Chapters 100-105 Colloids and Blood Products

Question 1

What are the formulations of hetastarch and pentastarch?

Answer 1

6% hetastarch and 10% pentastarch

Question 2

How is albumin treated?

Answer 2

from human whole bloood- heated to 60 degrees x 10 hours and gets HOw rid of both viral and bacterial products

Question 3

What are hetastarch and pentastarch made up of?

Answer 3

Hetastarch and pentastarch are componsed of chains of glucose molecules to which hydroxyethyl ether groups have been attached

Question 4

Will hetastarch and pentastarch interfere with cross matching?

Answer 4

no

Question 5

How long is the intravascular half life of both hetastarch and pentastarch?

Answer 5

hetastarch- 25 hour

pentastarch- 2.5 hour

Question 6

How are both hetastarch and pentastarch eliminated?

Answer 6

through kidney- molecules

Question 7

What are the coagulation effects of hetastarch and pentastarch?

Answer 7

Increase PT, aPTT and clotting time, may interfere with platelet function

Question 8

What is the molar substutition of hetastarch versus pentastarch

Answer 8

pentastarch has lower molar substitution ratio- and it is this property that makes it more quickly eliminated

Question 9

What is the theoretical risk of hetastach long tissue-half life?

Answer 9

tissue half life is 10-15 days and risk is impaired reticuloendothelial function. This is why pentastarch was developed to minimize this risk.

Question 10

What is max dose of hetastarch and pentastarch that should be administered?

Answer 10

15-20 mL/kg

Question 11

What other laboratory changes may be seen with administration of hetastarch and pentastarch?

Answer 11

increase in amylase and indirect bilirubin

Question 12

What does a “type” check for and how do you perform it?

Answer 12

Typing looks at A, B and Rh.

1) Take patients RBC and mix with commercially available antibodies and look for agglutination
2) Take patient’s serum and mix with commercially available Type A and Type B cells and look for agglutination because because almost everyone has naturally occurring IgM antibodies (either anti-A or anti-B)

Question 13

What does a “type” check for and how do you perform it?

Answer 13

Typing looks at A, B and Rh.

1) Take patients RBC and mix with commercially available antibodies and look for agglutination
2) Take patient’s serum and mix with commercially available Type A and Type B cells and look for agglutination because because almost everyone has naturally occurring IgM antibodies (either anti-A or anti-B)

Question 14

What does a screen check for and how is it performed?

Answer 14

A screen is a test that is done to determine if there are “unexpected” antibodie
If agglutination does take place, then additional testing will be done to identify which antibody is present and then for

Question 15

What are the more common and clinically significant antibodies that a patient may have?

Answer 15

Rh, Diego, Duffy, MNS, Kelly and Kidd

Question 16

What are the TYPE of antibodies that can be found on a screen and how are they different?

Answer 16

IgG antibodies develop as a result of previous transfusion of blood products

IgM antibodies are naturally occuring antibodies that are cold-reactive and usually clinically insignificant

Question 17

What does a screen check for and how is it performed?

Answer 17

A screen is a test that is done to determine if there are “unexpected” antibodies present

Commerically available O type blood with the significant hemolytic antigens present are mixed with the recipent blood and look for agglutination.

If agglutination does take place, then additional testing will be done to identify which antibody is present and then for an appropriate donor for transfusion

Question 18

How are crossmatches performed?

Answer 18

They can be done by a computer as long as the type has been performed twice (on current sample, comparing prior records, on 2nd sample)

Serologic crossmatch is 3 steps.

1) immediate spin- rechecks AB0 compatibility and some other minor antibodies. Patient’s serum mixed with donor RBC and centrifuged and assessed for agglutination
2) Incubation stage- add salt or albumin and incubate at 37 degrees for 10-45 min- patient antibodies will attach to donor cells but lack the strength to cause visual aggluttination
3) Antiglobulin stage- add antiglobulin to cause agglutination if recipient antibodies attached to donor cells

Question 19

What is purpose of adenosine additive for RBC?

Answer 19

for ATP production

Question 20

What defines a “viable” until by FDA standards?

Answer 20

More than 70% of RBC that were transfused are present at 24 hours.

Question 21

Why do you add glycerol when freezing RBCs?

Answer 21

Better at maintaining 2,3 DPG levels

Question 22

What is the timeline from transfusion to clinical picture for TRALI?

Answer 22

1-6 hours.

Question 23

What are the criteria for TRALI?

Answer 23

acute respiratory distress, bilateral pulmonary edema, severe hypoxemia, without cardiogenic edema.
1/5000 transfusions implicated

Question 24

What is pathogenesis of TRALI?

Answer 24

white blood cell HLA or neutrophil specific antibodies from donor bind to recipient white blood cell antigens. OR
2 hit theory in which there was a physiologic insult that “primed” the neutrophils in the lungs and then the plasma containing a biologically active mediator caused the neutrophils to activate- release ) O2 free radicals, proteases, etc.