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A1 > Fluids and blood APEX > Flashcards

Fluids and blood APEX Flashcards

1
Q

What is sodium used for?

A

Serum osmolarity

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2
Q

What has the most fibrinogen?

A

Cryo

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3
Q

What is in whole blood?

A

RBC
WBC
Plasma
Fibrinogen
Platelet fragments

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4
Q

FFP contains ___

A

All coag factors
Fibrinogen
Plasma proteins
Fibrinogen

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5
Q

FFP indications

A

Warfarin reversal 5-8ml/kg
Coagulopathy 10-20 ml/kg
Complete infusion within 24 hours of thawing

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6
Q

How much do platelets raise count?

A

1 pack per 10kg of body weight

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7
Q

What is in cryo?

A

Fibrinogen
8,13
vWF

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8
Q

Cryo indications, how much will improve, how soon to give after thaw

A

Fibrinogen deficiency (80-100 mg/dl)
vWF disease
Hemophilia
5 bag pool- 50mg/dl
cry for 6 hours

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9
Q

At what HCT should CAD patients be transfused?

A

28-30%
Too dilute, not enough cao2, do2, etc

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10
Q

EBV for neonates, infants, school age, and adults

A

Premie- 90-100
80-90
75-80
70
70

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11
Q

MABL maximum allowable blood loss formula

A

EBL x (sHGB-eHGB) / sHGB

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12
Q

PRBC volume and hct, how much will it increase hgb/ hct

A

200-300 cc
60-70%
1 hgb, 2 hct

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13
Q

Calcium is which factor?

A

4

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14
Q

What does phosphate do in stored blood?

A

buffer acidosis

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15
Q

Most common infections from blood transfusion

A

CMV 1%
Hep b 1 in 300k
Hep C 1 in 1.6 million
HIV 1 in 1.8 million

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16
Q

Leukoreduction, washing, irradiation

A

L- removes wbc from rbc and platelets, prevents HLA alloimmunization (patient attacks and is resistant to transfusion)
W- Removes plasma/ plasma antigens to prevent anaphylaxis in IgA deficient patients
I- Exposes unit to gamma radiation to destory donor leukocytes, prevents graft vs host disease in immunocompromised

17
Q

What will hep c progress to? how common is that?

A

cirrhosis, 85%, liver failure

18
Q

Signs of acute hemolytics reaction

A

Renal failure from acute tubular necrosis (hgb causes obstruction)
DIC- hemoglobinuria/ bleeding
Hypotension (hgb activates the kallikrein system which produces bradykinin, a vasodilator)

19
Q

Tx for acute hemolytic reaction

A

Stop tranfusion
UO 100ml/hr w iv fluids, mannitol (25g), lasix 20-40mg
Alkalinize urine with HCO3
Labs- urine, hgb, plt, pt, fibrinogen

20
Q

Donor vs recipient risk factors of TRALI

A

Donor high risk- multiparous women, history of transfusion, history of organ transplant
Recipient- critical illness, sepsis, burns, post CBG

20
Q

Most common cause of transfusion related mortality

A

TRALI

21
Q

Trali patho

A

Donor antibodies active neutrophil activation in the lungs

22
Q

Which blood products have highest risk of trali and why

A

FFP, platelets
High concentration of antibodies

23
Q

Diagnostic criteria of TRALI

A

<6 hours
Bilat infiltrates
PF <300
Normal PCWP (no left atrial htn or volume overload)

24
Q

Tx of trali

A

Like ards
PEEP, low Vt, avoid overhydration

25
Q

Side effects of blood transfusions

A

Alkalosis, hypothermia
Hyperglycemia hyperkalemia
Hypocalemia

26
Q

What temp are PT and PTT prolonged at

A

<34

27
Q

Lethal triad of trauma

A

Acidosis- hypoperfusion reduce do2, causing anaerobic metabolism and lactic acidosis
Hypothermia- from hemorrhage and exposure to room temp iv
Coagulopaty- from hypothermia <34, or massive dilutional coagulpathy

28
Q

When is intraoperative blood salvage indicated

A

WHEN BLOOD LOSS IS >1L or 20% BV
Cardiac
Major vascular
Trauma
Liver
Transplant
Ortho

29
Q

Steps of blood salvage

A

Blood is collected via suction device
Anticoag
Filtered
Concentrated, washed, filtered of anticoag, free hgb, wbc, plasma, plt
Dilute w saline to hct 70%
Ready to be autotransfused

30
Q

Why choose salvaged blood?

A

Better cao2, higher 23 DPG and ATP and shape

31
Q

Risks of salvaged blood

A

Contamination, fever, hemolysis

32
Q

Cx to salvaged

A

Sickle cell, thalassemia, betadyne, chg in sterile field, infected surgical site, oncology, pregnancy is controversy

A1 (125 decks)

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