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F1 anesthetics > Ward 4 (pneumonia) > Flashcards

Ward 4 (pneumonia) Flashcards

1
Q

How many units of blood at a time to be used in non bleeding patient

A
  • For non-bleeding adult patients, single unit transfusions are recommended by the National Institute of Health and Care Excellence (NICE) 2015
  • Transfusing one unit at a time improves patient outcomes and reduces serious risks such Transfusion Associated Circulatory Overload (TACO)
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2
Q

Amount of red cells and resulting increase in Hb

A

4mLs/kg of red cells will increase Hb by 10g/L in adult patients. For low weight patients (such as neonates and pediatric patients), consider calculating transfusion volume in mLs/kg.

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3
Q

Why are some donor’s blood irradiated?

A
  • Cellular blood components can be treated with radiation to prevent transfusion-associated graft-versus-host disease (TA-GvHD) in severely immunocompromised patients.
  • Irradiation prevents donor T cells causing tissue and organ damage, and ultimately death. Not all immunocompromised patients need irradiated blood and patient situations vary;
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4
Q

CMV screening blood donor

A
  • Cytomegalovirus (CMV) infection can cause serious morbidity in immunocompromised CMV-negative patients.
  • The virus lies latent in white blood cells, and UK blood components are leucodepleted which significantly reduces the risk of CMV transmission.
  • Therefore, CMV negative cellular blood components (red cells, platelets, and granulocytes) are only required for the following patient groups:
  • Elective transfusions in pregnancy (not in an emergency/time of delivery);
  • Intrauterine transfusions;
  • Neonates (up to 28 days post expected date of delivery);
  • Granulocytes to patients.
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5
Q

What are washed cells?

A

Red blood cells that have had most of the plasma, platelets and white blood cells removed and replaced with saline or another type of preservation solution

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6
Q

Who are washed cells indicated to?

A

Washed red cells are indicated for patients with recurrent or severe allergic reactions to red cells. These patient cases must be discussed with a consultant haematologist

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7
Q

When is HLA and HPA matching in platelets considered?

A
  • HLA or HPA selected platelets can be considered where there is a lower-than-expected improvement in platelet count following platelet transfusions, known as platelet refractoriness
  • These components require authorisation by a haematology consultant and the patient needs to have HLA typing and antibody testing before issue
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8
Q

RBC storage and shelf life and transfusion max time

A
  • Store at 2-6 degrees
  • 35 day shelf life, complete transfusion of each uni within 4 hours (3.5 hours since it takes time for the blood to arrive) of removal from TCS
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9
Q

Platelets storage and shelf life

A
  • Store at 20-24 degrees in an agitator
  • Never store platelets in a fridge as this reduces the length of time the platelets survive after transfusion
  • 5-7 day shelf life
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10
Q

FFP and cryoprecipitate storage and shelf life

A
  • Stored at -25 degrees
  • Shelf life of up to 3 years if frozen
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11
Q

Basic serological compatibility checks

A

The ABO system is the most important blood group system. The Rhesus (Rh) system is the second most important and includes the D antigen; red cells carrying the D antigen are D positive

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12
Q

How does ABO group work?

A
  • ABO groups are determined by the antigens present on the red cell surface and individuals produce antibodies in the plasma for the antigens absent from their own red cells.
  • Group O individuals have antibodies to both group A and group B.
  • Group AB individuals have no ABO antibodies
  • ABO grouping tests the red cells for ABO antigens and tests the plasma for anti-A and anti-B antibodies
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13
Q

Neonate or young infants red cell antibodies

A

Neonates or young infants (under 3-4 months) do not make any red cell antibodies, except in exceedingly rare cases. In general, group O D negative red cells are used for most neonatal top-up and exchange transfusions

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14
Q

What happens when you transfuse red cells to which the patient has antibodies to?

A
  • Transfusing red cells to a patient with corresponding antibodies can result in a severe or fatal reaction.
  • Just a few millilitres can trigger an immediate immune response leading to shock and disseminated intravascular coagulation, which can result in severe bleeding, or renal failure
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15
Q

Red cell matching in emergency situations

A
  • In life-threatening situations, group O red cells are deemed most appropriate to transfuse as they will not cause ABO-mediated haemolysis. However, they still contain other red cell antigens which can cause a reaction (usually less severe)
  • Males get o positive while females of child bearing age or pregnant get o negative
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16
Q

Population with D group antigen

A

Approx. 85% of the population are D positive and 15% D negative. D positive patients can receive components of either D type

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17
Q

Universal group for platelet donation

A
  • Platelets, like red blood cells (RBCs), express ABO antigens, although expression is variable and strongly expressed in only 4% to 7% of individuals
  • ABO antibodies in the donor’s plasma within the platelet component can cause haemolysis of the patient’s red cells.
  • Therefore, group AB (or A) are usually considered the “universal” group for platelets.
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18
Q

Blood transfusion relating to D antigen in pregnancy or child bearing age

A

Patients who are known to be D negative, or with childbearing potential and unknown blood group, should receive D negative components. If exposed to D positive red cells they may produce anti-D which can cause Haemolytic Disease of the Fetus and Newborn (HDFN) in future pregnancies

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19
Q

Plasma component matching

A
  • There are insufficient numbers of red cells in the plasma components to stimulate antibody production, therefore the D group is not considered important and only the ABO group must be matched.
  • As in platelets, it is the antibodies that are important here so when non-ABO identical groups are given, AB or A will usually be given
20
Q

Transfusion time of blood cells to adults

A
  • Routine transfusions are administered over 90 - 120 minutes per unit.
  • Patients at risk of TACO should be transfused more slowly and with careful haemodynamic monitoring
  • Rapid transfusion may be appropriate in a major haemorrhage
21
Q

Transfusion time of platelets to adults

A
  • Transfuse over 30 - 60 minutes.
  • Rapid transfusion may be appropriate in a major haemorrhage
22
Q

FFP transfusion time to adults

A
  • Transfuse at 10-20mLs/kg/hr (Usually 30-60 minutes).
  • Rapid transfusion may be appropriate in a major haemorrhage event to replace coagulation factors
23
Q

Cryo transfusion time to adults

A

Transfuse at 10-20mLs/kg/hr (Usually 30-60 minutes).

24
Q

Transfusion time of blood components in children

A
  • 10/20mls/Kg/hr for platelets, FFP, and cryo in neonates and pediatrics
  • 5mls/kg/hr with a maximum rate of 150mls/hr for rbc
25
Q

What should be monitored after transfusion?

A

The minimum observations recommended by BSH for each unit are: temperature, pulse, respiratory rate & blood pressure:
- Recorded within 60 minutes prior to starting the transfusion
- Repeated 15 minutes after starting the transfusion (most serious adverse reactions occur within the first 15 minutes);
- Repeated within 60 minutes after the transfusion is completed.

Additional (O2 saturations, urine output, and fluid balance) and increased frequency of observations may be required according to local policy and the patient’s condition, e.g. risk of TACO or co-morbidities. This is essential if the patient is unstable, or they appear to be experiencing a reaction

26
Q

Signs and symptoms of acute transfusion reactions

A

A mild reaction may be the initial stages of a severe reaction - DO NOT IGNORE IT.
- an increase in temperature by 1-2°C or Fever (neonates may become hypothermic rather febrile)
- Nausea
- New pain
- Fall in urine output, hemoglobinuria
- Hypo/hyper tension, tachycardia
- Urticaria, rash, pruritis, flushing
- Severe anxiety/impeding doom
- Angioedema, anaphylaxis
- Respiratory symptoms including dyspnea, stridor, wheeze, hypoxia

27
Q

Condition that can occur later on after transfusion

A

Delayed Haemolytic Transfusion Reaction (DHTR)

28
Q

What is DHTR?

A

This a rare type of reaction usually seen in patients with undetected red cell antibodies which may have developed following previous transfusion or pregnancy. A combination of symptoms can occur days after the transfusion, suggesting that the red cells are being destroyed too quickly.

29
Q

Signs and symptoms of DHTR

A
  • Jaundice
  • Fever
  • Hemoglobinuria
  • Falling Hb or lower than expected rise post transfusion
30
Q

What is an acute transfusion reaction?

A

An ATR occurs during, or up to 24 hours following, blood transfusion.

31
Q

Classification of increase in temperature in ATR

A

If you identify an increase in temperature by 1-2°C above baseline, or absolute temperature ≥ 38°C in isolation, it is consistent with a mild febrile reaction. An increase in temperature >39°C or a rise ≥ 2°C from baseline is classified as a moderate reaction

32
Q

What is the most common cause of morbidity in patients undergoing transfusion?

A

TACO

33
Q

Transfusion associated graft versus host disease mortality rate

A

The condition carries a >95% mortality and multi-organ failure can occur from a few days up to a few months following transfusion

34
Q

Management of milt transfusion reactions

A
  • Treat mild pyrexia with oral paracetamol;
  • Treat mild allergic reactions with antihistamines;
    If the reaction is confirmed as mild, you may restart the transfusion at a slower rate following a full clinical review (including patient ID/component label check) with close observation.
35
Q

Management of moderate transfusion reactions

A

Manage the patient symptomatically and according to severity of symptoms e.g. with paracetamol, antihistamines and if needed for respiratory symptoms, inhaled short-acting beta-2 agonists and/or oxygen.

36
Q

Standard investigations in case of reaction to transfusion

A

If your patient experiences a moderate or severe reaction, they should have the following (standard) investigations as a minimum:

Full Blood Count (FBC);
Urea and Electrolytes (U&Es), Liver Function Test (LFTs).

37
Q

Reversal agent for heparin

A

Protamine sulphate

38
Q

Reversal agent for warfarin. How long does it take to work

A

Phytomenadione (vitamin K). Takes 6 hours (IV) or 12 hours (oral) to take effect

39
Q

Blood constituents by volume

A
  • Around 40-50% RBC
  • Around 50-60% plasma
  • 1% WBC and platelets
40
Q

What is blood reused from the same person called?

A

Autologous blood transfusion is a blood conservation technique that involves the collection and reinfusion of the patient’s own blood

41
Q

What is blood donated by another person called?

A

Allogeneic blood

42
Q

Most common autologous blood transfusion technique

A

Cell salvage is the most commonly used form of autologous transfusion

43
Q

When is cell salvage recommended?

A

Cell salvage is recommended for many elective and emergency surgical procedures where there is a “clean” surgical field and the anticipated blood loss is greater than 500ml

44
Q

When is the cell salvage not recommended?

A

Cell salvage is not recommended when the surgical field is grossly contaminated with bacteria (e.g. bowel contents, gross infection). Gastric and pancreatic secretions should also be excluded from the blood collection.

Cell salvage is also not suitable for patients with sickle cell disease (not trait) as low oxygen concentrations in the reservoir may cause the red blood cells to sickle.

Substances not intended for intravenous (IV) use should not be collected into the cell salvage system. When these substances are used in the surgical field intraoperatively, cell salvage should be temporarily stopped and the standard theatre suction used instead. The wound should then be irrigated with copious amounts of IV sodium chloride 0.9% before ICS is resumed

45
Q

Most common cell salvage device

A

The most commonly used machine is a centrifugal cell salvage device, sometimes called a cell saver®

46
Q

Most common hospital associated acquired infections

A

1- Respiratory tact infection (22.8%)
2- Urinary tract infections (17.2%)
3- Surgical site infections (15.7%)
4- CLinical sepsis (10.5%)
5- GI infections (8.8.%)
6- Bloodstream infections (7.3%)

F1 anesthetics (22 decks)

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