Blood Component Therapy and Transfusion Management Quiz

Blood Component Therapy: Principles and Practices

• Blood type and screen involves mixing patient blood with commercial serums to determine ABO-Rh compatibility and identify potential antibodies.

• Cross matching involves mixing donor RBCs with recipient plasma to identify incompatibility, and is usually done for rare antibodies.

• Blood storage requires citrate to prevent clotting and additives like phosphate, dextrose, and adenine to maintain ATP and buffer pH.

• Stored blood undergoes biochemical changes that can cause acidosis, hyperkalemia, and left shift in the oxyhemoglobin dissociation curve.

• Transfusion is rarely indicated when the hemoglobin concentration is greater than 10 g/dL, and almost always indicated when it is less than 6 g/dL.

• Massive transfusion protocols are hospital-based and aim to streamline the release of large amounts of blood products in a short time.

• Blood products include packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate, each with their indications and risks.

• Preoperative blood conservation techniques include optimizing underlying conditions, using recombinant erythropoietin, and preoperative autologous donation.

• Preoperative autologous donation involves patients donating their own blood ahead of time, which can reduce the risk of transfusion-related diseases but has disadvantages like the risk of bacterial contamination and increased cost.

• Blood conservation techniques can help reduce the need for blood transfusions and their associated risks and complications.

• It is important to assess patients' history, labs, and potential complications before blood transfusions and to obtain informed consent.

• The American Association of Blood Banks and ASA Transfusion Task Force provide guidelines for transfusion thresholds, which should be based on the patient's risk for complications of inadequate oxygenation and other important factors affecting oxygenation.Blood Transfusion and Complications

• Blood transfusion is a common practice during surgeries, and it requires careful management to prevent complications.

• Preoperative evaluation should include assessment of anemia, bleeding times, and comorbidities.

• Intraoperative management should include keeping the patient warm, considering fibrinolytics, and monitoring blood loss and patient status.

• Blood conservation techniques, such as acute normovolemic hemodilution and cell saver, can reduce the need for transfusion.

• Tranexamic acid can be used prophylactically in surgeries with a high risk of bleeding.

• Donated blood is screened for viral and bacterial infections, but not for COVID-19 or malaria.

• Acute hemolytic transfusion reactions can be fatal and require immediate management, including stopping the transfusion and treating symptoms.

• Delayed hemolytic reactions and febrile nonhemolytic reactions are usually mild and self-limiting.

• Transfusion-associated graft versus host disease, transfusion-related acute lung injury, and transfusion-associated circulatory overload are rare but serious complications.

• Citrate toxicity can result from rapid transfusion of multiple units of stored blood and can cause hypocalcemia and other symptoms.

• The choice of fluid for transfusion should consider the risk of ionized calcium depletion and other potential complications.

• Proper management of blood transfusion and its complications can significantly improve patient outcomes.