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APEX > Unit 9 - Transfusions > Flashcards

Unit 9 - Transfusions Flashcards

1
Q

what determines blood type

A

antigenic glycoproteins on cell membranes of erythrocytes

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2
Q

what is required for a successful transfusion to occur

A

requires no antigen-Ab reaction
(plasma contains opposite antibodies from erythrocytes)

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3
Q

universal donors

A

erythrocytes: O negative
plasma: AB positive

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4
Q

universal acceptors

A

erythrocytes: AB positive
plasma: O negative

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5
Q

RBC Antigens & Plasma antibodies - Type O

A

no RBC antigens
Anti-A and anti-B antibodies

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6
Q

RBC antigens and plasma antibodies - type A

A

A RBC antigens
anti-B plasma antibodies

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7
Q

RBC antigens and plasma antibodies - type B

A

B antigens
Anti-A plasma antiobdies

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8
Q

RBC antigens and plasma antibodies - AB

A

A, B antigens
no plasma antibodies

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9
Q

blood compatible with type A

A

A, O

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10
Q

blood compatible with type O blood

A

O

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11
Q

blood compatible with type B blood

A

B, O

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12
Q

blood compatible with AB blood

A

A, B, AB, O

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13
Q

RBC antigens and plasma antibodies for Rh-positive blood

A

D antigens
no plasma antibodies

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14
Q

how can an Rh-negative person be sensitized to Rh-positive blood

A

transfusion or pregnancy (delivery)

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15
Q

how can Rh-negative mother be sensitized to Rh antigen

A

Rh antigen can cross placenta during delivery and sensitize mother

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16
Q

why is the first baby not at risk for Rh sensitization

A
  • It takes several days for the mother to develop antibodies to the Rh antigen
  • If the mother becomes sensitized and develops antibodies, a subsequent pregnancy with an Rh-positive fetus may lead to erythroblastosis fetalis (hemolytic disease of the newborn)
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17
Q

when might a woman need Rhogam

A

a Rh-negative mother with 2nd pregnancy whose first baby was Rh-positive

starting at 28 weeks

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18
Q

who does a fetus receive Rh antigen from

A

father

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19
Q

universal PRBC donor

A

O blood

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20
Q

universal FFP donor

A

type AB

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21
Q

universal FFP acceptor

A

Type O

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22
Q

universal RBC acceptor

A

AB

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23
Q

lab test that tests for ABO and Rh-D antigens

A

type

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24
Q

determines the presence of ABO and Rh-D antigens in recepient’s blood

A

typing

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25
Q

determines the presence of the most clinically significant antibodies

A

screening

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26
Q

provides the most accurate determination of compatibility by mixing recipient’s plasma with blood in actual unit to be transfused

A

crossmatching

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27
Q

how long does blood typing take

A

5 minutes

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28
Q

how long does blood screening take

A

45 min

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29
Q

how long does blood crossmatching take

A

45 minutes

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30
Q

chance of transfusion reaction with blood typing

A

0.2%

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31
Q

chance of transfusion reaction with blood screening

A

0.6%

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32
Q

chance of transfusion reaction with blood crossmatching

A

0.05%

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33
Q

what does blood screening test for

A

most clinically significant antibodies

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34
Q

recommended order of admin. uncrossmatched blood

(most to least favorable)

A
  1. type-specific partially crossmatched blood
  2. type-specific uncrossmatched
  3. o negative uncrossmatched
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35
Q

what percent of the population is Rh-D positive

A

85%

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36
Q

when is it ok to use O positive blood for emergency transfusion

A

emergency transfusion if pt isn’t a woman of childbearing age and has not received a previous transfusion

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37
Q

1st choice for administering emergency uncrossmatched blood

A

type-specific partially crossmatched blood

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38
Q

hgb level that often requires transfusion

A

< 6 g/dL

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39
Q

hgb > ____ rarely requires transfusion

A

10 g/dL

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40
Q

components of PRBC transfusion

A

RBCs only

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41
Q

components of whole blood

A

RBCs
WBCs
plasma
platelet debris
fibrinogen

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42
Q

when is whole blood indicated

A

RBC replacement
blood volume replacement

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43
Q

components of FFP

A
  • all coagulation factors
  • fibrinogen
  • plasma proteins
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44
Q

indications for FFP transfusion

A
  • coagulopathy (PT or PTT > 1.5x control)
  • warfarin reversal
  • antithrombin deficiency
  • massive transfusion
  • DIC
  • C1 esterase deficiency
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45
Q

dose of FFP for warfarin reversal

A

5-8 mL/kg

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46
Q

dose of FFP for coagulopathy

A

10-20 mL/kg

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47
Q

10-20 mL/kg of FFP increases factor concentration by:

A

20-30%

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48
Q

half life of factor 7

A

3-6 hours

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49
Q

time frame to give FFP

A

complete within 24 hours of thawing

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50
Q

plt count for NSGY that should get a platelet transfusion

A

< 100k

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51
Q

plt count that should get plt transfusion for most surgeries

A

< 50 k

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52
Q

components of cryopreceipitate

A

fibrinogen
factor 8
factor 13
vWF

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53
Q

cryo dose

A

5 bag pool to ↑ fibrinogen by 50 mg/dL

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54
Q

cryo infusion should be completed by:

A

within 6 hours of thawing

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55
Q

indications for cryo

A
  • fibrinogen deficiency (< 80-100 mg/dL)
  • von Willebrand disease
  • hemophilia
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56
Q

what should blood loss be replaced with

A

crystalloid or colloid solutions until the risk of anemia outweighs the risk of transfusion

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57
Q

when should pts with CAD be transfused

A

when hematocrit falls below 28 - 30%

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58
Q

indicators of tissue perfusion that should be considered before transfusing

A

DO2, SvO2, acid-base status, lactate, hemodynamic instability, myocardial ischemia, and oliguria

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59
Q

if a 70 kg patient has a Hgb of 12 g/dL and acutely loses 1L of blood, what’s the new Hgb value?

A

12 g/dL

Even though the patient has lost 1/5th of his blood volume, the amount of hgb per deciliter of blood hasn’t changed.

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60
Q

what does the MABL calculation assume about the patient?

A

euvolemic

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61
Q

blood volume of premature neonate

A

90-100 mL/kg

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62
Q

blood volume of full term neonate

A

80-90 mL/kg

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63
Q

blood volume of infants

A

75-80 mL/kg

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64
Q

blood volume of school aged child

A

70 mL/kg

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65
Q

blood volume of adults

A

70 mL/kg

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66
Q

MABL calculation

A
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67
Q

volume and hct of 1 unit PRBCs

A

~300 mL
Hct ~ 70%

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68
Q

how does 1 unit PRBCs affect hgb & hct

A

increases Hgb by 1 g/dL and Hct by 2 - 3%

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69
Q

how do erythrocytes convert glucose to ATP

A

Erythrocytes do not contain mitochondria, so they rely on glycolysis and the lactic acid pathway to convert glucose to ATP

70
Q

temp blood is stored

A

1-6 degrees C

extends its lifespan by slowing the rate of glycolysis

71
Q

temp blood is stored

A

1-6 degrees C

extends its lifespan by slowing the rate of glycolysis

72
Q

what is citrate

A

anticoagulant that inhibits calcium (factor 4)

After transfusion of multiple units, the citrate load can cause hypocalcemia

73
Q

function of phosphate in stored blood

A

buffer that combats acidosis

74
Q

primary substrate for glycolysis

75
Q

additives that increase shelf life of stored blood

A

citrate
phosphate
dextrose
adenine

76
Q

what is adenine

A

substrate that helps RBCs re-synthesize ATP

extends storage time from 21 to 35 days

77
Q

newer preservatives extend storage time of blood to:

78
Q

what is red blood cell storage lesion

A

important physiochemical changes that occur during blood storage

79
Q

oxyhgb curve with banked blood

A

decreased 2,3-DPG shifts curve to the left

80
Q

why is pH of banked blood decreased

A

increased lactic acid as a consequence of preservation

81
Q

why should PRBC transfusions be used cautiously in neonates and renal failure

A

contains increased K+

82
Q

what is leukoreduction

A

Removes WBCs from banked RBCs and platelets

83
Q

risks reduced by leukoreduction

A
  • Febrile nonhemolytic transfusion reactions
  • CMV transmission
  • HLA alloimmunization
84
Q

what is alloimmunization

A

process where the body develops antibodies against non-self antigens

85
Q

what is HLA alloimmunization

A

when the body develops antibodies against human leukocyte antigens

86
Q

what is HLA alloimmunization

A

when the body develops antibodies against human leukocyte antigens

87
Q

how does HLA alloimmunization affect platelets

A

it can make the patient “refractory” to platelet transfusions - the body attacks the HLA proteins that are present on the platelet’s surface

88
Q

most common cause of platelet refractoriness

A

HLA alloimmunization

89
Q

what is washing blood products

A

Washing blood products with saline removes any remaining plasma (and antigens) in the donor RBCs (RBC antigens are not removed)

90
Q

process that prevents anaphylaxis in IgA deficient patients

A

washing blood products

91
Q

what is irradiation of blood products

A

exposes units to gamma radiation

disrupts WBC DNA in the donor cells & destroys donor leukocytes

92
Q

process for banked blood that prevents graft v host disease in immunocompromised patients

A

irradiation

93
Q

what is graft v host disease

A

donor leukocytes attack recipient bone marrow

s/s: pancytopenia, fever, hepatitis, and diarrhea

94
Q

populations that benefit from irradiated cells

A
  • leukemia
  • lymphoma
  • hematopoietic stem cell transplants
  • DiGeorge syndrome
95
Q

most common infectious complication of blood producr transfusion

A

CMV

risk greatly reduced with leukoreduction

96
Q

most common infectious complication of blood product transfusion

A

CMV

risk greatly reduced with leukoreduction

97
Q

infectious risks of blood transfusion from most to least common

A

CMV > hepatitis B > hepatitis C > HIV

98
Q

in up to 85% of infections, hepatitis C can lead to:

A
  • cirrhosis
  • hepatocellular carcinoma
  • liver failure
  • death
99
Q

bacterial contamination and sepsis is most common with what blood product

A

platelets

stored at room temp

100
Q

what causes an acute hemolytic transfusion reaction

A

Complement activated in recipient’s blood

plasma antibodies attack antigens present on donor blood cell membranes

101
Q

most lethal acute hemolytic transfusion reaction

A

ABO incompatibility

102
Q

Most catastrophic complications of intravascular hemolysis with hemolytic transfusion rxn

A

renal failure, DIC, hypotension

103
Q

s/s acute hemolytic transfusion reaction

A
  • Presenting sign under anesthesia usually hemoglobinuria
  • Also: hypotension, bleeding, fever, chills, chest pain, dyspnea, nausea, flushing
104
Q

which blood product contains the highest conentration of fibrinogen

105
Q

a 5 bag pool of cryo is expected to increase fibrinogen by:

106
Q

blood product indicated to restore O2 carrying capacity

107
Q

blood product that should not be given with a filter or warmer

108
Q

what should determine decision to transfuse when Hgb 6-10 g/dL

A

based on patient’s physiologic response to anemia

109
Q

blood additive that is a substrate for ATP synthesis

110
Q

blood additive that is a substrate for glycolysis

111
Q

citrate binds what coagulation factor

A

4 (calcium)

112
Q

additive in blood that acts as a buffer to combat acidosis

113
Q

blood component processing that removes plasma antigens

114
Q

blood component processing that exposes blood to gamma radiation

A

irradiation

115
Q

risk of bacterial contamination from PRBCs

A

1 in 35,000

116
Q

risk of bacterial contamination from platelets

A

1 in 15,000

117
Q

antibodies contained in O blood

A

anti-A
anti-B

118
Q

what causes a hemolytic transfusion reaction

A

a patient receives an incompatible blood product

ABO incompatibiltiy is the most lethal

119
Q

what causes a hemolytic transfusion reaction

A

a patient receives an incompatible blood product

ABO incompatibiltiy is the most lethal

120
Q

complications of hemolytic transfusion reaction

A

flushing
renal failure (acute tubular necrosis)
DIC
hemodynamic instability

121
Q

treatment of hemolytic transfusion reaction

A
  • stop transfusion
  • maintain UOP > 75-100 mL/hr
  • alkalinize urine (bicarb)
  • check plts, PT, fibrinogen
  • send unused blood to blood bank for crossmatch
122
Q

what leads to DIC in hemolytic reaction

A

erythrocyin is released from RBC and activates intrinsic clotting cascade

leads to uncontrolled fibrin formation & consumes body’s supply of plts & factors 1, 2, 5, and 7

123
Q

most common adverse reaction assoc. with transfusion

A

febrile transfusion reaction (non-hemolytic)

124
Q

methods to maintain UOP with acute hemolytic transfusion reaction

A
  • IVF
  • 12.5-15 g mannitol
  • 20-40 mg lasix
125
Q

3 key signs of acute hemolytic transfusion reaction under GA

A
  1. hemoglobinuria
  2. hypotension
  3. bleeding
126
Q

6 signs of acute hemolytic transfusion reaction that are masked by GA

A
  1. fever
  2. chills
  3. chest pain
  4. dyspnea
  5. nausea
  6. flushing
127
Q

cause of febrile reactions

A

Pyrogenic cytokines and intracellular components are released from leukocytes in the donor blood product

128
Q

treatment of febrile transfusion reaction

A

supportive
acetaminophen

129
Q

presentation of febrile transfusion reaction

A

Fever, chills, headache, nausea, and malaise (hypotension, chest pain, and dyspnea are less common)

130
Q

cause of allergic transfusion reaction

A

Foreign proteins in the donor blood product

131
Q

presentation of allergic transfusion reaction

A

Urticaria with itching (most common) and facial swelling

132
Q

treatment of allergic transfusion reaction

A

Supportive + antihistamines.

Minor reaction = Continue transfusion

133
Q

s/s major allergic transfusion reaction

A

dyspnea, laryngeal edema, or hemodynamic instability)

134
Q

management of major allergic transfusion reaction

A

stop the transfusion and treat it as anaphylaxis

135
Q

what is TRALI

A

Transfusion Related Acute Lung Injury

Form of non-cardiogenic pulmonary edema that occurs following transfusion

136
Q

most common cause of transfusion-related mortality in US

137
Q

cause of TRALI

A

HLA & neutrophil antibodies in donor plasma

138
Q

patho of TRALI

A
  • donor antibodies activate neutrophils in lungs
  • causes endothelial injury
  • results in capillary leak and pulmonary edema
  • leads to impaired gas exchange, hypoxemia, and acidosis
139
Q

recipient patient populations at higher risk of TRALI

A
  • critically ill (highest risk)
  • anyone susceptible to acute lung injuries (sepsis, burns, post-CPB)
140
Q

blood products with highest risk of TRALI

A

FFP
platelets

141
Q

donor groups at higher risk for TRALI

A
  • multiparous women (highest)
  • hx blood transfusion
  • hx organ transplant
142
Q

diagnostic criteria of TRALI

A
  • Onset < 6 hours following transfusion
  • Bilateral infiltrates on frontal CXR
  • PaO2/FiO2 < 300 mmHg or SpO2 < 90% on room air
  • Normal PAOP (no LA HTN or volume overload)
143
Q

management of TRALI

A
  • Maximize PEEP
  • Low tidal volume
  • Avoid overhydration
144
Q

what is TACO

A

Transfusion Related Circulatory Overload

State of volume overload caused by expanding the plasma volume beyond patient’s compensatory ability

145
Q

s/s TACO

A
  • pulmonary edema
  • hypervolemia
  • LV dysfunction
  • mitral regurg 2/2 volume overload
  • ↑ PAOP
  • ↑ BNP
146
Q

consequences of massive transfusion

A
  • alkalosis
  • hypothermia
  • hyperglycemia
  • hypocalcemia
  • hyperkalemia
147
Q

why is massive transfusion assoc with alkalosis

A

citrate metabolism to bicarb in liver

148
Q

why is massive transfusion assoc with hypothermia

A

transfusion of cold blood

149
Q

why is massive transfusion assoc with hyperglycemia

A

dextrose additive to stored blood

150
Q

why is massive transfusion assoc with hypocalcemia

A

binding of calcium by citrate

151
Q

why is massive transfusion assoc with hyperkalemia

A

admin of older blood

152
Q

s/s heart failure from TACO

A
  • orthopnea
  • cyanosis
  • tachycardia
  • HTN
  • pulm edema
153
Q

hallmark of heart failure with TACO

A

resp distress d/t pulmomary edema

154
Q

hallmark of heart failure with TACO

A

resp distress d/t pulmomary edema

155
Q

why can admin of PRBCs to neonates cause hyperkalemia and cardiac arrest

A

When RBCs are stored, the cell membrane becomes dysfunctional & allows K+ to leak

156
Q

lethal triad of trauma

A

1) Acidosis
2) Hypothermia
3) Coagulopathy

157
Q

how to reduce risk of hyperkalemia with RBC admin

A

admin. washed or fresh cells that are < 7 days old

158
Q

why is acidosis assoc with trauma

A
  • Hypoperfusion & hypoxemia reduce O2 delivery
  • Body converts from aerobic to anaerobic metabolism = lactic acidosis
159
Q

why is trauma assoc with hypothermia

A

Hemorrhage and hypoperfusion impair the body’s ability to regulate heat

160
Q

why is trauma assoc with coagulopathy

A
  • Coagulation is an enzymatic process - impaired by hypothermia
  • acidosis also impairs enzymatic structures
  • massive volume causes dilutional coagulopathy
161
Q

at what temp are PT and PTT prolonged

A

< 34 deg C

162
Q

when is intraoperative blood salvage used

A

typically used during cardiac, major vascular, trauma, liver transplant, and orthopedic surgery when blood loss is expected to exceed 1,000 mL or 20% of the patient’s expected blood volume

also indicated for patients with pre-existing anemia or those that refuse allogeneic blood products, such as Jehovah’s Witnesses.

163
Q

how is intraoperative blood salvage performed

A
  1. blood loss collected by dedicated device
  2. filtered & centrifuged
  3. concentrated & washed
  4. diluted with NS to final Hct 60-70%
  5. ready to be transfused
164
Q

which has better O2-carrying capacity - banked or salvaged blood?

A

salvaged
contain higher concentrations of 2,3-DPG and ATP, and they are better able to maintain their biconcave shape

165
Q

consequence of transfusing a large volume of salvaged blood

A

dilutional coagulopathy

Platelets and coagulation factors are not returned to the patient

166
Q

consequence of transfusing a large volume of salvaged blood

A

dilutional coagulopathy

Platelets and coagulation factors are not returned to the patient

167
Q

risks of using salvaged blood

A

Contamination of collected blood by urine, feces, amniotic fluid, or malignant cells
* Fever
* Non-immunogenic hemolysis

(rare)

168
Q

risks of using salvaged blood

A

Contamination of collected blood by urine, feces, amniotic fluid, or malignant cells
* Fever
* Non-immunogenic hemolysis

(rare)

169
Q

contraindications for salvaged blood

A
  • Sickle cell disease
  • Thalassemia
  • Topical drugs in sterile field such as betadine, chlorhexidine, and topical antibiotics
  • Infected surgical site
  • Oncologic procedures
  • neoplastic disease
170
Q

why is salvaged blood use controversial in c sections

A

theoretical risk of anaphylactoid syndrome of pregnancy/AFE

171
Q

s/s citrate toxicity from blood transfusions

A
  • hypocalcemia
  • hypotension
  • longer QT
172
Q

estimating hgb based on hct

A

hgb can be estimated to be 1/3 of hct

APEX (54 decks)

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