CCP Blood Conservation & Transfusion Strategies Flashcards

What is the primary goal of intraoperative cell salvage (ICS) during cardiac surgery?

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.

Modified ultrafiltration (MUF) performed after CPB separation is used primarily to:

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.

What hematocrit level is typically accepted as the minimum safe threshold during hypothermic CPB?

Answer: 20-21%

A hematocrit of 20-21% is the generally accepted minimum threshold during hypothermic CPB to maintain adequate oxygen delivery to tissues.

Antifibrinolytic drugs such as tranexamic acid and epsilon-aminocaproic acid work by:

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.

Retrograde autologous priming (RAP) of the CPB circuit is intended to:

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.

The red blood cell transfusion trigger most commonly recommended by STS/SCA guidelines in stable cardiac surgical patients is hemoglobin below:

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.