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Anesthesia > Transfusion Therapy > Flashcards

Transfusion Therapy Flashcards

1
Q

Most common transfusion reaction?

A

ABO incompatibility

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2
Q

ABO, Rh typing

A
  1. 2% chance of transfusion reaction after this testing

- Rh-negative patients produce anti-Rh antibodies only after being exposed

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3
Q

T/S (type and screen)

A

recipients plasma + stock RBCs (known antigen) –> watch for reactions
- 0.06% chance of reaction after this testing

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4
Q

T/C (type and cross)

A

recipients plasma + donors RBCs –> watch for agglutination (incompatibility)
- 0.05% chance of reaction after this testing

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5
Q

Emergency Transfusion

A

give type specific or type O blood
Rh-negative patients should receive anti-Rh globulin
- after 8-10 units of type O blood, don’t switch for type-specific blood

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6
Q

Blood Type O

A

no antigens, both anti-A and anti-B antibodies

  • universal donor
  • can only accept from O
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7
Q

Blood type A

A

A antigens, anti-B antibodies

  • receive from A and O
  • can’t receive from B or AB
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8
Q

Blood type B

A

B antigens, anti-A antibodies

  • receive from B and O
  • can’t receive from A or AB
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9
Q

Blood type AB

A

A and B antigens, no antibodies

  • universal acceptor
  • can’t donate to anyone except AB
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10
Q

Red Blood Cells

A

1 unit = 300 mL
180 mL of RBCS, 130 mL of storage solution
- use for acutely ill hospitalized patients
age Hct Hct Hct

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11
Q

Packed Red Blood Cells

A

used to increased O2 carrying capacity
1 unit can increase Hct 2-3%, must be ABO and Rh compatible
*Leukocyte reduced = prevent nonhemolytic reaction

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12
Q

Frozen RBCs

A

no plasma, minimal other cells

- use for red cell replacement in special circumstances

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13
Q

Platelets

A

contains platelets and some plasma
- use for platelet counts between 50-100k
contains all plasma coagulation factors
no need for ABO compatibility

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14
Q

Fresh Frozen Plasma (FFP)

A

plasma proteins, all coagulation factors
- use for bleeding from factor deficiencies (liver disease), massive transfusion, coumadin reversal
Must be ABO compatible
DON’T USE FOR VOLUME EXPANSION

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15
Q

Cryoprecipitate

A

factors VIII, XIII, fibrinogen, vWf
- used for hemophilia, vWf disease
preferred ABO compatibility
- DON’T use with hypofibrinogenemia

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16
Q

Factor VIII concentrate

A

contains factors VIII, vWf, fibrinogen

- used for hemophilia A

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17
Q

Factor IX concentrate

A

contains factors II, VII, IX, X

- used for hemophilia B

18
Q

Whole blood

A

largely replaced by component therapy

exceptions = pediatric cardiac surgery and military hospitals

19
Q

Factor VII

A

used in uncontrollable bleeding in surgical and hemophilia patientis
- initiates coagulation in only those sites where tissue factor is also present

20
Q

DDAVP

A

release of endothelial stores of factor VIII and increases VIII:vWF

21
Q

Estimated blood volume

A

weight (kg) x average blood volume

22
Q

Estimated allowable blood loss

A

EBV x (Hct i - Hct low)/Hct i

23
Q

Complications of massive transfusion

A

High K+, low Ca++ (citrate binds Ca)
Dilutional thrombocytopenia
Metabolic alkalosis (citrate forming HCO3)
Hypothermia

24
Q

Infectious complications

A 
CMV
Hep B
Hep C
HIV
Bacteria
25
Q

Noninfectious complications

A 
Febrile
Allergic
Delayed hemolytic
acute hemolytic
fatal hemolytic
TRALI
26
Q

Coagulopathic complications

A

typically seen in setting of massive blood transfusions

  • dilutional thrombocytopenia
  • DIC
  • low factor levels
27
Q

Acute hemolytic transfusion reaction

A

due to ABO or major antigen incompatibility (clerical errors)
Sx: chills, fever, chest and flank pain (may only see hypotension)

28
Q

Nonhemolytic transfusion reaction

A

usually febrile or allergic -> caused by antibodies against donor WBC or plasma proteins
Sx: fever, hives, tachycardia, and hypotension
Tx: rule out hemolytic reaction
Prevention: leukocyte reduced PRBCs

29
Q

Treatment of hemolytic transfusion reaction

A
  1. stop transfusion
  2. treat hypotension with fluids/pressors
  3. Maintain urine output
  4. Alkalinize urine to prevent precipitation
  5. Send unused blood for recheck
  6. Send blood sample for Hb, haptoglobin, Coombs test, DIC
  7. COnsider corticosteroids
30
Q

Tranfusion related acute lung injury (TRALI_

A

noncardiogenic pulmonary edema occuring within 4 hrs of blood product
Mech: reaction between donor anti-HLA and recipients leukocytes
Tx: stop transfusion, supportive
mortality ~ 5-10%

31
Q

Metabolic Complications

A 
citrate intoxication - occurs with blood
- hypothermia, liver disease and hyperventilation all increase risk
- monitor ionized Ca++
- treat hypocalcemia with Ca gluconate
Hyperkalemia - unlikely
32
Q

Transfusion-related immunomodulation

A 
immune suppression (beneficial or harmful)
- mechanism unclear
33
Q

Red Cell Substitutes and Synthetic Oxygen Carriers

A

perfluorocarbons and Hb-based oxygen carriers

  • easy availability, universal compatibility, long shelf life, low risk of infection
  • none are clinically available at this time
34
Q

Primary hemostasis

A

constriction of blood vessels
exposure of subendothelial collagen
adhesion and aggregation of blood platelets to damaged surface
formation of hemostatic plug

35
Q

Secondary hemostasis

A

formation of thrombin clot

conversion of fibrinogen to fibrin

36
Q

Prothrombin time

A

PT - measures extrinsic pathway (II, V, VII, X)

INR standardizes it

37
Q

Partial Thromboplastin Time

A

PTT - measures intrinsic pathway (VIII-XII_

- elevated with heparin

38
Q

Activated Clotting TIme

A

modified clotting time of whole blood

measures intrinsic pathway

39
Q

Bleeding time

A

crude way of platelet function (rarely used)

40
Q

Fibrinogen

A 
normal level (170-410)
- may be depleted in massive hemorrhage or DIC
41
Q

Fibrin degradation products

A

increased in DIC, fibrinolysis, and severe liver disease

42
Q

D-dimer

A

specific fragment produced when plasma digests cross-linked fibrin
- increased in DIC, PE, and postop period

Anesthesia (20 decks)

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