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Surgical Skills > Transfusion/Problems > Flashcards

Transfusion/Problems Flashcards

1
Q

Is a blood transfusion considered an invasive procedure?

A

YES, still need informed consent!

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2
Q

Current literature for transfusion supports (restrictive/unrestrictive) blood transfusion strategy

A

Restrictive

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3
Q

Red blood cell transfusions are given to raise the ______ levels in patients with symptomatic/severe anemia or to replace losses after acute blood loss.

A

Hematocrit

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4
Q

Patients must meet at least one of the following criteria to receive a blood transfusion:

Acute hemorrhage (_____ mL blood loss) / rapid bleeding with ______ instability
Hgb ____g/dL
Hgb ____g/dL AND is a ________ patient, or has _____ dz w/o signs/sx of acute ______
Hgb ____g/dL AND has _____ dz with signs/sx of acute ______, or symptomatic ______, or ______ instability

A

Acute hemorrhage (>1500 mL blood loss) / rapid bleeding with hemodynamic instability
Hgb <7g/dL
Hgb <8g/dL AND is a post operative patient, or has cardiac disease without signs/symptoms of acute ischemia
Hgb<10g/dL AND has cardiac disease with signs/symptoms of acute ischemia (infuse slowly and with diuretic) or symptomatic anemia (light headedness, chest pain, dyspnea on exertion, severe fatigue preventing work or usual activity) or hemodynamic instability (sustained tachycardia, tachypnea not attributable to other causes, hypotension)

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5
Q

The volume of blood transfused should be just enough to relieve _____ / _____

A

clinical sx/hypoxia

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6
Q

It (is not/is) necessary to restore the hemoglobin to normal levels

A

Is not

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7
Q

What are some examples of preparations of RBCs for transfusion?

A 
Fresh Whole Blood
Packed Red Blood Cells (PRBC)
Leukocyte-Poor Blood
Frozen Packed Red Blood Cells
Autologous Packed Red Blood Cells
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8
Q

Fresh whole blood contains ____, ____, and ____.

A

RBCs, plasma, and platelets

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9
Q

T/F Fresh whole blood is never absolutely necessary

A

True

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10
Q

Major indications for the use of fresh whole blood are for _____ surgery or massive hemorrhage when _____ units of blood is required in a ____-hour period.

A

Major indications for the use of fresh whole blood are for cardiac surgery or massive hemorrhage when more than 10 units of blood is required in a 24-hour period.

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11
Q

What is PRBC most commonly used for?

A

To raise the hematocrit (Hct)

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12
Q

Each unit of PRBC has a volume of ____ mL and each unit will raise the patient’s hematocrit by ___%

A

300 mL

One unit raises Hct 4%

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13
Q

Leukocyte-poor blood is (frequently/rarely) needed, and is used in patients with what type of reaction?

A

Rarely; severe leukoagglutinin reactions to PRBC’s

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14
Q

T/F Most blood products today are relatively leukocyte-poor

A

True

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15
Q

PRBC’s can be frozen and stored up to ___ years, and is mainly done for what purpose?

A

3 years

Maintaining a supply of rare blood types

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16
Q

_______ PRBCs are donated by patients before their elective surgery and may be stored up to___ days before freezing is necessary

A

Autologous

35 days

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17
Q

Only the ___ and ____ antigen systems on RBCs are specifically tested prior to all transfusions

A

ABO and Rh

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18
Q

The ____ and ____ systems are the most important and giving blood from a donor lacking either one of these antigens can cause ______ of the incompatible RBCs

A

A and B

rapid intravascular lysis

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19
Q

In emergencies, when a pt’s blood type is unknown, type _____ blood can be given.

A

O/Rh-negative

20
Q

What are the three types of transfusion reactions?

A

Hemolytic
Leukoagglutinin
Hypersensitivity

21
Q

(Acute/Delayed) hemolytic transfusion reactions and are the most severe of reactions and are temporally related to the transfusion

A

Acute

22
Q

Hemolytic transfusion reactions are due to what? Secondary to what?

A

Incompatible mismatches in the ABO system

Secondary to clerical errors and mislabeled specimens

23
Q

(Acute/Delayed) hemolytic transfusion reactions are less severe and are caused by minor RBC antigen discrepancies

A

Delayed

24
Q

Delayed hemolytic transfusion reactions may be delayed ____-____ days after transfusion

A

5-10 days

25
Q

In a pt with a delayed hemolytic transfusion reaction, in the time since the transfusion, a new______ has formed

A

alloantibody

26
Q

What are some signs and sx that may occur in a pt experiencing an acute hemolytic transfusion reaction? What signs/sx may be seen in a more severe case?

A

Fever, chills with backache and HA
Severe cases with apprehension, dyspnea, hypotension and CV collapse
Acute DIC and kidney failure can occur

27
Q

Death occurs in ___% of acute hemolytic transfusion reactions

A

4%

28
Q

What are some signs and sx that may occur in a pt experiencing an delayed hemolytic transfusion reaction?

A

Usually, these pts are without sx or signs

29
Q

How do you tx a pt with a hemolytic transfusion reaction?

A

Stop the transfusion immediately and provide aggressive supportive care

30
Q

What laboratory findings will be seen in a pt with an acute hemolytic transfusion reaction? (think: what will happen to Hct?)

A

Hct will fail to rise

Hemoglobinuria

31
Q

What laboratory findings will be seen in a pt with a delayed hemolytic transfusion reaction? (think: what will happen to Hct? Bilirubin? Alloantibody?)

A

Hct will fall
Indirect bilirubin will rise
New alloantibody easily detected

32
Q

T/F Most transfusion reactions are hemolytic

A

False; they are not!

33
Q

_____ transfusion reactions are the the body’s response to antigens in transfused blood leukocytes by a patient who has been previously sensitized to leukocyte antigens from prior transfusions or pregnancy

A

Leukoagglutinin

34
Q

In a pt who is experiencing an leukoagglutinin transfusion reaction, what sx can be observed?

A

Fever, chills w/in 12 hours, cough, dyspnea, transient pulmonary infiltrates

35
Q

Hypersensitivity reactions are due to exposure to _____ plasma proteins rather than ______

A

allogenic; leukocytes

36
Q

Is there a high or a low risk of having a hypersensitivity reaction to a blood transfusion?

A

Very low risk

37
Q

What are two sx that may be experienced during a hypersensitivity reaction to a blood transfusion?

A

Urticaria, bronchospasm

38
Q

Other miscellaneous reactions to blood transfusions include ….

A

Contaminated blood
Infectious disease transmission
Transfusion Graft-Versus-Host Disease (GVHD)
Transfusion-Related Acute Lung Injury (TRALI)

39
Q

When are platelet transfusions indicated?

A

Indicated for thrombocytopenia due to decreased platelet production

40
Q

When considering a platelet transfusion for a patient, you start to think about the possible risks of having a low platelet count. As you think about these risks, you remember that when a pt has a platelet count of ______ , they have a risk of spontaneous bleeding. When they have a platelet count of _____ they are at risk of a life-threatening bleed.

A

Risk of spontaneous bleeding < 80,000

Risk life-threatening bleed <5,000

41
Q

When a pt has a platelet count of _____, you should give prophylactic platelets

A

<10,000

42
Q

When a pt has a Hx of a prior invasive procedures or surgery, you should keep their platelet count at ______

A

> 50,000

43
Q

How often are granulocyte transfusion indicated? Explain.

A

Granulocyte transfusiona re seldom indicated, due to development of myeloid growth factors

44
Q

When is a granulocyte transfusion useful?

A

In pts with profound neutropenia (<100/mcL) and acutely ill from infection

45
Q

Fresh frozen plasma is available in units of ____mL

A

200 mL

46
Q

Fresh frozen plasma contains (low/normal/high) levels of all coagulation factors

A

normal

47
Q

What is FFP used for?

A

To correct coagulation factor deficiencies, TTP, or HUS

Surgical Skills (8 decks)

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