Massive Transfusion

Question 1

What are some massive transfusion complications?

Answer 1

Dilutional TCP, hypothermia, potassium changes, alkalosis, citrate load, low 2,3-DPG, DIC

Question 2

How do you respond to dulutional TCP from massive transfusion?

Answer 2

Requires platelet transfusion if microvascular bleeding unrelated

Question 3

What does massive transfusion hypothermia cause?

Answer 3

Decreased platelet function, decreased clotting, hypoCa from increased citrate

Question 4

What happens to K+ with a massive transfusion?

Answer 4

Theoretical risk of hypoK+

HyperK+ from: increased aldosterone, increased ADH, permissive steroids

Question 5

How do patients become alkalotic with a massive transfusion?

Answer 5

Citrate gets converted to bicarbonate

Question 6

In a massive transfusion, what results from the citrate load?

Answer 6

Can cause hypoCA

• hypotension
• narrowed pulse pressure
• increased LVEDP
• increased PAP
• increased CVP
• prolonged QT

Question 7

What is the approach to a massive transfusion?

Answer 7

• pRBCs for O2 carrying capacity
• platelets for microvascular bleeding in normothermics
• crystalloid for intravascular volume

Question 8

What are the symptoms of anemia?

Answer 8

• tachycardia
• metal status changes
• evidence of myocardial ischemia
• SOB or dizzy with mild exertion
• orthostatic hypotension

Question 9

How much does one unit of blood raise the hematocrit?

Answer 9

3%

Question 10

When should you consider pRBC transfusion?

Answer 10

Hgb < 80* or acute blood loss in otherwise healthy patient with S/S of decreased O2 delivery with >/= 2 of:

• Estimated/anticipated blood loss of < 15% (750mL)
• dBP < 60
• sBP drop from baseline > 30
• tachycardia
• oliguria/anuria
• mental status changes

(* I (Alison) thought this should be 70 but cue cards say 80)

Question 11

When should you consider transfusing a patient with pRBCs and a hgb of 100?

Answer 11

Risk of CAD or pulmonary insufficiency who have sustained or are expected to sustain significant loss

Question 12

What are the guidelines for transfusing platelets?

Answer 12

• plt < 10
• plt < 50 with microvascular bleeding or planned invasive procedure
• precipitous fall with microvascular bleeding
• intraoperatively with microvascular bleeding (oozing) and complicated procedure or required > 10U pRBCs
• Documented plt dysfunction and microvascular bleeding or planned invasive procedure

Question 13

When should you not use platelets?

Answer 13

• renal failure

- vWD

Question 14

What are the guidelines for use of FFP?

Answer 14

• Tx multiple/specific coagulation factor deficiency with abnormal PTT or INR
• Abnormal specific factor deficiency or planned invasive procedure in the presence of: 1) congenital deficiency of antithrombin III, clotting factors, protein C or S, plasminogen, or antiplasmin, 2) acquired deficiency from warfarin, vitamin K, liver disease, massive transfusion, DIC

Question 15

What does cyroprecipitate contain?

Answer 15

• factor VIII
• fibrinogen
• fibronectin
• vWF
• factor XIII

Question 16

What are the indications to give cyroprecipitatie?

Answer 16

• hemophilia A
• vWD
• hypofibrinogenemia (i.e. DIC)
• ?uremic bleeding

Question 17

How do patients prepare for autologous blood transfusion?

Answer 17

• hematocrit must be > 30%
• donate q3-4d, starting 1 month pre-op
• iron supplementation and good nutrition
• can be done in those with cardiac and people of any age

Question 18

How does intraoperative hemodilution work?

Answer 18

• remove 1-3U and replace with colloid or crystalloid
• do it just before and reinfuse as needed intraoperatively
• blood stored at room temp for up to 4 hours

Question 19

What are the types of transfusion reactions?

Answer 19

no back to this card

my answer;

• febrile transfusion reaction
• hemolytic transfusion reaction
• allergic reaction
• TACO (transfusion associated cardiac overload)
• TRALI (transfusion related acute lung injury)

Question 20

How do you treat a transfusion reaction?

Answer 20

• stop the transfusion
• check all documentation
• hydrate
• give mannitol +/- lasix
• insert foley
• check for urinary hgb
• type patient’s blood from a different site

Question 21

What are the rates of infection transmission in blood transfusion?

Answer 21

• HAV = very rare
• HIV - 1 : 900 000
• HCV - 1 : 500 000
• HBV - 1 : 200 000
• HGV - 1 : 50 (non-known dz)
• CMV - 1 : 7500 (immunocomprimised need CMV negative blood)
• Syphilis - in platelet transfusions because stored at room temp