Massive transfusion Flashcards
What is massive transfusion
replacement of 1 or more blood volumes in 24 hrs
-blood volume is 5000 ml= 10 units
-blood products transfused exceed original blood volume
-XM policy in hospital
When is a massive tranfusion needed
-rapid blood loss
-hemorrhage affecting nervous, hormonal , and circulatory systems
-blood loss greater than 30% of total volume leading to hemorrhagic shock
-high stress and high mortality rate
What occurs when you are hemorraging ????
-electrolyte metabolism and O2 transport affected
-increased heart rate and stress on organs
-prolonged hypotension and tissue damage = cardiac and renal failure
-DIC, coag cascade activated by the hemorrhage
-hard to control bleeding
What is massive transfusion associated with
trauma
surgery
post partum hemorrhage
-bleeding due to internal abnormalities Esophageal varices, aneurysms, GI bleeds
hypothermia
when does it occur in massive transfusion and what is the treatment
-due to rapid infusion of blood products
-Red cell temp of 4C can drop body temp 0.25C
-a one degree drop in temp increased blood loss by 22%
-mortality after transfusion is inversely related to core temp
treat with high flow blood warmer
What are the consequences of hypothermia
-decrease in platelet function
-coagulopathy
decreased citrate clearance
decreased cardiac output
hypotension
arryhythmia
hypothermia is an adverse effect of specific massive transfusion
Citrate toxicity
when does it occur in massive transfusion
what is it
treatment
-decrease in CAI from anticoag in blood products
-citrate delivery can exceed livers capacity for its clearance
- results in metabolic alkalosis as a secondary condition due to the accumulation of bicarb and metabolic by product of citrate
-causes hypocalcemia,, tetany, tingling and hyperventilation
how to treat citrate toxicity
-slow infusion
-calcium replacement if severe
-in massivr transfusion the liver may be too overwhelmed to degrade citrate
What is hyperkalemia
when does it occur in massive transfusion
what is it
treatment
-PRC leak K into plasma or additive solution during storage
-rapid infusion of a large amount of packed RC in neonates or pts with cardiac , hepatic or renal dysfunction put them at a higher risk
how to treat hyperkalemia
transient hyperkalemia related to pts Acid-base balance
-must monitor hematologic, renal, electrolyte and infusion rates
What are Coagulation abnormalities/ Microvascular
Hemorrhage
- develop secondarily to hemodilution or disseminated intravascular coagulopathy
-Colloids and crystalloids like Albumin are given to prevent hypovalemia, maintain flow and decrease shock
-if coag values are abnormal then giving Albumin can cause dilution of coag factors
how to treat dilution of coagulation factors
-transfuse platelets
-transfuse frozen plasma to control deficiencies
-restore blood volume by controlling hemorrhage and replacing intravascular volume to prevent shock
-infuse fluid volume to maintain blood flow and pressure for O2 in tissue
What is hypovolemia
when does it occur in massive transfusion
what is it
treatment
-symptoms are decreased arterial pressure, hypotension, cooling of extremities , oliguria, acidosis, increased respiration and decreased central venous pressure
treat with
-crystalloids to correct hypovolemia
-increased O2 carrying capacity
-maintain hemostasis
-avoid metabolic disturbances
-maintain intravascular volume with colloids
how does uncontrolled bleeding occur
DIC activates coag cascades caused by hemorrhage = uncontrolled bleeding
treat with
desmopressin, factor VIIa and antifibriolytics (tranexamic acid) is used to control bleeding
Slide 20
What is Transfusion Associated
Circulatory Overload
how to treat
-when blood volume overwhelms the cardiovascular system and produces pulmonary edema
-ppl at risk are elderly, children, pts with impaired cardiac, renal and pulmonary functions
- treat
-resuscutation of trauma pts with 1:1:1 RBC:FP:PLTs to prevent dilutional coagulopathy
-ensure lab monitoring
Tranexamic acid (TXA)– Anti-fibrinolytic
what does it do
-acts as a antifibriolytic agent by binding receptor sites of plasminogen
-reduces coversion of plasminogen to plasmin and prevents fibrin degradation which helps to preserve fibrin matrix
-stablizes clot
-most effective when given immediately no benefit if you give in 3 hours
-prevents clot breakdown - good in surgeries added MHP
-reduces bleeding = reducing need for transfusion
-not given by blood bank
FVIIa – Activated FVII
what does it do
- controversial to use
-needs coag factors in body to work
-can reduce RBC transfusions
-increased risk of thromboembolic complications
Prothrombin Complex Concentrate-Octaplex
-treats underlying coagulopathies
-reverses oral anticaogs like Ins and Bans
-contains factors such as II, VII, IX, X,
Protein C, and Protein S.
What is the term of Massive transfusion in a hospital
MHP
code omega or code transfusion
policy is agreed by between the lab, techs, safety officers
What does code MHP allow the medical team to do
concentrate on treatment with problems with ordering blood products
-MLT in blood bank should be prepared
* Blood Bank / Transfusion Service Lab will immediately provide PRBC, thaw FP, and check inventory for
Platelets
* The hematology and Chemistry department will prepare for STAT blood analyses (CBC, Coagulation,
Electrolytes, and Blood Gases)
-PRBC issued as XM or unXM depending on patient
-Samples can be crossmatched if a valid T/S is available and there is time. Usually, patients are bleeding in the OR, ICU, and L&D.
-new admit to ER WITHOUT info will need unXM
-NEVER issue blood based on a
Historical Blood Group
-if you hear the code refrain from calling for nonemergency blood products and non-urgent test results
Transfusion
Coordinator
Responsibilities
Initiating MHP with BBK
Main point of contact
Follow Order Set
MLA
Responsibilities
Notifying MLT when samples
are received
Prioritizing MHP samples
MLT
Responsibilities
Prioritizing MHP samples
Preparing Blood products for pick
up
