Exam 3- Blood Therapy/Blood Transfusion Flashcards
What are the 4 components of blood:
Plasma
RBCs
WBCs
Platelets
What makes up plasma?
Clotting factors
What makes up platelets?
Thrombocytes
What makes up the Buffy coat?
WBCs and Platelets
Lifetime of RBC
100-120days
Men WBC
5,000-10,000
Women WBC
4,500-11,000
Children WBC
5,500-15,500
Newborn WBC
9,000-35,000
Men Hb
14-18
Women Hb
12-16
Children Hb
9.5-15.5
Newborn Hb
14-24
Men Hct
42-52
Women Hct
37-47
Children Hct
32-44
Newborn Hct
44-64
Comparing Hb and Hct:
Hct is 3x Hb
Men PLT
140,000-450,000
Women PLT
140,000-450,000
Children PLT
150,000-45,000
Newborn PLT
150,000-450,000
3 primary phases to create clot:
- Vascular spasm
- Formation of platelet plug (vWF)
- Coagulation (fibrin mesh creation)
What is fibrinolysis?
Destroys the blood clot
What factors are NOT produced by liver:
8 and vWF
Genetic causes of hypo coagulation:
Hemophilia
vWF disease
Genetic causes for hyper coagulation:
Factor 5 Leiden
AT 3 deficiency
Platelet lifespan:
7-10 days
Dual Antiplatelet therapy (DAPT)
Aspirin + ADP/P2Y12 inhibitor
Prothrombin time (PT)
Reflects extrinsic pathway
Normal time for PT
11.5-14.5sec
What is INR?
Standardizes PT results
Normal INR time:
.8-1.2 sec
Partial Prothrombin Time (PTT)
Reflects intrinsic pathway
Normal time for PTT
24.5-35.2sec
Normal time for Thrombin time
22.1-31.2sec
Normal fibrinogen levels in plasma:
175-433 mg/dL
Normal time for activated clotting time:
70-180sec
Antibodies react against foreign antigens:
Compatibility test
Two main labs for compatibility testing:
- Type and screen
2. Type and cross match
ABO-Rh type + antibody screen:
Type and screen
ABO-Rh type + cross match (mimics transfusion)
Type and cross match
How long does type and screen take:
45min
How long does type and cross match take:
1hr
Phase 1 of type and cross match:
Immediate phase (1-5min)
- ABO incompatibility
- AB
Phase 2 of type and cross match:
Incubation phase (30-45min)
- incomplete Ab that are bale to attach to Ag
- Ab from Rh system
Phase 3 of type and cross match:
Antiglobulin phase (60-90min) -performed on blood with + Ab screen
EBV preterm neonate:
95ml/kg
EBV full-term neonate:
85ml/kg
EBV infant (1-12month):
80mg/kg
EBV men:
75ml/kg
EBV women:
65ml/kg
Allowable blood loss equation:
ABL= [EBV x (Hctinitial - Hcttarget)]/Hctinitial
-vise versa for Hgb
What are the 5 blood products:
- Whole blood
- Packed RBCs
- Platelets
- Fresh Frozen Plasma
- Cryoprecipitate
How much of PRBCs is in centrifuge:
250ml
How much of PLTs in centrifuge:
50-70ml
How long can PLTs be stored:
20-25*C for 5 days
What is frozen to create FFP?
Plasma
How is cryo created?
Slowly thaw FFP
After donation anticoagulation: CPDA-1
Citrate binds Ca
Phosphate is a buffer
Dextrose gives RBCs energy
Adenosine is precursor for ATP synthesis
Shelf life for whole blood:
35 days
4 risks with PRBCs:
- Citrate toxicity
- Hypothermia
- Hyperkalemia
- Decreased 2,3-DPG
When should RBCs be administered:
Hgb is < 6g/dL
Blood loss is acute
What is FFP separated from ?
PRBCs/PLTs
How much does 1 unit of FFP increase clotting factors?
2-3%
Does FFP need ABO and Rh compatibility?
YES ABO
NO Rh
4 indications for FFP:
- Factor deficiencies
- Reversal of warfarin therapy
- Coagulopathy due to liver disease
- Massive blood loss
FFP should be given in doses calculated to achieve a minimum of what?
30% of plasma clotting factor concentration
-10-15ml/kg
3 indications for FFP:
- Antithrombin III deficiency
- Treat immunodeficiency’s
- Treat thrombotic thrombocytopenia purpura
What is PLTs centrifuged from:
PRBCs/plasma
One unit of PLT increases PLTs by:
5,000-10,000/mm3
Is ABO compatibility needed for PLTs:
NO
2 indications for PLTs:
- Thrombocytopenia
2. Dysfunctional PLTs
How is cryoprecipitate received?
After FFP is thawed slowly
Volume approx of cryo:
10-20ml
What does cryo have:
Factors 8,13, vWF, fibrinogen
One unit of cryo increases fibrinogen by:
5-7mg/dL
3 indications for cryo:
- Factor 8 deficiency
- Hemophilia A
- Fibrinogen deficiencies
When is cryo indicated because of fibrinogen concentration:
Less than 80-100mg/dL
What 5 things are checked before blood administration:
- Name
- Hospital ID number
- Blood type
- Expiration date
- Product number
What type of fluid is used for blood administration:
Normal saline
Why not LR for blood administration:
Ca binds citrate leading to blood clotting
What guage is used for adults and peds in blood administration:
Adult: 20ga
Peds: 24ga
If blood type is unknown and is emergency transfusion what should be given until cross match complete:
O- PRBCs
What labs show DIC (3):
- Decreased PLTs/fibrinogen
- Prolonged PT/PTT/INR
- Increased D-dimer
How to begin treating DIC:
1st treat underlying disease process
Most concerned hepatitis viral infections:
Hep b
Hep c
Hep B exposure:
1 in 200,000
Hep C exposure:
1 in 1,900,000
HIV exposure:
1 in 1,900,000
HTLV exposure:
1 in 2,900,000
Bacterial rxns from RBC exposure:
1 in 250,000
Bacterial rnx from PLTs exposure:
1 in 25,000
What is acute destruction of tranfused RBCs (3):
- Occur within 24 hr
- Intravascular
- ABO incompatibility
What is delayed destruction of tranfused RBCs (3):
- Occur after 24 hrs
- Extra vascular
- Rh incompatibility
What does acute hemolytic rxns lead to (3)
- Renal damage
- DIC
- Death
5 signs in acute hemolytic rxns anesthetize pt:
- Tachycardia
- Hypotension
- Increased temp
- Hemoglobinuria
- Diffuse oozing
4 symptoms for delayed hemolytic rxn:
- Malaise
- Jaundice
- Fever
- Decreased Hgb
How is delayed hemolytic rxn diagnosed?
Coombs test
Febrile rxn characterized by:
Increase of >1*C within 4 hrs
Anaphylactic rxn cause by:
Typically in IgA-deficient pts with anti-IgA Abs
5 symptoms for anaphylactic rxns:
- Hypotension
- Tachycardia
- Bronchospasm
- Swelling
- Hives
3 treatments for anaphylactic rxn:
- Epi
- Fluids
- Steroids
What presents as non cardiac pulmonary edema similar to ARDS:
TRALI
Leading cause of transfusion-related mortality:
TACO
Blood products administered faster than CO
-occur when source of bleeding controlled and provider continues to give blood products
TACO
Class 1 hemorrhage:
Loss of 5% of blood volume or less
Class 2 hemorrhage
15-30% blood volume loss
-sympathetic; HR and DBP increase
Class 3 hemorrhage
30-40% loss of blood volume
Class 4 hemorrhage
> 40% loss
-needs blood now or will die
How much blood loss needs a massive transfusion:
> 150ml/hr
4 variables for assessment of blood consumption score:
HR >120 BPM
SBP <90mmHg
Positive FAST (fast assessment with sonography)
Penetrating injury
How many pt scores is need to have massive blood transfusion:
Two or greater
When does tranexamic acid need to be given:
Early, within 3hrs of injury
Goals for SBP:
80-100
Goals for temp:
> 35*C
Goals for Hb:
> 7
Goals for pH:
> 7.2
Goals for BE:
> -6
Point of care test that can assess whole blood coagulation time:
Thromboelastography (TEG)
5 complications of massive transfusion:
- Hyperkalemia
- Coagulopathy
- Citrate toxicity
- Hypothermia
- Acid-base balance
Pt donates own blood prior to surgery
Autologous transfusion
