, transfuse IgA - deficient components
54
Q

Noncardiogenic Pulmonary Transfusion Reactions

**

A
  • Mediators: donor/recipiet WBC A/B
  • S/S: ARDs, cyanosis, hypotension, Noncardiac pulmonary edema
  • Treatment/Prevention: PEEP, steroids**
55
Q

Transfusion Related Acute Lung Injury (TRALI)

A
  • acute lung injury within 6 hours of transfusion.
  • difficult to diagnose
  • 1: 1300/5000
  • 5-25% mortality
56
Q

Criteria for TRALI

A
  • Acute onset of hypoxemia
  • PaO2/FiO2 ratio: <300 or SPO2 <90 RA
  • B/L diffuse pulmonary infiltrates
  • no evidence of left atrial hypertension (circulatory overload)
57
Q

Name the Disease

A

TRALI

58
Q

TRALI Immediate Management

A

* STOP THE INFUSION
* support the pt
* obtain undiluted edema fluid ASAP (<15 mins)
* CBC and CXR
* Notify Blood bank of possible TRALI

59
Q

What might TRALI patient require to survive?

A

ECMO

60
Q

Blood Transfusion: Acute Nonimmunologic Effects

A
  1. Bacterial Contamination
  2. Circulatory Overload (TACO)
  3. Hemolysis d/t physical/chemical means
61
Q

Blood Transfusion: Bacterial Contamination

A
  • Mediators: Endotoxin produced by Gram Negative Bacteria
  • S/S: fever, shock, hemoglobinuria
  • Treatment/Prevention: IV abx, treat hypotension, DIC
62
Q

Blood Transfusion: Circulatory Overload (TACO)

A
  • Mediate: Fluid Volume
  • S/S: Coughing cyanosis, orthopnea, severe headache, peripheral edema, difficulty breathing
  • Treatment/Prevention: administer susequent Tx slowly and in small volumes.
63
Q

Blood Transfusion: Hemolysis d/t physical/chemical means

A
  • Mediator: exogenous destruction of RBC
    * S/S: hemoglobinuria
  • Treatment/Prevention: document and role out hemolysis d/t other causes; treat DIC
64
Q

Delayed Immunologic Effects: Hemolytic Transfusion Rxn

A
  • Mediator: IgG A/B
    * S/S: Shortened RBC survival, decreased Hbg, fever, jaundice, hemoglobinuria
  • Treatment/Prevention: IG -negative blood for further transfusion
65
Q

Delayed Immunologic Effects: Transfusion Associated Graft v Host Disease

A
  • Mediators: viable donor lymphocytes
  • S/S: fever, skin rash, desquamation, anorexia, nausea/vomiting, pancytopenia
  • Treatment/Prevention: gamma irradiation of cellular components
66
Q

Delayed Immunologic Effects: Post- transfusion purpura

A
  • Mediators: platelet specific A/B
  • S/S:thrombocytopenia, clinical bleeding
  • Treatment/Prevention:IV Ig, plasma exchange, corticosteroids
67
Q

S/S of TRALI

A
  • Fever
  • Hypotension
  • Acute dyspnea
  • JVP unchanged
  • Ascultation - RALES
  • X-ray: diffuse bilateral lower infiltrates
  • EF Normal
  • Minimal response to diuretics
68
Q

S/S: TACO

A
  • No fever
  • Hypertension
  • Acute dyspnea
  • JVP can be changes
  • Rales + S3
  • diffuse bilateral lower infiltrates
  • Decreased EF
  • Significant improvement with diuretics
69
Q

Delayed Nonimmunologic Effects: Transfusion-Induced Hemosiderosis

A
  • MOA: Iron Overload
  • S/S/: subclinical to death
  • Treatment/Prevention: decrease frequency of transfusions, neocytes, iron chelation therapy
70
Q

What Steps do you need to follow if you believe your patient is having a Transfusion Reaction?

A
  1. discontinue the transfusion
  2. Keep the IV open
  3. Check all labels, forms, and pt identification
  4. Report to Blood bank personnel
  5. Send requested blood samples
71
Q

Class 1 Hemorrhage

A
  • blood loss: 750 mL (15%)
  • Fluids: Crystalloid
72
Q

Class 2 Hemorrhage

A
  • blood loss: 750 - 1500 mL (15-30%)
  • Fluid Replacement: Crystalloid
73
Q

Class 3 Hemorrhage

A
  • Blood Loss: 1500-2000 mL (30-40%)
  • Fluid Replacement: Crystalloid and blood
74
Q

Class 4 Hemorrhage

A
  • Blood Loss: >2000 (>40%)
  • Fluid Replacement: Crystalloid and Blood
75
Q

When do we normal start transfusing blood?

A
  • 30% blood loss
  • ~ 1500 mL
76
Q

What is the definition of MTP

A
  • Total blood volume is replaced within 24 hours
77
Q

What is the definition of MTP for Pediatrics?

A
  • > 40 mL/kg transfusion
78
Q

What is the current standard of care ratio of blood products at level 1 trauma centers?

A
  • 1:1:1
  • platelets: plasma: PRB
79
Q

What are the downfalls to Blood component therapy?

A
  • loss of coagulation factor + platelet function
  • Requires more product
  • Dilute blood mixtures
80
Q

Whole blood: Hgb, Hct, Plt, fibrinogen/factors

A
  • Hgb: 12-13
  • Hct: 35-37
  • Plt: 138-165
  • F/F: Normal/>50% d7
81
Q

Component blood (1:1:1): hgb,hct,plt, Fibringogen/factor

A
  • Hgb: 9
  • Hct: 28
  • Plt: 90-120
  • F/F: all 62% dilute, loss of F VIII
82
Q

Why is Whole Blood superior?

A
  • less dilution from anticoagulants and additives
  • Higher platelet count
  • Easier to store
83
Q

If your fibrinogen levels are low, what should you transfuse?

A
  • LTOWB - 1000mg
  • FFP- 400mg (longest to absorb)
  • Cryo - 2500 mg
84
Q

How long can Whole Blood be stored?

A

21-35 days

85
Q

What is LTOWB?

A
  • Low Titer O Whole Blood
  • Universal donor
86
Q

What Rh factor do we want to give to females of child bearing age?

A
  • Rh negative
87
Q

Why do we want to avoid given RH postive blood to females of child-bearing age?

A
  • Increases the chance needing RhoGAM in the future
88
Q

When transfusing Whole Blood to someone less than 15 yo or < 40 Kg, what is the transfusion limit?

A
  • 30 mL/kg
89
Q

What is calcium used to treat?

A
  • hypocalcemia
  • long QTc
  • decreased Cardiac Output
  • coagulapathy
  • seizures
90
Q

What percentage of trauma MTP are hypocalcemic?

A
  • 97.4%
  • iCAl < 1.12 mmol/L
91
Q

Why is calcium important?

A
  • coagulation
  • platelet adhesion
  • contractility of Myocardial and smooth muscle
  • Required for clotting factors 2, 7, 9, 10
92
Q

Where is Citrate metabolized?

A

Liver

93
Q

How many grams of Calcium gluconate to equal 1 gram of Calcium Chloride?

A
  • 3 grams gluconate = 1 gram chloride
94
Q

Teg Interpretation: R,K, MA, Angle, Ly30

A
  • R = long
  • K = firmness
  • MA = strength
  • Angle = Kinetics/signicance of clot
  • Ly30 = time
95
Q

TEG: ACT (rapid)

A
  • Normal: 80 - 140 seconds
  • Measures: Clotting factors
96
Q

Teg R Time

A
  • Normal: 5.0 - 10.0
  • Measures: Clotting factors
97
Q

TEG: K Time

A
  • Normal: 1.0 - 3.0
  • Measures: fibrinogen and platelet number
98
Q

TEG: a angle

A
  • Normal: 53- 72
  • Measures: fibrinogen and platelet number
99
Q

TEG: MA

A

Normal: 50 -70
Measures: platelet number and function

100
Q

TEG: G value

A
  • Normal: 5.3 - 12.4 dynes/cm2
  • Measure: Entire coagulation cascade
101
Q

TEG: Ly30

A
  • Normal: 0-30%
  • Measures: Fibrinolysis
102
Q

Treatment for TEG-ACT >140

A

FFP

103
Q

Treatment for TEG: R time >10

A

FFP

104
Q

Treatment for TEG: K time>3

A

Cryoprecipitate

105
Q
A
106
Q

Treatment for Alpha angel< 53

A

Cryo and platelets

107
Q

Treatment for TEG MA <50

A

platelets

108
Q

Treatment for Ly30 > 3%

A

Tranexamic Acid (TXA)

Health Assessment (7 decks)

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