What is the objectives for RBC administration?
The improvement of inadequate oxygen delivery.
Define class I hemorrhages.
A loss of up to 15% of total blood volume. Usually has little hemodynamic effects other than vasoconstriction and mild tachycardia.
Define class II hemorrhages.
A loss of 15-30% of blood volume. Produces tachycardia, a decreased pulse pressure, and anxiety or restlessness.
Define class III hemorrhages.
A loss of 30-40% of blood volume. Produces signs of hypovolemia, marked tachycardia, tachypnea, systolic hypotension, and altered mental status.
Define class IV hemorrhages.
Loss of more than 40% of blood volume. Life threatening. Accompanied by marked tachycardia and hypotension, very narrow pulse pressure, low UOP, mental status markedly depressed (unarousable).
What are the risks of diminished oxygen-carrying capacity?
Ischemic effects on the myocardium and brain.
How is oxygen carrying capacity defined?
The product of CO (Qt) and arterial oxygen content (CaO2). CaO2 is a function of hgb concentration, and the amount of oxygen physically dissolved in arterial blood.
Define acute anemia.
Reductions in arterial oxygen content usually are well tolerated because of the compensatory increases in CO.
Define chronic anemia.
CO usually does not change until the hemoglobin concentration falls below 7 g/dl.
What are the recommendations for RBC transfusions?
Indicated for hgb less than 6 g/dl, especially when anemia is acute. If patients are at risk for complications of inadequate oxygenation may need to transfuse at a higher level.
What factors affect CO and may indicate the patient needs to be transfused at a higher level than 6g/dl?
Left ventricular dysfunction, hypothermia, vasoactive agents (BBs, CCBs, NMBs, hypnotics), most anesthetics (except ketamine).
What are the risks/adverse reactions associated with RBC transfusion?
Fever, chills, urticaria, transfusion reactions, hepatitis B and C, HIV, cytomegalovirus, and parasitic and bacterial agents.
What are the most common adverse reactions associated with RBC transfusion?
Fever, chills, or urticaria.
What is the most common viral agent transmitted by blood transfusion?
What is HELLP syndrome?
A syndrome associated with pre-eclampsia.
What are the signs and symptoms of HELLP?
Hemolysis, elevated liver enzymes, and low platelet count.
How is HELLP treated?
Usually has spontaneous resolution by the 4th postpartum day despite the severe thrombocytopenia.
What are the recommendations for platelet transfusion?
Indicated when platelet count is less than 50,000. If actively bleeding, or requires surgery, may transfuse at a higher level. If actively bleeding and taking anti-platelet agents consider transfusing if plt. ct. is 90,000. May be indicated despite an apparently adequate plt. ct. if there is known plt. dysfunction and microvascular bleeding.
What are the recommendations for FFP transfusion?
Urgent reversal of warfarin, correction of known coagulation factor VIII or IX deficiencies (if meeds aren't available) and microvascular bleeding in the presence of elevated PT or PTT (>1.5 times normal), microvascular bleeding secondary to coagulation factor deficiency in patients transfused with more than one blood volume when PT and PTT cannot be obtained in timely fashion.
What are the components of cryoprecipitate?
Contains factors VIII, fibrinogen, fibronectin, von Willibrand's factor, and factor XII.
What are the recommendations for cryoprecipitate uses?
Prophylaxis in non-bleeding peri-operative or peri-partum patients with congenital fibrinogen deficiencies or von Willibrand's disease unresponsive to DDAVP. Bleeding patients with con Willibrand's disease. Correction of microvascular bleeding in massively transfused patients with fibrinogen concentrations less than 80-100 mg/dl (or when fibrinogen concentrations cannot be measures in a timely fashion).
What are the indications of albumin?
Indicated for plasma volume expansion and maintenance of CO in the treatment of certain types of shock; may be useful for burn patients, ARDS, and cardiopulmonary bypass.
What are the indications of plasma protein fraction?
What are some indications of IVIG?
Protects against clinical manifestations of hepatitis A when given before or within 2 weeks of exposure. Replacement therapy for patients with hypogammaglobulinemia. Idiopathic thrombocytopenia purpura, used along with appropriate antiviral antibiotic therapy in patients with immunodepression (CLL). Myasthenia gravis, SLE, Gullian-Barre syndrome.
What agents are used as blood volume expanders?
Hetastarch, dextran-70, dextran-40 (LMD), albumin (plasma expander), and plasma protein fraction (plasma expander).
What are advantages of hetastarch compared to albumin?
Oncotic properties, long duration of hemodynamic effects, low incidence of anaphylactoid reactions, absence of disease transmission, low cost.
What are the adverse reactions associated with hetastarch?
Serum microamylasemia, pruritis, prolongation of PTT and a decrease in plasma concentrations of factor VIII, von Willibrand's factor, and fibrinogen, plus decreased platelet function.
What are the indications for dextran?
Treatment of shock or impending shock when blood products are not available.
What are the adverse reactions associated with dextran use?
Allergic reactions, increased bleeding time, and non-cardiac pulmonary edema.