Fluid Management & Blood Transfusion Flashcards

Which crystalloid solution most closely resembles plasma electrolyte composition and is considered a balanced isotonic solution?

Answer: Lactated Ringer's solution

Lactated Ringer's is a balanced isotonic solution containing sodium, chloride, potassium, calcium, and lactate in concentrations closest to plasma, making it a preferred choice for surgical fluid replacement.

When comparing crystalloids to colloids for volume resuscitation, which statement best describes their volume distribution?

Answer: Crystalloids distribute throughout extracellular fluid requiring a 3:1 replacement ratio; colloids remain primarily intravascular

Crystalloids distribute throughout the extracellular fluid compartment (intravascular + interstitial), so approximately 3 mL of crystalloid is needed to replace 1 mL of blood loss, while colloids exert oncotic pressure keeping fluid intravascular.

According to current restrictive transfusion guidelines, what is the hemoglobin trigger for red blood cell transfusion in a stable, non-cardiac patient?

Answer: Hemoglobin < 7 g/dL

Restrictive transfusion strategies supported by multiple RCTs recommend transfusion when hemoglobin falls below 7 g/dL in stable, non-cardiac patients, which has been shown to be non-inferior to liberal strategies.

Transfusion-Related Acute Lung Injury (TRALI) is most commonly caused by which mechanism?

Answer: Donor antibodies against recipient HLA or neutrophil antigens causing neutrophil activation in the lungs

TRALI is most commonly caused by donor antibodies (anti-HLA or anti-neutrophil) that activate recipient neutrophils in pulmonary capillaries, leading to capillary leak and non-cardiogenic pulmonary edema within 6 hours of transfusion.

Which colloid solution has been associated with increased renal dysfunction and mortality in critically ill septic patients, leading to restricted use in the ICU?

Answer: Hydroxyethyl starch (HES)

The 6S and CHEST trials demonstrated that hydroxyethyl starch (HES) solutions were associated with increased rates of acute kidney injury requiring renal replacement therapy and increased 90-day mortality in septic patients compared to crystalloids.

Using the Holliday-Segar 4-2-1 rule, what is the maintenance fluid rate for a 25 kg child?

Answer: 65 mL/hr

The 4-2-1 rule calculates: 4 mL/kg/hr for the first 10 kg (40 mL/hr) + 2 mL/kg/hr for the next 10 kg (20 mL/hr) + 1 mL/kg/hr for remaining 5 kg (5 mL/hr) = 65 mL/hr.

Which blood product contains the highest concentration of fibrinogen, factor VIII, factor XIII, and von Willebrand factor per unit volume?

Answer: Cryoprecipitate

Cryoprecipitate is prepared by slowly thawing FFP and collecting the cold-insoluble precipitate, resulting in a concentrated source of fibrinogen (150-250 mg/unit), factor VIII, factor XIII, vWF, and fibronectin in a small volume (~15 mL/unit).