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Anesthesia Review Questions > Chp. 5 Blood and Blood Products > Flashcards

Chp. 5 Blood and Blood Products Flashcards

1
Q

What is blood component therapy?

A

-Involves administration of specific blood product according to need of the clinical condition of the patient

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2
Q

What are available blood products that can be used in SA before, during, and after GA?

A
  1. pRBCs
  2. Fresh frozen plasma
  3. Cryoprecipitate
  4. Cryoprecipitate-poor plasma
  5. PRP
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3
Q

How can practitioners acquire these products if they do not have the capability to process whole blood?

A

-blood banks

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4
Q

What are common indications for blood component therapy during perioperative period?

A

-Severe hemorrhage during surgery
-Acute/chronic anemia DT variety of causes -> trauma, neoplasia, chronic inflammation
-Hypoproteineima
-von Willebrand’s Disease
-Coagulopathies (DIC, liver dz)
-Thrombocytopenia

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5
Q

Components of: whole blood

A

RBCs
Clotting factors
Proteins
vWF
Platelets

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6
Q

Components of: pRBCs

A

red blood cells only

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7
Q

Components of: fresh frozen plasma

A

all clotting factors including albumin, vitamin-K dependent proteins

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8
Q

Components of: stored frozen plasma

A

similar to FFP with reduced concentration of cofactors V and VIII (check this*)

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9
Q

Components of: cryoprecipitate

A

high concentration of factor VIII, fibrinogen, vWF, fibronectin

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10
Q

Components of: cryoprecipitate-poor plasma

A

Similar to FFP or SFP with decreased VIII, fibrinogen, vWF, and fibronectin (check this*)

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11
Q

Indications for whole blood

A

-Massive blood loss (>20% blood volume) before/during GA
-Coagulopathy resulting in massive blood loss
-Some patients with DIC

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12
Q

Indications for pRBCs

A

-Less severe blood loss during surgery, normovolemic anemia

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13
Q

Indications for FFP

A

-von Willebrand’s disease
-Hemophila A, B
-Liver disease
-Coagulopathy
-DIC
-Rodenticide intoxication
-Hypoproteinemia

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14
Q

Indications for SFP

A

-Similar indications as for FFP except in patients with hemophilia A or wVF deficiency

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15
Q

Indications for cryoprecipitate

A

-DIC
-vWF deficiency
-Hemophilia A
-Generalized sepsis - fibronectin enhances mononuclear

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16
Q

Indications for cryoprecipitate

A

-DIC
-vWF deficiency
-Hemophilia A
-Generalized sepsis - fibronectin enhances mononuclear phagocytic activity

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17
Q

Indications for cryoprecipitate-free plasma

A

Similar to FFP or SFP except in conditions that require factor VIII, vWF, and fibronectin

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18
Q

What is the best approach to correcting hypoalbuminemia if you don’t have canine albumin?

A

-FFP ideally not used as only source of album
-To increase [alb] by 1g/dL, plasma should be given at 45mL/kg -> expensive
-Without concurrent administration of other colloids, albumin from transfused plasma equilibrates rapidly with extravascular space -> consider adding synthetic colloids

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19
Q

Do blood and blood products require special administration sets?

A

Should be administered through 170um filter bc have micro agglutinates

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20
Q

What are the advantages of blood component therapy in the field of anesthesia?

A
  • Main advantage = minimal volume needed for administration, preventing circulatory overload
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21
Q

In anemic patients with normal blood volume…

A
  • Administration of pRBCs preferable to whole blood
  • Colloid component of whole blood can result in vol overload when attempting to increase oxygen-carrying capacity of the patient
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22
Q

What are other advantages to using specific blood components?

A
  • Fewer complications assoc with transfusion bc unnecessary components not administered
  • Longer storage time for some components includ. plasma, plasma derivatives
  • Better use of blood resources
  • Better therapeutic approach to patient’s problem
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23
Q

Which crystalloid solution can be mixed with blood during administration?

A
  • Normal saline (0.9%) can be mixed with blood
  • Crystalloid solution that contain calcium will active coagulation system
  • Some preparations either hypotonic or hypertonic –> hemolysis
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24
Q

Is there any specific temperature requirement for blood products before administration to patient?

A
  • Blood and blood products, except PRP, should be warmed before transfusion
  • Temp should not be warmed to more than 37*C
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25
Q

What is the problem with blood products heated and administered at temps higher than 37*C?

A
  • Higher temperatures will result in hemolysis and precipitation of numerous proteins
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26
Q

At what temperature can PRP be administered?

A

22*C

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27
Q

Equation for calculating dose of blood and blood products

A

mL of blood required = Blood volume x (desired PCV - recipient PCV)/Donor PCV

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28
Q

How should blood products be administered?

A
  • Volume administered slowly for first 5-15’ at rate of 5.0mL/kg/hr
  • Animal closely observed for adverse reactions
  • Rate increased to 10mL/kg/hr if no complications observed
  • If patient hypovolemic, rate of infusion increased to 66mL/kg/hr
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29
Q

Dose: FFP

A
  • 10mL/kg
  • Repeated until bleeding controlled
30
Q

Dose: Frozen Plasma

A
  • 10mL/kg
  • Repeated until bleeding controlled
31
Q

Dose: cryoprecipitate-poor plasma

A
  • 10mL/kg
  • Repeated until bleeding controlled
32
Q

Dose: Cryoprecipitate

A

to effect at 1U/10kg
repeated after 12hrs, if bleeding continues

33
Q

Dose: PRP

A

1U/10kg

34
Q

Recommended rate of infusion of plasma products in normovolemic patient

A

22mL/kg for 24hr

35
Q

Recommended rate of infusion of plasma products in hypovolemic patient

A
  • rate of infusion should not be more than 22mL/kg/hr
  • Rate further reduced to 4.0mL/kg/hr in patients with compromised cardiac function
36
Q

How would you detect acute transfusion reaction during anesthesia?

A
  • Hypotension = most common sign associated with transfusion reaction in an anesthetized patient
  • Both acute hemolytic reactions and acute hypersensitivity reactions will be manifested as hypotension
  • Tachycardia can be manifested if acute hemolysis results in shock
37
Q

What are the early signs of a hemolytic transfusion reaction?

A
  • pyrexia
  • Tremors
  • Vomiting
  • Dyspnea
  • Salivation
38
Q

What is important to remember about anesthesia and the early signs of a hemolytic transfusion reaction?

A
  • Anesthesia will mask the early signs of a transfusion reaction
39
Q

T/F: presence of hypotension and tachycardia due to ongoing blood loss will complicate detection of an acute hemolytic reaction

A

True

Important to remember that acute hemolytic reaction can occur within minutes of the start

If hypotension persists despite blood transfusion and other therapeutic modalities (positive inotrope and lowered ax concentration), it is prudent to stop transfusion and check blood for hemolysis

40
Q

Signs of an acute hypersensitivity reaction to transfusion

A
  • Vasoactive substances (histamine, serotonin, kallikreins, proteases) are released
  • No hemolysis
  • Onset of a reaction usually 1-45min from start of infusion
  • In dogs, urticaria also seen with acute hypersensitivity reaction –> can also result in severe shock
41
Q

What steps should be taken to minimize reaction to blood and blood products?

A
  • Cross-matching in dogs
  • Cross-matching or blood-typing in cats prior to transfusion
42
Q

Minor Cross-Match

A
  • Will detect AB in donor plasma against cells of the recipient
  • Considered if will be receiving plasma product repeatedly
43
Q

Incompatibilities

A
  • Occur as a result of earlier sensitization of the recipient or presence of naturally occurring isoantibodies in either the donor or recipient
  • Impt to remember compatible cross-match does not stop patient from being sensitized against donor cells
44
Q

When do you expect to see incompatibility reactions?

A
  • Incompatibility reactions can occur as early as 4d following transfusion
  • Previously transfused patients should always be cross-matched, even if blood from same donor is used
45
Q

T/F: dog that has never received donor blood can safely be given a transfusion without cross-match

A

True check which type of blood

46
Q

Blood transfusions and cats

A
  • Blood typing or cross-matching should be done before transfusion
  • Have naturally-occurring alloantibodies
  • Untyped or uncross-matched blood given to a cat that has never received a transfusion can be fatal
47
Q

When are blood/blood products needed when hemorrhage occurs during ax? Which blood products an be administered in this situation?

A
  • Whole blood generally required when massive blood loss occurs during ax
  • Whole blood also indicated if blood loss and patient is hypoproteinemic
    -If blood loss <20% blood volume and PCV of patient approaching 20%, can administer pRBCs
    -Vol of blood products administered should equal blood loss, must be administered at a rate that should replace loss as rapidly as possible
48
Q

What is considered “massive” blood loss?

A
  • If more than 20% of blood volume is lost
49
Q

What can you do if you need whole blood but it’s not available?

A

Combine FFP and pRBCs

50
Q

A dog is under GA and severe bleeding occurs unexpectedly. No cross-match was made before GA, and hub-based oxygen carrying solution is not available. How do you approach this situation?

A
  • No prior transfusion: whole blood or pRBCs from any donor can be used
  • Prior transfusion: synthetic colloid may have to be used until cross-match performed
51
Q

A cat is under GA and severe bleeding occurs unexpectedly. No cross-match was made before GA, and hub-based oxygen carrying solution is not available. How do you approach this situation?

A
  • Breed may play role in decision making –> if cat belongs to breed with type B frequency of 0%, blood from type A donor can be used without cross-match
  • If breed has known type B blood, has to be typed before administration
52
Q

The patient has low oxygen carrying capacity, and no blood or blood products are available. What is an alternative therapy?

A

-Hbg-based oxygen-carrying solutions

53
Q

What is Oxyglobin?

A
  • ultra purified, polymerized hemoglobin solution (13.0mg/dL) of bovine origin in modified Ringer’s lactated solution
54
Q

What are main physical features of Oxyglobin?

A

pH 7.8
Osmolality of 300 most/kg
Less viscous than blood

55
Q

What are Oxyglobin’s main indications during the perioperative period?

A
  • Mainly indicated in relieving signs associated with anemia
  • Used to improve/maintain perfusion
  • Can be used in patients that develop severe hemorrhage during ax or any shock that in which volume loading is necessary
56
Q

Are there any reported complications associated with Oxyglobin?

A
  • Reported to increase pulmonary resistance
  • Patients with PTE or pulmonary contusion developed pulmonary edema and died
  • Best to avoid in patients with pulmonary disease
  • check current guidelines/recommendations
  • Other complications: volume overload, interference with some blood tests
57
Q

How is Oxyglobin administered to dogs and cats?

A
  • Standard IV set
  • Very small patients: infusion pump will aid in accurate dosing
58
Q

Oxyglobin dose in cats

A

10mL/kg at an infusion rate not to exceed 5.0mL/kg/hr

59
Q

Oxyglobin dose in dogs

A

15.0-30.0 mL/kg with rate of administration limited to 10.0mL/kg/hr
–In cases of hemorrhagic shock and hypovolemic shock, bolus administration can be used

60
Q

What should you see with administration of whole blood and pRBCs?

A
  • Will see increased HCT and plasma HGB
61
Q

What should you see with administration of Oxyglobin?

A
  • Plasma hgb should be checked bc HCT will stay low
62
Q

What should you see with administration of plasma to increase colloid oncotic pressure?

A

Increased plasma protein levels

Improvements DT synthetic colloid cannot be measured by refractometer –> will need oncometer to determine colloid oncotic pressure

63
Q

What should you see with administration of cryoprecipitate?

A

Normalize buccal mucosa bleeding time (2-4min, <5min)

64
Q

Practical approach to treating von Willebrand’s disease

A
65
Q

What is the most important endpoint of therapy when treating coagulopathies?

A

When active bleeding ceases

Coagulation tests using PT, aPTT can assist in determining success of surgery

66
Q

In the case of hemorrhage, hypovolemia, and shock during anesthesia, effective transfusion therapy should result in…

A
  • Normal HR
  • Improved systemic BP
  • Normal CVP
  • increased urine output
  • Pink mucous membranes

RR may not change bc of the blunting effects of anesthetics

If capnography is being used for monitoring, increased ETCO2 without any change in ventilatory status indicates an improving perfusion rate

67
Q

How do you time the administration of blood products?

A
  • Determined by severity of the problem and need to perform surgery immediately in life-threatening conditions
  • If there is bleeding associated with coagulopathies, admin of plasma components before ax should be timed such that patient received initial dose before surgery
68
Q

How to time blood products for von Willebrand’s Disease?

A
  • Cryoprecipitate started 1-2hr prior to surgery, usually continues through surgery until required dose is given
  • More units of cryoprecipitate will be needed if there is bleeding through surgery
69
Q

How to time blood products for anemic patients?

A
  • If PCV <20%, whole blood or pRBCs can be administered until the desired PCV is reached (~25%)
70
Q

In invasive procedures during which blood loss is expected…

A

Infusion of pRBCs continues through surgery at a rate of 5.0mL/kg/hr

71
Q

In hypoproteinemic patients…

A
  • plasma administered before anesthesia until plasma protein concentration greater than or equal to 4.0 g/dL is reached
72
Q

What are signs of volume overload during anesthesia?

A
  • Serous nasal discharge
  • Chemosis
  • Pulmonary crackles, edema
  • With severe PE, frothy fluid may be found in the ETT and breathing circuit
  • Sudden elevation in CVP
  • In conscious patients, tachypnea, dyspnea, tachycardia –> anesthetics tend to blunt these responses

Anesthesia Review Questions (43 decks)

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