Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
74 Cards in this Set
- Front
- Back
How long does a type and screen take vs a type and cross? |
-screen - 5 min |
|
What routine tests are done on donor blood? |
1. HbAg |
|
In a blood bank, how is red cell survival measured? |
On the basis of 70% RBC survival 24 hrs after transfusion |
|
Does Rh status matter when giving platelets? |
Yes, only in life threatening instances should platelets from a Rh+ donor be given to a Rh- recipient |
|
Does ABO status matter when giving platelets? |
ABO compatible platelets are no better than incompatible platelets in terms of hemostasis but they probably last longer and should be used if possible. |
|
Is Rh status important when giving FFP or cryo? |
No bc there are no red blood cells in FFP or cryo |
|
What are the 4 types of blood transfusion reactions? |
1. Urticarial-Pruritic reaction |
|
Within what time must washed RBCs be administered? |
-If stored at 20 degrees C - 6 hrs |
|
What are the risks associated with giving FFP? |
1. Hepatitis |
|
If a pt is bleeding at the end of surgery in which many units of blood have been transfused what do you do? |
1. Determine if a coagulopathy exists based upon lab values |
|
How fast must blood be given to see cardiovascular changes with ACD blood? |
If average adult size - 1 unit/5 min |
|
How depleted must factors be to see spontaneous bleeding? Oozing from surgical wound? |
- spont bleeding: 10-20% factor range |
|
What are the causes of intraop coagulopathies, ie unexplained bleeding? |
1. DIC |
|
In the setting of clinical bleeding, where should you maintain platelets? |
in the range 50,000-75,000 |
|
What is the minimal safe level of Hg? |
- the 10 gm hemoglobin rule is unnecessarily restrictive |
|
What are the alternatives for pts who refuse blood transfusions? |
1. Autologous blood |
|
What is the estimated blood volume of the following age groups? |
Preterm newborn - 100 cc/kg |
|
What is the equation to determine maximum allowable blood loss? |
ABL = EBV x (starting Hct - final Hct/starting Hct) |
|
What is the volume of PRBCs necessary to achieve a desired Hct? |
-Useful rule of thumb is that 10 cc/kg PRBCs increases Hct 1% |
|
What antigen is on the cell membrane of the following blood types? What antibody will it react with? |
A = A antigen which will react with the anti-A antibody |
|
In a pt's serum, there are naturally occurring.... |
Antibodies directed at the missing antigen |
|
What antibodies does a pt's serum contain with the following blood types? |
A = antibody to B antigen |
|
If donor PRBCs are O, A, B, or AB, list what the plasma of the recipient can be for each. (ie what blood types can use the donor PRBCs) |
O = O, A, B, AB (ie universal donor) |
|
If donor PRBCs are O, the plasma of the recipient can be... |
O = antibodies to both A and B antigen are present in O serum. There are no A or B antigens on O so O serum is acceptable. |
|
If donor PRBCs are A, the plasma of the recipient can be... |
A and AB |
|
If donor PRBCs are B, the plasma of the recipient can be... |
B and AB |
|
If donor PRBCs are AB, the plasma of the recipient can be... |
AB only |
|
When should one not be switched back to the pts blood type after being transfused with uncrossmatched? |
After the admin of 2 units of Group O WHOLE blood |
|
Can an AB- patient safely receive O- plasma? |
NO |
|
Aspirin MOA |
Irreversible COX-1 inhibitor |
|
What is GP IIb/IIIa? |
An aggregation receptor and inhibition of this receptor inhibits platelet aggregation |
|
What are the IV and oral GP IIb/IIIa inhibitors? |
- IV (reversible) - Abciximab, Eptifibatide, Tirofaban |
|
What is the mechanism for the development of a coagulapathy following massive tranfusion? |
1. Dilutional thrombocytopenia (more likely) |
|
When is dilutional thrombocytopenia seen? |
After >10 units of whole blood bc there are essentially no viable platelets in blood stored at 4 deg C for >24hrs. |
|
What happens to factor 5 and 8 in whole blood when stored? |
Concentration decreases to 20-50% of normal after 21 days of storage. |
|
How much blood is needed to cause an acute hemolytic transfusion reaction? |
As little as 50cc of blood bc this is the amount that typically exceeds the haptoglobin binding capacity |
|
What tests are used to diagnose an acute hemolytic transfusion reaction? |
1. plasma free hemoglobin |
|
Why is protamine highly basic? |
Bc of its high arginine content |
|
What is the recommended rate of protamine infusion? |
50 mg per 10 min or no faster than 20 mg per min |
|
How fast should citrated blood be infused? |
Infusion of 50 cc/ 70 kg/ min is ok bc it has little effect on Ca levels |
|
Are pediatric pts more susceptible to hypocalcemia following transfusion? Why or why not? |
Yes bc they have a decreased ability to metabolize citrate and to mobile calcium stores |
|
What other co-existing factors may increase the tendency to hypocalcemia during rapid transfusion? |
1. hyperventilation which causes a decrease in Ca levels due to an alkalosis induced increase in binding of Ca by proteins |
|
Manifestation of hypocalcemia in an awake pt |
1. numbness |
|
Manifestations of hypocalcemia in the anesthetized pt |
1. hypotension |
|
What is FFP? |
The liquid portion of a single unit of whole blood separated from RBCs within 6 hrs and frozen |
|
Platelet count in primary vs secondary polycythemia |
Primary - platelets elevated |
|
What is polycythemia? What are the 2 types? |
An overproduction of red blood cells |
|
Describe the hemoglobin levels found in polycythemia |
Hgb levels >20 is unequivolcally associated with increased red cell mass |
|
What are the signs and symptoms of primary polycythemia AKA polycythemia vera? |
1. increased platelet count and WBC |
|
What is erythropoietin? |
A glycosylated protein that is synthesized in resonse to hypoxia, mainly by the peritubular capillary endothelial cells of the reanl cortex by means of an oxygen sensing mechanism |
|
What are the most common causes of hypoxic polycythemia? |
Cardiovascular defects involving right to left shunts and pulmonary dz interfering with proper oxygenation |
|
What are the clinical findings associated with hypoxic polycythemia? |
1. cyanosis |
|
What is the treatment for polycythemia? |
phlebotomy when the Hct rises > 65%, as well as when HAs and htn occur due to hyperviscosity |
|
How does living at high altitudes effect hemoglobin? |
Living at high altitudes causes hypoxic polycythemia |
|
What drugs can prolong bleeding time? |
1. ASA |
|
What is the most common coagulation defect in the setting of renal failure? |
Decreased platelet adhesiveness |
|
AT-III normally function by neutralizing which activated clotting factors? |
2, 10, 11, 12, 13 |
|
How long can CPD vs CPDA-1 blood be stored? |
CPD - 21 days |
|
How do you treat the following deficiencies? |
I (fibrinogen) - Cryo or fibrinogen (inc to >50 mg/dl) |
|
What are indications for platelets? |
1. thrombocytopenia associated with clinical coagulopathy |
|
During coagulopathy what should ou use first, platelets or FFP? |
Platelets bc dilutional thrombocytopenia or platelet dysfunctionproduces a coagulopathy well before clinically significant plasma coagulation deficiency |
|
What are the physical signs of vWD? |
1. epistaxis |
|
One unit of whole blood yields how much PRBCs after being centrifuged? |
250 mL with a HCT of 70% and following the addition of saline preservatives volume reaches 350mLs |
|
What are the components of FFP? |
1 unit/mL of all pro coagulants and 3-4 mg/cc fibrinogen |
|
What are the components of cryoprecipitate? |
Fibrinogen 250 mg, fibronectin, vWF, factor 8 (80-145 units, factor 13 |
|
The supernatant of centrifuged whole blood is centrifuged to yield... |
Platelets and plasma |
|
The unit of platelets obtained usually contains how much plasma? |
50-70 mLs |
|
How is plasma obtained? |
Remaining plasma supernatant is further processed and frozen to yield FFP |
|
How is FFP processed? |
It is rapidly frozen to help prevent inactivation of labor factors 5 and 8 |
|
How is cryo made? |
By the slow thawing of FFP |
|
What does cryo contain? |
High concentrations of factor 8 and fibrinogen. |
|
How much plasma does one unit of blood yield? |
200 mLs |
|
How much does one unit of FFP increase the level of each clotting factor? What is the initial therapeutic dose? |
2-3%; 10-15 cc/kg |
|
How long do transfused platelets generally survive? |
1-7 days |