Week 9 - Blood and Blood Component Therapy Flashcards
What is the maximum allowable blood loss formula?
MABL = EBV x (initial Hct - lowest acceptable Hct) / initial Hct
Visual blood loss estimates for a fully soaked surgical sponge and a fully soaked laparotomy sponge?
10 mL, 100 - 150 mL
Rapid interventions of ________ and _________ point of care monitoring has become popular, however it doesn’t estimate the amount of blood loss.
Hct, Hgb
Physiological responses suggestive of anemia or intra operative hemorrhage?
Tachycardia, decreased blood pressure and eventually decreased oxygen saturation
What are various assessments monitoring vital organ perfusion?
Echocardiography, urine output, cerebral oximetry, ABG, and mixed venous oxygen saturation, near infrared spectroscopy (NIRS)
What should be monitored if anemia is suspected?
Hgb and Hct
How can coagulopathy be assessed?
Monitoring platlets, fibrinogen, thromboelastography (TEG), INR, and aPTT
What emerging technology can aid in discerning coagulation dynamics?
Ultrasound technique called sonic estimation of elasticity via resonance (SEER Sonorheometry)
What are some commonly practiced “transfusion triggers”?
Hgb less than 6 –> Almost always transfuse
Hgb 6 - 10 –> Transfusion based on specific patient factors
Hgb 10 or more –> “Never transfusing”
What are some specific patient factors aiding in your decision to transfuse blood product?
Consideration of cardiopulmonary reserve, experienced and expected blood loss, O2 consumption (reflected in indices such as arterial and mixed venous oxygen saturation) and the presence of atherosclerotic disease.
Withholding transfusions with Hgb as low as ______ g/dL is considered justifiable practice in patients with no cardiac, renal, or hematologic disorders
7
What is the purpose of the patient blood management strategy developed by AABB (American Association of Blood Banks)?
Optimize patient outcomes while helping guarantee blood components are available for those in need
What are the three strategies of patient blood management?
- Optimizing the patient own red blood cell mass
- Minimizing blood loss
- Treatment of anemia
What is the average blood volume of a premature infant?
90-105 mL/kg
What is the male average blood volume?
70 mL/kg
What is the female average blood volume?
65 mL/kg
What is the average blood volume of a term newborn infant?
80-90 mL/kg
Endogenous erythropoietin increases in responses of __________ and ___________
hypoxia, anemia
Erythropoietin production is blunted in ___________ __________
Critical illness
What are the two forms of oxygen in the human body?
- Dissolved O2 –> Physical form
- O2 combined with hemoglobin –> Chemical form (most important)
Minimal blood loss can be accomplished successfully with volume replacement of what fluids?
Crystalloids 1:3 (Give LR 1st choice, NS 2nd –> Due to risk of hyperchloremia) and colloids 1:1 or 1:2
If blood losses are hemorrhagic, generally replacement therapy should include __________ and ____________ ____________
blood, blood components
What is considered a safe Hgb threshold for blood replacement?
7 g/dL
What is the oxygen carrying content equation?
CaO2 = (SaO2 x Hgb x 1.34) + 0.003(PaO2)
CaO2 –> Oxygen carrying content
1.34 mL of O2 is bound to each gram of Hgb