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Transfusion Medicine Fellowship > Transfusion Therapy > Flashcards

Transfusion Therapy Flashcards

1
Q

What is the normal P50 for oxygen and hemoglobin?

A

26.3 mm Hg

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2
Q

What causes right-shift on an oxygen-hemoglobin dissociation curve?

A

Temperature, acidity (-pH), 2,3-DPG

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3
Q

What is the most optimal blood hemoglobin level for oxygen delivery?

A

16-20 g/dL. Above this, viscosity impairs delivery.

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4
Q

How is oxygen delivery (DO2) calculated?

A

Cardiac output x (Hb*1.39mL/g + 0.03 mL/mmHg)

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5
Q

At what anemia level do organ systems suffer?

A

Below 5g/dL

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6
Q

How does normal oxygen delivery (DO2) typically compare to oxygen consumption (VO2)?

A

Usually DO2 exceeds by a factor of 4. But in exercise and some diseased states, the ratio can approach 1.5. A ratio of 2 may trigger anaerobic respiration.

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7
Q

How much blood do the coronaries receive, and how is this regulated?

A

Up to 5% of cardiac output. Due to high basal oxygen extraction, coronaries can dilate to increase their flow up to 10-fold.

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8
Q

What is the benefit of an MSBOS?

A

Standardized transfusion practices in a workgroup, found to generally decrease the crossmatch:transfuse ratios.

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9
Q

What are some NON-indications for transfusion in HbSS disease?

A

Uncomplicated VOC
Priapism
AKI
Ulcers

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10
Q

What are some contraindications to platelet transfusion?

A

ITP, TTP, HIT
Bleeding due to coagulopathy only (not plt)
Bleeding due to anatomic/surgical defect

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11
Q

Platelet transfusion thresholds for:
Lumbar puncture
Line placement

A

Lumbar puncture: 50k per AABB (despite no benefit per Cochrane review)
Line placement: 20k

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12
Q

What happens to about half of platelets that are transfused?

A

They are sequestered in spleen and other reticuloendothelial organs. Some are also lost to the normal maintenance of vascular integrity.

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13
Q

Why does maintaining a hematocrit above 30% improve bleeding?

A

Higher crit facilitates more platelet-endothelial interactions through Bernoulli principles.

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14
Q

What is the goal of plasma therapy in coagulopathic patients?

A

Never to fully replete, but to give enough to maintain hemostasis.

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15
Q

What is a typical therapeutic dose of plasma for treatment of coagulopathy?

A

Aim to restore 30% of factor activity&raquo_space; 30% of TBV transfused (usually ~4 units).

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16
Q

What coagulation factors have the worst recovery in transfusion?

A

Factor IX, II.

17
Q

What are the best choices in treating congenital factor deficiencies?

A

Recombinant concentrates > PCCs > plasma products.

18
Q

What what congenital factor deficiencies is plasma the only real option for repletion?

A 
Thrombin
Factor V
Factor XI
Protein S
Plasminogen
19
Q

What thrombophilias can be treated with replacement therapy?

A 
Antithrombin deficiency (concentrate available)
Protein C (concentrate)
Protein S (plasma only)
Plasminogen (plasma only)
20
Q

What is the primary use for cryo-poor plasma?

A

Formerly for TTP, now due to evidence of worsened outcomes, mostly slated for fractionation.

21
Q

How are PCCs dosed?

A

Based on patient weight and degree of INR abnormality.

22
Q

Idaricizumab

A

Reversal agent for Dabigatran

23
Q

Adnexanet alfa

A

Reversal agent for Xa inhibitors

24
Q

What are the four causes of postpartum hemorrhage?

A

Tone (Uterine atony)
Trauma
Tissue (retained POC)
Thrombin (coagulopathy)

25
Q

How does hemostasis change during pregnancy?

A

Gestational thrombocytopenia
INCREASE in circulating von willebrand factor
INCREASE in fibrinogen (400-600mg/dL normal)

26
Q

How is blood loss during peripartum hemorrhage calculated?

A 
Colorimetric methods
Gravimetric methods (weigh sponges)
27
Q

How is pregnancy in HbSS patients managed?

A

Transfuse up to 10g/dL per NIH recs. Keep HbS <30%. Beware increased risk of fat embolization?

28
Q

Review the general management algorithm for HDFN.

A

Check titers (and paternal testing)&raquo_space; MCA (1.5x)&raquo_space; IUT.

29
Q

What special requirements are applied to units chosen for IUT?

A

O-neg, volume-reduced, fresh, CMV-seroneg, irradiated, HbS-neg, washed (if maternal)

30
Q

How is IUT performed?

A

Cannulate umbilical artery or intraperitoneal space. Transfuse slowly. Multiple volume calculations to determine dose…

Transfusion Medicine Fellowship (34 decks)

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