PBM

Question 1

________ is an evidence-based multidisciplinary approach to optimize care of patients who might need transfusion. Its priary goal is to improve patient safety and clinical outcomes by appropriately managing the patient’s “own blood”.

Answer 1

Patient blood management

Question 2

The three reasons for PBM; aligned with the Institute for Health Improvement’s “triple aim” initiative are _______, ________, and ________.

Answer 2

Safe and quality care, improved patient experience and outcomes, reduced health care costs

Question 3

True/false - one rationale for PBM is that, fewer transfusions lead to better outcomes, lower mortality risk, and cardiac and respiratory complications

Answer 3

True

Question 4

True/false - Blood transfusion is one of the top five overused procedures in hospitalized patients

Answer 4

True

Question 5

Which off the following is considered non-surgical/pre-operative scope of patient blood management?
A. Avoiding hypothermia
B. Iron therapy
C. Screening for bleeding risk and optimize coagulation
D. Wound drainage

Answer 5

C. Screening for bleeding risk and optimize coagulation
This is done by:
-Discontinuing anticoagulants and antiplatelet drug
-Discontinuing herbal supplements and some vitamins
-Addressing genetic coagulation

Question 6

Which off the following is considered an intraoperative scope of patient blood management?
A. Avoiding hypothermia
B. Iron therapy
C. Screening for bleeding risk and optimize coagulation
D. Preoperative autologous donation

Answer 6

A. Avoiding hypothermia

Question 7

Which off the following is considered an ICU and postoperative scope of patient blood management?
A. Avoiding hypothermia
B. Iron therapy
C. Acute normovolemic hemodilution
D. Preoperative autologous donation

Answer 7

B. Iron therapy

Question 8

As per WHO, what lab values are considered an indication of anemia in men and in women?

Answer 8

Men: <13 g/dL
Women: <12 g/dL (premenopausal and non pregnant)

Question 9

________ Is one of the strongest predictors of the need for perioperative blood transfusion.

Answer 9

Anemia

Question 10

True/false - obtaining perioperative laboratory Hgb levles / results is sufficient in diagnosing anemia in patients.

Answer 10

False.

Additional testing is needed if anemia is detected : creatinine levels, reticulocyte count, iron and iron binding capacity, ferritin, vit B12 and folate should be considered to aid diagnosis.

Question 11

________ is a safe, effective and preferred route in treating anemia (preoperative), which reduces the need for allogeneic RBC transfusions.

Answer 11

Intravenous (IV) iron

Question 12

True/false - There has been a significant increase in perioperative autologus blood donation (PAD ) in the last few years and has been used as the primary means to reduce the use of allogeneic blood.

Answer 12

False

Ther has been a significant downward trend in the number of autologous units.

Question 13

______ is an intraoperative PBM strategy where whole blood is removed from patient immediately before or shortly after the beginning of a surgical procedure.

Answer 13

Acute Normovolemic Hemodilution

Question 14

True/ false - in acute normovolemic hemodilution (ANH), patient’s whole blood is stored at room temperature up to 8 hours and often reinfused near the end of the procedure.

Answer 14

True

Question 15

A type of PBM intraoperative blood recovery strategy where blood is collected at the surgical site, spinned down and washed, and reinfused to patient.
A. Laparoscopy
B. Use of recovered shed blood
C. Autologous blood donation
D. Acute normovolemic hemodilution

Answer 15

B. Use of recovered shed blood

Question 16

True/false - maintaining normothermia is and intraoperative PBM strategy where the patient is kept at a cooler than body temperature to help decrese surgical blood loss.

Answer 16

False

Normothermia - normal body temperature (36-38C)

Maintaining normothermia during surgery is important for optimal coagulation and hemostasis; avoiding hypothermia decreases surgical blood loss

Question 17

Which of the ff PBM strategy is used to assess a patient’s coagulation status particularly in liver and MTP patients?
A. Laparoscopy
B. Acute normovolemic hemodilution (ANH)
C. Phlebotomy
D. TEG/ ROTEM

Answer 17

D. TEG/ ROTEM

TEG = thromboelastography

Question 18

Which antifibrinolytics is most commonly used in and intraoperative setting (as a PBM strategy) to inhibit fibrinolytic activity by preventing premature breakdown of blood clots?
A. Tranexamic acid (TXA)
B. Aminocaproic acid
C. Desmopressin (DDVAP)
D. Topica agents (hemostatics, sealants, adhesive)

Answer 18

A. Tranexamic acid (TXA)

Question 19

Which antifibrinolytic agents is most commonly used in an intraoperative setting (as a PBM strategy) to stimulate the release of von Willebrand factors and FVIII from the endothelium, which increases the circulating levels of these factors and plt adhesion to endothelial cells?
A. Tranexamic acid (TXA)
B. Aminocaproic acid
C. Desmopressin (DDVAP)
D. Topica agents (hemostatics, sealants, adhesive)

Answer 19

C. Desmopressin (DDVAP)

Question 20

Which antifibrinolytic agents is used in an intraoperative setting (as a PBM strategy) for cardiac surgery patients who have ingested aspirin or experienced prolonged extracorporeal cardiopulmonary bypass?
A. Tranexamic acid (TXA)
B. Aminocaproic acid
C. Desmopressin (DDVAP)
D. Topica agents (hemostatics, sealants, adhesive)

Answer 20

C. Desmopressin (DDVAP)

Question 21

Which antifibrinolytic agents is used in an intraoperative setting (as a PBM strategy) as tools to reduce surgical bleeding by enhancing clotting, sealing vessels or gluing tissues?
A. Tranexamic acid (TXA)
B. Aminocaproic acid
C. Desmopressin (DDVAP)
D. Topica agents (hemostatics, sealants, adhesive)

Answer 21

D. Topica agents (hemostatics, sealants, adhesive)

Question 22

Which antifibrinolytic agents is used in an intraoperative setting (as a PBM strategy) and is becoming increasingly common to use as a blood conservation strategy in joint replacemen surgery?
A. Tranexamic acid (TXA)
B. Aminocaproic acid
C. Desmopressin (DDVAP)
D. Topica agents (hemostatics, sealants, adhesive)

Answer 22

A. Tranexamic acid (TXA)

Question 23

True/false - the use of unwashed shed blood is becoming increasingly desirable because it has a Hct of 20-30% and it contains activated clotting annd complement factors, inflammatory mediatiors, cytokines and fat particles that can decrease the risk of febrile reactions.

Answer 23

False

the use of unwashed shed blood is LESS desirable because it has a Hct of 20-30% and it contains activated clotting annd complement factors, inflammatory mediatiors, cytokines and fat particles that can INCREASE the risk of febrile reactions.

Question 24

True/false - the use of antifibrinolytics has led to a decline in surgical bleeding making postoperative blood recovery unnecessary.

Answer 24

True

Question 25

Which of the ff statements is an example of limiting phlebotomy related blood loss?
A. The use of regular sized tubes to draw pediatric patients
B. Drawing labs from patients with central venous or aterial lines
C. Reinfusing the initial draw back to patients with central venous or arterial lines instead of discarding
D. Maintaining the same amount of routine lab test orders to monitor stable patients

Answer 25

C. Reinfusing the initial draw back to patients with central venous or arterial lines instead of discarding

A - use pediatric / bullets to draw
B - these lines are invasive abd require first ml draw to be discarded
D - order only if clinically justified and will change patient management

Question 26

True/false - increasing a patient’s tolerace for lower Hgb/anemia (increase in oxygen delivery or decreased oxygen consumption) leads to reduced need for RBC transfusions.

Answer 26

True