Ch. 25 Fluid Therapy and Transfusion Medicine
A 23% saline solution must be ____ before given IV to avoid osmotic injury to the tissues.
diluted (but not greater than 7.5%)
Concerning anticoagulants used for blood collection: IF blood is going to be stored, either _________ or ________ anticoagulant should be used. If blood will be transfused immediately, _______ _______ is acceptable. (Used of abbreviations is okay)
CPD; CPDA; sodium citrate
What separates ICF and the ECF?
Cell membrane
What is the correct catheter placement for a patient requiring multiple blood samples to be taken over a period of time, or that needs multiple medications given at constant rate infusion?
Central line
Normal Central Venous Pressure (CVP)
0-10 cm H2O
ECF is approximately ___ of TBW.
1/3
IVF is approximately ___ of ECF.
1/4
When 0.9% saline solution is administered intravenously, within a short time, only about _________ will remain in the vascular space.
1/4 (25-35%)
The shock dose of isotonic crystalloid fluids in a cat is... (in mL/kg body weight)
10-15
During the resuscitation phase of IV fluid therapy, arterial systolic blood pressure should be maintained at approx....
110-140mm Hg
The max recommended blood donation for dogs expressed as a percent of the blood volume is...
15%-20%
ICF is approximately ____ of TBW.
2/3
During an acute bleeding episode, a blood transfusion is necessary if the PCV drops below...
20%-25%
If a blood donation is taken from a dog in an amount equivalent to 20% of the blood volume ___________to____________ml/kg intravenous crystalloid fluids should be given to compensate for the fluid loss
20-40
When giving blood to hypothermic patients or those receiving large volumes of blood, refrigerated blood should be warmed to between __C and __C.
22-37 Celsius (71.6-98.6 F)
ISF is approximately ___ of ECF.
3/4
If incompatible blood is given to a horse for a first transfusion, it takes approx. __ to __ days for RBC antibodies to form
5-7
Using the rule of thumb provided, if you want to raise the PCV of a 25-kg patient by 10%, you should give approximately...
500mL of whole blood or 250 mL of packed RBCs
Fluids administered subcutaneously are usually absorbed in approximately
6-8 hours
Donor blood plasma is considered to be fresh plasma if used within _________ hours of collection.
8
Donor blood plasma that is frozen within ________ hour(s) of collection and is less than ________ month(s) old is considered to be fresh-frozen plasma. Otherwise, it is considered to be frozen plasma.
8 hours; 12 months
The appropriate circulating blood volume of a dog is estimated to be approx. ____ to ___ mL/kg body weight.
80-90
Canine blood-typing cards are used to detect...
DEA 1.1
The ideal equine blood donor is negative for factors ___ and ___
Aa & Qa
Ideal equine donor
Aa and Qa negative
TBW (total body water) is ____ of body weight
Approximately 60%
(Name Species) More than 70 blood group factors; negative for factor J
Bovine
Which of the following devices is often used to decrease the risk of fluid overload: Buretrol, admin line filter, carboy, or 10 drops/mL drip set?
Buretrol
(Name Species) Many, including 1.1, 1.2, and 3 through 7 blood group factors
Canine
The circulating blood volume as a proportion of total body weight (mL/kg) is the lowest in a...
Cat
What blood product is used to treat von Willebrand disease?
Cryoprecipitate
(Name Species) Many, including Aa, Ca, Pa, Qa, and Ua blood group factor
Equine
T/F The circulating blood volume of a horse is approx. 40-60mL/kg body weight.
False; 80mL/kg
T/F Only certain medications that are safe for IV admin can be given IO.
False; ALL IV medications can be IO
T/F Arterial blood pressure is an accurate indicator of response to fluid resuscitation.
False; Arterial blood pressure is highly preserved and only drops in advanced stages as a patient decompresses.
T/F If a patient has severe, acute hemorrhaging, the PCV will be deceased.
False; PCV can remain the same for the first 12 hours following hemorrhaging
T/F Glass blood-collection bottles are preferred over bags because they preserve blood cells more effectively.
False; Vacuum glass bottles inactivates platelets and can cause damage to RBCs
T/F Like dogs, cats do not have naturally occurring antibodies to erythrocyte antigens, and so a reaction following a first transfusion is unlikely.
False; cats do have naturally occurring circulating alloantibodies to the blood type they do not have so a risk for reaction to a first transfusion on incompatible blood varies in intensity
T/F Sodium bicarbonate is commonly used to treat a variety of conditions that lead to acidosis.
False; controversial, only used in select cases
T/F Dextrose 5% in water is an example of an isotonic fluid
False; hypotonic
T/F An advantage of SC fluid admin is that this route works well for resuscitation, replacement, or maintenance.
False; not to be used with resuscitation of patients that are hypovolemic or hypotensive
T/F Admin of hypertonic saline IV will promote rapid and long-lasting expansion of the vascular volume.
False; rapid but only lasts 20-30 minutes
T/F Transfusion reactions will occur as long as major and minor crossmatches indicate compatibility.
False; reactions may occur even if the major and minor crossmatches indicate compatibility.
T/F When calculating the ongoing losses so that the fluid admin rate can be increased appropriately, normal urinary losses should be included in this calculation.
False; should NOT
T/F Both water and electrolytes are able to move freely across all fluid space barriers (the cell membrane and vascular endothelium) and so distribute throughout the TBW.
False; water can but electrolytes only moves freely across the vascular endothelium
(Name Species) A, B, and AB blood group factors
Feline
What blood product is used to replace some coagulation factors?
Fresh or fresh-frozen plasma
Which of the following fluids would increase intravascular oncotic pressure in a patient with hypoproteinemia: Hetastarch, Normosol M, Plasmalyte 148, or D5W?
Hetastarch
What blood product is used to treat neonatal foals with FPT?
Hyperimmune plasma
3% NaCl tonicity
Hypertonic
7% NaC1 tonicity
Hypertonic
0.45% NaC1 tonicity
Hypotonic
0.45% Sodium Chloride tonicity
Hypotonic
Dextrose 5% in water (D5W) tonicity
Hypotonic
Normosol-M tonicity
Hypotonic
Plasmalyte 56 tonicity
Hypotonic
Which route of fluid admin is used in neonates, because it has essentially the same effect as IV admin but does not require catheterization of a vein?
IO
The maintenance fluid admin rate includes appropriate losses from the following three sources...
Inappropriate urinary loss, the respiratory system, and the GI tract.
0.9% Saline tonicity
Isotonic
Lactated Ringer Solution tonicity
Isotonic
Normosol-R tonicity
Isotonic
Plasmalyte 148 tonicity
Isotonic
The ideal bovine donor should be negative for factor
J
Ideal Bovine donor
J negative
When tissues don't receive enough oxygen because of decreased tissue perfusion, the levels of _____________ increase.
Lactate
When transfusing blood, it is usually given concurrently with isotonic crystalloid fluids. Which of the following fluids should not be used for this purpose because it can result in activation of the coagulation cascade: Normosol R, Plasmalyte 148, 0.9% Saline or Lactated Ringer solution?
Lactated Ringer Solution
A route of fluid administration used in small animals, but not usually in large animals is via a(n) ____ tube.
Nasogastric
What blood product is used for anemia?
Packed RBCs
Universal feline donor
None
Which of the following fluids has an acidifying effect: LRS, 0.9% saline, normosol R, or plasmalyte 148?
Normosol R
Even though it is isotonic, which of the fluids can cause discomfort when given SC owing it to its acidic pH: LRS, Plasmalyte 148, Normosol R, or Dextrose 5% in water?
Plasmalyte 148
Which fluid of the following fluids is NOT a hypotonic fluid? 0.45% saline; Normosol M, Plasmalyte 148, D5W?
Plasmalyte 148
What blood product is used to treat thrombocytopenia?
Platelet-rich plasma or platelet concentrate
Universal canine donor
Positive for only the DEA 4 antigen
A "major crossmatch" detects...
Reactions between donor RBCs and a recipient plasma
During severe, acute hemorrhage, the total protein (TP) will decrease before the packed cell volume (PCV) because of contraction of the __________.
Spleen
T/F Colloids tend to remain in the vascular space
True
T/F Dogs do not have naturally occurring antibodies to erythrocyte antigens and so a reaction is less likely following a transfusion of red blood cells.
True
T/F Hetastarch and 23.4% NaC1 can be mixed in a 2:1 ratio to produce a combination fluid that reduces both the total dose of each and the side effects.
True
T/F Normosol-R would be a appropriate for a patient with severe acidemia.
True
T/F Pain and irritation when an IV catheter is flushed is a sign that the vein is inflamed.
True
T/F SC fluids can be given by a client at home
True
T/F Sodium bicarbonate can be used for severe causes of hyperkalemia to promote a shift in potassium into the cells.
True
T/F The primary goal of blood transfusion is to improve oxygen delivery to the tissues
True
T/F To achieve optimal RBC viability during blood storage, blood bags should be weighed to ensure adequate fill (blood-to-anticoagulant ratio)
True
What blood product is used for Neonatal isoerythrolysis?
Washed RBCs
What separates the ISF and IVF?
Vascular endothelium
A blood plasma transfusion is not indicated for treatment of...
anemia
Central venous pressure (CVP) is the pressure inside the vena cava. This pressure is used to monitor fluid therapy because it approximates cardiac preload and thereby ____ volume.
blood
The product VetStartch is a synthetic _____ that has a lesser negative effect on blood coagulation than hetastarch.
colloid
The two main categories of fluids based on the size of their solute molecules are...
crystalloids and colloids
Subcutaneously admin fluids should have an osmotic pressure that is approx. ____ to extracellular fluid.
equal
3% or 7% hypertonic saline is used to treat
head trauma
Impaired blood coagulation is a possible side effect of admin of the synthetic colloid...
hetastarch
Enteral fluids are often used to treat large bowel impaction in
horses
Hypotonic fluids are used to treat...
hypernatremia
The combination of PU/PD, cardiac arrhythmias, and severe muscle weakness is very suggestive of...
hypokalemia
For patients with hemorrhage, the volume of blood to be transfused can be calculated based on the estimate blood ____, whereas for patients with chronic anemia, it can be calculated based on the ___ ____ ___.
loss; packed cell volume (PCV)
Does a transfusion of type B blood into a type AB cat cause a reaction?
no, AB cats can receive any blood type
The primary goal of blood transfusion is to increase the __________-carrying capacity of the blood.
oxygen
A significant complication of fluid therapy is fluid overload. Of greatest concern in these patients is the possibility of...
pulmonary edema
