Podcast
Questions and Answers
What is the primary method to replace intravascular volume loss due to bleeding?
What is the primary method to replace intravascular volume loss due to bleeding?
Which of the following processes is NOT involved in hemostasis?
Which of the following processes is NOT involved in hemostasis?
Which factor is NOT part of the intrinsic pathway of coagulation?
Which factor is NOT part of the intrinsic pathway of coagulation?
What is the role of thromboxane A2 (TXA2) in hemostasis?
What is the role of thromboxane A2 (TXA2) in hemostasis?
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Which component is converted to fibrin during the coagulation cascade?
Which component is converted to fibrin during the coagulation cascade?
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Which of the following substances is released by platelets and injured endothelium to promote vasoconstriction?
Which of the following substances is released by platelets and injured endothelium to promote vasoconstriction?
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What initiates the intrinsic pathway of coagulation?
What initiates the intrinsic pathway of coagulation?
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What is the end product of the common coagulation pathway?
What is the end product of the common coagulation pathway?
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What is the maximum allowable fibrinogen level before administering cryoprecipitate?
What is the maximum allowable fibrinogen level before administering cryoprecipitate?
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Which reaction is characterized by an increase in temperature > 1 degree C during transfusion?
Which reaction is characterized by an increase in temperature > 1 degree C during transfusion?
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What is a common cause of Acute Hemolytic Transfusion Reaction?
What is a common cause of Acute Hemolytic Transfusion Reaction?
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What is a potential consequence of using vasopressors during hemorrhagic shock?
What is a potential consequence of using vasopressors during hemorrhagic shock?
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Which of the following is a key nursing protocol during blood transfusions?
Which of the following is a key nursing protocol during blood transfusions?
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Which of the following represents a severe complication of blood transfusions?
Which of the following represents a severe complication of blood transfusions?
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What is the recommended treatment for allergic reactions during transfusion?
What is the recommended treatment for allergic reactions during transfusion?
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In which condition should diuretics be considered before or between blood units?
In which condition should diuretics be considered before or between blood units?
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What is a typical clinical manifestation of Transfusion Associated Circulatory Overload (TACO)?
What is a typical clinical manifestation of Transfusion Associated Circulatory Overload (TACO)?
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What is a significant risk associated with Transfusion Transmitted Infections?
What is a significant risk associated with Transfusion Transmitted Infections?
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What does a positive Coombs test indicate?
What does a positive Coombs test indicate?
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Which of the following may not be required for delayed hemolytic transfusion reaction management?
Which of the following may not be required for delayed hemolytic transfusion reaction management?
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What is the primary function of fibrinolysis in the body?
What is the primary function of fibrinolysis in the body?
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What is a clinical sign of Transfusion-Related Acute Lung Injury (TRALI)?
What is a clinical sign of Transfusion-Related Acute Lung Injury (TRALI)?
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What is a common initial symptom of an allergic transfusion reaction?
What is a common initial symptom of an allergic transfusion reaction?
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Which blood type does not have any antibodies present in its plasma?
Which blood type does not have any antibodies present in its plasma?
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What is the typical storage duration for Fresh Frozen Plasma (FFP) once thawed?
What is the typical storage duration for Fresh Frozen Plasma (FFP) once thawed?
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For which condition would platelet transfusion NOT typically be indicated?
For which condition would platelet transfusion NOT typically be indicated?
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What is the recommended goal for hemoglobin levels when transfusing PRBCs in patients with significant coronary artery disease?
What is the recommended goal for hemoglobin levels when transfusing PRBCs in patients with significant coronary artery disease?
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Which component is commonly used in the management of massive bleeding due to its antifibrinolytic properties?
Which component is commonly used in the management of massive bleeding due to its antifibrinolytic properties?
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What is the standard adult dose for cryoprecipitate transfusion in the context of hypofibrinogenemia?
What is the standard adult dose for cryoprecipitate transfusion in the context of hypofibrinogenemia?
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What is the primary purpose of a Massive Transfusion Protocol?
What is the primary purpose of a Massive Transfusion Protocol?
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In a 1:1:1 replacement strategy during massive transfusion, what does the ratio represent?
In a 1:1:1 replacement strategy during massive transfusion, what does the ratio represent?
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Which of the following agents is used for the reversal of dabigatran?
Which of the following agents is used for the reversal of dabigatran?
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What is the purpose of the leukocyte-reduced technique in red blood cell transfusions?
What is the purpose of the leukocyte-reduced technique in red blood cell transfusions?
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Which coagulation factor is NOT inherently a component of cryoprecipitate?
Which coagulation factor is NOT inherently a component of cryoprecipitate?
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What is the effect of antifibrinolytic agents like tranexamic acid in bleeding control?
What is the effect of antifibrinolytic agents like tranexamic acid in bleeding control?
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In patients undergoing massive transfusion, when should fresh frozen plasma be administered?
In patients undergoing massive transfusion, when should fresh frozen plasma be administered?
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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.
