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In comparison to crystalloids, colloids have a greater capacity to remain within the _______.
They are also more efficient volume expanders than crystalloids.
Name 3 examples of colloids.
albumin, hydroxyethyl starches, dextran
What are colloids?
homogenous, noncrystalline substances consisting of large molecules dissolved in solute.
What is albumin made from??
- made from purified human plasma
- this is a blood product
Jehovah's witnesses may refuse this considering it is against their religion.
It has NO known risks of HIV, Hepatitis B or C transmission.
What are the two concentrations of albumin available??
5% and 25%
What is the half life of albumin?
What percentage of albumin remains within the intravascular system?? and how long does it stay there??
remains in the intravascular system x 2 hours
Where is albumin made??
List some characteristics of albumin.
- fat soluble vitamin
- it is 60% of totally protein in plasma
- maintains oncotic pressure
- binds Ca
- protein bound/binds lots of drugs
- most soluble of all the proteins
What is hydroxyethyl starch (hetastarch)?
a semisynthetic colloid synthesized from amylopectin (which is a plant substance)
High molecule weight hetastarch
6% in saline --- ______
6% in balanced 'lytes --- ____
What is the half life for hetastarch??
**Don't give more than two bags!
What is dextran biosynthesized from??
What are the two forms of Dextran??
Dextran 40 has a low molecular weight. What is it thought to do??
thought to improve blood flow through microcirculation by decreasing the blood viscosity
Which form of Dextran is cleared rapidly in the urine??
Dextran 40 -- has smaller particles so it is easily cleared.
Only takes a few hours.
Which form of Dextran will vascular surgeons request during surgeries of small vessels??
Which form of Dextran is preferred for volume expansion??
80% of its volume remains in the intravascular
What is the half life for Dextran 70?
takes a long time to clear the body of 1L of Dextran 70
What is the risk of using Dextran for replacement purposes??
risk for decrease Na and other 'lytes
Dextran does not provide 'lytes. It is a basically a sugar when broken down.
Of the colloids, which substance rarely produces any hypersensitivity & anaphylaxis reactions??
What are 2 complications of Hydroxyethyl Starch??
pruritus (this reaction is dose dependent)
reduction in factor 8 and von Willebrand factors, impaired platelet function, prolonged PTT
What is a complication of Dextran??
dose related decrease in platelet aggregation and adhesiveness
Why are crystalloids used generally over colloids for volume replacement??
- crystalloids have a better safety profile
- crystalloids are cheaper
No study has determined a distinct advantage or better outcomes concerning complications or survival.
What are 3 reasons that blood transfusions are necessary for volume replacement??
- needed if
- 1.inadequate oxygen-carrying/delivering capacity
- 2. coag deficits
- 3. inadequate intravascular fluid volume
Blood is given secondary to increase intravascular fluid volume. Use crystalloids first.
What is the universal blood donor??
What is the universal recipient??
If a patient is type A blood type, list the following....
Blood group compatibility??
If a patient is type B blood type, list the following....
Blood group compatibility??
If a patient is type AB blood type, list the following....
Blood group compatibility??
If a patient is type O blood type, list the following....
Blood group compatibility??
If a patient is Rh +, which blood group is compatible for this patient??
Rh + and -
If a patient is Rh -, which blood group is compatible for this patient??
In an emergency situation, what is the best, next best and least desirable options for the delivery of blood transfusions??
- 1. Best option---transfuse type-specific, partially cross-matched blood (only takes 5 mins to complete)
- 2. Next best---transfuse type specific, non-cross matches blood.
- 3. Least desirable---transfuse O negative PRBC's.
For the least desirable option with an emergency transfusion of blood, why do you want to use PRBC's not whole blood??
whole blood can have Anti-A and Anti-B antibodies.
If in an emergency situation, you administer two units of O negative blood and they are needing more blood but you know now the blood type and the patient has been cross matched.... what type of blood should you transfuse??
Continue transfusing O negative blood
How long can blood typically be stored?
Blood stored <__ days is recommended for critically ill patients. Why is this???
recommended to improve oxygen-delivery potential to critically ill patients.
What are some changes that occur to blood when it is stored ??
- -depletion of 2,3 DPG
- -altered RBC morphology
- -Accumulation of microaggregates
- -absence of viable platelets (after 2 days)
- -absence of factors V and VIII
Estimating blood volume (chart pg. 15)
Full term Neonate
A saturated lap sponge = ___ ml of blood loss
A saturated 4X4 = ___ ml of blood loss
Deciding whether to transfuse is based on a combination of what 3 factors?
- 1. monitoring for blood loss (counting sponges, etc. during procedure)
- 2. monitoring for inadequate perfusion and oxygenation of vital organs (vitals, echo, ekg)
- 3. monitor for transfusion indicators (HBG)
Monitoring for transfusion indicators -- What would you do with these HBG values??
HBG >10: ______
HGB <6: _______
- 1. rarely requires a transfusion
- 2. almost always requires a transfusion especially with anemia and obvious bleeding
- 3. based on the patients risk of complications, such as any signs of ischemia
How do you calculate allowable blood loss??
- ABL=EBVx(starting HCT-target HCT)
- starting HCT
Once HCT drops below ____ a transfusion is necessary.
PRBC's are generally used for the treatment of ______ from surgical blood loss.
What is the normal volume of blood in a bag of PRBC??
1 unit of PRBC raises the Hgb by ___.
When available, whole blood may be preferable to PRBC's when replacing blood losses that exceed ____ of blood volume.
use with big traumas bc it has the coag factors you need
Platelets are given to treat _______.
Platelets are not used unless the platelet count is ____.
1 platelet concentrate increases the platelet count _______.
5,000 to 10,000 cells/mm3
When do you use fresh frozen plasma in surgery??
When treating hemorrhage from presumed coagulation factor deficiency
What is FFP?
- fluid (non-cell) portion from whole blood
- contains all coagulation factors, except platelets
FFP is given for 3 additional reasons besides the treatment of hemorrhage, what are these reasons??
- 1. if PT or PTT is >1.5 times normal
- 2. Urgent reversal of coumadin
- 3. Heparin resistance
What is cryoprecipitate?? What is it used to treat??
fraction of plasma that precipitates after FFP is thawed
contains factor 8, Von Willebrand Factor and Fibrinogen
treats -- Hemophilia A, hypofibrinogenemia
Bacterial contamination most often occurs with _____ transfusions. Why is this??
it is stored at a warmer temp in comparison to other blood products (20 to 24 degrees C instead of 4 degrees C).
What should you do if a patient develops a fever within 6 hours after receiving a platelet infusion??
suspect platelet-induced sepsis, start abx therapy
What is the number 1 cause of complications after a transfusion??
Transfusion related acute lung injury (TRALI)
What is TRALI?
- respiratory distress syndrome
- patient presents with dyspnea and hypoxemia 2ndary to noncardiogenic pulmonary edema
If you suspect a patient has TRALI what should you do?
- 1. stop the transfusion
- 2. support VS
- 3. Determine protein concentration of pulmonary fluid (via ETT)
- 4. CBC and chest Xray
- 5. notify the blood bank
most patients will recover within 96 hours
What is transfusion related immunomodulation??
a transfusion suppresses a patients cell mediated immunity -- places patient at risk for post-op infection
Which of the different types of transfusions provides the least amount of immunodulation??
bc they have less plasma.
How can you decrease the occurrence of immunomodulation??
remove WBC from blood
What are some metabolic abnormalities of blood products? (5)
- -preservatives and continued metabolic function of blood cells increases hydrogen ion content in the stored blood
- -potassium content increases with the duration of stored blood
- -stored blood has decreased levels of 2,3 DPG (meaning there is less o2 getting to the tissues)
- -citrate metabolism to bicarbonate can cause metabolic acidosis
- -citrate binds calcium, causing hypocalcemia
Because of citrate being part of blood products, if you're given several units of blood, what may you need to replace in your patients??
citrate binds with Ca so you may need to give the patient Ca replacements
What is a reason for given Lasix during blood transfusions??
to decrease the K level
*remember, the potassium content increases during the storage of blood
Postoperative shivering increases what??
What are 3 types of transfusion reactions??
What is the most common type of transfusion reaction??
If a febrile transfusion reaction is suspected, what should you do during administration of blood??
slow the infusion and given antipyretics
What are severe signs of febrile transfusion reaction? And what should you do if your patient exhibits these signs??
stop the transfusion (don't throw blood away, put in bag and take to lab)
When does a hemolytic transfusion reaction occur??
when the wrong blood type is administered
**Make sure to double check blood
What are immediate signs of a hemolytic transfusion reaction??
lumbar and substernal pain, fever, chills, dyspnea, skin flushing, hypotension
**remember all these signs except hypotension can be masked by anesthesia
What are the complications with hemolytic transfusion reactions??
Acute Renal Failure and DIC
Free Hgb may appear in urine or plasma
Precipitation of contents of hemolyzed cells in distal tubules causing renal failure
How do you treat hemolytic transfusion reactions??
- -immediately d/c of transfusion
- -infuse fluids to maintain UOP (cystalloids, mannitol, furosemide)
- -support patients vital signs
What is the main evidence that leads to the evidence of a hemolytic transfusion reaction??
hgb in the plasma or urine
What is predeposited autologous donation??
predonated blood by the patient prior to surgery for possible transfusions needed during surgery
What is intra-op and post-op blood salvage??
red blood cells that are lost during surgery are collected and washed, then delivered back to the patient
what is normovolemic hemodilution??
withdrawing of blood from the patient prior to surgery and administering crystalloids to replace volume lost
blood is hemodiluted so when blood is lost during surgery there is less blood cells to be lost per ml of blood during surgery
at the end of surgery, the patients blood is reinfused