Blood Products » Department of Anesthesiology » College of Medicine

Blood Transfusion

Coagulopathy in Trauma

Blood Components Therapy

Transfusion Reactions

MTP/Belmont

Blood Product Transfusion

*Please take the quiz below the video to receive credit.

Objectives

Understand the financial costs associated with blood product transfusions
Describe the morbidity and mortality associated with blood product transfusion
Describe the indications for transfusing blood products along with the appropriate laboratory measurements and ranges targeted

Articles

Fresh frozen plasma transfusion in critically ill medical patients with coagulopathy
A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care

Lecture

Quiz

Blood Product Transfusion

Name*
First Last
1. Transfusion of a single unit of PRBC is associate with a _______ increase in hospitalization costs.*
- a. 1%
- b. 5%
- c. 10%
- d. 15%
2. Which is not a possible sequelae of blood transfusion*
- a. Febrile Non-Hemolytic reactions
- b. Transfusion-related acute lung injury (TRALI)
- c. Transfusion-associated circulatory overload (TACO)
- d. Transfusion-associated Grafter Versus Host Disease (TA-GVHD)
- e. Thrombopenic Thrombotic Purpura (TTP)
3. In patients identifying as Jehovah’s Witnesses, a dramatic increase in morbidity and mortality rates has been noted to occur when the hemoglobin concentration becomes less than:*
- a. 4g/dL
- b. 5g/dL
- c. 6g/dL
- d. 7g/dL
4. According to the TRICC trial, what transfusion trigger constituted a restrictive transfusion strategy?*
- a. Hematocrit of 21%
- b. Hematocrit of 22%
- c. Hemoglobin 7g/dL
- d. Hemoglobin 8g/dL
5. True or False: A decreased short term mortality has been noted in patients who were transfused to a hematocrit of 30% if they were admitted with STEMI myocardial infarction and were greater than 65 years old*
- True
- False
6. When transfusing Fresh Frozen Plasma (FFP), how much is needed to effectively improve the patient’s coagulation profile?*
- a. 3-5ml/kg
- b. 8-10ml/kg
- c. 10-15ml/kg
- d. 15-20ml/kg
7. Appropriate indications for FFP transfusion include all of the following except*
- a. Replacement of congenital clotting deficiency
- b. Immediate warfarin reversal with bleeding
- c. Treatment of TTP
- d. Massive blood transfusion with active bleeding
- e. INR 1.9 in a patient undergoing an invasive procedure
8. True or False: Blood transfusion is an independent risk factor for mortality and morbidity
- True
- False
9. After only 2 weeks of storage, all the following are true concerning RBCs except:*
- a. Decreased ability to deform and unload O2
- b. Loss of RBC antioxidants
- c. Conversion of hemoglobin to methemoglobin
- d. Accumulation of histamine, lipids, and cytokines
- e. Increased clumping and adhesion to storage bag
10. All of the following are true of FFP except:*
- a. Should be dosed 5-10ml/kg
- b. Each unit is approximately 250mL
- c. Contains 1-2mg/ml of fibrinogen
- d. Can be frozen for up to 1 year

Coagulopathy in Trauma: Emergency Uses vs. MTP

*Please take the quiz below the video to receive credit.

Objectives

Understand the physiology of hemostasis, coagulation, and fibrinolysis
Understand the correct laboratory tests utilized to diagnose coagulopathies in the ICU
Describe the management and treatment of HIT, DIC, and the reversal of direct oral anticoagulants (DOACs)

Articles

Emergency anticoagulation reversal protocol
Clinical Practice Guideline on the Evaluation and Management of Adults with Suspected Heparin-Induced Thrombocytopenia
Bleeding and Coagulopathies in Critical Care

Lecture

Quiz

Bleeding and Coagulopathy Quiz

Name*
First Last
1. Pro-thrombin Time (PT), Partial Thromboplastin Time (PTT), Thrombin Time (TT ) are tests used in the evaluation of which of the following*
- a. Secondary hemostasis
- b. Primary hemostasis
- c. Intrinsic pathway
- d. Extrinsic pathway
2. Primary hemostasis is characterized by all o the following except:*
- a. Superficial bleeding sites such as skin and mucous membranes
- b. Petechiae
- c. Immediate but mild to moderate bleeding after surgery
- d. Commonly causes hemarthrosis or muscle hematomas
3. Pseudothrombocytopenia is identified using which of the following tests*
- a. Peripheral blood smear
- b. Platelet function assay
- c. Bleeding time
- d. Platelet mapping TEG
4. If a patient is diagnosed with HIT, Heparin should be discontinued and no other anticoagulation started if the platelet count is less than 50,000.*
- True
- False
5. All of the following are true of HIT except*
- a. 25-50% percent of cardiac surgery patients will have a positive HIT ELISA
- b. It is more common in females than males
- c. Less commonly associated with Low-molecular weight heparin
- d. Is associated with a platelet Nader <20,000
6. PF4 antibody ELISA carries a more specificity for HIT than the Serotonin Release Assay*
- True
- False
7. All of the following are Factor Xa inhibitors except which of the following?*
- a. Dabigatran (Pradaxa)
- b. Rivaroxiban (Xarelto)
- c. Apixaban (Eliquis)
- d. Edoxaban (Savaysa)
8. All of the following are true of Prothrombin Complex Concentrate (Kcentra) except:*
- a. It contains factors II, VII, IX, and X
- b. It is contraindicated if a patient has a history of HIT
- c. Given in conjunction with vitamin K when given for emergent reversal of warfarin
- d. May be used to treat intractable DIC
9. DIC is characterized by all of the following except:*
- a. Schistocytes on peripheral smear
- b. Reduction in platelets due to deposition in non-physiologic areas
- c. Most commonly present with micro-thombi (such as digital ischemia)
- d. Prolongation of the PT, PTT
10. All of the following are true regarding the treatment of DIC except:*
- a. Maintain a platelet count > 50,000/m3
- b. Maintain fibrinogen >150mg/dL
- c. Target PT and PTT less than 1.5 times the normal control
- d. Treat the underlying condition
- e. B and D
- f. All of the above

Blood Components for Physicians

*Please take the quiz below the video to receive credit.

Objectives

Introduction to safety- Testing of Blood Donors
Overview of Blood Component Therapy
Introduction to Blood Product Modifications
Recognizing Transfusion Reactions
Documentation of Transfusions and Reactions

Articles

Explaining the excess morbidity of emergency general surgery: packed red blood cell and fresh frozen plasma transfusion practices are associated with major complications in non-massively transfused patients
Can Blood Transfusion Be Not Only Ineffective, But Also Injurious?
Fresh frozen plasma transfusion fails to influence the hemostatic balance in critically ill patients with a coagulopathy
Transfusion of fresh-frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial

Lecture

Quiz

Blood Components Quiz

Name
First Last
1. What volume typically comes in a bag of packed red blood cells?*
- a. 250-350 ml
- b. 100-200 ml
- c. 350-400 ml
- d. 150-250 ml
2. How many grams/dL will 1 unit of PRBC increase the patient’s hemoglobin and hematocrit?*
- a. Increase of 2 g/dl of Hemoglobin and 6 % hematocrit
- b. Increase of 1 g/dL of hemoglobin and 3% hematocrit
- c. Increase of 3 g/dl of hemoglobin and 3% hematocrit
- d. Increase of 2 g/dl of hemoglobin and 5% hematocrit
3. For what SvO2 would you consider administering a unit of packed red blood cells?*
- a. Greater than 80%
- b. Greater than 90%
- c. Less than 80%
- d. Less than 60%
4. Which is not an indication for platelet transfusion?*
- a. Platelets < 50 K/µ who is bleeding or undergoing an invasive procedure
- b. Bleeding with evidence of platelet dysfunction
- c. Less than 100 K with CNS bleeding
- d. Less than 70 K with no evidence of bleeding
5. Which of the following is a contraindication for administration of platelets unless the patient is suffering life-threatening bleeding?*
- a. TTP
- b. HIV
- c. DIC
- d. None of the above
6. When administering fresh frozen plasma, what dose should be administered?*
- a. 10-20 ml/kg
- b. 5-10 ml/kg
- c. 20-30 ml/kg
- d. 15-30 ml/kg
7. How many mL’s are in one bag of fresh frozen plasma?*
- a. 300-350 ml
- b. 200-250 ml
- c. 100-150 ml
- d. 150-200 ml
8. Which of the following are not found in cryoprecipitate?*
- a. 80-100 units of Factor VIII
- b. 40-70% of von Willebrand Factor plasma
- c. Factor XIII
- d. Platelets
9. Which of the following is an indication for ordering irradiated blood products?*
- a. Bone Marrow Transplant
- b. Human Immunodeficiency Virus
- c. Pregnancy
- d. Solid Organ Transplant
10. When ordering blood products at Shands, do you ever have to specify leukocyte reduced?*
- a. Yes, not all blood products at shands are leukocyte reduced
- b. No, all blood products at Shands are leukocyte reduced.

Transfusion Reactions

*Please take the quiz below the video to receive credit.

Objectives

List how to identify transfusion reactions.
Describe the management of transfusion reactions.
List how to prevent future transfusion reactions.

Articles

Transfusion related acute lung injury: a clinical review
Scratching the surface of allergic transfusion reactions

Lecture

Quiz

Transfusion Reactions Quiz

Name*
First Last
1. Which of the following is the most common transfusion reaction?*
- a. Hemolytic Transfusion Reactions
- b. TRALI
- c. TACO
- d. Microbial infection
2. What is the first step when there is a suspected transfusion reaction?*
- a. Maintain patient's airway
- b. Stop the Transfusion
- c. Administer medications
- d. Place Epic order for reaction evaluation per protocol
3. True or False: If you suspect a transfusion reaction, you take down the blood and discard it in an appropriate waste bin.*
- True
- False
4. Which of the following is a symptom of a blood transfusion reaction?*
- a. Pain
- b. Hypo or hypertension
- c. Respiratory distress
- d. All of the above
5. What medication should you administer to treat a mild allergic reaction (urticaria)?*
- a. Hydrocortisone
- b. Benadryl
- c. Albuterol
- d. Pepcid
6. True or False: If a patient has a known history of severe allergic reaction to blood transfusions, you may administer Benadryl, steroids, H2 Blockers, and/or ephedrine prior to administering another transfusion.*
- True
- False
7. Which of the following is a sign of a delayed hemolytic reaction?*
- a. Declining H/H without bleeding
- b. Jaundice immediately after the transfusion
- c. DIC
- d. Anaphylaxis
8. True or False: Aspirin based products can be utilized to treat the fever in a febrile nonhemolytic reaction.*
- True
- False
9. How soon after a blood transfusion does graft versus host disease present?*
- a. 2-3 days
- b. 1-2 hours
- c. 10-12 days
- d. 14-21 days
10. True or False: Diuretics and steroids are contra-indicated in the treatment of TRALI.*
- True
- False

MTP/Belmont/Level 1 Rapid Transfuser

*Please take the quiz below the video to receive credit.

Lecture

Reference Videos

Level 1 Rapid Transfuser Guide

Belmont Rapid Transfuser Guide

Quiz

Name(Required)

First Last

1. At UF Health, an Adult Massive Transfusion is defined as the need to rapidly transfuse how many products within a 2 hour time?(Required)

a. 2

b. 5

c. 10

d. 20

2. MTP may be initiated in all of the following areas except:(Required)

a. ED

b. ICU

c. L&D

d. IMC

3. Which of the following is not a goal of MTP?(Required)

a. Prevent hypokalemia and hypercalcemia

b. Maintain core temperature

c. Prevent symptomatic anemia

d. Maintain Hemoglobin > 7, INR 100

4. Which rapid transfuser used at UF Health Shands will automatically purge air and prime the tubing without stopping the infusion pump?(Required)

a. Level 1

b. Belmont

5. True or False: An APP may initiate MTP.(Required)

True

False

6. How much will 1 pool of platelets increase your platelet count?(Required)

a. 100K

b. 50K

c. 75K

d. 25 K

7. True or False: It is acceptable to infuse platelets through a rapid transfuser.(Required)

True

False

8. How much will 1 pack pool of cryo increase the fibrinogen?(Required)

a. 60-100

b. 80-150

c. 200

d. 40-60

9. True or False: TXA comes from the blood bank in the second cooler of blood.(Required)

True

False

10. How much PRBC and FFP comes in each cooler AND which coolers come with platelets?(Required)

a. 8 PRBC and 8 FFP, and 1 bag of platelets in each cooler

b. 6 PRBC and 6 FFP, and 1 bag of platelets in every 2nd cooler

c. 4 PRBC and 4 FFP, and 2 bags of platelets in every 3rd cooler

d. 10 PRBC and 10 FFP and 1 bag of platelets in each cooler