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Exam 3 - Blood Transfusions Flashcards

1
Q

What percentage of blood volume is made up by plasma?
What does plasma mostly consist of?

A
  • 55%
  • 92% water
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2
Q

What blood type is a universal donor? Universal acceptor?

A
  • Donor = O neg
  • Acceptor = AB +
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3
Q

What are 3 Hgb alterations we will see most often in clinical settings?

A
  • β thalassemia → Hgb Barts
  • α thalassemia → Hgb H
  • Sickle Cell → Hgb S
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4
Q

What is the distrubution of Rh factor in the population?

A

Rh+ (85%) and Rh- (15%)

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5
Q

What 4 things can cause a right shift of the OxyHb curve?

A
  • ↑ H+ (acidosis)
  • ↑ CO2
  • ↑ temp
  • ↑ 2,3-DPG

O2 leaves hgb more readily - decreased affinity

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6
Q

For blood type O which Antigen is present on erythrocyte and which Antibody is in the serum?

A
  • Antigen: n/a
  • Antibody: Anti-A and Anti-B
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7
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
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8
Q

For blood type B, which Antigen is present on erythrocyte and which Antibody is in the serum?

A
  • Antigen: B
  • Antibody: Anti-A
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9
Q

For blood type A which Antigen is present on erythrocyte and which Antibody is in the serum?

A
  • Antigen: A
  • Antibody: Anti-B
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10
Q

AB donor blood will react with which other blood types?

A
  • A, B, and O
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11
Q

B donor blood will react with which blood types?

A
  • A
  • O
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12
Q

A donor blood will react with which blood types?

A
  • B
  • O
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13
Q

O donor blood will react with which blood types?

A
  • none
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14
Q

What is contained within FFP?

A

Plasma, fluids, clotting factors, and proteins

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15
Q

When whole blood is centrifuged what separation products result?

A
  • Platelet rich plasma (PRP)
  • WBC
  • RBC
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16
Q

What happens if we centrifuge platelet rich plasma (PRP) again?

A
  • Separates plasma from platelets
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17
Q

Where is PRP used in surgery?

A
  • Surgeon injects locally → ortho, dental, plastics cases commonly
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18
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
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19
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)

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20
Q

What happens to 2,3-DPG in stored blood?
What does this do to the OxyHb association curve?

A
  • ↓ 2,3-DPG
  • Left shift → impairs O2 delivery
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21
Q

PRBCs contain ______ unless they have been specifically ________?

A
  • Leukocytes (WBCs)
  • Leukoreduced
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22
Q

How much does 1 unit of PRBCs ↑ H&H level?

A
  • Hb: ↑ 1 g/dL
  • Hct: ↑ 3%
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23
Q

Which blood transfusion product is a source of antithrombin III?

A

FFP

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24
Q

What is the dose of FFP?

A
  • 10-15 mL/kg
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25
How much will 1 unit of FFP ↑ level of each clotting factor?
* ↑ 2 to 3% for each factor
26
2 major indications for FFP?
* Heparin resistance d/t antithrombin deficiency * Treat angioedema (also use TXA along with FFP)
27
What clotting factors does cryoprecipitate have?
* Factor VIII: C * Factor VIII: vWF * Factor XIII * Fibrinogen
28
What target of fibrinogen are we trying to maintain when using cryo?
100 mg/dL
29
Dosing for fibrinogen replacement? How much will this raise fibrinogen concentrations?
* 2 units of cryo/10 kg body weight * ~ 100 mg/dL
30
Indications for cryo transfusions?
- Bleeding with evidence of low fibrinogen - Prophylaxis in pt's with hemophilia A and vWD
31
How much will one unit of PLT increase PLT count by?
* 5,000 to 10,000
32
Why should you not give LR with blood products?
LR has Ca++ and can cause the products to clot
33
Is there any clinical data that says warming platelets is bad?
No its a common practice → no data to support not warming platelets BUT still recommended to not warm
34
Indications for platelet transfusion?
- Stable w/o bleeding and PLT < 10,000 - PLT < 50,000 and invasive procedure, evidence of bleeding, DIC - Eye or CNS procedures and PLT < 100,000
35
What is the trauma triad of death?
* Hypothermic * Coagulopathic * Acidotic
36
What are the IV fluid recommendations for blood product transfusion?
- Electrolyte R (normosol/plasmalyte) - NS - Only use for prming tubing and flushing before and after
37
When is WB indicated for transfusion?
* To maintain blood volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss)
38
What are S/Sx of hemolytic transfusion reaction?
* fever * chill * hemoglobinemia * hemoglobinuria (seen under GETA) * hypotension (seen under GETA) * dyspnea.
39
What are mediators of an acute hemolytic transfusion reactions?
IgM antibodies (ABO usually)
40
What are the S/S of nonhemolytic febrile transfusion reactions? Treatment?
- Fever and chills - Antipyretics and leukocyte reduced blood
41
What are the mediators of non-hemolytic febrile transfusion reactions?
HLA Class Ag antibodies
42
What are some S/S of an allergic transfusion reaction?
* urticaria * erythema * itching * anaphylaxis.
43
What are the mediators of allergic transfusion reactions?
* plasma proteins (allergic) * IgA antibodies (anaphylactic)
44
How do we treat allergic transfusion reactions?
* antihistamines * treat symptoms * IgA component transfusion
45
What are S/S of  Non-cardiogenic pulmonary transfusion reactions?
* ARDS (↑ airway pressures and secretions) * Fever * Chill * Hypotension * Cyanosis
46
What are the mediators for a non-cardiogenic pulmonary transfusion reaction?
Recipient WBC antibodies
47
How do we treat  Non-cardiogenic pulmonary transfusion reactions?
* Vigorous respiratory support (↑ PEEP) * Steroids
48
Criteria for TRALI diagnosis?
* Blood transfusion within the last 6 hours * Acute hypoexemia (P/F < 300 or SpO2 < 90% on RA) * B/l diffuse infiltrates * No evidence of circulatory overload
49
Incidence of TRALI? Mortality rate?
- 1:1,300 - 5,000 - 5-25%, most patients recover within 72 hours
50
What types of blood products is TRALI most associated with?
* Can occur in any product with plasma * FFP * PLTs
51
Patho behind TRALI?
Leukoagglutination and pooling of granulocytes leads to damage to cellular membranes and endothelial surfaces resulting in dyspnea and pulonary infiltrates
52
TRALI treatment?
- Stop the transfusion - Vent support - CBC and CXR - Notify blood bank - Pt may need ECMO
53
What are the 3 acute nonimmunologic transfusion reactions?
- Bacterial contamination - TACO - Hemolysis d/t exogenous physical/chemical means
54
What are the three delayed immunologic effects of transfusion reaction? MOA of each?
* Hemolytic transfusion reactions (IgG) * Transfusion associated Graft-versus-host disease (donor lymphocytes) * Post-transfusion purpura (platelet specific antibodies)
55
Symptoms and treatment for hemolytic transfusion reactions?
Symptoms * Decreased Hb * Fever * Jaundice * Hemoglobinuria Treament - Ig negative blood for future transfusions
56
GVHD symtoms and treatment?
Symptoms - Fever - Skin rash - Desquamation (skin shedding) - N/V/D - Hepatitis - Pancytopenia Treatments - Gamma irradiation of cellular components
57
Post-transfusion purapura symptoms and treatment?
Symptoms - Thrombocytopenia - Clinical bleeding Treatments - IV Ig - Plasma exchange - Steroids
58
What are some quick ways to differentiate between TRALI and TACO?
* TRALI → Fever, ↓BP, EF normal, minimal response to diuretics * TACO → No fever, HTN, ↑JVP, ↓ EF, significant improvement with diuresis
59
What is transfusion induced hemosiderosis?
Transfusion related iron overload
60
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%)
61
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 * Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss
62
What is considered MTP for Kids?
* > 40mL/kg transfusion
63
What is balanced resuscitation?
* 1:1:1 ratio (PLT:Plasma:RBC)
64
Why does whole blood have superior hemostatic potential over individualr blood components?
- Less dilution from anticoagulants and additives - Higher platelet counts and coagulation factor levels
65
What are the fibrinogen levels of Cryo, FFP, and LTOWB?
* Cryo = 2500 mg * LTOWB = 1000 mg * FFP = 400 mg
66
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 | Not many studies available
67
Which clotting factors required Ca++ to work?
2 ,7, 9, 10, protein C and S
68
Which drug has more elemental calcium; Ca gluconate or CaCl?
* CaCl (270 mg/10mL vs 90 mg/10ml for gluconate)
69
What causes drops in calcium from blood transfusion?
Hypothermia + Liver injury = decreased citrate metabolism = increased chelation of serum calcium
70
What will 1,2, and 5 units of blood decrease iCa levels to?
* 1 unit = 1.12 mmol/L * 2 unit = < 1mmol/L * 5 units = < 0.8 mmol/L
71
What is the normal value for TEG-ACT (rapid)? What is it measuring?
* 80-140 sec * Time to initial fibrin formation
72
What is the normal value for R time? What is it measuring?
* 5.0 - 10.0 min * "Reaction Time" to initial fibrin formation - intrinsic pathway
73
What is the normal value for K time? What is it measuring?
* 1-3 minutes * "Kinetic Time" for fibrin cross linkage to reach 20 mm clot strength (fibrinogen and plt number)
74
What is the normal value for α angle? What is it measuring?
* 53 - 72° * Slope from baseline representing clot formation (fibrinogen and plt number)
75
What is the normal value for MA? What is it measuring?
* 50-70mm * Maximum Amplitude of tracing (plt number and function)
76
What is the normal value for G value? What is it measuring?
* 5.3-12.4 dynes/cm2 * Calculated value of clot strength (entire coag cascade)
77
What is the normal value for LY 30? What is it measuring?
* 0-3% * Clot lysis at 30 mins after maximum aplitude (fibrinolysis)
78
If TEG-ACT is > 140 what do we transfuse?
* FFP
79
If R time is > 10 what do we transfuse?
* FFP
80
If K time is > 3 what do we transfuse?
* Cryo
81
If α angle < 53° what do we transfuse?
* Cryo and/or platelets
82
If MA < 50 what do we transfuse?
* PLT
83
If LY30 > 3% what do we transfuse?
TXA (Tranexamic Acid)

Assessment (22 decks)

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