Transfusions ppt

Questions and Answers

What is the primary method to replace intravascular volume loss due to bleeding?

Blood products (correct)

Intravenous isotonic fluids

Hypotonic IV fluids

Hypertonic IV fluids

Which of the following processes is NOT involved in hemostasis?

Fibrin clot formation

Blood vessel dilation (correct)

Vascular constriction

Platelet aggregation

Which factor is NOT part of the intrinsic pathway of coagulation?

Factor 9

Factor 12

Factor 11

Factor 3 (correct)

What is the role of thromboxane A2 (TXA2) in hemostasis?

Stimulates platelet aggregation Signup and view all the answers

Which component is converted to fibrin during the coagulation cascade?

Fibrinogen Signup and view all the answers

Which of the following substances is released by platelets and injured endothelium to promote vasoconstriction?

Serotonin Signup and view all the answers

What initiates the intrinsic pathway of coagulation?

Surface damage Signup and view all the answers

What is the end product of the common coagulation pathway?

Fibrin Signup and view all the answers

What is the maximum allowable fibrinogen level before administering cryoprecipitate?

<200 mg/dL Signup and view all the answers

Which reaction is characterized by an increase in temperature > 1 degree C during transfusion?

Febrile Non-Hemolytic Transfusion Reaction Signup and view all the answers

What is a common cause of Acute Hemolytic Transfusion Reaction?

Administration of ABO-incompatible blood Signup and view all the answers

What is a potential consequence of using vasopressors during hemorrhagic shock?

False sense of security Signup and view all the answers

Which of the following is a key nursing protocol during blood transfusions?

Monitor vital signs at regular intervals Signup and view all the answers

Which of the following represents a severe complication of blood transfusions?

Transfusion Associated Graft vs Host Disease Signup and view all the answers

What is the recommended treatment for allergic reactions during transfusion?

Antihistamines and possible Epi or steroids Signup and view all the answers

In which condition should diuretics be considered before or between blood units?

Transfusion Associated Circulatory Overload Signup and view all the answers

What is a typical clinical manifestation of Transfusion Associated Circulatory Overload (TACO)?

Cough Signup and view all the answers

What is a significant risk associated with Transfusion Transmitted Infections?

Malaria Signup and view all the answers

What does a positive Coombs test indicate?

Presence of significant antibodies Signup and view all the answers

Which of the following may not be required for delayed hemolytic transfusion reaction management?

Specific intervention Signup and view all the answers

What is the primary function of fibrinolysis in the body?

To degrade fibrin and restore blood flow Signup and view all the answers

What is a clinical sign of Transfusion-Related Acute Lung Injury (TRALI)?

Cough Signup and view all the answers

What is a common initial symptom of an allergic transfusion reaction?

Rash or urticaria Signup and view all the answers

Which blood type does not have any antibodies present in its plasma?

Group AB Signup and view all the answers

What is the typical storage duration for Fresh Frozen Plasma (FFP) once thawed?

5 days Signup and view all the answers

For which condition would platelet transfusion NOT typically be indicated?

Dehydration Signup and view all the answers

What is the recommended goal for hemoglobin levels when transfusing PRBCs in patients with significant coronary artery disease?

Hgb > 7 Signup and view all the answers

Which component is commonly used in the management of massive bleeding due to its antifibrinolytic properties?

Tranexamic Acid (TXA) Signup and view all the answers

What is the standard adult dose for cryoprecipitate transfusion in the context of hypofibrinogenemia?

10 units Signup and view all the answers

What is the primary purpose of a Massive Transfusion Protocol?

To alert the blood bank for timely supply Signup and view all the answers

In a 1:1:1 replacement strategy during massive transfusion, what does the ratio represent?

RBCs to FFP to Platelets Signup and view all the answers

Which of the following agents is used for the reversal of dabigatran?

Idarucizumab Signup and view all the answers

What is the purpose of the leukocyte-reduced technique in red blood cell transfusions?

To minimize transfusion reactions Signup and view all the answers

Which coagulation factor is NOT inherently a component of cryoprecipitate?

Factor V Signup and view all the answers

What is the effect of antifibrinolytic agents like tranexamic acid in bleeding control?

Inhibit plasminogen activation Signup and view all the answers

In patients undergoing massive transfusion, when should fresh frozen plasma be administered?

Simultaneously with RBCs Signup and view all the answers

Study Notes

Opening Cases

Intravascular volume loss can be managed through fluid and blood replacement.
IV fluids (isotonic, hypertonic, hypotonic) lack clotting factors and cannot stop bleeding effectively.
Blood products are essential for patients experiencing hemorrhage; fluids can only provide temporary management.

Hemostasis

Four key processes of hemostasis: vascular constriction, platelet plug formation, fibrin clot formation, and fibrinolysis.
Intrinsic Pathway: Activated by surface damage through factors 12, 11, 9, 8, and 10; assessed by PTT test.
Extrinsic Pathway: Triggered by trauma/inflammation via factors 3, 7, and 10; assessed by PT test.
Common pathway: Factor 10 converts prothrombin to thrombin, leading to fibrinogen conversion into fibrin.

Key Processes of Hemostasis

Vasoconstriction: Local contraction of vascular smooth muscle, influenced by substances like TXA2 and endothelin.
Platelet Aggregation: Forming a plug on damaged endothelium, attracting more platelets.
Coagulation: Intrinsic and extrinsic factors work together to form a stable clot.
Fibrinolysis: Occurs simultaneously with clot formation; degradation of fibrin by plasmin.

Blood Types

Group A: RBC type A; anti-B antibodies; Antigen A present.
Group B: RBC type B; anti-A antibodies; Antigen B present.
Group AB: RBC type AB; no antibodies; Antigens A & B present.
Group O: RBC type O; anti-A and anti-B antibodies; no antigens.

Rh Factor

Major antigen present in ~85% of the population (Rh positive).
Blood components for transfusion include red blood cells (RBCs), platelets, cryoprecipitate, and fresh frozen plasma (FFP).

Packed Red Blood Cells (PRBCs)

Concentrated RBCs with plasma removed; usually leukocyte reduced.
Transfusion indications: Anemia (Hgb > 7; > 8 in CAD patients) and acute hemorrhage.
Essential for volume resuscitation, especially in trauma or surgery.

Platelets

Concentrated solution; lifespan of ~5 days post-donation.
Indicated for thrombocytopenia, massive bleeding, and platelet dysfunction.
Transfusion goal: maintain platelet count > 50k; > 100k in CNS bleeding situations.

Fresh Frozen Plasma (FFP)

Contains vitamin K dependent factors and Factor V; can be stored up to 20 years.
Thawing time: 20-30 minutes; "thawed" plasma lasts 5 days.
Indications: Multiple coagulation deficiencies, liver disease, and active bleeding.

Cryoprecipitate

Derived from FFP; rich in fibrinogen and clotting factors.
Used for hypofibrinogenemia (fibrinogen < 100) due to acute bleeding.
Standard adult dose: 10 units; one unit attempts to increase fibrinogen by ~100 mg/dL.

Tranexamic Acid (TXA)

Antifibrinolytic agent that prevents clot breakdown.
Commonly used in surgery and trauma settings; administered empirically for massive bleeding.

Anticoagulation Reversal Agents

Warfarin: Vitamin K & 4 factor PCC (KCentra).
Heparin/LMWH: Protamine sulfate.
Dabigatran: Idarucizumab.
Direct Factor Xa inhibitors: Andexanet alfa.

Resuscitation Protocols

Blood transfusions managed by blood banks; typically not done in outpatient settings.
Emergency use of un-matched O- blood possible; prompt typing and cross-matching preferred.
Massive transfusion protocols require simultaneous supply of PRBCs, FFP, and platelets in a 1:1:1 ratio.

Transfusion Process & Monitoring

Transfusions considered procedures with associated risks; informed consent is necessary.
Monitor vital signs at intervals throughout the transfusion for early detection of complications.

Complications of Transfusion

Febrile Non-Hemolytic Transfusion Reaction (NHTR): Mild fever response; treat with acetaminophen.
Allergic Reactions: Common and mild; respond to antihistamines, severe reactions may need Epi or steroids.
Acute Hemolytic Reaction: Usually due to ABO incompatibility; can be fatal; symptoms include pain, flushing, and renal failure.

Transfusion Associated Graft vs Host Disease (TAGVHD)

Rare but severe condition where donor T-lymphocytes attack the recipient’s cells.
Can occur up to 6 weeks post-transfusion; outcomes can be fatal.

Transfusion Transmitted Infections

Very rare due to stringent screening; concerns include malaria, Chagas’ disease, hepatitis C, and HIV.

Respiratory Complications

Transfusion Associated Circulatory Overload (TACO): Rapid infusion leading to pulmonary edema; management includes slowing infusion and diuresis.
Transfusion-Related Acute Lung Injury (TRALI): Non-cardiogenic pulmonary edema with significant respiratory distress; treatment is supportive and may require ventilation.

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Description

This quiz covers the critical aspects of blood transfusions and fluid replacement in patients experiencing intravascular volume loss. It delves into the types of fluids used, their tonicity, and the importance of blood replacement in cases of bleeding. Test your understanding of these essential medical concepts.