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APEX-Fluids and Blood > FLUIDS-transfusion > Flashcards

FLUIDS-transfusion Flashcards

1
Q

What is on the cell membrane of erythrocytes that determines blood group

A

Antigenic glycoprotein

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2
Q

What does the plasma contain that opposes erythrocyte blood goup

A

Opposing Antibodies to the erythrocyte cell membrane antigenic glycoprotein

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3
Q 
What Plasma antibodies does each blood type contain
O
A
B
AB
A 
O = Anit-A, Anti-B
A = Anti-B
B = Anti-A 
AB = none
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4
Q

Universal donor

Universal recipient

A 
donor = O negative (no ABO or Rh antigens)
recipient = AB positive (contains anti-A, anti-B, and Rh antigens)
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5
Q

Can Rh-negative blood type receive Rh-positive

A

No

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6
Q

How does a mother become sensitized to the Rh antigen if she is Rh-negative and fetus is Rh-positive

A

During delivery, the Rh-positive antigen crosses the placenta
The mother will then develop antibodies to the Rh antigen

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7
Q

How does maternal Rh-sensitization put subsequent pregnancies at risk

A

The mother is sensitized following the first pregnancy

Subsequent pregnancies with an Rh-positive fetus can lead to erythroblastosis fetalis

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8
Q

What is erythroblastosis fetalis

A

A hemolytic disease of a newborn that is Rh-positive of an Rh-negative mother that has been sensitized, developing antibodies against the Rh antigen

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9
Q

How is erythroblastosis fetalis prevented

A

Mother is given Rhogam (Rh immune globulin) starting at 28 weeks gestation to prevent sensitization

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10
Q

What is the plasma universal donor and acceptor

A 
Donor = AB positive (contains no anti-A, anti-B, or Rh antigens)
Acceptor = O negative (contains anti-A, anti-B, and Rh antigens)
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11
Q

What does the type, screen, and crossmatch test

A 
Type = determines ABP and Rh-D antigens type
Screen = Most clinically significant antibodies
Crossmatch = compatibility between recipient plasma and blood to be transfused
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12
Q

Consequences of large RBC transfusion

A

Coagulopathy

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13
Q

Which blood component has the highest risk of bacterial contamination and why

A

Platelets

They are stored at room temp for 5 days

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14
Q

Infusion recommendations for platelets

A

No filter or fluid warmer

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15
Q

How much is fibrinogen increased with a 5 bag pool

A

50 mg/dL

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16
Q 
At what lab values are the following transfusions indicated
PRBC
FFP
Platelets
Cryo
A 
PRBC = hgb<6 g/dL
FFP = PT or PTT >1.5 control
Platelets = Thrombocytopenia of 50,000-100,000
Cryo = fibrinogen <80-100 mg/dL
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17
Q

How much does a unit of FFP increase factor concentration

A

20-30%

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18
Q

What components are in FFP

A

All coagulation factors
Fibrinogen
Plasma proteins

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19
Q

What components are in cryoprecipitate

A

Concentrated fibrinogen
Factor 8
Factor 13
vWF

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20
Q

What components are in whole blood

A 
RBCs
WBCs
Plasma
Plt debris
Firbinogen
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21
Q

6 indications for FFP transfusion

A
  1. Coagulopathy
  2. Warfarin reversal
  3. AT deficiency
  4. Massive transfusion
  5. DIC
  6. C1 esterase deficiency (angioedema)
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22
Q

2 Indications for platelet transfusion

A
  1. Thrombocytopenia

2. Qualitative platelet defect

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23
Q

3 indications for cryoprecipitate transfusion

A
  1. Fibrinogen deficiency
  2. Von Willebrand disease
  3. Hemophilia
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24
Q

At what point should patients with CAD receive a blood transfusion

A

when hct falls below 28-30%

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25
Q 
What is the estimated blood volume for the following populations
Neonate (premature)=
Neonate (full term)=
Infant=
School-age child=
Adult=
A 
Neonate (premature)= 90-100 mL/kg
Neonate (full term)= 80-90 mL/kg
Infant= 80 mL/kg
School-age child= 70 mL/Kg
Adult= 70 mL/kg
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26
Q

What is the equation for max allowable blood loss

A

MABL = EBV x ([start hgb - target hgb]/start hgb)

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27
Q

What is MABL for a 70 kg male with a hgb 12 g/dL and transfusion threshold of 6 g/dL

A

2,450 mL

4,900 mL x ([12-6]/12)

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28
Q

What is the average hct of a unit of PRBC

A

70%

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29
Q

How much does 1 unit of PRBC increase hgb/hct

A 
hgb = 1 g/dL
Hct = 2-3%
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30
Q

How do erythrocytes utilize energy

A

They don’t contain mitochondria so they rely on glycolysis and lactic acid to convert glucose to ATP

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31
Q

Why is blood stored at 1-6*C

A

To extend the lifespan by slowing the rate of glycolysis

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32
Q

What are 4 additives to PRBCs that increase shelf life

A

Citrate
Phosphate
Dextrose
Adenine

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33
Q 
What is the function of each additive in the the storage of PRBCs
Citrate
Phosphate
Dextrose
Adenine
A 
Citrate= anticoagulant (inhibits fx 4 Ca++)
Phosphate = Buffer against acidosis
Dextrose = Substrate for glycolysis
Adenine = substrates for ATP
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34
Q

What are 7 changes to PRBCs that can occur during storage

A
  1. Decreased 2,3-DPG (left shift)
  2. Decreased ATP
  3. Decreased pH
  4. Increased K+
  5. Impaired ability to change shape
  6. Hemolysis
  7. Increased production of proinflammatory mediators
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35
Q

What is leukoreduction

A

Removes WBCs from RBC and platelets

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36
Q

What is the purpose of leukoreduction

A

To decrease the chances of HLA alloimmunization, febrile nonhemolytic transfusion rxn, and CMV transmission

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37
Q

What is HLA alloimmunization

A

When the body develops antibodies against human leukocyte antigens

38
Q

How does HLA alloimmunization affect platelet transfusions

A

It can make the pt “refractory” to plt transfusion b/c the body attacks the HLA proteins present of the plt surface

39
Q

What is the process of washing in transfusion preparation

A

Using saline to wash the blood product and removing any remaining plasma and antigens in the donor unit
RBC antigens are not removed

40
Q

What is the purpose of washing when processing blood units

A

To prevent anaphylaxis in IgA deficient patients

41
Q

What is the purpose of irradiation when preparing a transfusion

A

It exposes the unit to gamma radiation and disrupts WBC DNA in the donor cells, destroying donor leukocytes

42
Q

What does irradiation of donor blood prevent

A

graft v. host disease in immunocompromised pts

43
Q

What is graft-vs-host disease

A

Donor leukocytes attack recipient bone marrow, leading to pancytopenia, fever, hepatitis, and diarrhea

44
Q

Which populations benefit from irradiated blood products

A

Leukemia
Lymphoma
Hematopoietic stem cell transplant
DiGeorge syndrome

45
Q

Which blood product processing technique reduces the risk of HLA alloimmunization

A

Leukoreduction

46
Q

Which blood product processing technique reduces the risk of anaphylaxis in IgA deficient patients

A

Washing

47
Q

Which blood product processing technique reduces the risk of graft-vs-host disease in immunocompromised pts

A

Irradiation

48
Q

Rank the following viral complications from blood transfusions from greatest to least
CMV, HIV, Hep C, Hep B, Human T-Cell lymphotropic virus

A

CMV > Hep B > Hep C > HIV > HTLV

49
Q

What type of infection is most common with blood transfusion

A

CMV

50
Q

What is the cause of acute hemolytic reaction to blood transfusion

A

ABO incompatibility

Complement is activated in recipient’s blood, and plasma antibodies attach the antigens on donor cell membranes

51
Q

What pathological processes can result from acute hemolytic reaction

A

Renal failure
DIC
HoTN

52
Q

What 3 signs of acute hemolytic reaction are present during anesthesia

A
  1. Hemoglobinuria
  2. HoTN
  3. Bleeding
53
Q

What 6 signs of acute hemolytic reaction are masked by anesthesia

A
  1. Fever
  2. Chills
  3. Chest pain
  4. Dyspnea
  5. Nausea
  6. Flushing
54
Q

What is the cause of hemoglobinuria with acute hemolytic reactions

A

Free hgb in the form of acid hematin precipitates inside the renal tubules
This causes mechanical obstruction and ATN

55
Q

What is the cause of DIC with an acute hemolytic reaction

A

Erythrocyin is released from the RBC and activates the intrinsic clotting cascade.
This leads to uncontrolled fibrin formation and consumes plts and factors 1, 2, 5, and 7

56
Q

How does acute hemolytic reaction cause hypotension

A

Free hgb activates the kallikrein system. The final product of the pathway is bradykinin, a potent vasodilator

57
Q

What is the treatment for acute hemolytic reaction

A
  1. Stop transfusion
  2. Maintain UO >75-100 mL/hr with IV fluids, mannitol, and lasix
  3. Alkalinize urine w/ NaHCO3
  4. Send urine and blood to blood bank
  5. Check labs: plt, PT, fibrinogen
  6. Send unused blood to BB
  7. Support hemodynamics with IVF and vasopressors
58
Q

What are the 2 categories of nonhemolytic transfusion reactions

A

Febrile

Allergic

59
Q

What is febrile transfusion reaction

A

Pyrogenic cytokines and intracellular components are released from leukocytes in the donor blood products

60
Q

What blood processing technique decreases febrile transfusion reaction

A

Leukoreduction

61
Q

What is the most common adverse reaction to blood transfusion

A

febrile reaction

62
Q

What are 5 common s/sx of febrile transfusion reaction

A
  1. Fever
  2. Chills
  3. HA
  4. Nausea
  5. Malaise
63
Q

What is the treatment for febrile transfusion reaction

A
  1. Supportive

2. Acetaminophen

64
Q

What is the cause of allergic transfusion reaction

A

Foreign protein in the donor blood product

65
Q

What are the 2 types of allergic transfusion reactions

A
  1. Anaphylactic (IgE mediated)

2. Anaphylactoid (NOT IgE mediated)

66
Q

Usual presentation of allergic transfusion reactions

A
  1. Urticaria

2. Facial swelling

67
Q

Treatment for allergic transfusion reactions

A
  1. Supportive

2. Antihistamines

68
Q

Should transfusions be continued when an allergic transfusion reaction is identified

A

For minor reactions = yes continue transfusion

For major reactions = stop transfusion and treat anaphylaxis (dyspnea, laryngeal edema etc)

69
Q

What is TRALI (transfusion-related acute lung injury)

A

A form of non-cardiogenic pulmonary edema following transfusion

70
Q

What is the cause of TRALI

A

Human leukocyte antigens (HLA) and neutrophil antibodies present in the donor plasma

Neutrophils are activated in the lungs causing endothelial injury and capillary leak. Pulmonary edema results, impairing gas exchange

71
Q

What is the most common cause of transfusion related mortality

A

TRALI

72
Q

Which blood components are at greatest risk of causing TRALI and why

A

FFP and platelets

These components have the highest concentration of TRALI causing antibodies

73
Q

Which populations are at higher risk of suffering TRALI

A
  1. Critically ill
  2. Sepsis
  3. Burns
  4. Post-CPB
74
Q

Which donor groups impart the highest risk of TRALI

A
  1. Multiparous women
  2. History of blood transfusion
  3. history of organ transplant
75
Q

What are 4 diagnostic criteria for TRALI

A
  1. Onset <6 hrs post transfusion
  2. Bilat infiltrates on CXR
  3. PaO2/FiO2 <300 mmHg or SpO2 <90% RA
  4. Normal PAOP (no LA HTN)
76
Q

What is the recommended management of TRALI

A

Supportive lung-protective strategies

  1. PEEP
  2. Low Vt
  3. Avoid overhydration
77
Q

What is TACO (transfusion associated circulatory overload)

A

A state of volume overload caused by expanding plasma volume beyond pts compensatory ability

78
Q

What are 6 s/sx of TACO

A
  1. Pulmonary edema
  2. Hypervolemia
  3. LV dysfunction
  4. Mitral regurg 2/2 volume overload
  5. Increased PAOP
  6. Increased BNP
79
Q

What are 5 pathophysiologic consequences of massive transfusion

A
  1. Alkalosis
  2. Hypothermia
  3. Hyperglycemia
  4. Hypocalcemia
  5. Hyperkalemia
80
Q 
Why are the following possible with massive transfusion
Alkalosis
Hypothermia
Hyperglycemia
Hypocalcemia
Hyperkalemia
A 
Alkalosis= citrate metabolizes to HCO3 in the liver
Hypothermia= cold blood
Hyperglycemia= dextrose additive in stored blood
Hypocalcemia= binding of Ca++ by citrate
Hyperkalemia= Older blood causes leak of K+ from cell membrane
81
Q

What is the lethal triad of trauma

A
  1. Acidosis
  2. Hypothermia
  3. Coagulopathy
82
Q

What factors impact coagulation in a trauma pt

A
  1. Temperature = hypothermia impairs enzymatic processes of the clotting cascade
  2. Acidosis = from hypoperfusion impact enzymatic structures of clotting cascade
  3. Massive volume resuscitation= dilutional coagulopathy
83
Q

What 5 surgical procedures may utilize intraoperative blood salvage techniques

A
  1. Cardiac
  2. Major vascular
  3. Trauma
  4. Liver transplant
  5. Orthopedic
84
Q

What threshold of expected blood loss is intraop blood salvage recommended

A

EBL 1,000 mL or 20% of EBV

85
Q

What 2 populations may benefit from blood salvage techniques

A
  1. Pre-existing anemia

2. Refusal of allogenic blood i.e. JW

86
Q

What is the process of intraop blood salvage

A
  1. Blood is collected from field with dedicated suction device
  2. Mixed w/ anticoag
  3. Filtered and centrifuged for RBC concentration
  4. Washed
  5. Diluted w/ saline to HcT 60-70%
87
Q

What components of blood are removed during blood salvage

A

Platelets

Coag factors

88
Q

What are 4 benefits of salvaged blood over banked blood

A
  1. better O2-carrying capacity
  2. Higher 2,3-DPG concentration
  3. Greater ATP
  4. Better shape
89
Q

What are the risks of intraop blood salvage transfusion

A
  1. Contamination (malignant cells, amniotic fluid, urine etc)
  2. Fever
  3. Non-immunogenic hemolysis
90
Q

What should be given in addition to a large transfusion of salvaged blood and why

A 
Coagulation factors (FFP) and Plt
B/c of dilutional coagulopathy
91
Q

What are 5 contraindications for blood salvage use

A
  1. Sickle cell disease
  2. Thalassemia
  3. Topical drugs in the field (betadine, CHG, topical abx)
  4. Infected surgical site
  5. Oncologic procedures
92
Q

A patient with which blood type is least likely to experience a hemolytic transfusion reaction

A

AB positive

APEX-Fluids and Blood (3 decks)

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