transfusions Flashcards
what kind of plasma antibodies does recipient type O have
anti A and anti B antibodies
what kind of plasma antibodies does recipient type A have?
anti B antibodies
what kind of recipient type RBC antigens and plasma antibodies does a Rh(+) patient have?
D antigens, no plasma antibodies
what kind of recipient type RBC antigens and plasma antibodies does a Rh(-) patient have?
no RBC antigens, anti D plasma antibodies if sensitized
universal plasma acceptor
O(-). contains anti an anti b and rh antigens (aka no antibodies) so other blood types with these antigens won’t cause problems
universal plasma donor
AB(+) because it doesn’t have any anti A anti B or Rh plasma antigens
universal RBC donor
O(-) because doesn’t have ABO or Rh RBC antigens
universal RBC recipient
AB(+) because it has anti a anti b and Rh antigens
if you’ve got type specific partially crossmatched blood, what has been checked?
ABO compatibility and a few antibodies
you’ve got type specific uncross matched blood, what has been checked?
ABO test only
large transfusion of this will cause dilutional coagulopathy
RBC’s
what does whole blood contain
RBC’s, WBC’s, platelet debris, fibrinogen
what is utilized for blood volume replacement (but not often utilized in the OR)
whole blood
what does FFP contain
all coags, fibrinogen, plasma proteins
when to utilize FFP
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)
FFP increases factor concentration by
20-30%
what is the half life of factor 7
3-6h
what do platelets contain
solely platelets
how many packs of platelets should be transfused per 10kg of body weight?
1pack/10kg
what do you not use with platelets when transfusing
filter or warmer
what does cryoprecipitate contain
fibrinogen, factor 8, factor 13, vWF
when to use cryo
fibrinogen deficiency <80-100mg/dL
vWF disease
hemophilia
5 bag pool of cryo increases fibrinogen by
50mg/dL
how long after thawing cryo do you have to transfuse
within 6h
patients with significant CAD should be transfused when HCT reaches
28-30%
EBV of premature neonate
90-100mL/kg
EBV of full term neonate
80-90mL./kg
EBV of infant
75-80mL/kg
EBV of adult
70mL/kg
maximum allowable blood loss equation
=EBV*(starting HGB- target HGB)/starting HGB
1U PRBC’s contains ______mL with a HCT of ___%
300mL, 70%
what is citrate utilized for in banked blood
anticoagulant that inhibits calcium (factor 4)
what is phosphate utilized for in banked blood
buffer for acidosis
what is dextrose utilized for in banked blood
primary substrate for glycolysis
what is adenine utilized for in banked blood
helps RBC’s resynthesizes ATP. extends storage from 21-35d
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
describe alloimmuniziation
body develops antibodies against non self antigens/human leukocyte antigens. its the cause of platelet refractoriness
most common alloimmunization
HLA
what is washing
removes any remaining plasma and antigens in donor RBC’s
prevents anaphylaxis in IgA deficient patients
what is irradiation
exposes units to gamma radiation. disrupts WBC DNA in honor cells and destroys donor leukocytes. prevents graft versus host disease
4 most common infectious complications of banked blood in order
CMV>hepB>hepC>HIV
describe acute hemolytic reaction
antibodies attack antigens present on donor cell membrane.
presents as renal failure, DIC, HoTN
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
treatment of acute hemolytic reaction
- stop transfusion
- maintain UOP 75-100mL/h with IVF, mannitol 12.5-25g, furosemide 20-40mg (if IVF and mannitol fail)
- alkalinize UOP with sodium bicarbonate
- send urine and plasma HGB to blood bank
- check platelets, PT, fibrinogen
- send unused blood to double check cross match
- support hemodynamics with IVF and pressors PRN
cause of febrile transfusion reaction
pyrogenic cytokines and intracellular components released from leukocyte of donor blood
presentation of febrile transfusion reaction
fever, chills, HA, nausea, malaise
treatment of febrile transfusion reaction
supportive, acetaminophen
cause of allergic transfusion reaction
foreign bodies in donor blood product
presentation of allergic transfusion reactions
urticaria with itching (most common) and facial swelling
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
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
which two blood products carry the highest risk of TRALI
FFP and platelets
highest risk of TRALI based on where blood comes from (3)
multiparous women*, hx of transfusion, hx of organ transplant
TRALI s/sx/dx
onset <6h post transfusion, bilateral infiltrates on CXR, PaO2/FiO2 <300 orr SpO2 <90% on RA, normal PAOP
TRALI management
maximize PEEP, low Vt, avoid over hydration
pathophysiology of TACO
volume overload via transfusion beyond compensation
s/sx of TACO
HF, pedema, resp distress (hallmark), hypervolemia, LV dysfunction, mitral regurgitation secondary to volume overload, increased PAOP, increased BNP
management of TACO
supportive measures
what is the etiology of alkalosis during massive transfusion
due to citrate metabolism to bicarb in liver
what is the etiology of hypothermia during massive transfusion
due to transfusion of cold blood
what is the etiology of hyperglycemia during massive transfusion
dextrose additive in stored blood
what is the etiology of hypocalcemia during massive transfusion
binding of calcium by citrate
what is the etiology of hyperkalemia during massive transfusion
administration of older blood
to reduce the risk of hyperkalemia during massive transfusion, you can administer
washed or fresh cells less than 7 days old
what is the lethal triad of trauma
- acidosis
- hypothermia
- coagulopathy (PT/PTT prolonged when <34c, hemostasis impaired)
when to consider intraop blood salvage
heart, vascular, trauma, liver transplant, orthopedic surgery.
EBL >1000mL or 20% of patients EBV
describe steps of intraop blood salvage
- blood is mixed with anticoagulants such as heparin or citrate
- filtered to remove debris and centrifuged to concentrate RBC’s
- concentrated and washed to remove any remaining contaminants such as anticoagulants, free HGB, WBC’s, plasma, platelets
- diluted with saline to a final HCT 60-70%
- ready to be auto transfused via standard blood filter tubing
what are the risks of salvaged blood
contaminants
fever
non immunogenic hemolysis
contraindications of salvaged blood (6)
sickle cell
thalassemia
topical drugs in sterile field such as butadiene, chlorhexidine, topical abx
infected surgical site
oncologic procedures
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