FLUIDS AND

ELECTROLYTE
ABNORMALITIES
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FLUIDS AND ELECTROLYTE ABNORMALITIES

BLOOD TRANSFUSION

CONTENTS
BLOOD TRANSFUSION ................................................................................................................................................... 4
BLOOD GROUPING .................................................................................................................................................... 4
BLOOD COMPONENTS .............................................................................................................................................. 4
BLOOD TRANSFUSION ............................................................................................................................................... 5
COMPLICATIONS OF BLOOD TRANSFUSION ............................................................................................................. 5
ELECTROLYTE ABNORMALITIES ..................................................................................................................................... 6
ANION GAP ............................................................................................................................................................... 6
GENERAL FEATURES OF ACID BASE DISORDERS ....................................................................................................... 6
INTERPRETATION OF ABG VALUES ............................................................................................................................ 7
METABOLIC ACIDOSIS ............................................................................................................................................... 7
METABOLIC ALKALOSIS ............................................................................................................................................. 8
RESPIRATORY ACIDOSIS ............................................................................................................................................ 8
RESPIRATORY ALKALOSIS .......................................................................................................................................... 9
ENTERAL NUTRITION..................................................................................................................................................... 9
TOTAL PARENTERAL NUTRITION ................................................................................................................................... 9
FEATURES OF TPN ..................................................................................................................................................... 9
COMPLICATIONS OF TPN ........................................................................................................................................ 10
SHOCK ......................................................................................................................................................................... 10
GENERAL FEATURES OF SHOCK............................................................................................................................... 10
ANAPHYLACTIC SHOCK............................................................................................................................................ 10
HYPOVOLEMIC SHOCK ............................................................................................................................................ 11
SEPTIC SHOCK ......................................................................................................................................................... 11
CARDIOGENIC SHOCK.............................................................................................................................................. 12
NEUROGENIC SHOCK .............................................................................................................................................. 12
HEMORRHAGIC SHOCK ........................................................................................................................................... 12
MANAGEMENT OF SHOCK ...................................................................................................................................... 12
ELECTROLYTE IMBALANCE .......................................................................................................................................... 13
GENERAL FEATURES OF ELECTROLYTE IMBALANCE ............................................................................................... 13
INTRAVENOUS FLUIDS ............................................................................................................................................ 13
WATER .................................................................................................................................................................... 13
SODIUM .................................................................................................................................................................. 14
HYPERNATREMIA .................................................................................................................................................... 14
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FLUIDS AND ELECTROLYTE ABNORMALITIES

BLOOD TRANSFUSION

HYPONATREMIA ...................................................................................................................................................... 14
POTASSIUM ............................................................................................................................................................. 15
HYPERKALEMIA ....................................................................................................................................................... 15
HYPOKALEMIA......................................................................................................................................................... 16
MAGNESIUM ........................................................................................................................................................... 16
HYPERMAGNESEMIA............................................................................................................................................... 16
HYPOMAGNESEMIA ................................................................................................................................................ 17
PHOSPHATE ............................................................................................................................................................. 17

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FLUIDS AND ELECTROLYTE ABNORMALITIES

BLOOD TRANSFUSION

KEY TO THIS DOCUMENT

Text in normal font Must read point.
Asked in any previous medical entrance
examinations
Text in bold font Point from Harrisons
text book of internal medicine 18th
edition
Text in italic font Can be read if
you are thorough with above two.

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BLOOD TRANSFUSION

FLUIDS AND ELECTROLYTE ABNORMALITIES

BLOOD TRANSFUSION
BLOOD GROUPING
Gene determining ABO blood group
Universal blood group donor
ABO blood group antigen
ABO blood group system remains most important in
clinical medicine because
Genotype of a person with blood group A should be
Deoxysugar characteristic of blood group
polysaccharide
ABO antigen NOT seen in
Both parents A group
ABO incompatibility occurs when mothers blood group
is
Bombay Blood Group
Kell antigen on
MC blood group in Indian people
Diagnosis of ABO incompatibility can NOT be made
from
ABO antigen NOT found in
NOT true about blood grouping
ABO incompatibility is NOT seen with
MC cause of incompatibility in
pretransfusion screening

Chromosome 9p
O negative
Found of RBC membrane, Glycoprotein in nature, Highly
immunogenic
ABO antibodies are invariably present in plasma when
persons RBC lack the corresponding antigen
AO
Fucose
CSF
Children A or O
O
Lack of other Blood Group Antigens (only H)
Chromosome X
O
CSF
CSF
It is the method to conclusively fix paternity
Cryoprecipitate
Lewis system

BLOOD COMPONENTS
Blood product least likely to carry
infectious disease
Cryoprecipitate is stored at
Cryoprecipitate is rich source of
Cryoprecipitate is rich in
Cryoprecipitate does NOT contain
Cryoprecipitate does NOT contain
Cryoprecipitate does NOT contain
Cross matching NOT required for transfusion of
Which blood fraction is stored at -40*C
Shelf Life of CPD
Blood stored in CPDA for
Stored plasma is deficient in
NOT true about FFP
In cholecystectomy, FFP is given
Uses of fresh frozen plasma

Red blood cells

Minus 40 degrees
VIII
Fibrinogen I, Factor VIII, Von willebrand factor
Antithrombin
Factor IX
Factor IX
Cryoprecipitate
Cryoprecipitate
28 days
35 days
Factor 5 and 8
Used as volume expander
Just before operation
Antithrombin III deficiency, massive
transfusion bleeding diathesis, reversal of

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BLOOD TRANSFUSION

FLUIDS AND ELECTROLYTE ABNORMALITIES

Volume of one unit of cryoprecipitate

Volume of one unit of packed RBC
Volume of one unit of platelet concentrate
One unit of platelet concentrate increases
platelet count by
Maximum lifespan of transfused RBC
RBC stored in blood bank
Blood platelets in stored blood do not remain functional
after
Stored blood
IMP is added to stored blood to act as
source of
Platelets can be stored at
Refrigerated blood stored up to 48 hours before
transfusion can destroy
Irradiation of blood products
Cryoprotectant

warfarin effect
10-15 ml
300 ml
50 ml
10,000
60 days
Decreased 2,3 DPG, Decreased Na+, Decreased pH,
Increased K+
24 hours
Decrease in ATP, INCREASE in K+, decrease in Na+
2,3 DPG
20-24*C for 5 days
Treponema pallidum
Prevent donor white cells from
proliferating in recipients body
Dimethylsulfoxide

BLOOD TRANSFUSION
Reverse type of pre blood transfusion
testing
Best investigation done immediately to confirm non
matched blood transfusion
Better indicator for need of blood transfusion
Blood transfusion
Massive blood transfusion defines
One unit of fresh blood rises Hb% concentration by
Rh negative individual who is transfused
for first time with Rh positive blood is
likely to developed
Test for non mismatched blood transfusion
Indication for calcium replacement after
transfusion

To detect isoagglutinin in recipient

Direct coombs test
Hematocrit
Antigen D determines Rh positivity, febrile reaction is
due to HLA antigen
Whole blood volume
1 gm%
Delayed transfusion reaction

Antibodies in recipient serum

Blood given at faster rate, blood
transfusion given to a patient suffering
from liver disease, neonates requiring
transfusion

COMPLICATIONS OF BLOOD TRANSFUSION

MC transfusion reaction

Febrile Non hemolytic reaction

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ELECTROLYTE ABNORMALITIES

FLUIDS AND ELECTROLYTE ABNORMALITIES

Acute hemolytic blood transfusion
Transfusion associated lung injury
Most probable reason for transfusion associated
hepatitis
Transfusion related acute lung injury is triggered by
ABO transfusion reaction
Mismatched blood transfusion in an anesthetic patient
present as
Intra operative mismatch blood transfusion
Massive blood transfusion results in
Complication likely to result after several units of blood
transfusion
Massive transfusion in previous healthy adult male can
cause hemorrhage due to
NOT a complication of massive blood transfusion
NOT a complication of Massive blood transfusion
NOT a complication of Massive blood transfusion
NOT a complication of blood transfusion
FALSE about anaphylactic blood transfusion
Treatment of transfusion siderosis
Drug for Hemolytic transfusion reaction
Transfusion transmitted virus
MC virus associated with Transfusion Hepatitis
Blood transfusion does NOT transmit
NOT transmitted via blood transfusion
NOT transmitted by blood transfusion
Post transfusion infection is commonly due to

Complement mediated hemolysis

Within 6 hours of transfusion
Chronic carriers negative for HbsAg
Anti HLA antibodies
Type II reaction
Hypotension and bleeding from wound site
Excessive bleeding, hypotension, bronchospasm, rash
Hyperkalemia, DIC, Hypothermia, Thrombocytopenia
Metabolic alkalosis
Dilutional thrombocytopenia
Hypokalemia
Metabolic acidosis
Hypokalemia, Hypercalcemia
Hypokalemia
Occurs in IgG deficient
Desferiprone
Steroids
HBV,HTLV I, CMV, Toxoplasma, Syphilis
HCV
Leukemia
Dengue
EBV
HCV

ELECTROLYTE ABNORMALITIES
ANION GAP
Anion gap
Normal anion gap
Anion gap is mostly due to
Urinary anion gap is an indication for excretion of
Increased anion gap
Increased anion gap is NOT seen in
NOT associated with increased anion gap
NOT a cause of Normal anion gap

{Na+ + K+} - {HCO3- + Cl-}

12 - 16 mEq/L
Protein
NH4+ ion
Lactic acidosis, DKA, Cardiac failure
Diarrhea
Glue sniffing
Aspirin overdose

GENERAL FEATURES OF ACID BASE DISORDERS

Acid base disorder

Important role in regulation of acid base

balance in neonates

pH is determined by PCO2 and HCO3-, metabolic

acidosis is compensated by decreased PCO2, buffering
may be intra and extracellular
Kidney

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