Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Heme / Onc > SM_255b: Blood Transfusions - Indications > Flashcards

SM_255b: Blood Transfusions - Indications Flashcards

1
Q

Describe indications for blood component transfusions

A

Indications for blood component transfusions

  • RBCs: bleeding, anemia, perioperative blood management
  • Platelets: thrombocytopenia, platelet dysfunction and hemostasis need
  • Plasma: coagulopathy and bleeding / procedure
  • Cryoprecipitate: low fibrinogen and bleeding / procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe whole-blood donation

A

Whole-blood donation

  • 500 mL into citrate anticoagulant
  • Separated at lab: RBCs plus plasma or platelets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe apheresis donation

A

Apheresis donation

  • Blood drawn into continuous flow centrifuge: citrate anticoagulation
  • Desired elements skimmed off
  • Rest returned to donor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe normal blood volume

A

Normal blood volume

  • Adult: 70 mL/kg
  • Normal hematocrit: 40% RBCs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

One RBC unit is ____ and includes ____ packed RBCs after centrifugation

A

One RBC unit is RBC content from a 500-mL whole blood collection that includes 300 mL packed RBCs after centrifugation

  • 1 g/dL rise in Hb per unit
  • Half life in blood: 30 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Descriibe indications for RBC transfusion in acute bleeding

A

Indications for RBC transfusion in acute bleeding

  • Intravascular blood volume is first priority: IV fluids, avoid hypovolemia and hypoperfusion
  • Very early Hgb/Hct levels may not yet reflect blood loss, until intravascular volume expanded with fluid
  • RBC transfusions usually needed when acute blood loss reaches 30% of blood volume (1500 mL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Massive transfusion is ___

A

Massive transfusion is ≥ 1 blood volume of RBCs transfused

  • About 10 units RBCs in average adult
  • Hemodilution of plasma and platelets without replacement
  • Current approach is 1 unit RBC: 1 unit plasma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe anemia compensation

A

Anemia compensation

  • Cardiac: increased cardiac output
  • Pulmonary: maintain blood oxygenation
  • Vascular bed: preserve blood flow to brain and heart
  • Hgb < 5 g/dL: cannot be fully compensated even when healthy but tranfuse cautiously in long-standing anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most stable patients have a transfusion Hgb threshold of ____

A

Most stable patients have a transfusion Hgb threshold of 7 g/dL

  • Higher if symptomatic anemia
  • Restrictive vs liberal criteria have no effect on morbidity or 30-day mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In stable anemic patients, ____ between non-emergent transfusions and give only the exact number of RBCs needed

A

In stable anemic patients, check Hgb and clinical parameters between non-emergent transfusions and give only the exact number of RBCs needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe perioperative blood management

A

Perioperative blood management

  • Minimize blood component transfusions
  • Identify and treat anemias / coagulopathies before surgery
  • Judicious use in selected patients (time permitting) of preoperative autologous RBC donations or preoperative erythropoietin
  • Plan and execute surgery with minimum blood loss
  • Reinfuse shed RBCs from surgical field intraop/postop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe platelet units

A

Platelet units

  • Plateletpheresis unit: 300 mL
  • Whole blood platelet unit: 60 mL
  • Stored for 5 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

___ matching to platelet gives best response when transfusing platelets

A

ABO matching to platelet gives best response when transfusing platelets

  • D+ RBCs in platelet units might immunize D-negative patients to make anti-D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe response to platelet dose

A

Response to platelet dose

  • 1/3 of transfused platelets are held by spleen
  • One dose of platelets to thrombocytopenic patient increases platelet count a lot but then decreases a bit
  • Circulating lifespan of 1-2 days in thrombocytopenic patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe plasma products

A

Plasma products

  • Fresh frozen plasma: separated, frozen in < 8 hours
  • Plasma: frozen in < 24
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe plasma compatibility

A

Plasma compatibility

  • Donor has anti-A or anti-B so avoid giving anti-A/-B versus the patient’s RBC ABO type
  • Group AB is universal plasma donor
17
Q

___ group is the universal plasma donor

A

AB group is the universal plasma donor

18
Q

Describe response to plasma

A

Response to plasma

  • Plasma content concentrations measured in total plasma volume
  • Plasma volume is 60% of HCt
  • One unit of plasma is 200 mL (6% of total plasma volume)
  • ≥ 3-4 units needed for significant clotting factor deficiency
19
Q

Describe clotting factor half lives

A

Clotting factor half lives

  • VII: 4-6 hours, vitamin K dependent (along with II, IX, X), warfarin-sensitive
  • VIII: 12 hours
  • Most others: 1-2 days
  • Fibrinogen: 2-4 days
20
Q

Describe cryoprecipitate

A

Cryoprecipitate

  • Protein precipitate involving fibrinogen, FVIII, and vWF form
  • 15 mL bag of cryo from one unit of zFFP
  • Usually 400 mg fibrinogen/bag
  • Adult dose is 5 bags (75 mL, 2000 mg fibrinogen)
  • Ideal response is 65 mg/dL rise in fibrinogen concentration
21
Q

Describe transfusion doses

A

Transfusion doses

  • Platelets: one dose - mostly single unit apheresis
  • Cryo: one dose - five bags per dose
22
Q

Describe platelet counts

A

Platelet counts

  • 150,000-400,000/uL: normal
  • <75,000-100,000/uL: need for CNS hemostasis: bleeding or invasive procedure
  • <50,000/uL: need for hemostasis: bleeding or invasive procedure
  • <10,000/uL: risk of spontaneous bleeding
23
Q

In immune thrombocytopenia purpura, ___ and tranfuse only in ___

A

In immune thrombocytopenia purpura, autoantibodies prevent platelet count rise and transfuse only in emergency

24
Q

Describe platelets for dysfunction or dilution

A

Platelets for dysfunction or dilution

  • Antiplatelet medications, cardiac bypass, congenital platelet disorder
  • Two platelet doses are 50,000-60,000/uL functional platelets
  • Massive transfusion ≥ 10 units RBCs: platelet dilution, pending platelet count
25
Q

Describe platelet refractoriness

A

Platelet refractoriness

  • Normal immediate response: platelet count rise is 25-30K/uL
  • Refractory: repeated immediate responses ≤ 10 K/uL
  • Non-immune reasons: splenomegaly, consumption, high turnover, large blood volume
  • Test for antibodies
  • Use ABO matched platelets
26
Q

Describe indications for platelet transfusions

A

Platelet transfusion indications

  • Multiple clotting factor deficiencies and need for hemostasis: bleeding or invasive procedure
  • Liver disease
  • Disseminated intravascular coagulation
  • Emergency warfarin reversal
  • Massive transfusion ≥ 10 units of RBCs and 1:1 RBC units : plasma units
  • Congenital factor deficiencies when specific factor concentrate is not available
27
Q

INR measures ___ and ___ is therapeutic range

A

INR measures factors II-VII-IX-X defieciency and 2.0-3.0 is in therapeutic range

28
Q

Hemostasis is generally adequate with ___

A

Hemostasis is generally adequate with 30% of normal factor levels

  • PT 1.5 times normal
  • PTT 1.5 times normal
29
Q

Describe the effect of plasma on INR

A

Effect of plasma on INR

  • Highly elevated INR: very low factors, plasma transfusion readily improves INR
  • Modestly elevated INR (~1.6): very difficult to reduce further with plasma transfusion
30
Q

Complete normalization of INR with plasma transfusion ____

A

Complete normalization of INR with plasma transfusion often cannot be done

31
Q

Describe cryoprecipitate indications

A

Cryoprecipitate indications

  • Normal fibrinogen: 200-400 mg/dL plasma
  • Hypofibrinogenemia and need for hemostasis: not responding to plasma (normal fibrinogen levels), transfusion threshold is plasma fibrinogen < 100 mg/dL
  • Obstetrical bleeding: transfusion threshold < 150-200 mg/dL
  • Congenital dysfibrinogenemia and need for hemostasis is rare
32
Q

Describe fibrinogen concentrate

A

Fibrinogen concentrate

  • Plasma-derived pharmaceutical
  • Pathogen-inactivated
  • Used in many countries to treat low fibrinogen
  • Ready to use without thawing
  • Approved for congenital hypo and dysfibrinogenemias

Heme / Onc (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions