Blood Transfusions Flashcards

1
Q

In which situations are packed red cells used?

A

Substantial haemorrhage

Severe anaemia

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2
Q

What is FFP and in which situations is it used?

A

Fresh frozen plasma = plasma separated from fresh whole blood and frozen, containing clotting factors

Used to:

  • during major haemorrhage
  • replace def of coag factors in continued bleeding, e.g. liver disease, DIC, thrombotic thrombocytopenia purpura
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3
Q

In which situations are platelet concentrates used?

A

Indicated if platelet count <50 x 10^9/L:

  • platelet exhaustion during major haemorrhage
  • thrombocytopenia
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4
Q

In which situations are cryoprecipitate, fibrinogen and other specific clotting factor concentrates used?

A

In various coagulation deficiencies, e.g. haemophilia, hypofibrinogenaemia

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5
Q

Which blood groups are the universal donors? The universal receivers?

A

Universal donors = O-

Universal receivers = AB+

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6
Q

What would you give a patient with <30% blood volume loss?

A

Requires only crystalloids/colloids

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7
Q

What would you give a patient with 30-40% blood volume loss?

A

Requires red cell transfusion

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8
Q

What would you give a patient with >40% blood volume loss (>2L)?

A

Requires rapid volume replacement with crystalloids/colloids + urgent provision of blood and blood products

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9
Q

Define massive blood loss. What is the clinical manifestation of this?

A

Haemorrhage of 50% blood volume in 3hrs, >1x blood volume in 24hrs or >150ml/min

Leads to a systolic pressure <90mmHg or HR >110bpm

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10
Q

Describe the massive blood loss protocol

A
  1. Immediate resuscitation with 4 units RBCs (O-)
  2. If bleeding continues: further RBCs + FFP
  3. Platelet concentrates given to maintain levels >100 x 10^9/L
  4. Repeat coag screens after every 4 units to determine need for other blood products
  5. If bleeding persists, recombinant activated factor VII occasionally recommended.
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11
Q

A patient who has received a blood transfusion immediately has a temp rise >1 degree and starts shivering. What is the likely diagnosis? How would you manage?

A

FEBRILE NON-HAEMOLYTIC TRANSFUSION REACTION

  • caused by leukocyte incompatibility
  • common in multi-transfused or parous women
  • symptoms subside after stopping transfusion for 15-30min and administering anti-pyretics and anti-histamines
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12
Q

A patient receiving a blood transfusion develops a haemolytic transfusion reaction. Why does it occur?

A

Occurs due to: blood group incompatibility (mostly due to human error)

If major ABO incompatibility, massive haemolysis may be fatal

Incompatibility of minor determinants causes lesser degree of haemolysis

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13
Q

What are the symptoms of a haemolytic transfusion reaction? How would you confirm diagnosis?

A

Symptoms:

  • pyrexia
  • dyspnoea and constrictive feeling in chest
  • intense headache
  • hypotension
  • severe loin pain and acute oliguric renal failure with haemoglobinuria (obstruction of tubules with haemoglobin causing ATN)
  • jaundice (hrs-days later)
  • DIC with spontaneous bruising and haemorrhage

Diagnosis confirmed by blood test:

  • hyperbilirubinaemia
  • positive Coomb’s test
  • new antibody
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14
Q

How should a haemolytic transfusion reaction be managed?

A

Transfusion must be halted immediately and patient resuscitated

Oliguria treated by osmotic diuresis, e.g. mannitol +/- loop diuretic

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15
Q

A patient having had a blood transfusion develops an acute and rapid onset SOB and cough. What is the diagnosis? How is this managed?

A

TRANSFUSION-RELATED ACUTE LUNG INJURY

  • donor Abs reacting with Pt’s leucocytes
  • especially occurs in transfusion of plasma-containing products
  • usually requires intensive care and mechanical ventilation
  • typically a ‘white-out’ on CXR
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16
Q

1 week after a blood transfusion, a patient develops thrombocytopenia and bleeding. What is the diagnosis? How is this managed?

A

POST-TRANSFUSION PURPURA

  • platelet-specific alloAbs
  • most common in women
  • treated with high dose IV Igs (favourable resp in 85%)
17
Q

What is blood tested for before it can be sent to the blood bank?

A

HIV

Hep B, C, E

CJD

EBV

Syphilis

Malaria

18
Q

What are the components of FFP and cryoprecipitate? And when might they be used?

A

Factor VIII, vWF, fibrinogen

Used = vonWillebrand disease, hypofibrinogenemia, pts with coagulopathy that are bleeding/at risk of bleeding

19
Q

List the possible EARLY complications of a blood transfusion

A

Acute haemolytic reaction (ABO incompatibility)

TACO - transfusion associated circulatory overload (potential in frail IHD/CCF pts)

TRALI - transfusion related acute lung injury

Allergic reaction

Infective/bacterial shock

20
Q

List the possible LATE complications of a blood transfusion

A

Infection

GvH disease

Iron overload

21
Q

What ways can Hb be increased prior to surgery?

A

EPO - takes 2-6 weeks to have an effect

Find the causes of anaemia and treat it

22
Q

What are the alternatives to a blood transfusion?

A

Blood substitutes - provide O2 carrying capacity

Exogenous EPO

Cell salvage

23
Q

Outline the potential special requirements of a blood transfusion

A
• Irradiated blood (prevent TA-GvHD)
	◦ Neonates (<1)
	◦ Chemo
	◦ Haemolytic disease
	◦ Organ transplants 

• CMV -ve products
◦ Intrauterine transfusions
◦ Neonates (<28 days)
◦ Immunosuppressed

24
Q

What is the most helpful test for identifying causes of haemolytic anaemia?

A

Direct anti-globulin test (raised LDH + bilirubin)