Quick hits blood

Question 1

What happens if mom becomes sensitized and develops antibodies to the Rh antigen?

Answer 1

Potential for baby to develop erythroblastosis

Mom should receive RhoGAM on following baby at 28 weeks

Question 2

How long do type, screen, and crossmatch take?

Answer 2

Type - 5 min
Screen - 45 min
Cross - 45 min

Question 3

In the setting of an acute hemorrhage, what should be given if there is not time to complete a full crossmatch?

Answer 3

1. Type specific partially crossmatched
2. Type specific uncrossmatched
3. O negative

Question 4

What is a type? How is it done?

Answer 4

5 minutes to figure out what type of blood

Mix recipient blood with anti-A, anti-B, and Rh-D antibodies

Question 5

What is a screen? How is it done?

Answer 5

45 minutes to look for known antigens

Recipient plasma mixed with prepared O RBC’s and known antigens

Question 6

What is a crossmatch? How is it done?

Answer 6

45 minutes

Takes donor and recipients blood and mixes them in a test tube

Question 7

Which blood product contains the highest concentration of fibrinogen?

Answer 7

Cryo

Question 8

What does cryo contain?

Answer 8

Factor 1, 13, 8, vwF

Question 9

When is FFP given?

Answer 9

Contains all coag factors

• acute warfarin reversal
  -Elevated PT or PTT
• AT deficiency
  -Massive transfusion
  -DIC
  -C1 esterase deficiency

Question 10

Estimated blood volumes?

Answer 10

Premature neonate - 100ml/kg
Full term neonate - 90ml/kg
Infant- 80ml/kg
Adult - 70ml/kg

Question 11

MABL?

Answer 11

Question 12

What additives are in blood? why?

Answer 12

Citrate - anticoagulant

Dextrose - substrate for glycolysis

Adenine - Substrate for ATP

Phosphate - Acid buffer

Question 13

What does irradiation do?

Answer 13

Destroys leukocytes and reduces Graft v Host

Question 14

What does washing do?

Answer 14

Washes any remaining plasma and reduces IgA anaphylaxis

Question 15

What does leukoreduction do?

Answer 15

Removes WBC and reduces CMV, HLA, and febrile reactions

Question 16

What happens to blood when stored for a while?

Answer 16

Decreased 2,3 DPG

Decreased pH (acidosis)

Increased potassium

Can’t change shape

Proinflammatory mediators

Question 17

Most common infections for transfusion ? Number 1?

Answer 17

1. CMV
2. Hep B
3. Hep C
4. HIV

Question 18

Which signs and symptoms of a reaction can be seen under anesthesia?

Answer 18

Bleeding
Hypotension
Hemoglobinuria (presenting sign)

Question 19

Steps if a reaction occurs?

Answer 19

1. Stop
2. Maintain urine output >75 with fluids and diuretics
3. Alkalinize urine with bicarb
4. Send labs
5. Send blood
6. Hemodynamic support

Question 20

Most common type of transfusion reaction?

Answer 20

Febrile - support and Tylenol

Question 21

FFP from which donor imparts the highest risk of TRALI?

Answer 21

Multiparous female

Also

previous transfusion and organ transplant

Question 22

What is TRALI caused by?

Answer 22

HLA and neutrophil antibodies in PLASMA

Question 23

How to treat TRALI?

Answer 23

PEEP, lung protective vent, avoid fluids

Question 24

What is TACO?

Answer 24

Volume overload that can’t be compensated

**MOST COMMON CAUSE OF DEATH IN TRANSFUSION COMPLICATIONS

Question 25

Diagnostic criteria for TRALI?

Answer 25

Onset < 6 hours

Bilateral infiltrates on CXR

PaO2/FiO2 or SpO2 < 90%

NORMAL PA pressures

Question 26

What is the lethal triad?

Answer 26

Hypotension

Coagulopathy

Hypothermia

Question 27

Is acidosis or alkalosis seen in a massive transfusion?

Answer 27

Alkalosis

Question 28

Are Plt or coag factors returned during blood salvage?

Answer 28

No

Question 29

Contraindications for blood salvage?

Answer 29

Sickle cell

Thalassemia

Oncology

Infected surgical site

Question 30

3 risks of using salvaged blood?

Answer 30

Contamination

Fever

Non immunogenic hemolysis

Question 31

How is Hematocrit calculated?

Answer 31

Hgb is 1/3 Hct

Hct is 18% then Hgb is 6