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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
Q

patients with significant CAD should be transfused when HCT reaches

A

28-30%

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26
Q

EBV of premature neonate

A

90-100mL/kg

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27
Q

EBV of full term neonate

A

80-90mL./kg

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28
Q

EBV of infant

A

75-80mL/kg

29
Q

EBV of adult

A

70mL/kg

30
Q

maximum allowable blood loss equation

A

=EBV*(starting HGB- target HGB)/starting HGB

31
Q

1U PRBC’s contains ______mL with a HCT of ___%

A

300mL, 70%

32
Q

what is citrate utilized for in banked blood

A

anticoagulant that inhibits calcium (factor 4)

33
Q

what is phosphate utilized for in banked blood

A

buffer for acidosis

34
Q

what is dextrose utilized for in banked blood

A

primary substrate for glycolysis

35
Q

what is adenine utilized for in banked blood

A

helps RBC’s resynthesizes ATP. extends storage from 21-35d

36
Q

what happens during RBC storage lesion

A

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
Q

describe alloimmuniziation

A

body develops antibodies against non self antigens/human leukocyte antigens. its the cause of platelet refractoriness

38
Q

most common alloimmunization

A

HLA

39
Q

what is washing

A

removes any remaining plasma and antigens in donor RBC’s
prevents anaphylaxis in IgA deficient patients

40
Q

what is irradiation

A

exposes units to gamma radiation. disrupts WBC DNA in honor cells and destroys donor leukocytes. prevents graft versus host disease

41
Q

4 most common infectious complications of banked blood in order

A

CMV>hepB>hepC>HIV

42
Q

describe acute hemolytic reaction

A

antibodies attack antigens present on donor cell membrane.
presents as renal failure, DIC, HoTN

43
Q

s/sx of acute hemolytic reaction

A

hemoglobinuria (usually presenting sign), HoTN, bleeding. fever, chills, CP, dyspnea, nausea, flushing masked by GA.
renal failure, DIC, hemodynamic instability

44
Q

treatment of acute hemolytic reaction

A
  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
Q

cause of febrile transfusion reaction

A

pyrogenic cytokines and intracellular components released from leukocyte of donor blood

46
Q

presentation of febrile transfusion reaction

A

fever, chills, HA, nausea, malaise

47
Q

treatment of febrile transfusion reaction

A

supportive, acetaminophen

48
Q

cause of allergic transfusion reaction

A

foreign bodies in donor blood product

49
Q

presentation of allergic transfusion reactions

A

urticaria with itching (most common) and facial swelling

50
Q

treatment of allergic transfusion reactions

A

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
Q

cause of TRALI

A

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
Q

which two blood products carry the highest risk of TRALI

A

FFP and platelets

53
Q

highest risk of TRALI based on where blood comes from (3)

A

multiparous women*, hx of transfusion, hx of organ transplant

54
Q

TRALI s/sx/dx

A

onset <6h post transfusion, bilateral infiltrates on CXR, PaO2/FiO2 <300 orr SpO2 <90% on RA, normal PAOP

55
Q

TRALI management

A

maximize PEEP, low Vt, avoid over hydration

56
Q

pathophysiology of TACO

A

volume overload via transfusion beyond compensation

57
Q

s/sx of TACO

A

HF, pedema, resp distress (hallmark), hypervolemia, LV dysfunction, mitral regurgitation secondary to volume overload, increased PAOP, increased BNP

58
Q

management of TACO

A

supportive measures

59
Q

what is the etiology of alkalosis during massive transfusion

A

due to citrate metabolism to bicarb in liver

60
Q

what is the etiology of hypothermia during massive transfusion

A

due to transfusion of cold blood

61
Q

what is the etiology of hyperglycemia during massive transfusion

A

dextrose additive in stored blood

62
Q

what is the etiology of hypocalcemia during massive transfusion

A

binding of calcium by citrate

63
Q

what is the etiology of hyperkalemia during massive transfusion

A

administration of older blood

64
Q

to reduce the risk of hyperkalemia during massive transfusion, you can administer

A

washed or fresh cells less than 7 days old

65
Q

what is the lethal triad of trauma

A
  1. acidosis
  2. hypothermia
  3. coagulopathy (PT/PTT prolonged when <34c, hemostasis impaired)
66
Q

when to consider intraop blood salvage

A

heart, vascular, trauma, liver transplant, orthopedic surgery.
EBL >1000mL or 20% of patients EBV

67
Q

describe steps of intraop blood salvage

A
  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
Q

what are the risks of salvaged blood

A

contaminants
fever
non immunogenic hemolysis

69
Q

contraindications of salvaged blood (6)

A

sickle cell
thalassemia
topical drugs in sterile field such as butadiene, chlorhexidine, topical abx
infected surgical site
oncologic procedures
c section

Apex Flashcards (71 decks)

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