Peds Blood

Question 1

Risks of blood product administration:

1. what 2 types of infections? (B,V)
2. what 2 transfusion related reactions? (F, A/A)
3. what error? (M)
4. what 2 transfusion related disease and injury? (GVHD, TRALI)

Answer 1

1. bacterial, viral
2. febril, allergic/anaphylactic
3. medical error
4. graft vs host disease, transfusion related acute lung injury

Question 2

Irradiated blood products

1. Blood is exposed to a measured amount of what making the donor what incapable of replication? (R,L)
2. Prevents graft versus host disease – where the donor W. C. attack the transfusion recipient
3. Decreases the S. life of the blood product
4. Increases the transfusion related C.
5. Often done for transfusion for p., i. and c. patients

Answer 2

1. radiation, lymphocytes
2. white cells
3. shelf life
4. cost
5. preemies, infants, cancer pts

Question 3

CMV Negative Blood Products are reserved for what 4 pt populations? (P, N, CI, UC)

Answer 3

preemies, newborns, critically ill, and undergoing chemotherapy

Question 4

Leukoreduction filtered blood products:

1. Used to prevent reoccurrence of f. n.-h. transfusion reactions caused by donor white blood cell antigen reacting with recipient white blood cell antibodies.
2. Reduced c. transmission
3. Reduced risk of h.-a. and platelet r.– this is a big deal in patient’s who need b. m. and s. o. transplants
4. Universal leukoreduction is not practiced in the U.S.– some hospitals and states may have universal policies

Answer 4

1. febrile non-hemolytic transfusion reactions
2. CMV
3. HLA-alloimmunization and plt refractoriness; bone marrow and solid organ transplants
4. united states

Question 5

Washed Products
 Washing significantly decreases the blood cell l. in the circulation and its e.
 Used in patients who have had a life threatening a. reaction in spite of pretreatment with diphenhydramine ?mg/kg and hydrocortisone ?mg/kg
 Patient may need dialysis to prevent h. and r.f.

Answer 5

1. lifespan, effectiveness
2. allergic, 1.25 mg/kg, 2mg/kg
3. hyperkalemia, renal failure

Question 6

Compatibility Chart Blood Group

1. O - PRBCs and FFP/Plts
2. A - PRBCs and FFP/Plts
3. B - PRBCs and FFP/Plts
4. AB - PRBCs and FFP/Plts
5. Positive - PRBCs and FFP/Plts
6. Negative - PRBCs and FFP/Plts

Answer 6

1. O; O, A,B, AB
2. A, O; A, AB
3. B, O; B, AB
4. AB, A, B, O; AB
5. positive/negative; positive/negative
6. negative; positive/negative

Question 7

hemoglobin is the primary what carrying protein (O)

Answer 7

oxygent

Question 8

Normal Hb values (g/dl) with age:

1. 1st day (range)
2. 2nd week
3. 3 mo (range)
4. 2 yr
5. 3-5 yr (range)
6. 5-10 yr (range)
7. over 10 yr

Answer 8

1. 20 (18-22)
2. 17
3. 10-11
4. 11
5. 12.5-13
6. 13-13.5
7. 14.5

Question 9

Fetal Hemoglobin
 P50 value of what? (versus what value for hemoglobin A)
 left or right shift of the oxyhemoglobin dissociation curve
 This is important because fetal hemoglobin needs to have greater a. for oxygen so it can draw the oxygen out of the m. blood supply.
 Fetal hemoglobin more or less interactive with 2,3 DPG
 Synthesis of Hb F ceases at what weeks gestational age
 Birth – what % range?
 6 months – what %?
 1 year – what %? - similar to a.
 Life span of what day range?

Answer 9

1. 19; 29.8
2. left
3. affinity, maternal
4. less interactive with
5. 38 weeks
6. 70-80%
7. 5%
8. 2%; adults
9. 60-90 days

Question 10

physiologic anemia of infancy:
 Occurs as the conversion from what Hb to what Hb
 Preterm Infant: occurs e., nadir is l. and it lasts l.
 Full term infant: what age weeks and what nadir range?

Answer 10

1. fetal Hb to Hb A
2. earlier; naider is lower and lasts longer
3. 8-12 weeks; 10-11 g/dl

Question 11

Anemia of Prematurity:

1. true anemia or physiologic anemia:
2. what 5 S/S are produced? (T, B, A, DG, PWG)

Answer 11

1. true anemia

2. tachycardia, bradycardia, apnea, delayed growth, poor weight gain

Question 12

PRBC transfusion indications:
 Only 2 accepted indications for the transfusion of PRBCs
1. Increase oxygen c. c. or avoid an impending inadequate oxygen c. s.
2. Suppress the production or dilute the amount of endogenous hemoglobin in selected patients with t. or s. c. disease

Answer 12

1. carrying capacity; carrying state

2. thalassemia; sickle cell disease

Question 13

transfusion in pt < 4 months:
 what % of transfusions are for replacement of iatrogenic blood loss from blood draws for laboratory test?
 what age group receives the most transfusions of all patient groups?
 Are exposed to up to how many different donors?
 Transfusion decisions should include factors c.s., h.l., and l. of time over which the blood loss occurred.
 Transfusion Requirements in the Pediatric Intensive Care Unit (Lacroix et al 2007): found that restrictive strategy of transfusion for hb trigger of 7g/dl vs 9.5 g/dl did not alter patient outcomes but resulted in what % fewer transfusions?

Answer 13

1. 90%
2. infants
3. 10
4. clinical status, Hb level, length of time
5. 44%

Question 14

Indications for transfusions of pts > 4 months:
 Rarely Indicated when hb >what g/dl?
 Almost always Indicated when hb < g/dl?
 For intraoperative blood loss of what % of EBV?
 For children with significant cardiac disease Hct < what %?
 Healthy children Hct < what %?
 Sudden massive surgical bleeding associated with h. i.
 Sickle cell patient with Hb < what for any surgical procedure? If < this Hb, it puts them at risk for what in the OR? (C)
 Sickle cell patients can have what symptoms? (S, ACS, SS, RP)
 Type and Cross for any procedure with an expected EBL of what % of EBV or greater?

Answer 14

1. 10
2. 6
3. 15%
4. 40%
5. 24%
6. hemodynamic instability
7. 10; crisis
8. stroke, acute chest syndrome, splenic sequestration, recurrent priapism
9. 10%

Question 15

estimated blood volume mL/kg per age group

1. premature infants (range)
2. term newborns (range)
3. infants < 1 yr (range)
4. older children (range)

Answer 15

1. 90-100
2. 80-90
3. 75-80
4. 70-75

Question 16

what is the max allowable formula?

Answer 16

(EBV x (starting hct – lowest allowable hct))/starting hct

Question 17

PRBCs:
 how many ml/kg PRBCs increase the Hb concentration 1 gram?
 Consider a Massive Transfusion Protocol when you have administered how many blood volumes of PRBCs?
 She gives how many ml/kg of undiluted PRBCs or how many ml/kg of diluted PRBCs?

Answer 17

1. 4 mL/kg
2. 1 blood volume
3. 5 mL/kg of undiluted; 10 mL/kg of diluted

Question 18

FFP transfusion indications:
 Not indicated for v. r.
 For colloid volume replacement use a. or s. based product
 Emergency reversal of what? (W)
 Congenital bleeding disorders should be treated with t. f. s. therapies unless those are unavailable
 Correction of coagulopathic bleeding with an INR> what?
 Correction of c. b. with massive transfusion - i.e. transfusion of more than 1 blood volume
 Typical dose of FFP is what range of ml/kg?

Answer 18

1. volume replacement
2. albumin, starch
3. warfarin
4. targeted factor specific
5. > 1.5
6. coagulopathic bleeding
7. 10-20 mL/kg

Question 19

Plts transfusion indications:
 Platelets < how many /microliter
 Platelets < how many /microliter and bone marrow infiltration, DIC, anticoagulation therapy, platelet level likely to fall, local tumor invasion, other factor leading to high likelihood of bleeding
 Invasive procedures platelets < what /microliter?
 1 platelet concentration per 10 kg of body weight will increase platelet count how many per microliter?
 Give how many ml/kg of apheresis platelets?

Answer 19

1. < 10,000
2. < 20,000
3. < 50,000
4. 50,000 microliter
5. 5 mL/kg

Question 20

Platelets

1. 1 platelet concentration is the platelets that are spun out of 1 unit of w. b.
2. 1 platelet concentration per 10 kg of body weight will increase the platelet count approximately how many /microliter?
3. Because a single platelet concentration is not enough to be clinically significant (in an adult) platelets are pooled what range of concentrations per bag or unit?
4. When giving platelets to small babies and children, you will most likely be giving apheresis platelets at how many ml/kg?

Answer 20

1. whole blood
2. 50,000
3. 4-10
4. 5 mL/kg

Question 21

Cryoprecipitate
 Prepared from p.
 Contains what 5 factors?
-Indications for use include m. b. and prior to invasive procedures for pts with h.
 Availability of s. f. concentrates has reduced the use of cryo
 Do not use cryoprecipitate as a first line treatment what 2 diseases? (VWD, H)

Answer 21

1. plasma
2. 1, 8, 13, fibrinogen, vWF
3. microvascular bleeding; hypofibrinogenemia
4. specific factor
5. von willebrand disease, hemophilia

Question 22

Cryoprecipitate
 Fibrinogen normal values what range of mg/dl?
 Adult use - prepooled concentrated of how many units?
 Pediatric use – 1 unit per how many kg with a max of how many units?
 1 unit raises fibrinogen by how many mg/dl?

Answer 22

1. 200-250 mg/dl
2. 6 units
3. 5 kg; 4 units
4. 50 mg/dl

Question 23

when to initiate a massive transfusion protocol:

 Replacement of > how many ml/kg of RBCs within the first hour of resuscitation
 Anticipated continued blood loss amounting to 1 blood volume in how many hours?
 Class IV shock (> what % blood loss with a critical blood pressure and heart rate)
 a. or i. a. blood loss
 In the OR after giving how many blood volumes of PRBCs many providers initiate a MTP?

Answer 23

1. 20 mL/kg
2. 24 hours
3. > 40%
4. acute or imminent acute
5. give 1 blood volume

Question 24

Goals of massive transfusion protocol:

 Maintenance or restoration of tissue p. and o.
 Restoration of circulating b. v. and h.
 Arrest of bleeding by surgical treatment of the source and c. of coagulopathy
 Remember to also:
 Maintain n., treat e. i., and underlying c. of DIC

Answer 24

1. perfusion and oxygenation
2. blood volume and hemoglobin
3. correction
4. normothermia, electrolyte imbalances, cause

Question 25

How to Administer A Massive Transfusion Protocol Give PRBCs if: 1. Hb < what gm/dl? 2. If how many 20 ml/kg fluid boluses is required to maintain blood pressure? 3. Dose – PRBC dose of what ml/kg? Give FFP if: 4. If PT > how many sec, INR > what, and PTT > how many seconds 5. Once how many ml/kg PRBCs given and if still bleeding? 6. Diffuse m. b. Give Platelets if: 7. Platelet count < what with ongoing bleeding? 8. Once what range of ml/kg RBCs have been replaced? Give Cryoprecipitate if: 9. Fibrinogen < what mg/dl? 10. “Clinical” DIC o., major h. i., uncontrolled h.

Answer 25

1. < 8 gm/dl 2. third 3. 15 mL/kg 4. > 15 seconds, > 1.5, > 40 seconds 5. 40 mL/kg 6. microvascular bleeding 7. 75,000 8. 40-80 mL/kg 9. 100 mg/dl 10. DIC oozing, head injury, hemorrhage