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Perf Tech II (exam 1) > Topic 7 - Blood conversion > Flashcards

Topic 7 - Blood conversion Flashcards

1
Q

Average units of blood used during heart surgery?

A

6 units of blood

6 units of platelets

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2
Q

Average units of blood used during organ transplant?

A

40 units of blood
30 units of platelets
20bags of Cryo
25 units FFP

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3
Q

% of open heart patients require transfusions

A

30-70%

Leads to 2-4 donor exposures

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4
Q

% of RBC units transfused in US occur during

CABG procedures

A

10%

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5
Q

Blood transfusions can lead to complications?

A

Lead to complications–post op infections, ventilator-acquired pneumonia, central line sepsis, Increased LOS, mortality rates

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6
Q

Blood transfusions Infectious risks (3)

A

Bacterial
Hepatitis
HIV

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7
Q

Blood transfusions non-Infectious risks (8)

A
  • febrile reactions
  • uticarial (allergic) reactions
  • anaphylactic reactions
  • acute hemolytic reactions
  • volume overload
  • hypothermia
  • citrate toxicity
  • potassium effects
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8
Q

Febrile reactions

A

-non infectious
-Pt antibodies are reacting with white cell antigens or white cell fragments in the transfused blood products.
OR-due to cytokines which accumulate during storage.
-Most common with platelet transfusions

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9
Q

uticarial (allergic) reactions

A
  • non infectious
  • 1%
  • Urticaria, itching , flushing
  • Caused by foreign proteins
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10
Q

Anaphylactic Reactions

A
  • non infectious
  • -Hypotension, tachycardia, cardiac arrhythmia, shock, cardiac arrest
  • -caused by patients who have IgA deficiency who have anti-IgA antibodies.
  • -Require special washed/ tested blood products
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11
Q

Acute Hemolytic Reactions

Symptoms?

A

-Non infectious
-Caused by transfusion of ABO incompatible blood
-Chills, fever, pain, hypotension, dark urine,
uncontrolled bleeding due to DIC

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12
Q

Hypothermia

A

-non infectious risks

Caused by transfusion of too many cold blood products

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13
Q

Citrate Toxicity

A
  • non infectious risks
  • Metabolized by liver
  • Rapid transfusion of large quantity of blood products
  • Binds calcium and magnesium–depleting stores
  • Myocardial depression
  • Coagulopathy
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14
Q

Potassium effects from bagged RBCs

A

-non infectious risks
-Stored RBC leak K+
-Irradiation increased the rate of leak ( irradiation is
the process or fact of irradiating or being irradiated)
-Cardiac effects

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15
Q

TRALI (transfusion related acute lung injury)

– symptoms

A
  • Similar to ARDS

- Hypotension, Fever, Dyspnea, Tachycardia

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16
Q

TRALI occurs within what time frame and how often?

A

-Occurs within 6 hours of tx
Most cases present w/in 1-2 hours
-Occurs 1/2000 transfusions

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17
Q

TRALI (transfusion related acute lung injury)

A

Non-Cardiogenic pulmonary edema with diffuse bilateral pulmonary infiltrates on CXR

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18
Q

TRALI attributed to?

A

Pathophysiology: Unclear.
Attributed to HLA Antibodies, Granulocyte
antibodies and biologically active mediators in the blood

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19
Q

TRALI treatment?

A

Treatment: Ventilator support for ~96 hours
Mortality: 5-10%

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20
Q

MULTIMODALITY and MULTIDISCIPLINARY

approach to patient care without the use of allogenic blood

A

Bloodless medicine

Transfusion Free

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21
Q

Blood conservation

A

Global concept aimed at reducing patient exposure to allogenic blood products. Does not exclude use

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22
Q

Surgeon Gerald Klebanoff (Vietnam Vet) introduced

A

the first cell saver in a military hospital

23
Q

Recombinant Factor VIIa

A

For Hemopheliacs
Israeli army discovered potential to stop life
threatening hemorrhage

24
Q

tolerance of anemia is ___ dependent

A

Age dependent
Elderly don’t tolerate
As age increases, risk of transfusion increases

25
Q

Gender and transfusion

A

women are more likely than men to get
transfused
Lower hct and prone to blood loss with menses

26
Q

Weight and Height affect on tranfusion?

A

Small patients and obese patients are at risk for transfusion

27
Q

Pre-Op lab work

A

Hgb
PT/INR / PTT
Platelet Count and Platelet Function Tests

28
Q

Treat Polycythemia pre-op

A

Risk of hemorrhage during surgery (hyperviscosity)

Plebotomy

29
Q

Pre-op pharmacological coagulopathies to avoid ? (7 ish)

A

Drugs (not anticoagulants) than have increased
bleeding risk
NSAIDs, PCN, NTG, High dose Vitamin C, St. John’s Wort, Ginger, Garlic, etc.

30
Q

Fluid administration

A

Restrict until surgical hemostasis is achieved

Intravascular pressure is not too high

31
Q

Autologous Donation

A

Donation where the donor and recipient are
identical
-Patient donates blood to be used on themselves during surgery.
-Avoids use/ risks of donor blood
-May not be practical or cost effective for most cardiac surgeries

32
Q

pre-op autologous donation avoided

unless at least …

A

2 weeks/unit of blood removed to regenerate lost RBC

33
Q

Autodonation requires a hematocrit of what?

A

Requires a hematocrit of 33%

34
Q

Autodonation contraindications (7)

A 
Recent MI
CHF
Aortic Stenosis
Transient Ischemic Attacks
Hypertension
Unstable Angina
Bacteremia
35
Q

Plateletpheresis and Plasmapheresis in Autodonation

A

Allows the donation of platelets and plasma

36
Q

Prebypass autologous normovolemic hemodilution

- hct%

A

requires a hct of 35%

37
Q

Prebypass autologous normovolemic hemodilution

– removes how many mls? depending on what?

A

about 500-1000mL (1-3 units)

Depends on starting hct
Depends on age of patient
Depends on BSA
Depends on coexisting conditions

38
Q

Prebypass autologous normovolemic hemodilution

A
  • Used to remove blood from the patient pre-bypass for transfusion later in the case
  • Removed volume is replaced with crystalloid
39
Q

Prebypass autologous normovolemic hemodilution

– Contraindications (7)

A 
COPD
CHF
CAD
Unstable Angina
Renal Insufficiency
Severe Aortic Stenosis
Coagulopathy
40
Q

Prebypass autologous normovolemic hemodilution

– reinfused when?

A

Reinfused after protamine is administered

41
Q

retrograde autologous priming

A

Performed prior to bypass
Arterial and venous cannula are in place
Use the patient’s blood pressure to displace
prime.

42
Q

retrograde autologous priming

– Remove prime via: (3)

A
  • Stopcock on ALF
  • Arterial sampling manifold
  • Y’s in circuit
43
Q

Dry venous line technique

 - - how?
 - - how much volume?
A

Venous line is emptied prior to connection to
the venous cannula
Volume is removed to a bag and discarded or
sequestered
Eliminates about 400-1000mL

44
Q

Dry venous line technique

— Only works if

A

Only works if patient has adequate volume pre-op

45
Q

Mini Circuits do? (3)

A

Decreases foreign surface area
Decreases prime volume
Decreases blood-air contact

46
Q

Mini Circuit attempt to ? (3)

A

Decrease hemodilution
Decrees inflammatory response
Decrease volume shifts

47
Q

Mini Circuits is a ?

A

Closed A-V Loop with centrifugal pump, membrane oxygenator, coated tubing
- No venous reservoir
- No cardiotomy
- Often no heat exchanger or arterial line filter
Centrifugal pump provides kinetic assisted venous drainage and blood flow

48
Q

Mini Circuits prime volume ?

A

Prime volume is about 500mL

◦Can be decreased with RAPing

49
Q

Mini Circuits used mostly for what procedures?

A

CABG

50
Q

Mini Circuits

– 2 Types

A

Totally Integrated Devices

Combination of components

51
Q

Mini Circuit: Totally Integrated Devices

A

Include air handling and elimination systems,
centrifugal pump and membrane oxygenator.
CorX (Cardiovention)
Cobe Synergy

52
Q

Mini circuit: Combination of components

A

MECC System (Jostra)
MCPB
DeltaStream ERP (Medos)
Resting Heart System (Medtronic)

53
Q

Mini circuit

Benefits: (5)

A

Less inflammatory reaction
Less activation of coagulation and fibrinolysis
Less hemodilution
Less use of autologous blood
Marginally improved renal and neurological function

54
Q

Mini Circuit

variables impacting outcomes: (5)

A 
steroids
Aprotinin
degree of heparinization
type of tubing coating
patient population

Perf Tech II (exam 1) (9 decks)

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