Transfusion Medicine #2

Question 1

What is pentaspan

Answer 1

Is a synthetic colloid used for volume expansion. It remains intravascular to the same degree as NS, however you need less fluid to do it

Question 2

contraindications to pentaspan?

Answer 2

Bleeding disorders: b/c pentaspan has an antiplatelet effect

Question 3

When should you stop ASA preop?

Answer 3

7 days prior as this is the lifetime of a platlet and it takes that long for the affected plts to be taken out of circulation

Question 4

What is the minimum amount of time to disctoniue ASA prior to surgery?

Answer 4

2 days minimum,

Question 5

How long do you need to hold plavix or clopidogrel preop?

Answer 5

5 days minimum, 7 days optimally

Question 6

When should you stop NSAIDs preop?

Answer 6

optimally, 5 half lives prior to surgery.

Question 7

why do we stop ASA, plavix/ clopidogrel/ NSAIDS prior to surgery?

Answer 7

to reduce periooperative bleeding. We need them to be able to clot

Question 8

How do you transition someone from warfarin for their surgery?

Answer 8

stop warfarin/coumadin 4 days prior and then preop day 1 get an INR and decide if you need vit K reversal.

• If its a high risk OR like cardiac surgery, stop it 4 days prior, start on LMWH ( 12 hour halflife).
• Alternative option is to admit them, heparin infusion, which you can turn off instantly

Question 9

What is autologous donation and why don’t we do it?

Answer 9

PAD - perioperative autologous donation means donating blood q4 days prior to your surgery so that they can give you your won stuff intraop. Its not cost effective though so its not encouraged.

Question 10

What are the contraindications to intraop cell salvage/ cell saver?

what are the risks?

Answer 10

cancer apparently
bacterial contamination in the field

risks:
air embolism, bacterial sepsis, tumor dissemination

Question 11

why is it that syphilis can be transmitted in platelets?

Answer 11

because platelets are stored at room temperature

Question 12

What are the major transfusion reactions***

Answer 12

Two big categories are febrile and hemolytic
1) febrile, non hemolytic - usually due to WBCs
2) febrile+ hemolytic - dark urine, hypotension - ABO incompatibility
TACO - volume overload
TRALI - Lung Injury
Anaphyaxis - IgA mediated

Question 13

What steps should you take once a transfusion reaction has been identified?

Answer 13

stop transfusions ABCs
IV NS unless TACO
type and screen patient from an alternate site
foley
Call the lab

Question 14

What transmission rates re infection should you quote to patients getting a blood transfusion?

Answer 14

HIV is 1 in a million
HCV 1 in 500,000
HBV 1:200 000
CMV 1 in 7500- very common actually and if someone is immunocompromised they need to get CMV neg blood
remember also symphilis can be transmitted in plts