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transfusions Flashcards

1
Q

what kind of plasma antibodies does recipient type O have

A

anti A and anti B antibodies

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2
Q

what kind of plasma antibodies does recipient type A have?

A

anti B antibodies

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3
Q

what kind of recipient type RBC antigens and plasma antibodies does a Rh(+) patient have?

A

D antigens, no plasma antibodies

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4
Q

what kind of recipient type RBC antigens and plasma antibodies does a Rh(-) patient have?

A

no RBC antigens, anti D plasma antibodies if sensitized

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5
Q

universal plasma acceptor

A

O(-). contains anti an anti b and rh antigens (aka no antibodies) so other blood types with these antigens won’t cause problems

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6
Q

universal plasma donor

A

AB(+) because it doesn’t have any anti A anti B or Rh plasma antigens

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7
Q

universal RBC donor

A

O(-) because doesn’t have ABO or Rh RBC antigens

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8
Q

universal RBC recipient

A

AB(+) because it has anti a anti b and Rh antigens

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9
Q

if you’ve got type specific partially crossmatched blood, what has been checked?

A

ABO compatibility and a few antibodies

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10
Q

you’ve got type specific uncross matched blood, what has been checked?

A

ABO test only

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11
Q

large transfusion of this will cause dilutional coagulopathy

A

RBC’s

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12
Q

what does whole blood contain

A

RBC’s, WBC’s, platelet debris, fibrinogen

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13
Q

what is utilized for blood volume replacement (but not often utilized in the OR)

A

whole blood

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14
Q

what does FFP contain

A

all coags, fibrinogen, plasma proteins

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15
Q

when to utilize FFP

A

for coagulopathy (PT/PTT >1.5x control, use 10-20mL/kg)
warfarin reversal (5-8mL/kg)
antithrombin deficiency
massive transfusion
DIC
C1 esterase deficiency (hereditary angioedema)

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16
Q

FFP increases factor concentration by

A

20-30%

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17
Q

what is the half life of factor 7

A

3-6h

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18
Q

what do platelets contain

A

solely platelets

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19
Q

how many packs of platelets should be transfused per 10kg of body weight?

A

1pack/10kg

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20
Q

what do you not use with platelets when transfusing

A

filter or warmer

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21
Q

what does cryoprecipitate contain

A

fibrinogen, factor 8, factor 13, vWF

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22
Q

when to use cryo

A

fibrinogen deficiency <80-100mg/dL
vWF disease
hemophilia

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23
Q

5 bag pool of cryo increases fibrinogen by

A

50mg/dL

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24
Q

how long after thawing cryo do you have to transfuse

A

within 6h

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25
patients with significant CAD should be transfused when HCT reaches
28-30%
26
EBV of premature neonate
90-100mL/kg
27
EBV of full term neonate
80-90mL./kg
28
EBV of infant
75-80mL/kg
29
EBV of adult
70mL/kg
30
maximum allowable blood loss equation
=EBV*(starting HGB- target HGB)/starting HGB
31
1U PRBC's contains ______mL with a HCT of ___%
300mL, 70%
32
what is citrate utilized for in banked blood
anticoagulant that inhibits calcium (factor 4)
33
what is phosphate utilized for in banked blood
buffer for acidosis
34
what is dextrose utilized for in banked blood
primary substrate for glycolysis
35
what is adenine utilized for in banked blood
helps RBC's resynthesizes ATP. extends storage from 21-35d
36
what happens during RBC storage lesion
decease in 2,3 DPG (shift oxyHGB curve to left) decrease in ATP decrease in pH increase in K impaired ability to change shape (affects capillary BF) hemolysis increased production of inflammatory mediators
37
describe alloimmuniziation
body develops antibodies against non self antigens/human leukocyte antigens. its the cause of platelet refractoriness
38
most common alloimmunization
HLA
39
what is washing
removes any remaining plasma and antigens in donor RBC's prevents anaphylaxis in IgA deficient patients
40
what is irradiation
exposes units to gamma radiation. disrupts WBC DNA in honor cells and destroys donor leukocytes. prevents graft versus host disease
41
4 most common infectious complications of banked blood in order
CMV>hepB>hepC>HIV
42
describe acute hemolytic reaction
antibodies attack antigens present on donor cell membrane. presents as renal failure, DIC, HoTN
43
s/sx of acute hemolytic reaction
hemoglobinuria (usually presenting sign), HoTN, bleeding. fever, chills, CP, dyspnea, nausea, flushing masked by GA. renal failure, DIC, hemodynamic instability
44
treatment of acute hemolytic reaction
1. stop transfusion 2. maintain UOP 75-100mL/h with IVF, mannitol 12.5-25g, furosemide 20-40mg (if IVF and mannitol fail) 3. alkalinize UOP with sodium bicarbonate 4. send urine and plasma HGB to blood bank 5. check platelets, PT, fibrinogen 6. send unused blood to double check cross match 7. support hemodynamics with IVF and pressors PRN
45
cause of febrile transfusion reaction
pyrogenic cytokines and intracellular components released from leukocyte of donor blood
46
presentation of febrile transfusion reaction
fever, chills, HA, nausea, malaise
47
treatment of febrile transfusion reaction
supportive, acetaminophen
48
cause of allergic transfusion reaction
foreign bodies in donor blood product
49
presentation of allergic transfusion reactions
urticaria with itching (most common) and facial swelling
50
treatment of allergic transfusion reactions
supportive and antihistamines if its a minor reaction, complete the transfusion if its a major reaction (dyspnea, laryngeal edema, hemodynamic instability) stop and treat as anaphylaxis
51
cause of TRALI
human leukocyte antigens (HLA) and neutrophil antibodies in donor plasma. donor antibodies -> neutrophil activation in lungs -> endothelial injury -> capillary leak -> pedema -> impaired gas exchange -> hypoxemia -> acidosis -> death
52
which two blood products carry the highest risk of TRALI
FFP and platelets
53
highest risk of TRALI based on where blood comes from (3)
multiparous women*, hx of transfusion, hx of organ transplant
54
TRALI s/sx/dx
onset <6h post transfusion, bilateral infiltrates on CXR, PaO2/FiO2 <300 orr SpO2 <90% on RA, normal PAOP
55
TRALI management
maximize PEEP, low Vt, avoid over hydration
56
pathophysiology of TACO
volume overload via transfusion beyond compensation
57
s/sx of TACO
HF, pedema, resp distress (hallmark), hypervolemia, LV dysfunction, mitral regurgitation secondary to volume overload, increased PAOP, increased BNP
58
management of TACO
supportive measures
59
what is the etiology of alkalosis during massive transfusion
due to citrate metabolism to bicarb in liver
60
what is the etiology of hypothermia during massive transfusion
due to transfusion of cold blood
61
what is the etiology of hyperglycemia during massive transfusion
dextrose additive in stored blood
62
what is the etiology of hypocalcemia during massive transfusion
binding of calcium by citrate
63
what is the etiology of hyperkalemia during massive transfusion
administration of older blood
64
to reduce the risk of hyperkalemia during massive transfusion, you can administer
washed or fresh cells less than 7 days old
65
what is the lethal triad of trauma
1. acidosis 2. hypothermia 3. coagulopathy (PT/PTT prolonged when <34c, hemostasis impaired)
66
when to consider intraop blood salvage
heart, vascular, trauma, liver transplant, orthopedic surgery. EBL >1000mL or 20% of patients EBV
67
describe steps of intraop blood salvage
1. blood is mixed with anticoagulants such as heparin or citrate 2. filtered to remove debris and centrifuged to concentrate RBC's 3. concentrated and washed to remove any remaining contaminants such as anticoagulants, free HGB, WBC's, plasma, platelets 4. diluted with saline to a final HCT 60-70% 5. ready to be auto transfused via standard blood filter tubing
68
what are the risks of salvaged blood
contaminants fever non immunogenic hemolysis
69
contraindications of salvaged blood (6)
sickle cell thalassemia topical drugs in sterile field such as butadiene, chlorhexidine, topical abx infected surgical site oncologic procedures c section

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