Massive Transfusion Flashcards
What are some massive transfusion complications?
Dilutional TCP, hypothermia, potassium changes, alkalosis, citrate load, low 2,3-DPG, DIC
How do you respond to dulutional TCP from massive transfusion?
Requires platelet transfusion if microvascular bleeding unrelated
What does massive transfusion hypothermia cause?
Decreased platelet function, decreased clotting, hypoCa from increased citrate
What happens to K+ with a massive transfusion?
Theoretical risk of hypoK+
HyperK+ from: increased aldosterone, increased ADH, permissive steroids
How do patients become alkalotic with a massive transfusion?
Citrate gets converted to bicarbonate
In a massive transfusion, what results from the citrate load?
Can cause hypoCA
- hypotension
- narrowed pulse pressure
- increased LVEDP
- increased PAP
- increased CVP
- prolonged QT
What is the approach to a massive transfusion?
- pRBCs for O2 carrying capacity
- platelets for microvascular bleeding in normothermics
- crystalloid for intravascular volume
What are the symptoms of anemia?
- tachycardia
- metal status changes
- evidence of myocardial ischemia
- SOB or dizzy with mild exertion
- orthostatic hypotension
How much does one unit of blood raise the hematocrit?
3%
When should you consider pRBC transfusion?
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)
When should you consider transfusing a patient with pRBCs and a hgb of 100?
Risk of CAD or pulmonary insufficiency who have sustained or are expected to sustain significant loss
What are the guidelines for transfusing platelets?
- 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
When should you not use platelets?
- renal failure
- vWD
What are the guidelines for use of FFP?
- 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
What does cyroprecipitate contain?
- factor VIII
- fibrinogen
- fibronectin
- vWF
- factor XIII
What are the indications to give cyroprecipitatie?
- hemophilia A
- vWD
- hypofibrinogenemia (i.e. DIC)
- ?uremic bleeding
How do patients prepare for autologous blood transfusion?
- 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
How does intraoperative hemodilution work?
- 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
What are the types of transfusion reactions?
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)
How do you treat a transfusion reaction?
- stop the transfusion
- check all documentation
- hydrate
- give mannitol +/- lasix
- insert foley
- check for urinary hgb
- type patient’s blood from a different site
What are the rates of infection transmission in blood transfusion?
- 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
