CCP CCP Blood Conservation & Transfusion Strategies 1 — Questions and Answers
Question 1: What is the primary goal of intraoperative cell salvage (ICS) during cardiac surgery?
- Increase platelet count
- Recover and reinfuse the patient's own washed red blood cells (Correct answer)
- Remove air bubbles from the circuit
- Filter bacterial contamination from shed blood
Correct answer: Recover and reinfuse the patient's own washed red blood cells
ICS collects shed blood, washes it in a centrifuge bowl, and returns concentrated autologous red blood cells to reduce allogeneic transfusion requirements.
Question 2: Modified ultrafiltration (MUF) performed after CPB separation is used primarily to:
- Remove excess potassium from the blood
- Hemoconcentrate blood and remove inflammatory mediators (Correct answer)
- Anticoagulate the patient post-bypass
- Increase pump prime volume
Correct answer: Hemoconcentrate blood and remove inflammatory mediators
MUF hemoconcentrates the blood after bypass and removes excess fluid along with inflammatory cytokines released during CPB, offering particular benefit in pediatric patients.
Question 3: What hematocrit level is typically accepted as the minimum safe threshold during hypothermic CPB?
- 15%
- 20-21% (Correct answer)
- 25%
- 30%
Correct answer: 20-21%
A hematocrit of 20-21% is the generally accepted minimum threshold during hypothermic CPB to maintain adequate oxygen delivery to tissues.
Question 4: Antifibrinolytic drugs such as tranexamic acid and epsilon-aminocaproic acid work by:
- Activating thrombin directly
- Inhibiting plasminogen activators to prevent fibrin clot breakdown (Correct answer)
- Neutralizing residual heparin
- Increasing platelet aggregation
Correct answer: Inhibiting plasminogen activators to prevent fibrin clot breakdown
These lysine analogs competitively block plasminogen binding sites, preventing fibrinolysis and reducing post-bypass bleeding and transfusion requirements.
Question 5: Retrograde autologous priming (RAP) of the CPB circuit is intended to:
- Increase the total prime volume
- Reduce hemodilution by replacing crystalloid prime with the patient's own blood (Correct answer)
- Anticoagulate the circuit before cannulation
- Test circuit integrity before bypass initiation
Correct answer: Reduce hemodilution by replacing crystalloid prime with the patient's own blood
RAP displaces crystalloid prime with patient blood drawn from the arterial and venous cannulae, minimizing dilutional anemia at the onset of bypass.
Question 6: The red blood cell transfusion trigger most commonly recommended by STS/SCA guidelines in stable cardiac surgical patients is hemoglobin below:
- 10 g/dL
- 8 g/dL
- 7 g/dL (Correct answer)
- 6 g/dL
Correct answer: 7 g/dL
Current STS/SCA guidelines support a restrictive transfusion strategy, recommending RBC transfusion when hemoglobin falls below 7 g/dL in stable patients without active ischemia.
CCP CCP Blood Conservation & Transfusion Strategies 1
What is the primary goal of intraoperative cell salvage (ICS) during cardiac surgery?