Exam 3: Blood Products/ Transfusion Flashcards
1
Q
What is blood comprised of primarily?
A
Plasma 55%
the rest are elements:
- platelets
- leukocytes
- erythrocytes
2
Q
Which blood product has a ↑ risk of infection and why?
A
Pooled packs d/t being from multiple donors. (Platelets and Cryo are pooled from multiple donors)
3
Q
What blood type is a universal donor? Universal acceptor?
A
Donor = O neg
Acceptor = AB +
4
Q
What blood type should we give pregnant moms?
If we have to, how can we compensate for this?
A
should give them O negative… if they get O+ give Rhogam
5
Q
What are 2 Hb related issues we will see often in clinical settings?
A
- β thalassemia → Hb Barts
- α thalassemia → Hb H
6
Q
What are the possible blood antigen types? What are possible Rh factors?
A
- Antigen → A B AB O
- Rh → Rh+ and Rh-
7
Q
Is the general population primarily Rh+ or Rh- ?
A
Rh+ (85%)
Rh- (15%)
8
Q
What 4 things can cause a right shift of the OxyHb curve?
A
- ↓ pH
- ↑ CO2
- ↑ temp
- ↑ 2,3-DPG
decreased O2 affinity
increased O2 unloading
9
Q
T or F: If our O₂ saturation is good so is our PO₂?
A
- False → O₂sat has nothing to do with PO₂ (could have 1 Hb fully saturated; ex. anemia)
10
Q
For blood type O which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: n/a (no antigens, blood can go to anyone)
- Antibody: Anti-A and Anti-B
11
Q
For blood type AB which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: A and B
- Antibody: none (no antibodies, can receive blood from anyone)
12
Q
For blood type B, which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: B
- Antibody: Anti-A
13
Q
For blood type A which Antigen is present on erythrocyte and which Antibody is in the serum?
A
- Antigen: A
- Antibody: Anti-B
14
Q
AB donor blood will react with which other blood types?
A
- A, B, and O
15
Q
B donor blood will react with which blood types?
A
- A
- O
16
Q
A donor blood will react with which blood types?
A
- B
- O
17
Q
O donor blood will react with which blood types?
A
none
18
Q
When whole blood is centrifuged what separation products result?
A
- Platelet rich plasma (PRP)
- WBC
- RBC
19
Q
What happens if we centrifuge platelet rich plasma (PRP) again?
A
- Centrifuge PRP again → Separates plasma from platelets
20
Q
Where is PRP used in surgery?
A
- Surgeon injects locally → ortho, dental, plastics cases commonly
21
Q
What are the 5 different blood components we can use for treatments?
A
- RBC
- FFP
- Cryo
- PLT
- LTOWB - Low titer Group O Whole Blood
22
Q
What chemicals are added to blood that allows it to be stored?
A
- 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)
23
Q
Due to the chemicals used to allow blood to be stored, what labs do we need to check when transfusing lots of blood?
A
- Ca++ (it will ↓)
- Blood Glucse (it will ↑)
24
Q
Which electrolyte will stored blood always have ↑ levels of? Why?
A
- K+ d/t cells lysing as they degrade in the bag
25
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
26
PRBCs contain ______ unless they have been specifically ________?
* Leukocytes (WBCs)
* Leukoreduced
immunocompromised patients should received leukoreduced
27
How much does 1 unit of PRBCs ↑ H&H level?
* Hb: ↑ 1 g/dL (10 g/L)
* Hct: ↑ 3%
28
Which blood transfusion product is a source of antithrombin III?
FFP
29
What is the dose of FFP?
* 10-15 mL/kg
30
How much will 1 unit of FFP ↑ level of each clotting factor?
* ↑ 2 to 3% for each factor
31
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
32
What is the INR of FFP?
* 1.5 to 1.8
33
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
34
What target of fibrinogen are we trying to maintain when using cryo?
100 mg/dL
35
How much will two units of cryo raise fibrinogen levels?
* 2 bags of cryo/10 kg body weight = 100 mg/dL ↑ in fibrinogen
36
Which patient population is cryo really important for?
* Pregnant women who are bleeding
37
How much will one unit of PLT increase PLT count by?
* 5000 to 10000
38
Is there any clinical data that says warming platelets is bad?
No, it's a common practice.
*Except for platelet*
39
When platelets are low at what level will we start to spontaneously bleed?
PLT < 30000
40
What is the deadly triad when transfusing a patient?
* Hypothermic
* Coagulopathic
* Acidotic (NS pH is 5.5)
41
When is WB indicated for transfusion?
* To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss )
42
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
43
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
44
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
45
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
46
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
47
What types of blood products is TRALI most associated with this?
* FFP
* PLTs
48
What are the 3 acute nonimmunologic effects of transfusion reaction?
* Bacterial contamination
* Circulatory overload TACO
* Hemolysis d/t physical /chemical means
49
What are the three delayed immunologic effects of transfusion reaction?
* Hemolytic transfusion reactions
* Transfusion-associated Graft-versus-host disease
* Post-transfusion purpura
50
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)
51
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%)
52
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
53
What is considered MTP for Kids?
* > 40mL/kg transfusion
54
What is balanced resuscitation?
* 1:1:1 ratio (PLT:Plasma:RBC)
55
What are the fibrinogen levels of Cryo, FFP, and LTOWB?
* Cryo = 2500 mg
* LTOWB = 1000 mg
* FFP = 400 mg
56
What is the difference between stored whole blood (SWB) and LTOWB?
* SWB anticoagulants < LTOWB
57
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
58
Which clotting factors require Ca++ to work?
2 7 9 10
protein C
protein S
59
Which drug has more elemental calcium; Ca gluconate or CaCl?
* CaCL (270 mg/10mL vs 90 mg/10ml for gluconate)
60
Uses of Calcium:
hypocalcemia, long QTc, coagulopathy, seizures, decreased CO
61
What is the value for TEG-ACT?
80-140 sec
activated clotting time to initial fibrin formation
measures intrinsic and extrinsic pathways
62
What is the normal value for R time?
5.0 - 10.0 min
reaction time to initial fibrin formation
intrinsic pathway
63
What is the normal value for K time?
1-3 minutes
kinetic time
for fibrin to cross-linkage to reach 20 mm clot strength
64
What is the normal value for α angle?
53 - 72°
firmness
65
What is the normal value for MA?
50-70mm
maximum amplitude of tracing; how strong the clot gets
66
What is the normal value for G value?
5.3-12.4 dynes/cm2
calculated value of clot strength
67
What is the normal value for LY 30?
0-3%
percent lysis 30 minutes after MA
68
If TEG-ACT is > 140 what do we transfuse?
FFP
69
If R time is > 10 what do we transfuse?
FFP
70
If K time is > 3 what do we transfuse?
Cryo
71
If α angle < 53° what do we transfuse?
Cryo and platelets
72
If MA < 50 what do we transfuse?
PLT
73
If LY30 > 3% what do we transfuse?
TXA (Tranexamic Acid)
74
Whole blood
Contains:
Uses:
all cells:
platelets, clotting factors, plasma
replace blood loss
75
PRBCs
Contains:
Uses:
PRBCs
some plasma
anemia
76
Platelets
Contains:
Uses:
thrombocytes
some plasma
thrombocytopenia
77
FFP
Contains:
Uses:
plasma contains fluids, clotting factors, proteins
replacing volume (burns, hypovolemia)
78
Shelf life:
Whole blood?
WB 3-5 weeks, 21-35 days
*less bad components (citrate)
FFP, plts, PRBC: months
79
gravity of RBC
gravity of Platelet
RBC 1.08-1.09
platelet 1.03-1.04
80
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
81
FFP:
Frozen vs thawed lifespan?
frozen: 1 year
thawed: 72 hours
82
How is FFP prepared:
removing plasma from WB within 8 hours of collection
83
Whats is FFP:
water, carbohydrates, fats, minerals, proteins
84
What temp is cryo stored at?
18 C
85
What IV fluid can't you give with blood products?
LR
contains Ca+ -> clotting in the line
86
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
87
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
88
acute non-immunological effect:
Hemolysis: physical/chemical means
- mediators
- s/s
- treatment
mediators: exogenous destruction of RBC
s/s: hemoglobinuria
TX: treat DIC
89
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
90
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
91
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
92
delayed non-immunologic effect
Hemosiderosis
MOA: iron overload
s/s: very rarely death
TX: decrease frequency of transfusions, neophytes, iron chelation therapy
93
storage temp:
whole blood
FFP
cryo
WB 2-6 C
FFP -18 C
Cryo -18C
94
MLs:
whole blood
FFP
PLT
PRBC
WB: 400-500 ml
FFP: 200-250 ml
PLT 250-300
PRBC: 200-350
