chapter 49. quiz 7. complications
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Questions and Answers

What is the defining factor of fresh whole blood according to some investigators?

  • Storage at 1°C to 6°C for less than 48 hours
  • Storage at 4°C for less than 6 hours
  • Storage at 2°C to 5°C within 48 hours after collection and used within 24 hours
  • Storage at 1°C to 6°C within 8 hours after collection and used within 24 hours (correct)

    • Which factor is directly related to the effectiveness of fresh whole blood?

  • The type of blood group
  • The temperature of storage
  • The length of storage (correct)
  • The age of the recipient

    • Why does blood stored for longer periods become less effective, especially in terms of coagulation?

  • Improved hemostasis
  • Increased platelet aggregability
  • Decreased platelet aggregability (correct)
  • Enhanced coagulation factors

    • What is the impact of storing whole blood for 24 hours at 4°C on its hemostatic effects compared to storing it for less than 6 hours?

    <p>Decreased hemostatic effects</p> Signup and view all the answers

    What is retained in typed and crossmatched warm whole blood that has not been cooled?

    <p>Most of the factors of normal in vivo blood</p> Signup and view all the answers

    Which event did the experience in Vietnam show warm whole blood to be extremely effective in treating?

    <p><strong>Coagulopathy from massive transfusions</strong></p> Signup and view all the answers

    What is the primary cause of consumptive coagulopathy in patients experiencing major trauma or blood loss?

    <p>Crystalloid administration</p> Signup and view all the answers

    What is the key factor that differentiates patients who may tolerate multiple units of blood without developing a coagulopathy?

    <p>Adequate perfusion</p> Signup and view all the answers

    Which condition does a patient develop when hypotensive and receiving many units of RBCs in the presence of bleeding?

    <p>coagulopathy that resembles DIC.</p> Signup and view all the answers

    What are the common clinical signs indicating a coagulopathy due to excessive blood transfusion?

    <p>oozing into the surgical field</p> Signup and view all the answers

    Which factor contributes significantly to dilutional thrombocytopenia in patients receiving massive blood transfusions?

    <p>Dilution of platelets by volume administration</p> Signup and view all the answers

    What best describes the coagulopathy that develops in patients who are hypotensive and have received numerous units of RBCs?

    <p>'DIC-like' syndrome</p> Signup and view all the answers

    At what platelet count do patients usually experience clinical bleeding during surgery?

    <p>Less than 50 × 10^9/L</p> Signup and view all the answers

    What platelet count indicates a patient will develop a bleeding problem from dilutional thrombocytopenia according to Miller and colleagues?

    <p>Less than 75 × 10^9/L</p> Signup and view all the answers

    At what platelet count does spontaneous bleeding usually occur?

    <p>Less than 10 × 10^9/L</p> Signup and view all the answers

    What happens to platelets in whole blood stored at 4°C for more than 24 hours when infused for patient?

    <p>They are absorbed by the reticuloendothelial system</p> Signup and view all the answers

    How many units of blood given to acutely wounded soldiers can decrease platelet counts to less than 100 × 10^9/L?

    <p>10-15 units</p> Signup and view all the answers

    What platelet count is considered a guide for developing a hemorrhagic diathesis due to multiple units of bank blood transfusion?

    <p>&lt;50 × 10^9/L</p> Signup and view all the answers

    What platelet count range is likely to impair coagulation due to a combination of dilutional thrombocytopenia and DIC?

    <p>50 to 70 x 10^9/L</p> Signup and view all the answers

    Why do patients with acute induced thrombocytopenia develop a hemorrhagic diathesis at a higher platelet count than those with chronic thrombocytopenia?

    <p>Platelets are poorly functioning in acute induced thrombocytopenia.</p> Signup and view all the answers

    In what scenario is giving platelets to treat laboratory evidence of thrombocytopenia NOT recommended?

    <p>When there is no clinical coagulopathy present.</p> Signup and view all the answers

    Why is the efficacy of blood product administration often difficult to assess according to the text?

    <p>Platelet function and impact on clinical bleeding can be unpredictable.</p> Signup and view all the answers

    Why are decreases in blood fibrinogen concentrations during blood loss and replacement considered significant?

    <p>fibrinogen is critical for effective clot formation</p> Signup and view all the answers

    What is the impact of storage on Factors V and VIII in whole blood?

    <p>They decrease to approximately 50% and 30% of normal after 21 days of storage.</p> Signup and view all the answers

    Why is administration of Fresh Frozen Plasma (FFP) recommended?

    <p>It contains all clotting factors including Factors V and VIII.</p> Signup and view all the answers

    What role does fibrinogen supplementation play in the treatment of acquired bleeding?

    <p>It is the most effective method of supplementation according to prospective studies.</p> Signup and view all the answers

    How do Factor V and Factor VIII levels change in whole blood after 35 days of storage?

    <p>They fall further to approximately 20% activity of normal.</p> Signup and view all the answers

    What is the significance of fibrinogen supplementation in major bleeding?

    <p>It should be recognized as critical for effective clot formation.</p> Signup and view all the answers

    What is the primary function of the clotting system in the coagulation process?

    <p>To prevent excessive blood loss</p> Signup and view all the answers

    What leads to the development of disseminated intravascular coagulation (DIC)-like syndrome?

    <p>Deposition of fibrin rendering blood unclottable</p> Signup and view all the answers

    What is a potential cause for the activation of the coagulation system in DIC syndrome?

    <p>Hypoxic acidotic tissues releasing tissue thromboplastin</p> Signup and view all the answers

    Which factor contributes to the consumption of factors in DIC syndrome?

    <p>Tumor necrosis factor</p> Signup and view all the answers

    What does activation of the fibrinolytic system aim to achieve in the presence of a hypercoagulable state?

    <p>Counteract excessive fibrin by lysing it</p> Signup and view all the answers

    How does the release of thromboplastin into the circulating blood affect the coagulation system?

    <p>Results in generalized activation of coagulation system</p> Signup and view all the answers

    What traditional approach for DIAGNOSIS AND TREATMENT OF A HEMORRHAGIC DIATHESIS ?

    <p>obtain a blood sample for platelet count, PTT, and plasma fibrinogen level</p> Signup and view all the answers

    In diagnosing a bleeding problem, if the PTT is 1.5 times normal or more and other tests are normal, what factors are likely to be at very low levels?

    <p>Factors V and VIII</p> Signup and view all the answers

    Which component can be used to treat a bleeding problem resulting from very low levels of factors V and VIII?

    <p>Fresh Frozen Plasma (FFP)</p> Signup and view all the answers

    What determines whether platelets should be administered in the form of fresh blood, platelet-rich plasma, or platelet concentrates?

    <p>Intravascular volume replacement requirements</p> Signup and view all the answers

    For treating very low levels of factors V and VIII, which of the following can be used besides Fresh Frozen Plasma (FFP)?

    <p>Cryoprecipitate</p> Signup and view all the answers

    How many units of platelet concentrates are required in a 70-kg person to increase the platelet count by 10 × 10^9/L in the absence of a consumptive process?

    <p>10 units</p> Signup and view all the answers

    What did Lavee and associates find regarding the effectiveness of fresh whole blood compared to platelet units?

    <p>Fresh whole blood was superior to platelet units</p> Signup and view all the answers

    What is the volume of platelet-rich plasma compared to a unit of blood?

    <p>half of the volume</p> Signup and view all the answers

    What is the approximate percentage of platelets that platelet concentrates provide in a unit of blood?

    <p>70%</p> Signup and view all the answers

    Why is determining the plasma fibrinogen level useful in diagnosing coagulation disorders?

    <p>It remains stable in whole blood.</p> Signup and view all the answers

    What is the significance of a low in vivo plasma fibrinogen level?

    <p>strongly suggests DIC</p> Signup and view all the answers

    How does the plasma fibrinogen level behave in the presence of blood loss and replacement?

    <p>It decreases significantly.</p> Signup and view all the answers

    How does a low plasma fibrinogen level aid in diagnosing coagulation disorders compared to other factors?

    <p>It is more sensitive than platelet counts.</p> Signup and view all the answers

    What can lead to hypocalcemia, dysrhythmia, and hypotension due to blood transfusions?

    <p>Citrate intoxication</p> Signup and view all the answers

    In which scenario is citrate intoxication more likely to occur?

    <p>Pediatric populations</p> Signup and view all the answers

    What rate of blood infusion can lead to decreasing ionized Ca2+ levels?

    <p>More than 1 unit every 10 minutes</p> Signup and view all the answers

    What is a common occurrence during apheresis for donation of blood components?

    <p>Citrate intoxication reactions</p> Signup and view all the answers

    In what scenario is hyperkalemia as a result of transfusion relatively rare?

    <p>With large amounts of blood transfusion</p> Signup and view all the answers

    When does clinically significant hyperkalemia from banked blood transfusion usually occur?

    <p>From banked blood given at a rate of 120 mL/minute or more</p> Signup and view all the answers

    What is the recommended method to prevent decreases in body temperature when administering stored blood to a patient?

    <p>Warming the blood to body temperature before transfusing</p> Signup and view all the answers

    What can happen if a patient's body temperature decreases to less than 30°C during blood transfusion?

    <p>Ventricular irritability and cardiac arrest may occur</p> Signup and view all the answers

    Why is shivering from mild hypothermia considered counterproductive in patients receiving stored blood transfusions?

    <p>It contributes to tissue ischemia</p> Signup and view all the answers

    How does hypothermia affect coagulation factors and platelet function?

    <p>Significantly impairs coagulation factors and platelet function</p> Signup and view all the answers

    What temperature range is typically used for warming blood before transfusing it to a patient?

    <p>37-38°C</p> Signup and view all the answers

    What is the primary reason for the decrease in pH of bank blood to approximately 6.9 after 21 days of storage?

    <p>Accumulation of lactic and pyruvic acids by RBC metabolism</p> Signup and view all the answers

    What is the consequence of a high Pco2 in stored blood when adequate ventilation is provided to the recipient?

    <p>Insignificant effect on the recipient</p> Signup and view all the answers

    Why is the administration of sodium bicarbonate not recommended is not indicated

    <p>because of these unpredictable acid-base changes</p> Signup and view all the answers

    What should guide the administration of sodium bicarbonate during blood transfusions?

    <p>Analysis of arterial blood gases</p> Signup and view all the answers

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