Ap Ii Blood Component Therapy

Front 1

AP II BLOOD COMPONENT THERAPY

Back 1

AP II BLOOD COMPONENT THERAPY

Front 2

Blood types

Back 2

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

Front 3

What are the coagulation pathways?

Back 3

1. intrinsic (8,9,11,12)
2. extrinsic (3&7)
3. common (the merge of both)

Front 4

What process does coagulation follow?

Back 4

It's a cell based process.

Front 5

Where does coagulation occur?

Back 5

On the surface of endothelial cells, subendothelial cells, and platelets.

Front 6

What are the factors in evaluating coagulation?

Back 6

1. platelet count
2. ACT (activated clotting time)
3. PTT
4. PT
5. INR

Front 7

What's another word for platelets?

Back 7

Thrombocytes

Front 8

How do you define platelet count?

Back 8

The actual number of platelets per cubic mL of blood.

Front 9

Normal platelet value?

Back 9

150-400K/mm3

Front 10

Thrombocytopenia

Thrombocytosis

Back 10

< 100,000/mm3

> 400,000/mm3

Front 11

What other factors must be present for PTT?

Back 11

I, II, V, and X

Front 12

What is the normal time for PTT?

Back 12

25-38 sec or 30-40 sec

Front 13

PTT can be used to monitor what?

Back 13

Heparin therapy

Front 14

What situations can prolong PTT?

Back 14

Hemophilia

Prob with one of the factors

Von Willebrands

Front 15

Activated clotting time (ACT)

Back 15

Measures time required for whole blood to clot in a test tube.

Front 16

ACT is used to monitor what?

Back 16

Heparin therapy in the OR

Front 17

Normal time for ACT?

Back 17

70-180 sec

Front 18

Partial thromboplastin time (PTT)

Back 18

An intrinsic pathway

Front 19

What factors does PTT measure?

Back 19

VIII, IX, XI, and XII

Front 20

What factors does Prothrombin Time (PT) measure through the extrinsic pathway and common pathway?

Back 20

Extrinsinc pathway: VII

Common pathway: X, V, II, and I

Front 21

What is the ONLY cause of a prolonged PT with a normal PTT?

Back 21

Factor VII deficiency

Front 22

International normalized ratio (INR) was developed to do what?

Back 22

To standardize PT values to better monitor oral anticoagulation therapy.

Front 23

When is warfarin therapy indicated?

Back 23

When INR = 2-3

Front 24

What must be done before you can transfuse blood?

Back 24

Compatibility testing

Front 25

What are the two compatibility tests that can be used?

Back 25

1. type and screen
2. type and cross-match

Front 26

What is involved in Type and Screen testing?

Back 26

Recipient's blood: A, B, and Rh antigens are typed.

Common antibodies are screened.

Front 27

What is involved in Type and Cross Match testing?

Back 27

Recipient's blood is incubated with donor blood product.

Clumping? Incompatible

Front 28

What if it's an emergency?

Back 28

1st choice:


2nd choice:

Front 29

PRBC

Back 29

Antigens are found on the SURFACE of rbcs.

Antibodies are found in the serum portion of the blood.

Front 30

How are serum and plasma differ?

Back 30

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.

Front 31

Universal donors and recipients?

Back 31

Type O: donors

Type AB: recipients

Front 32

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

Back 32

A, O

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

Type O: can receive O

Front 33

When to transfuse?

Back 33

1. extensive blood loss
2. inadequate perfusion
3. low Hb conc
4. poor coagulation

FYI:
Soaked lap pad: 100-300cc
Soaked 4x4: 10cc

Front 34

What are the specific blood component therapy?

Back 34

1. PRBCs
2. Cell Saver
3. Platelets
4. FFP
5. Cryoprecipitate

Front 35

When is the use of PRBC indicated?

Back 35

Tx of anemia (often associated with blood loss)

Front 36

1 unit of PRBC equals?

Back 36

250-300 mL volume with hct of 70-80%

Front 37

Hb level when PRBC is needed?

Back 37

Hb < 7g/dL

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

>10 g/dL: Not indicated

Front 38

What preservative is in PRBC that will precipitate with Ca in LR?

Back 38

Bicitrate

Front 39

1 Unit of PRBC will affect the pt how?

Back 39

Inc Hb by 1g/dL

Hct increase 3%

Front 40

How do you administer PRBC?

Back 40

1. warm them first
2. DON'T use LR in the same IV tubing! (use NS)
3. use a filter (at least 150 microns)

Front 41

What are the few varieties in which PRBCs can be administered?

Back 41

1. washed
2. leukocyte-reduced
3. irradiated

Front 42

How do you prepare washed RBCs?

Back 42

Centrifuged in saline to remove plasma and cytokines.

Front 43

After washing, how long can it be stored for?

Back 43

Up to 24 hrs.

NOTE: good for 35-42 dys before washing.

Front 44

What are the indications for washing?

Back 44

1. remove excess K+ from older units.
2. For pts with transfusion reactions.

Front 45

How do you perform leukocyte-reduced PRBCs?

Back 45

By centrifuging, washing, or filtering.

NOTE: filtering is most effective.

Front 46

What are the indications for leukocyte-reduced PRBCs?

Back 46

1. to avoid nonhemolytic febrile reactions.
2. prevent sensitization of pts with aplastic anemia
3. minimize transmission of HIV or CMV.

Front 47

Who needs irradiated PRBCs?

Back 47

For people who are not capable of mounting a counterattack and neutralizing transfused lymphocytes.

Front 48

What happens during irradiating PRBCs?

Back 48

Cells are exposed to a standard dose of ionizing radiation.

Front 49

What is cell saver?

Back 49

Blood salvaged from surgical field.

Hct: ~65-70%

Front 50

Things to know when administering cell saver:

Back 50

1. do not warm
2. use a 40 micron filter
3. DON'T pressurize
4. NEVER clamp a delivery line

Front 51

When is platelet transfusion indicated?

Back 51

< 50,000/mm3

Front 52

How are platelets prepared?

Back 52

1. centrifuging individual units, and pooled together in a single bad.
2. single donor apheresis (an apparatus that separates constituents.

Front 53

1 six-pack or 1 unit of apheresis of whole blood platelets will raise pt's platelet count by?

Back 53

30-50 x 10^9/L

NOTE: initial dose = 10cc/kg

Front 54

Temp. of platelets when transfusing?

Back 54

Room temp

Front 55

Which filter should be used when transfusing platelets?

Back 55

150 micron

NOTE: microaggregate filters (20-40) should not be used b/c they remove most of the platelets.

Front 56

What is FFP?

Back 56

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.

Front 57

When is FFP transfusion indicated?

Back 57

When PT, PTT, or both are at least 1.5X normal.

Front 58

Can FFP be used to reverse the effects of warfarin prior to surgery?

Back 58

Yes

Front 59

How much to give FFP?

Back 59

10-15mL/kg will raise most coagulation proteins by 25-30%.

Usually 5-8ml/kg may be sufficient to reverse warfarin anticoagulation.

Front 60

What is cryoprecipitate?

Back 60

The fraction of plasma that precipitates when FFP is thawed.

Front 61

Each bag of cryo contains what?

Back 61

200mg of fibrinogen and 100 units of Factor VIII

Front 62

When is cryo indicated?

Back 62

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.

Front 63

What are some complications of blood transfusion?

Back 63

1. Transfusion reactions
2. transmission of dz
3. transfusion-related acute lung injury (TRALI)
4. suppression of immunity
5. metabolic derangements.

Front 64

What are some examples of transfusion reactions?

Back 64

1. febrile
2. allergic
3. hemolytic

Front 65

Febrile reaction

Back 65

Due to immune rxn between DONOR antigens with recipient antibodies.

Manifestations: fever, chills, mild dyspnea.

Front 66

Mild allergic reactions

Back 66

1. can occur even after proper typed and matched.
2. manifests increased temp and pruritis
3. Tx is antihistamine

Front 67

Hemolytic reactions

Back 67

Due to ABO incompatible blood

Rapid destruction of DONOR erythrocytes by recipient's antibodies.

Usually from clerical error.

Front 68

Tx for hemolytic reactions

Back 68

1. immediate discontinuation of transfusion.
2. maintain BP, HR, urine output, and pt's airway.

Front 69

Some nitty gritty details of hemolytic reactions:

Back 69

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.

Front 70

Treatment for anaphylactic rxns:

Back 70

1.epi: bolus and possible infusion
2. airway maintenance, oxygenation
3. vol maintenance with saline
4. vasopressors if necessary

Front 71

Transmission of dz

Back 71

Hep B: 1:31K-220K
Hep C: 1:1.6M-3.1M
HIV: 1:1.5M-4.7M

Front 72

Transfusion Related Acute Lung Injury (TRALI)

Back 72

Tx: supportive. High dose of steroid therapy (ineffective though).

Front 73

Other derangements of blood transfusion complications?

Back 73

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