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73 Cards in this Set

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  • Back
Blood types
1. A: has antigens A and Anti-B
2. B: has antigens B and Anti-A
3. AB: has BOTH antigens A&B and NO antibodies.
4. O: has NO antigens and BOTH anti-A and anti-B
What are the coagulation pathways?
1. intrinsic (8,9,11,12)
2. extrinsic (3&7)
3. common (the merge of both)
What process does coagulation follow?
It's a cell based process.
Where does coagulation occur?
On the surface of endothelial cells, subendothelial cells, and platelets.
What are the factors in evaluating coagulation?
1. platelet count
2. ACT (activated clotting time)
3. PTT
4. PT
5. INR
What's another word for platelets?
How do you define platelet count?
The actual number of platelets per cubic mL of blood.
Normal platelet value?

< 100,000/mm3

> 400,000/mm3
What other factors must be present for PTT?
I, II, V, and X
What is the normal time for PTT?
25-38 sec or 30-40 sec
PTT can be used to monitor what?
Heparin therapy
What situations can prolong PTT?

Prob with one of the factors

Von Willebrands
Activated clotting time (ACT)
Measures time required for whole blood to clot in a test tube.
ACT is used to monitor what?
Heparin therapy in the OR
Normal time for ACT?
70-180 sec
Partial thromboplastin time (PTT)
An intrinsic pathway
What factors does PTT measure?
What factors does Prothrombin Time (PT) measure through the extrinsic pathway and common pathway?
Extrinsinc pathway: VII

Common pathway: X, V, II, and I
What is the ONLY cause of a prolonged PT with a normal PTT?
Factor VII deficiency
International normalized ratio (INR) was developed to do what?
To standardize PT values to better monitor oral anticoagulation therapy.
When is warfarin therapy indicated?
When INR = 2-3
What must be done before you can transfuse blood?
Compatibility testing
What are the two compatibility tests that can be used?
1. type and screen
2. type and cross-match
What is involved in Type and Screen testing?
Recipient's blood: A, B, and Rh antigens are typed.

Common antibodies are screened.
What is involved in Type and Cross Match testing?
Recipient's blood is incubated with donor blood product.

Clumping? Incompatible
What if it's an emergency?
1st choice:

2nd choice:
Antigens are found on the SURFACE of rbcs.

Antibodies are found in the serum portion of the blood.
How are serum and plasma differ?
Serum differs from plasma, the liquid portion of normal unclotted blood containing the red and white cells and platelets. It is the clot that makes the difference between serum and plasma.

Serum: the clear yellowish fluid obtained upon separating whole blood into its solid and liquid components after it has been allowed to clot.
Universal donors and recipients?
Type O: donors

Type AB: recipients
For Blood group A, PRBCs to receive which groups? In other words, what PRBCs can Type A RECEIVE?
A, O

Type B: can receive B, O
Type AB: can receive A, B, AB, O

Type O: can receive O
When to transfuse?
1. extensive blood loss
2. inadequate perfusion
3. low Hb conc
4. poor coagulation

Soaked lap pad: 100-300cc
Soaked 4x4: 10cc
What are the specific blood component therapy?
1. PRBCs
2. Cell Saver
3. Platelets
4. FFP
5. Cryoprecipitate
When is the use of PRBC indicated?
Tx of anemia (often associated with blood loss)
1 unit of PRBC equals?
250-300 mL volume with hct of 70-80%
Hb level when PRBC is needed?
Hb < 7g/dL

7-10 g/dL: unclear if transfusion is needed.

>10 g/dL: Not indicated
What preservative is in PRBC that will precipitate with Ca in LR?
1 Unit of PRBC will affect the pt how?
Inc Hb by 1g/dL

Hct increase 3%
How do you administer PRBC?
1. warm them first
2. DON'T use LR in the same IV tubing! (use NS)
3. use a filter (at least 150 microns)
What are the few varieties in which PRBCs can be administered?
1. washed
2. leukocyte-reduced
3. irradiated
How do you prepare washed RBCs?
Centrifuged in saline to remove plasma and cytokines.
After washing, how long can it be stored for?
Up to 24 hrs.

NOTE: good for 35-42 dys before washing.
What are the indications for washing?
1. remove excess K+ from older units.
2. For pts with transfusion reactions.
How do you perform leukocyte-reduced PRBCs?
By centrifuging, washing, or filtering.

NOTE: filtering is most effective.
What are the indications for leukocyte-reduced PRBCs?
1. to avoid nonhemolytic febrile reactions.
2. prevent sensitization of pts with aplastic anemia
3. minimize transmission of HIV or CMV.
Who needs irradiated PRBCs?
For people who are not capable of mounting a counterattack and neutralizing transfused lymphocytes.
What happens during irradiating PRBCs?
Cells are exposed to a standard dose of ionizing radiation.
What is cell saver?
Blood salvaged from surgical field.

Hct: ~65-70%
Things to know when administering cell saver:
1. do not warm
2. use a 40 micron filter
3. DON'T pressurize
4. NEVER clamp a delivery line
When is platelet transfusion indicated?
< 50,000/mm3
How are platelets prepared?
1. centrifuging individual units, and pooled together in a single bad.
2. single donor apheresis (an apparatus that separates constituents.
1 six-pack or 1 unit of apheresis of whole blood platelets will raise pt's platelet count by?
30-50 x 10^9/L

NOTE: initial dose = 10cc/kg
Temp. of platelets when transfusing?
Room temp
Which filter should be used when transfusing platelets?
150 micron

NOTE: microaggregate filters (20-40) should not be used b/c they remove most of the platelets.
What is FFP?
FLUID portion obtained from single unit of whole blood.

Then it gets frozen w/in 6hrs of collection.

Whole blood--> platelet rich plasma--> platelets + PLASMA.

NOTE: platelets are not in FFP, but all the coagulating factors are.
When is FFP transfusion indicated?
When PT, PTT, or both are at least 1.5X normal.
Can FFP be used to reverse the effects of warfarin prior to surgery?
How much to give FFP?
10-15mL/kg will raise most coagulation proteins by 25-30%.

Usually 5-8ml/kg may be sufficient to reverse warfarin anticoagulation.
What is cryoprecipitate?
The fraction of plasma that precipitates when FFP is thawed.
Each bag of cryo contains what?
200mg of fibrinogen and 100 units of Factor VIII
When is cryo indicated?
1. Hypofibrinogenemia due to massive hemorrhage or disseminated intravascular coagulopathy (DIC).
2. pts with congenital fibrinogen deficiencies or acquired Factor XIII deficiency.

NOTE: no longer indicated for Hemophilia A and Von Willibrand's dz.
What are some complications of blood transfusion?
1. Transfusion reactions
2. transmission of dz
3. transfusion-related acute lung injury (TRALI)
4. suppression of immunity
5. metabolic derangements.
What are some examples of transfusion reactions?
1. febrile
2. allergic
3. hemolytic
Febrile reaction
Due to immune rxn between DONOR antigens with recipient antibodies.

Manifestations: fever, chills, mild dyspnea.
Mild allergic reactions
1. can occur even after proper typed and matched.
2. manifests increased temp and pruritis
3. Tx is antihistamine
Hemolytic reactions
Due to ABO incompatible blood

Rapid destruction of DONOR erythrocytes by recipient's antibodies.

Usually from clerical error.
Tx for hemolytic reactions
1. immediate discontinuation of transfusion.
2. maintain BP, HR, urine output, and pt's airway.
Some nitty gritty details of hemolytic reactions:
1. LR has Ca which may initiate clotting.
2. use NS
3. avoid dextrose which may hemolyze any of the remaining rbcs in the line.
Treatment for anaphylactic rxns:
1.epi: bolus and possible infusion
2. airway maintenance, oxygenation
3. vol maintenance with saline
4. vasopressors if necessary
Transmission of dz
Hep B: 1:31K-220K
Hep C: 1:1.6M-3.1M
HIV: 1:1.5M-4.7M
Transfusion Related Acute Lung Injury (TRALI)
Tx: supportive. High dose of steroid therapy (ineffective though).
Other derangements of blood transfusion complications?
1. Hydrogen, increases but leads to alkalosis due to metabolizing of bicarb.
2. Potassium: increases and leads to heart problem
3. 2,3 diphosophoglycerate decreases (causes left shift on oxy-hb curve)
4. Ca decreases
5. hypothermia