Lecture 7 - Alternatives to Transfusion

Question 1

what risks to white blood cells cause in the blood?

Answer 1

risk of infection, inflammation and immunosuppression

Question 2

how can red blood cells cause risk to patient?

Answer 2

may tax the body’s monocytes and macrophages and the overload may trigger inflammation and immunosuppression by altering oxygen, iron and haemoglobin

Question 3

how can platelets cause risk to patient?

Answer 3

Microparticles derived from platelets can suppress or activate immune cells

Question 4

what effect can bioactive lipids have?

Answer 4

polyunsaturated fatty acids can accumulate in blood units during storage and may play a role in inflammation and transfusion related immunosuppression

Question 5

what is autologous blood transfusion?

Answer 5

collection and rein fusion of the patients own blood cells

Question 6

why was predeposit autologous donations brought about?

Answer 6

due to concerns about viral transmission in donor blood, especially during HIV epidemic

Question 7

why might a PAD be useful?

Answer 7

if someone does not want foreign blood, if unique blood is hard to obtain

Question 8

what is acute normovolemic haemodilution?

Answer 8

removal of whole blood from a patient and replacement of coruscating blood volume with colloid and or crystalloid solutions

Question 9

when are acute normovolemic haemodilutions performed?

Answer 9

immediately prior to surgery

Question 10

what are the advantages of ANH?

Answer 10

minimise red cell loss

Question 11

what are the clinical implications of ANH?

Answer 11

adult patients undergoing surgery in which high blood loss expected, in patients who refuse transfusion

Question 12

what are the contradictions of ANH?

Answer 12

anaemia, renal failure, significant heart disease

Question 13

what is intraoperative cell salvage?

Answer 13

collection and reinfusion of blood spilled during surgery

Question 14

how does inoperative cell salvage work?

Answer 14

blood lost in surgical field is aspirated into collection reservoir after filtration to remove debris, then anticoagulated

Question 15

what is blood anti coagulated with?

Answer 15

heparin or citrate

Question 16

what are the issues of IOC?

Answer 16

can cause dilution of clotting factors and thrombocytopenia if used in large volumes

Question 17

what is postoperative cell salvage?

Answer 17

blood collected from wounds drains and filtered and washed in automated system and then returned

Question 18

when is postoperative cell salvage used?

Answer 18

in orthopaedic procedures, especially after knee or hip replacement or correction of scoliosis

Question 19

what are the antifibronolytic and procoagulant drugs?

Answer 19

tranexamic acid, recombinant activated factor VII, fibrinogen concentrate

Question 20

what is tranexamic acid?

Answer 20

inhibits fibrinolysis (breakdown of blood clots) by reducing the conversion of plasminogen to plasmin

Question 21

what are the uses of tranexamic acid?

Answer 21

reduces need for transfusion and need for further surgery due to re-bleeding

Question 22

what are the advantaged of tranexamic acid?

Answer 22

oral or IV, low cost

Question 23

what is the mechanism of action of recombinant activated factor VIII?

Answer 23

directly activates blood clot formation at sites of exposed tissue factor in damaged blood vessels

Question 24

in what patients is recombinant activated factor VIII used?

Answer 24

patients with haemophilia A or B or those with haemorrhages

Question 25

what are the main off label uses of recombinant activated factor VIII?

Answer 25

cardiac surgery, trauma, intracranial haemorrhage and liver or abdominal surgery

Question 26

what are the disadvantages of recombinant activated factor VIII?

Answer 26

extremely expensive, acidosis decreases effectiveness as adequate levels of fibrinogen are needed for clot formation

Question 27

what is the purpose of fibrinogen concentrate?

Answer 27

replaces lost fibrinogen by serving as a physiological substrate of thrombin (which converts soluble fibrinogen to insoluble fibrinogen)

Question 28

what is the mechanism of action of fibrinogen concentrate?

Answer 28

under the influence of factor XIIIa, fibrin strands cross-linked to provide strength and stability to the blood clots

Question 29

what are the disadvantages of fibrinogen concentrate?

Answer 29

expensive, can cause anaphylactic reactions and thrombotic events

Question 30

what are is EPO?

Answer 30

produced in the kidneys and increases red cell production in the bone marrow in response to reduced oxygen delivery

Question 31

what are the indications of EPO stimulating agents?

Answer 31

anaemia or renal failure, reducing need to transfusion in cancer patients undergoing chemotherapy

Question 32

what are the advantages of EPO stimulating agents?

Answer 32

increases yield for PAD, reducing exposure to donor blood in adults undergoing major surgery

Question 33

what are the disadvantages of EPO stimulating agents?

Answer 33

higher hematocrits may cause thromboembolic complications and expense

Question 34

what are the complications with oral iron therapy?

Answer 34

GI effects and compliance is poor

Question 35

what are the indications of IV iron?

Answer 35

iron deficiency anaemia yet intolerance of oral iron or inflammatory bowel disease, as an alternative to transfusion when an urgent need for Hb (e.g. severe anaemia in late pregnancy)

Question 36

what is an example of an IV iron?

Answer 36

ferrinject