Term
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Definition
provides oxygen carying capacity and volume expansion. Ideal for pts with acute hemorrhage or 25% volume loss.
Not readily available because whole blood usually broken down into other components. |
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Term
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Definition
12,000,000 units given/year. 18-57%given inappropriately.
Objective-improve inadequate O2 delivery. |
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Term
| adverse affects of decreased O2 capacity? |
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Definition
| +ischemia to brain and myocardium. oxygen delevery defined as product of CO and the arterial O2 content. |
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Definition
| up to 15% of total blood volume. has little hemodynamic affect other than vasoconstriction and mild tachycardia. |
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Definition
| 15-30% volume loss. S/S tachy, decreased pulse pressure, anxiety or restlessness-anesthesia may mask. |
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Definition
30-40% blood loss. S/S hypovolemia including marked tachy, tachypnea, hypotension, altered mental status.
+young healthy pts may tolerate replacement of volume with crystalloids. |
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Term
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Definition
| >40% blood loss. Life threatening. Marked tachy, hypotension, very narrow pulse pressure, low urine output, depressed mental status. |
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Term
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Definition
lower limits of anemia not established.
Os delivery can be adequate @7g/dl and hct as low as 18-25%.
chronic anemia better tolerated. CO not affected until hgb <7. Significant S/S unusual unless RBC <50%.
Acute anemia better tolerated if pt able to compensate with increased CO. Pt must have capacity to compensate. |
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Term
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Definition
Left Ventricle dysfunction.
hypothermia, b-blockers, Ca+channel blockers, anesthetics, hypnotics, NMB,
Anesthetics reduce CO, but better tolerated because of decrease O2 demand. |
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Term
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Definition
One unit of whole blood or RBCs will increase HCT 3% and hgb 1g/dl in 70kg non-bleeding pt. MI can be r/t perioperative anemia.
Hgb between 6-10g/dl dependant on risks r/t inadequate oxygenation.Indications for autologous blod more liberal than allogenic blood due to risk decreased. |
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Term
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Definition
| fever, chills, urticaria-masked by anesthesia. 1-5%of all transfusions has reaction. ABO incompatability is 1:33,000; fatal in 1:5-800,000; .03% can seroconvert HepC; HIV 1:450-600,000; most common is cytomegalovirus, but most are subclinical. Parasites and bacteria incidence low in US. |
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Term
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Definition
| probability of clinically significant thrombocytopenia increases proportionately with # of blood transfusions. Gestational decrease in platelets is normal. HELLP (hemolysis, elevated liver enzymes, and low platelet count) r/t preeclampsia-spontaneous resolution 4 days post-partum. platelet dysfunction r/t ASA more significant in determining post-op bleed rather than # of platelets. |
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Term
| platelet transfusion-effectiveness |
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Definition
| one platelet concentrate will ^count by 5-10,000. results vary due to release of platelets from spleen. Dose usually 1:10kg. many transfusions may make body become alloimmunized and refractory to platelet transfusions-then will need leukocyte antigen matched or crossmatched platelets. |
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Term
| recommendations for platelet transfusions |
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Definition
| <50,000 transfusion indicated. 50-100,000 determined by risk of bleeding. Vaginal delivery or procedures with low risk of bleeding OK to proceed with count<50,000. transfusions may indicated with apparent adequate count, but known platelet dysfunction or microvascular bleeding. |
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Term
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Definition
blood usually coagulate OK with coagulation factors 20-30% of norm and fibrinogen level 75mg/dl. replacement of entire blood volume gives pt 1/3 of original coagulation factors.
Shock, even without blood loss, can lead to consumption coagulopathy and microvascular bleeding. normal people with abnormal PT/PTT with no hx of bleeding, poo predictor of intra-op bleeding |
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Term
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Definition
Urgent reversal of warfarin therapy.
correction of known coagulation factor deficiencies when specific concentrations unavailable.
elevated PT or PTT >1.5X with bleeding
When more than 1 blood volume has been replaced.
Should be given to obtain >30% plasma concentration. 4-5 platelet concentrations or 1 unit of whole blood provide same amt coag factors as 1 unit FFP.
FFP contraindicated for volume or to ^ albumin concentration |
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Term
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Definition
contains factors VIII, fibrinogen, fibronectin, vonWillebrands, and XIII.
Used for correction of inheritied and aquired coagulopathies. 1 unit/10kg raises fibrinogen levels by 50mg/dl when bleeding absent. Most patients with factor VIII deficiencies will be tx with factor VIII concentrate and subtypes of vW tx with DDAVP.
recomend to give pre-op to pts with fibrinogen deficiencies or vW unresponsive to DDAVP. Give to bleeding pts with VonWillebrands. Correction of microvascular bleeding when large volume transfusions given or fibrinogen <80-100mg/dl. |
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Term
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Definition
From fractionated human plasma.
coag factors and blod group antibodies not present. 25gram=osmotically to 500ml plasma. Used for plasma volume expansion, maintain CO with shock, burn pts, ARDS, and cardiopulmonary bypass. 25%concentration will draw 4ml/every 1ml of albumin given.
Need to treat cause for hypoproteinemia because albumin only temporary fix. Not to be used as a nutritional supplement. |
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Term
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Definition
PPF is 5% pooled solution of stableized proteins in saline containing at least 83%albumin, 17% globulins with <1%gamma globulins.
Given to treat hypovolemic shock. |
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Term
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Definition
Concentrated solution of globulins, primarily immunoglogulins, prepared from large pools of human plasma.
Used to protect against clinical manifestations of Hep A if given before or with in 2 weeks of exposure.
can be used for replacment therapy in pts with hypogammaglobulinemia.
used for idiopathic thrombocytopenia prupura, with antiviral and antibiotic therapy in immunodepressedion-CLL, myasthenia gravis, SLE, Guillian-Barre |
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Term
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Definition
| gelfoam, gelfilm, oxycel, thrombin |
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Term
| hetastarch (Hydroxyehel starch) |
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Definition
complex polysaccharide indicated for intravascular volume expansion. volume expansion = to albumin.
Advantages:oncotic properties, long duration of effects, low incidence of anaphalaxis, absence of disease transmission, and lower cost than albumin.
reactions:micramylasemia, pritis, prolonged PTT and decrease of factor VIII, vWs and fibrinogen, plus decreased platelet function. maximum dose 1500ml/day or 20mg/kg/day. |
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Term
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Definition
Water soluble glucose polymer. high molecular wt remain in intravascular space for 12 hrs. Used for volume expander to tx shock or impending shock when blood not available. dose-20mg/kg/1st day, 10mg/kg after that. Used inhysteroscopy to irrigate the uterine cavity and decrease # of adhesions. Injected with epi to slow intravascular absorption. Intercostal nerve blocks with bupivicaine give post-op anesthesia up to 40 hrs compared with giving bupivicaine alone is about 12 hours.
Can cause allergic reactions, increased bleeding time, and noncardiac pulmonary edema |
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