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Health Assessment (spring 2024/mebs) > Spring 2024 (Exam II)-Blood Products and Transfusion > Flashcards

Spring 2024 (Exam II)-Blood Products and Transfusion Flashcards

1
Q

What is blood comprised of primarily?

A

Plasma

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2
Q

What percentage of blood volume is made up by plasma?

A

55%

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3
Q

Which blood product has a ↑ risk of infection and why?

A
  • Pooled packs d/t being from multiple donors. (Platelets and Cryo are pooled from multiple donors)
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4
Q

If we had to pick one thing to transfuse what would it be?

A
  • whole blood
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5
Q

What blood type is a universal donor? Universal acceptor?

A
  • Donor = O -
  • Acceptor = AB +
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6
Q

Which patient is the potential exception to accepting blood from an O+ donor?
If we have to, how can we compensate for this?

A
  • Pregnant women who are O- (Rh-), may have problems with the fetus
  • Rhogam
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7
Q

What are 2 Hb related issues we will see often in clinical settings?

A
  • β thalassemia → Hb Barts
  • α thalassemia → Hb H
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8
Q

What are the possible blood antigen types? What are possible Rh factors?

A
  • Antigen → A B AB O
  • Rh → Rh+ and Rh-
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9
Q

What are the different blood types? What antigens are present on erythrocytes? Serum?

A

Blood type; erythrocyte; serum
* O; none; Anti-A, Anti-B
* AB; A and B; none
* B;B; Anti-A
* A; A; Anti-B

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10
Q

Is the general population primarily Rh+ or Rh- ?

A

Rh+ (85%) and Rh- (15%)

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11
Q

What 4 things can cause a right shift of the OxyHb curve?

A
  • ↓ pH
  • ↑ CO2
  • ↑ temp
  • ↑ 2,3-DPG
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12
Q

T or F: If our O₂ saturation is good so is our PO₂?

A
  • False → O₂sat has nothing to do with PO₂ (could have 1 Hb fully saturated; ex. anemia)
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13
Q

AB donor blood will react with which other blood types?

A
  • A, B, and O

slide 7

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14
Q

B donor blood will react with which blood types?

A
  • A
  • O

slide 7

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15
Q

A donor blood will react with which blood types?

A
  • B
  • O

slide 7

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16
Q

O donor blood will react with which blood types?

A
  • none

slide 7

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17
Q

When whole blood is centrifuged what separation products result?

A
  • Platelet rich plasma (PRP)
  • WBC
  • RBC

slide 10

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18
Q

Blood component preparation based on different specific gravities?

A
  • RBC 1.08-1.09
  • Platelet 1.03- 1.04
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19
Q

What happens if we centrifuge platelet rich plasma (PRP) again?

A
  • Centrifuge PRP again → Separates plasma from platelets

slide 10

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20
Q

Where is PRP used in surgery?

A
  • Surgeon injects locally → ortho, dental, plastics cases commonly
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21
Q

What are the 5 different blood components we can use for treatments?

A
  • RBC
  • FFP
  • Cryo
  • PLT
  • LTOWB - Low titer Group O Whole Blood
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22
Q

What is the lifespan of WB?

A

~ 3 wks

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23
Q

What chemicals are added to blood that allows it to be stored?

A
  • CPDA-1 → Citrate phosphate dextrose adenine;
  • Citrate → chelates Ca++ to prevent clotting
  • Phosphate → used as buffer
  • Dextrose → fuel source
  • Adenine → to support ATP synthesis (extends storage from 21 to 35 days)

slide 13

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24
Q

Due to the chemicals used to allow blood to be stored, what labs do we need to check when transfusing lots of blood?

A
  • Ca++ (it will ↓)
  • Blood Glucose (it will ↑)
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25
Q

Which electrolyte will stored blood always have ↑ levels of? Why?

A
  • K+ d/t cells lysing as they degrade in the bag
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26
Q

What happens to 2,3-DPG in stored blood?
What does this do to the OxyHb association curve?

A
  • ↓ 2,3-DPG
  • Left shift → impairs O2 delivery

slide 14

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27
Q

PRBCs contain _______ unless they have been specifically ________?

A
  • Leukocytes (WBCs)
  • Leukoreduced
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28
Q

PRBC facts

A
  • volume 200-350 mL
  • no functional platelets/ granulocytes
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29
Q

What are PRBCs and how much does 1 unit of PRBCs ↑ H&H level?

A
  • PRBCs are dervied from whole blood from which the plama has been removed
  • Hb: ↑ 1 g/dL; Hct: ↑ 3%

slide 14

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30
Q

FFP facts

A
  • volume 200-250 mL
  • expires 12 months
  • contains proteins which may affect volume distribution or how pts process medications
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31
Q

Which blood transfusion product is a source of antithrombin III?

A

FFP

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32
Q

What is the dose of FFP?

A
  • 10-15 mL/kg
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33
Q

How much will 1 unit of FFP ↑ level of each clotting factor?

A
  • ↑ 2 to 3% for each factor
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34
Q

What are the indicated uses of FFP ?

A
  • Correction of inherited factor deficiences
  • Correction of aquired multi-factor deficinces with clinical evidence of bleeding or anticipated surgery/ invasive procedure
  • Liver dysfunction
  • DIC
  • Microvascular bleeding with blood loss > 1L
    *** Reversal of vitamin K agonists (Warfarin)
  • Heparin resistance d/t antithrombin deficiency
  • Treat angioedema (also use TXA along with FFP**
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35
Q

What is the INR of FFP?

A
  • 1.5 to 1.8
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36
Q

What is Cryoprecipitate?

What clotting factors does cryoprecipitate have?

A

The protein fraction that is taken off the top of the FFP when being thawed.

  • Factor VIII: C
  • Factor VIII: vWF
  • Factor XIII
  • Fibrinogen

slide 18

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37
Q

What target of fibrinogen are we trying to maintain when using cryo?

A

100 mg/dL

38
Q

How much will two units of cryo raise fibrinogen levels?

A
  • 2 bags of cryo/10 kg body weight = 100 mg/dL ↑ in fibrinogen
    except in DIC or continued bleeding with massive transfusion
39
Q

Clinical indications for use of Cryo?
Which patient population is cryo really important for?

A
  • See chart
    • Pregnant women who are bleeding
40
Q

How much will one unit of PLT increase PLT count by?

A
  • 5000 to 10000
41
Q

Are there any contraindications for warming IV-administered fluids and blood products ?

A

No, it’s a common practice.

Except for platelet- which has no clinical data to support it but is listed as a contraindication in the operator’s manual for the Level 1 fluid warmer

slide 20

42
Q

When platelets are low at what level will we start to spontaneously bleed?

A

PLT < 30000

43
Q

Indications for Plt transfusions?

A
  • Invasive procedures need >/= 50
  • stable pts without evidence of bleeding/ coagulopathy <10
  • stable pts with evidence of bleeding/ coagulopathy <50
44
Q

What are the 4 IV solutions we could use with blood transfusions?

A
  • Electrolyte-R (preferred)
  • Normosol
  • Pasmalyte
  • NS 0.9%
45
Q

What is the deadly triad when transfusing a patient?

A
  • Hypothermic
  • Coagulopathic
  • Acidotic (NS pH is 5.5)
46
Q

When is WB indicated for transfusion?

A
  • To maintain volume and O2 carrying capacity in acute massive hemorrhage (> 20% blood volume loss )

slide 24

47
Q

What are S/Sx of Hemolytic transfusion reactions?

A
  • fever
  • chill
  • hemoglobinemia
  • hemoglobinuria (keep an eye on foley bag)
  • hypotension
  • dyspnea (look for high airway pressure and RR)
48
Q

What are the mediators of Hemolytic transfusion reactions?

A

IgM antibodies

This is usually a result of the patient getting incompatible blood.

49
Q

What are the S/S of nonhemolytic febrile transfusion reactions?

A

Fever and chills

50
Q

What are the mediators of non-hemolytic febrile transfusion reactions?

A

HLA Class I Ag antibodies

51
Q

How do we treat Non-hemolytic febrile transfusion reactions?

A
  • Antipyretics
  • Use leukocyte reduced products
52
Q

What are some S/S of an allergic transfusion reaction?

A
  • urticaria
  • erythema (blotchy red rashes)
  • itching
  • anaphylaxis.
53
Q

What are the mediators of allergic transfusion reactions?

A
  • plasma proteins
  • IgA antibodies
54
Q

How do we treat allergic transfusion reactions?

A
  • antihistamines
  • treat symptoms
55
Q

What are S/S of Non-cardiogenic pulmonary transfusion reactions?

A
  • Noncardiogenic pulmonary edema - from a minimal amount of blood transfused.
  • ARDS
  • Fever
  • Chill
  • Hypotension
  • Cyanosis

focus on the pulmonary symptoms
* increases airway pressures

56
Q

What are the mediators for a non-cardiogenic pulmonary transfusion reaction?

A

Recipient WBC antibodies

57
Q

How do we treat Non-cardiogenic pulmonary transfusion reactions?

A
  • Lots of PEEP (to force fluid back across the membrane)
  • Steroids
58
Q

What is TRALI?

A

Transfusion Related Acute Lung Injury - temporarily r/t to blood transfusion within 1st 6 hrs of a transfusion

slide 31 (read notes section)

59
Q

What types of blood products is TRALI most associated with this?

A
  • Mostly with FFPs and PLTs
  • some reports with PRBCs since there is some residual plasma
60
Q

What are the acute nonimmunologic effects of transfusion reaction?

A

Nonimmunologic
* Bacterial contamination (hemoglinuria- give abx)
– s/s fever, shock, hemoglobinuria
* Transfusion Associated Circulatory Overload (TACO)
–see other card for s/s
–tx administer subsequent Tx slowly & in small volume
* Hemolysis d/t physical /chemical means
Immnologic
–s/s hemoglobinuria

61
Q

What are the delayed immunologic effects of transfusion reaction?

A
  • Hemolytic transfusion reactions (Decrease Hgb value, Ig negative blood for future reactions.)
    –s/s shortened RBC survival, decreased Hb, fever, jaundice, hemoglobinuria
  • Transfusion-associated Graft-versus-host disease (N/V, Pancytopenia)
    –s/s fever, skin rash, desquamation, anorexia, n/v/d, hepatitis, pancytopenia
  • Post-transfusion purpura (Oozing–sterioids, IV Ig)
    –MOA platelet specific A/b
    –s/s thrombocytopenia, clinical bleeding
62
Q

Criteria for TRALI?

A
  • Acute onset hypoxemia
  • Ratio of PaO2/ FiO2 <300 or SpO2 <90% on RA
  • Occurs within 6 H of transfusion
  • B/L diffuse pulmonary infiltrates
  • no evidence of LA hypertenion (i.e. circulatory overload)

slide 32

63
Q

Transfusion Associated Circulatory Overload (TACO) s/s?

A
  • coughing
  • cyanosis
  • orthopnea
  • severe headache
  • peripheral edema
  • dyspnea

Symptom based treatments

64
Q

Immediate Management of TRALI?

A
  • Stop the transfusion immediately
  • Support the patient
  • If intubated, obtain undiluted edema fluid and simultaneous plasma for determination of total protein (within 15 min)
  • CBC/ CXR
  • Notify blood bank
  • may require ECMO
65
Q

What are some quick ways to differentiate between TRALI and TACO? (This is very cut down from the main list)

A
  • TRALI → Fever and ↓BP (Immunologic Response)
  • TACO → HTN, ↑JVP, ↓ EF (Fluid Overload)
66
Q

What are the delayed nonimmunologic effects of blood transfusion reactions? MOA, S/S, Tx?

A
  • Transfusion-Induced Hemosiderosis
  • MOA: Iron overload
  • s/s: subclinical death
  • Tx/ Prevention: decreased frequency of transfusion, neocytes, iron chelation therapy

slide 41

67
Q

What classes of hemorrhage are there and what is associated blood loss for each?

A
  • Class 1 = up to 750 mL (< 15%)
  • Class 2 = 750 to 1500 mL (15-30%)
  • Class 3 = 1500 to 2000 mL (30-40%)
  • Class 4 = > 2000 mL (>40%)
68
Q

Which classes of hemorrhage require blood transfusions?

A
  • Class III and Class IV
69
Q

What are 3 definitions of Massive Transfustion Protocol (MTP) in Adults?

A
  • Total blood volume is replaced within 24 hours
  • 50% of total blood volume is replaced in 3 hours ←Most common
  • Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss
70
Q

What is considered MTP for Kids?

A
  • > 40mL/kg transfusion
71
Q

What is balanced resuscitation?

A
  • 1:1:1 ratio (PLT:Plasma:RBC)
72
Q

What are the fibrinogen levels of Cryo, FFP, and LTOWB?

A
  • Cryo = 2500 mg
  • LTOWB = 1000 mg
  • FFP = 400 mg
73
Q

What is the difference between stored whole blood (SWB) and LTOWB?

A
  • SWB amount of anticoagulants < LTOWB
  • SWB is preffered resuscitation product
  • LTOWB is universal donor
74
Q

What are the recommendations for whole blood transfusion in kids?

A
  • If they are <15 yr old or <40 kg then limit WB to 30 mL/kg
  • few studies in pediatric pts; no established clinical data
75
Q

Which clotting factors required Ca++ to work?

A
  • 2,7,9,10 as well as proteins C and S
  • Ca stabilizes fibrinogen and plateles in the developing thrombus
76
Q

Which drug has more elemental calcium; Ca gluconate or CaCl?

A
  • Calcium chloride contains about 3 times more elemental calcium than an equal volume of calcium gluconate: 1 g of calcium chloride has 270 mg of elemental calcium, whereas 1 g of calcium gluconate has 90 mg
    *Citrate (additive for stored blood) is processed by the liver; if liver is not functioning properly, increased citrate levels results in slower release of ionized Ca2+
77
Q

How much will 1, 2, and 5 units of blood decrease iCa?

A
  • 1 unit = 1.13 mmol/L
  • 2 unit = < 1mmol/L
  • 5 units = < 0.8 mmol/L
78
Q

What is the value for TEG-ACT?

A
  • 80-140 sec
79
Q

What is R and the normal value for R time?

A
  • Reaction timeto initial fibrin formation
  • 5.0 - 10.0 min
80
Q

What is K and the normal value for K time?

A
  • fibrin cross linkage to reach 20 mm clot strength
  • 1-3 minutes
81
Q

What is the α angle adn the normal value for α angle?

A
  • measures kinetics of clot development
  • 53 - 72°
82
Q

What is MA and the normal value for MA?

A
  • Maximum amplitude of tracing
  • 50-70mm
83
Q

What is G and the normal value for G value?

A
  • Measures entire coagulation cascade
  • 5.3-12.4 dynes/cm2
84
Q

What is the LY 30 and the normal value for LY 30?

A
  • Percent lysis 30 min after MA (max strength of clot)
  • 0-3%
85
Q

If TEG-ACT is > 140 what do we transfuse?

A
  • FFP
86
Q

If R time is > 10 what do we transfuse?

A
  • FFP
87
Q

If K time is > 3 what do we transfuse?

A
  • Cryo
88
Q

If α angle < 53° what do we transfuse?

A
  • Cryo and platelets
89
Q

If MA < 50 what do we transfuse?

A
  • PLT
90
Q

If LY30 > 3% what do we transfuse?

A

TXA (Tranexamic Acid)

91
Q

EKG changes with hypocalcemia?

A
  • narrowing QRS
  • reduced PR interval
  • T-wave flattening and inversion
  • QT prolongation
  • Prominent U wave
  • Prolonged ST and ST-depression
92
Q

EKG changes with hyperkalemia?

A
  • Wide, low amplitude P-waves
  • Wide QRS with fusion of QRS-T and loss of ST segment
  • Tall tented T-waves

Health Assessment (spring 2024/mebs) (29 decks)

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