Podcast
Questions and Answers
What is the basic philosophy behind blood component therapy?
What is the basic philosophy behind blood component therapy?
- Treating patients with a mixture of plasma and components
- Providing patients with the specific fraction of blood they lack (correct)
- Administering whole blood to patients for maximum effect
- Using crystalloid solutions exclusively for transfusions
Why is lactated Ringer solution not recommended as a diluent or carrier for PRBCs?
Why is lactated Ringer solution not recommended as a diluent or carrier for PRBCs?
- Because it lacks essential nutrients for RBCs
- Because it causes RBCs to swell and lyse
- Because it makes the RBCs shrink
- Because it contains Ca2+ which can cause clotting (correct)
What is the approximate Hct value of PRBCs?
What is the approximate Hct value of PRBCs?
- 40%
- 50%
- 60% (correct)
- 30%
How does using hypotonic solutions as diluents affect RBCs?
How does using hypotonic solutions as diluents affect RBCs?
Which component of blood is conserved by using PRBCs rather than whole blood?
Which component of blood is conserved by using PRBCs rather than whole blood?
What is the purpose of utilizing crystalloid or colloid as a carrier for PRBCs?
What is the purpose of utilizing crystalloid or colloid as a carrier for PRBCs?
What is the recommended solution compatible with packed erythrocytes that has a pH of 7.4?
What is the recommended solution compatible with packed erythrocytes that has a pH of 7.4?
What is the primary reason for administering RBC transfusions?
What is the primary reason for administering RBC transfusions?
Why is increasing intravascular volume alone not an indication for blood transfusion?
Why is increasing intravascular volume alone not an indication for blood transfusion?
What should prompt transfusion therapy besides the patient's Hb value?
What should prompt transfusion therapy besides the patient's Hb value?
What does the Hb value primarily serve as in defining transfusion strategies?
What does the Hb value primarily serve as in defining transfusion strategies?
What can be created by using crystalloids or colloids to treat hypovolemia?
What can be created by using crystalloids or colloids to treat hypovolemia?
At what Hb level did inadequate splanchnic and preportal oxygen delivery and consumption occur in a study by Mathru and colleagues?
At what Hb level did inadequate splanchnic and preportal oxygen delivery and consumption occur in a study by Mathru and colleagues?
In which patients did a 1988 NIH Consensus Conference conclude that perioperative blood transfusions are rarely needed?
In which patients did a 1988 NIH Consensus Conference conclude that perioperative blood transfusions are rarely needed?
What is a key consideration for determining when a patient should benefit from a blood transfusion?
What is a key consideration for determining when a patient should benefit from a blood transfusion?
What does the O2 extraction ratio require for prediction of benefits from blood transfusions?
What does the O2 extraction ratio require for prediction of benefits from blood transfusions?
patients with chronic anemia (as in renal failure) might tolerate an Hb concentration of
patients with chronic anemia (as in renal failure) might tolerate an Hb concentration of
What is the recommended solution compatible with packed erythrocytes ?
What is the recommended solution compatible with packed erythrocytes ?
What is the recommended solution compatible with packed erythrocytes ?
What is the recommended solution compatible with packed erythrocytes ?
why 5% Dextrose in 0.2% saline is not recommended solution compatible with packed erythrocytes ?
why 5% Dextrose in 0.2% saline is not recommended solution compatible with packed erythrocytes ?
which solution cause the most hemolysis at 37 temperature
which solution cause the most hemolysis at 37 temperature
American College of Surgeons Classes of Acute Hemorrhage- class I defined by
American College of Surgeons Classes of Acute Hemorrhage- class I defined by
Metabolic Characteristics of Packed Red Blood Cells,
what is the pH value ?
Metabolic Characteristics of Packed Red Blood Cells, what is the pH value ?
Metabolic Characteristics of Packed Red Blood Cells,
what is the pCO2 value ?
Metabolic Characteristics of Packed Red Blood Cells, what is the pCO2 value ?
What approach is typically used to measure blood loss when assessing the need for blood transfusions?
What approach is typically used to measure blood loss when assessing the need for blood transfusions?
In what way did anesthesiologists tend to misjudge blood loss according to a study in patients undergoing spine surgery?
In what way did anesthesiologists tend to misjudge blood loss according to a study in patients undergoing spine surgery?
Why did optical scanners tend to underestimate blood loss compared to standard gravimetric calculations?
Why did optical scanners tend to underestimate blood loss compared to standard gravimetric calculations?
What is a key consideration needed to determine whether subsequent units of blood are necessary after the initial transfusion?
What is a key consideration needed to determine whether subsequent units of blood are necessary after the initial transfusion?
Why is there no universally accepted standard for quantifying blood loss?
Why is there no universally accepted standard for quantifying blood loss?
What is an important component related to intraoperative transfusion medicine?
What is an important component related to intraoperative transfusion medicine?
What is a limitation of intermittent measurements of Hb levels during blood loss?
What is a limitation of intermittent measurements of Hb levels during blood loss?
How does the accuracy of SpHb (spectrophotometric finger technology) relate to patients with moderately to severely low Hb levels?
How does the accuracy of SpHb (spectrophotometric finger technology) relate to patients with moderately to severely low Hb levels?
Which factor can help assess the accuracy of the SpHb value provided by the monitor?
Which factor can help assess the accuracy of the SpHb value provided by the monitor?
How does a bupivacaine digital nerve block impact the accuracy of SpHb values?
How does a bupivacaine digital nerve block impact the accuracy of SpHb values?
What is an important feature that can improve the accuracy of SpHb measurements?
What is an important feature that can improve the accuracy of SpHb measurements?
In what situation would SpHb monitoring perform worse according to the text?
In what situation would SpHb monitoring perform worse according to the text?
What is the recommended method for clinicians to detect a changing Hb level ?
What is the recommended method for clinicians to detect a changing Hb level ?
According to Giraud and colleagues, what was the main advantage of SpHb monitoring?
According to Giraud and colleagues, what was the main advantage of SpHb monitoring?
What factor should prompt clinicians to explore the reasons behind sudden changes in SpHb value, even if the absolute value is satisfactory?
What factor should prompt clinicians to explore the reasons behind sudden changes in SpHb value, even if the absolute value is satisfactory?
Which point-of-care Hb test is mentioned as providing quick and efficient bedside Hb level determination in less than 5 minutes?
Which point-of-care Hb test is mentioned as providing quick and efficient bedside Hb level determination in less than 5 minutes?
What is the primary advantage of using warming of the finger in terms of SpHb monitoring accuracy?
What is the primary advantage of using warming of the finger in terms of SpHb monitoring accuracy?
Preoperative anemia (i.e., low Hb value in women <12 g/ dL; in men <13 g/dL) is a common comorbidity among patients undergoing major surgery with an incidence of
Preoperative anemia (i.e., low Hb value in women <12 g/ dL; in men <13 g/dL) is a common comorbidity among patients undergoing major surgery with an incidence of
Preoperative anemia is an independent risk factor that can increase
Preoperative anemia is an independent risk factor that can increase
when the Hb value should be obtained In patients with a moderate to high risk of significant blood loss (defined as >500 mL)
when the Hb value should be obtained In patients with a moderate to high risk of significant blood loss (defined as >500 mL)
what is the goal of treating anemia preoperatively
what is the goal of treating anemia preoperatively
Erythropoiesis-stimulating agents (ESAs)
Erythropoiesis-stimulating agents (ESAs)
What Hb value range is considered for a restrictive transfusion strategy?
What Hb value range is considered for a restrictive transfusion strategy?
In a liberal transfusion strategy, at what Hb value is blood transfusion typically administered?
In a liberal transfusion strategy, at what Hb value is blood transfusion typically administered?
What did Ely and Bernard confirm regarding transfusion triggers?
What did Ely and Bernard confirm regarding transfusion triggers?
What is a potential advantage of using a restrictive transfusion strategy?
What is a potential advantage of using a restrictive transfusion strategy?
What conclusion arises from studies comparing liberal and restrictive transfusion strategies?
What conclusion arises from studies comparing liberal and restrictive transfusion strategies?
What is the primary concern highlighted with a one-value transfusion strategy?
What is the primary concern highlighted with a one-value transfusion strategy?
Why might a one-size-fits-all approach to transfusion decision-making be insufficient?
Why might a one-size-fits-all approach to transfusion decision-making be insufficient?
What does the American College of Surgeons propose as a basis for transfusion decisions?
What does the American College of Surgeons propose as a basis for transfusion decisions?
What is the main limitation highlighted in the liberal versus restrictive strategy associated with Patient Blood Management (PBM)?
What is the main limitation highlighted in the liberal versus restrictive strategy associated with Patient Blood Management (PBM)?
What is one of the important conclusions made about Hb levels and transfusion decisions?
What is one of the important conclusions made about Hb levels and transfusion decisions?
What is a caution highlighted regarding using Hb levels for transfusion decisions?
What is a caution highlighted regarding using Hb levels for transfusion decisions?
ASA’s 2015 updated practice guidelines recommendations?
ASA’s 2015 updated practice guidelines recommendations?
Study Notes
Blood Transfusions
- Recommended solutions compatible with packed erythrocytes: 5% dextrose in 0.45% saline, 5% dextrose in 0.9% saline, 0.9% saline, and Normosol-R with a pH of 7.4.
- RBC transfusions are given to increase O2-carrying capacity, not to increase intravascular volume.
Indications for Transfusion
- A sole Hb value should not be the only basis for a transfusion decision.
- Consider the overall status of the patient, including hemodynamics, organ perfusion, and oxygen delivery.
- Goals for transfusion in hemorrhaging patients: restore and maintain intravascular volume, cardiac output, and organ perfusion.
Hemoglobin Values
- 1988 National Institutes of Health (NIH) Consensus Conference: healthy patients with Hb > 10 g/dL rarely require perioperative blood transfusions, while patients with acute anemia with Hb < 7 g/dL frequently require blood transfusions.
- Patients with chronic anemia (e.g., renal failure) may tolerate Hb < 6 to 7 g/dL.
Blood Component Therapy
- PRBCs contain the same amount of Hb as whole blood but with less plasma.
- Hct value of PRBCs is approximately 60%.
- Most indications for RBCs can be effectively treated with PRBCs, conserving plasma and components for other patients.
Determination of Hemoglobin Concentration
- Continuous blood Hb monitoring is available using spectrophotometric finger technology (Masimo SpHb).
- SpHb measurements are relatively accurate, but may be inaccurate in patients with moderately to severely low Hb levels or during active resuscitation.
- Accuracy can be improved with a perfusion index (PI) > 4% to 5%.
Additional Blood Transfusions
- To determine whether subsequent units of blood are indicated, reassess the overall condition of the patient and the clinical situation.
- Consider vital signs, blood loss, intravenous fluids, Hb concentration, and surgical concerns.
Measurement of Blood Loss
- A standard approach includes visualization and gravimetric measurements based on weight differences between dry and blood-soaked gauze pads.
- Accuracy of measurements is not uniformly consistent, and no "gold standard" for blood loss quantification exists.
Liberal Versus Restrictive Transfusion Strategy
- Terminology refers to the Hb value when a transfusion decision is made.
- Restrictive policy: administer blood transfusion when Hb value is 7-8 g/dL or less.
- Liberal policy: administer blood transfusion when Hb value is 9-10 g/dL or greater.
- Recent studies show no benefit to a liberal strategy compared to a restrictive strategy.
General Conclusions
- Emphasis on Hb levels for transfusion decisions needs caution.
- Individual patient's Hb level may vary perioperatively independent of and in addition to transfusions of RBCs.
- Development of more sensitive indicators of tissue oxygenation (e.g., intramucosal pH) may provide indicators for transfusion in the future.
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Description
Explore the concept of blood component therapy and the indications for transfusion in medical treatments. Understand the philosophy of administering specific blood fractions for optimal patient care. Learn about the challenges faced by surgical teams in balancing the need for whole blood with the benefits of blood component therapy.
