Transfusion 3

Question 1

Describe the pathophysiology of TRALI:

Answer 1

donor antibodies–> neutrophil activation in the lungs–> endothelial injury–> capillary leak–> pulmonary edema–> impaired gas exchange–> hypoxemia–> acidosis–> death

Question 2

Diagnostic criteria of TRALI includes:

Answer 2

onset <6 hours following tx
bilateral infiltrates on frontal CXR
normal pulmonary artery occlusion pressure
PaO2/FiO2 <300 mmHg or SpO2 <90% on room air

Question 3

Signs and symptoms of TACO include

Answer 3

pulmonary edema
hypervolemia
left ventricular dysfunction
mitral regurgitation secondary to volume overload
increased pulmonary artery occlusion pressure
increased brain natriuretic peptide

Question 4

Consequences of massive transfusion include all of the following EXCEPT:
a. hyperkalemia
b. hypercalcemia
c. hyperglycemia
d. alkalosis

Answer 4

b. hypercalcemia

Question 5

Massive transfusion is associated with

Answer 5

alkalosis
hypothermia
hyperglycemia
hypocalcemia
hyperkalemia

Question 6

The “lethal triad” of trauma consists of

Answer 6

hypoperfusion (acidosis)
hypothermia
coagulopathy

Question 7

Massive volume resuscitation can cause a

Answer 7

dilutional coagulopathy

Question 8

Why might patients who receive mass transfusion become alkalotic?

Answer 8

due to citrate metabolism to bicarb in the liver

Question 9

Why might patients who receive mass transfusion become hyperkalemic?

Answer 9

due to the administration of older blood

Question 10

The risk of hyperkalemia related to mass transfusion is reduced by

Answer 10

administering washed or fresh cells that are less than 7 days old

Question 11

Intraoperative blood salvage is MSOT appropriate for: (select 2)
a. living donor kidney transplant
b. C-section
c. Whipple procedure
d. anterior hip arthroplasty

Answer 11

a. living donor kidney transplant
d. anterior hip arthroplasty

Question 12

Intraoperative blood salvage is typically used when blood loss is expected to exceed

Answer 12

1000 mL or 20% of the patient’s blood volume

Question 13

Blood salvage is also indicated for patients with

Answer 13

pre-existing anemia or those that refuse allogenic blood products such as jehovah’s Witnesses

Question 14

The blood lost to the surgical field is collected by a

Answer 14

dedicated suction device and ultimately returned to the patient

Question 15

____________ and ___________ are not returned to the patient so the patient should be watched for _____________-

Answer 15

platelets & coagulation factors; dilutional coagulopathy

Question 16

When compared to bank blood, salvaged blood has a

Answer 16

higher oxygen-carrying capacity

Question 17

Contraindications to blood salvage include

Answer 17

sickle cell anemia
thalassemia
oncologic procedures
infected surgical site

Question 18

Salvaged erythrocytes contain higher concentrations of ________ & __-

Answer 18

2,3 DPG & ATP

Question 19

Risks of intraoperative blood salvage are rare and include

Answer 19

fever
non-immunogenic hemolysis
contamination of collected blood by urine, feces, amniotic fluid, or malignant cells

Question 20

Is intraoperative blood salvage considered safe for transplant surgery?

Answer 20

Yes