Peds Blood Flashcards
Risks of blood product administration:
- what 2 types of infections? (B,V)
- what 2 transfusion related reactions? (F, A/A)
- what error? (M)
- what 2 transfusion related disease and injury? (GVHD, TRALI)
- bacterial, viral
- febril, allergic/anaphylactic
- medical error
- graft vs host disease, transfusion related acute lung injury
Irradiated blood products
- Blood is exposed to a measured amount of what making the donor what incapable of replication? (R,L)
- Prevents graft versus host disease – where the donor W. C. attack the transfusion recipient
- Decreases the S. life of the blood product
- Increases the transfusion related C.
- Often done for transfusion for p., i. and c. patients
- radiation, lymphocytes
- white cells
- shelf life
- cost
- preemies, infants, cancer pts
CMV Negative Blood Products are reserved for what 4 pt populations? (P, N, CI, UC)
preemies, newborns, critically ill, and undergoing chemotherapy
Leukoreduction filtered blood products:
- Used to prevent reoccurrence of f. n.-h. transfusion reactions caused by donor white blood cell antigen reacting with recipient white blood cell antibodies.
- Reduced c. transmission
- Reduced risk of h.-a. and platelet r.– this is a big deal in patient’s who need b. m. and s. o. transplants
- Universal leukoreduction is not practiced in the U.S.– some hospitals and states may have universal policies
- febrile non-hemolytic transfusion reactions
- CMV
- HLA-alloimmunization and plt refractoriness; bone marrow and solid organ transplants
- united states
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.
- lifespan, effectiveness
- allergic, 1.25 mg/kg, 2mg/kg
- hyperkalemia, renal failure
Compatibility Chart Blood Group
- O - PRBCs and FFP/Plts
- A - PRBCs and FFP/Plts
- B - PRBCs and FFP/Plts
- AB - PRBCs and FFP/Plts
- Positive - PRBCs and FFP/Plts
- Negative - PRBCs and FFP/Plts
- O; O, A,B, AB
- A, O; A, AB
- B, O; B, AB
- AB, A, B, O; AB
- positive/negative; positive/negative
- negative; positive/negative
hemoglobin is the primary what carrying protein (O)
oxygent
Normal Hb values (g/dl) with age:
- 1st day (range)
- 2nd week
- 3 mo (range)
- 2 yr
- 3-5 yr (range)
- 5-10 yr (range)
- over 10 yr
- 20 (18-22)
- 17
- 10-11
- 11
- 12.5-13
- 13-13.5
- 14.5
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?
- 19; 29.8
- left
- affinity, maternal
- less interactive with
- 38 weeks
- 70-80%
- 5%
- 2%; adults
- 60-90 days
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?
- fetal Hb to Hb A
- earlier; naider is lower and lasts longer
- 8-12 weeks; 10-11 g/dl
Anemia of Prematurity:
- true anemia or physiologic anemia:
- what 5 S/S are produced? (T, B, A, DG, PWG)
- true anemia
2. tachycardia, bradycardia, apnea, delayed growth, poor weight gain
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
- carrying capacity; carrying state
2. thalassemia; sickle cell disease
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?
- 90%
- infants
- 10
- clinical status, Hb level, length of time
- 44%
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?
- 10
- 6
- 15%
- 40%
- 24%
- hemodynamic instability
- 10; crisis
- stroke, acute chest syndrome, splenic sequestration, recurrent priapism
- 10%
estimated blood volume mL/kg per age group
- premature infants (range)
- term newborns (range)
- infants < 1 yr (range)
- older children (range)
- 90-100
- 80-90
- 75-80
- 70-75
what is the max allowable formula?
(EBV x (starting hct – lowest allowable hct))/starting hct
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?
- 4 mL/kg
- 1 blood volume
- 5 mL/kg of undiluted; 10 mL/kg of diluted
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?
- volume replacement
- albumin, starch
- warfarin
- targeted factor specific
- > 1.5
- coagulopathic bleeding
- 10-20 mL/kg
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?
- < 10,000
- < 20,000
- < 50,000
- 50,000 microliter
- 5 mL/kg
Platelets
- 1 platelet concentration is the platelets that are spun out of 1 unit of w. b.
- 1 platelet concentration per 10 kg of body weight will increase the platelet count approximately how many /microliter?
- 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?
- When giving platelets to small babies and children, you will most likely be giving apheresis platelets at how many ml/kg?
- whole blood
- 50,000
- 4-10
- 5 mL/kg
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)
- plasma
- 1, 8, 13, fibrinogen, vWF
- microvascular bleeding; hypofibrinogenemia
- specific factor
- von willebrand disease, hemophilia
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?
- 200-250 mg/dl
- 6 units
- 5 kg; 4 units
- 50 mg/dl
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?
- 20 mL/kg
- 24 hours
- > 40%
- acute or imminent acute
- give 1 blood volume
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
- perfusion and oxygenation
- blood volume and hemoglobin
- correction
- normothermia, electrolyte imbalances, cause
How to Administer A Massive Transfusion Protocol
Give PRBCs if:
- Hb < what gm/dl?
- If how many 20 ml/kg fluid boluses is required to maintain blood pressure?
- Dose – PRBC dose of what ml/kg?
Give FFP if:
- If PT > how many sec, INR > what, and PTT > how many seconds
- Once how many ml/kg PRBCs given and if still bleeding?
- Diffuse m. b.
Give Platelets if:
- Platelet count < what with ongoing bleeding?
- Once what range of ml/kg RBCs have been replaced?
Give Cryoprecipitate if:
- Fibrinogen < what mg/dl?
- “Clinical” DIC o., major h. i., uncontrolled h.
- < 8 gm/dl
- third
- 15 mL/kg
- > 15 seconds, > 1.5, > 40 seconds
- 40 mL/kg
- microvascular bleeding
- 75,000
- 40-80 mL/kg
- 100 mg/dl
- DIC oozing, head injury, hemorrhage
