Exam 3: Blood Products/ Transfusion Flashcards
What is blood comprised of primarily?
Plasma 55%
the rest are elements:
- platelets
- leukocytes
- erythrocytes
Which blood product has a ↑ risk of infection and why?
Pooled packs d/t being from multiple donors. (Platelets and Cryo are pooled from multiple donors)
What blood type is a universal donor? Universal acceptor?
Donor = O neg
Acceptor = AB +
What blood type should we give pregnant moms?
If we have to, how can we compensate for this?
should give them O negative… if they get O+ give Rhogam
What are 2 Hb related issues we will see often in clinical settings?
- β thalassemia → Hb Barts
- α thalassemia → Hb H
What are the possible blood antigen types? What are possible Rh factors?
- Antigen → A B AB O
- Rh → Rh+ and Rh-
Is the general population primarily Rh+ or Rh- ?
Rh+ (85%)
Rh- (15%)
What 4 things can cause a right shift of the OxyHb curve?
- ↓ pH
- ↑ CO2
- ↑ temp
- ↑ 2,3-DPG
decreased O2 affinity
increased O2 unloading
T or F: If our O₂ saturation is good so is our PO₂?
- False → O₂sat has nothing to do with PO₂ (could have 1 Hb fully saturated; ex. anemia)
For blood type O which Antigen is present on erythrocyte and which Antibody is in the serum?
- Antigen: n/a (no antigens, blood can go to anyone)
- Antibody: Anti-A and Anti-B
For blood type AB which Antigen is present on erythrocyte and which Antibody is in the serum?
- Antigen: A and B
- Antibody: none (no antibodies, can receive blood from anyone)
For blood type B, which Antigen is present on erythrocyte and which Antibody is in the serum?
- Antigen: B
- Antibody: Anti-A
For blood type A which Antigen is present on erythrocyte and which Antibody is in the serum?
- Antigen: A
- Antibody: Anti-B
AB donor blood will react with which other blood types?
- A, B, and O
B donor blood will react with which blood types?
- A
- O
A donor blood will react with which blood types?
- B
- O
O donor blood will react with which blood types?
none
When whole blood is centrifuged what separation products result?
- Platelet rich plasma (PRP)
- WBC
- RBC
What happens if we centrifuge platelet rich plasma (PRP) again?
- Centrifuge PRP again → Separates plasma from platelets
Where is PRP used in surgery?
- Surgeon injects locally → ortho, dental, plastics cases commonly
What are the 5 different blood components we can use for treatments?
- RBC
- FFP
- Cryo
- PLT
- LTOWB - Low titer Group O Whole Blood
What chemicals are added to blood that allows it to be stored?
- CPDA-1 → Citrate phosphate dextrose adenine; chelates Ca++ to prevent clotting
- Phosphate → used as buffer
- Dextrose → fuel source
- Adenine → to support ATP synthesis (extends storage from 21 to 35 days)
Due to the chemicals used to allow blood to be stored, what labs do we need to check when transfusing lots of blood?
- Ca++ (it will ↓)
- Blood Glucse (it will ↑)
Which electrolyte will stored blood always have ↑ levels of? Why?
- K+ d/t cells lysing as they degrade in the bag
What happens to 2,3-DPG in stored blood?
What does this do to the OxyHb association curve?
- ↓ 2,3-DPG
- Left shift → impairs O2 delivery
PRBCs contain ______ unless they have been specifically ________?
- Leukocytes (WBCs)
- Leukoreduced
immunocompromised patients should received leukoreduced
How much does 1 unit of PRBCs ↑ H&H level?
- Hb: ↑ 1 g/dL (10 g/L)
- Hct: ↑ 3%
Which blood transfusion product is a source of antithrombin III?
FFP
What is the dose of FFP?
- 10-15 mL/kg
How much will 1 unit of FFP ↑ level of each clotting factor?
- ↑ 2 to 3% for each factor
What are two specific uses of FFP Dr. C mentioned in class?
- Heparin resistance d/t antithrombin deficiency
- Treat angioedema (also use TXA along with FFP)
*HELP
What is the INR of FFP?
- 1.5 to 1.8
What is Cryoprecipitate?
What clotting factors does cryoprecipitate have?
The protein fraction that is taken off the top of the FFP when being thawed. Can be refrozen for 1 year
- Factor VIII: C
- Factor VIII: vWF
- Factor XIII
- Fibrinogen
What target of fibrinogen are we trying to maintain when using cryo?
100 mg/dL
How much will two units of cryo raise fibrinogen levels?
- 2 bags of cryo/10 kg body weight = 100 mg/dL ↑ in fibrinogen
Which patient population is cryo really important for?
- Pregnant women who are bleeding
How much will one unit of PLT increase PLT count by?
- 5000 to 10000
Is there any clinical data that says warming platelets is bad?
No, it’s a common practice.
Except for platelet
When platelets are low at what level will we start to spontaneously bleed?
PLT < 30000
What is the deadly triad when transfusing a patient?
- Hypothermic
- Coagulopathic
- Acidotic (NS pH is 5.5)
When is WB indicated for transfusion?
- To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss )
What are S/Sx of Hemolytic transfusion reactions?
mediators?
- fever (late sign)
- chill
- hemoglobinemia
- hemoglobinuria (keep an eye on foley bag)
- hypotension
- dyspnea (look for high airway pressure and RR)
mediators:
* IgM antibodies
usually a result of the patient getting incompatible blood
What are the S/S of nonhemolytic febrile transfusion reactions?
mediators?
treatment?
Fever and chills
mediators:
antibodies to HLA Class 1 Ag
TX: antipyretics, leukocyte reduced
What are some S/S of an allergic transfusion reaction?
mediators:
treatment:
- urticaria
- erythema (blotchy red rashes)
- itching (affected extremity)
- anaphylaxis
mediators:
plasma proteins (mild)
IgA antibodies (anaphylactic)
TX: antihistamines, transfuse IgA deficient components
What are S/S of Non-cardiogenic pulmonary transfusion reactions?
mediators:
Treatmnet:
- Noncardiogenic pulmonary edema - from a minimal amount of blood transfused.
- ARDS
- Fever
- Chill
- Hypotension
- Cyanosis
mediators: donor/recipient WBC antibodies
Tx: Peep, steroid, lasix
What is TRALI?
mortality rate?
ratio?
Transfusion Related Acute Lung Injury - temporarily r/t to blood transfusion within 1st 6 hrs of a transfusion
mortality 5-25% with most recovering within 72 hours
occurs in 1:1300-1:5000 plasma containing transfusions
What types of blood products is TRALI most associated with this?
- FFP
- PLTs
What are the 3 acute nonimmunologic effects of transfusion reaction?
- Bacterial contamination
- Circulatory overload TACO
- Hemolysis d/t physical /chemical means
What are the three delayed immunologic effects of transfusion reaction?
- Hemolytic transfusion reactions
- Transfusion-associated Graft-versus-host disease
- Post-transfusion purpura
What are some quick ways to differentiate between TRALI and TACO? (This is very cut down from the main list)
- TRALI → Fever and ↓BP (Immunologic Response)
- TACO → HTN, ↑JVP, ↓ EF (Fluid Overload)
What classes of hemorrhage are there and what is associated blood loss for each?
- Class 1 = up to 750 mL (< 15%)
- Class 2 = 750 to 1500 mL (15-30%)
- Class 3 = 1500 to 2000 mL (30-40%)
- Class 4 = > 2000 mL (>40%)
What are 3 definitions of MTP in Adults?
- Total blood volume is replaced within 24 hours
- 50% of total blood volume is replaced in 3 hours ←Most common
- Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss
What is considered MTP for Kids?
- > 40mL/kg transfusion
What is balanced resuscitation?
- 1:1:1 ratio (PLT:Plasma:RBC)
What are the fibrinogen levels of Cryo, FFP, and LTOWB?
- Cryo = 2500 mg
- LTOWB = 1000 mg
- FFP = 400 mg
What is the difference between stored whole blood (SWB) and LTOWB?
- SWB anticoagulants < LTOWB
What are the recommendations for whole blood transfusion in kids?
- If they are <15 yr old or <40 kg then limit WB to 30 mL/kg
Which clotting factors require Ca++ to work?
2 7 9 10
protein C
protein S
Which drug has more elemental calcium; Ca gluconate or CaCl?
- CaCL (270 mg/10mL vs 90 mg/10ml for gluconate)
Uses of Calcium:
hypocalcemia, long QTc, coagulopathy, seizures, decreased CO
What is the value for TEG-ACT?
80-140 sec
activated clotting time to initial fibrin formation
measures intrinsic and extrinsic pathways
What is the normal value for R time?
5.0 - 10.0 min
reaction time to initial fibrin formation
intrinsic pathway
What is the normal value for K time?
1-3 minutes
kinetic time
for fibrin to cross-linkage to reach 20 mm clot strength
What is the normal value for α angle?
53 - 72°
firmness
What is the normal value for MA?
50-70mm
maximum amplitude of tracing; how strong the clot gets
What is the normal value for G value?
5.3-12.4 dynes/cm2
calculated value of clot strength
What is the normal value for LY 30?
0-3%
percent lysis 30 minutes after MA
If TEG-ACT is > 140 what do we transfuse?
FFP
If R time is > 10 what do we transfuse?
FFP
If K time is > 3 what do we transfuse?
Cryo
If α angle < 53° what do we transfuse?
Cryo and platelets
If MA < 50 what do we transfuse?
PLT
If LY30 > 3% what do we transfuse?
TXA (Tranexamic Acid)
Whole blood
Contains:
Uses:
all cells:
platelets, clotting factors, plasma
replace blood loss
PRBCs
Contains:
Uses:
PRBCs
some plasma
anemia
Platelets
Contains:
Uses:
thrombocytes
some plasma
thrombocytopenia
FFP
Contains:
Uses:
plasma contains fluids, clotting factors, proteins
replacing volume (burns, hypovolemia)
Shelf life:
Whole blood?
WB 3-5 weeks, 21-35 days
*less bad components (citrate)
FFP, plts, PRBC: months
gravity of RBC
gravity of Platelet
RBC 1.08-1.09
platelet 1.03-1.04
How are PRBCs derived?
How many ml in a bag of PRBC?
by removing 200-250 ml of plasma from a unit of whole blood
PRBC = 200-350 ml
FFP:
Frozen vs thawed lifespan?
frozen: 1 year
thawed: 72 hours
How is FFP prepared:
removing plasma from WB within 8 hours of collection
Whats is FFP:
water, carbohydrates, fats, minerals, proteins
What temp is cryo stored at?
18 C
What IV fluid can’t you give with blood products?
LR
contains Ca+ -> clotting in the line
acute non-immunologic effect:
bacterial contamination
- mediators
- s/s
- treatment
endotoxins caused by GN bacteria
s/s: shock, fever, hemoglobinuria
TX: IV ABX, tx hypotension and DIC
acute non-immunologic effect:
TACO
- mediators
- s/s
- treatment
fluid overload
s/s: coughing, cyanosis, orthopnea, severe HA, peripheral edema, difficulty breathing, decreased EF
TX: give remaining units slow, diuretics
acute non-immunological effect:
Hemolysis: physical/chemical means
- mediators
- s/s
- treatment
mediators: exogenous destruction of RBC
s/s: hemoglobinuria
TX: treat DIC
delayed immunologic effect:
Hemolytic reactions
- mediators
- s/s
- treatment
mediators: IgG antibodies
s/s: shortened RBC survival, decreased hemoglobin, fever, jaundice, hemoglobinuria
TX: Ig-negative blood for future transfusions
delayed immunologic effect:
graft vs. host
- mediators
- s/s
- treatment
mediators: viable donor lymphocytes
s/s: fever, skin rash, desquamation, anorexia, N/V, diarrhea, hepatitis, pancytopenia
TX: gamma irradiation of cellular components
delayed imunoglogic effect:
post-tranfusion purpura
- mediators
- s/s
- treatment
MOA: platelet specific antibody
s/s: thrombocytopenia, confused, allergic reaction
TX: Iv Ig, plasma exchange, corticosteroids, get CBC
delayed non-immunologic effect
Hemosiderosis
MOA: iron overload
s/s: very rarely death
TX: decrease frequency of transfusions, neophytes, iron chelation therapy
storage temp:
whole blood
FFP
cryo
WB 2-6 C
FFP -18 C
Cryo -18C
MLs:
whole blood
FFP
PLT
PRBC
WB: 400-500 ml
FFP: 200-250 ml
PLT 250-300
PRBC: 200-350
