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Y3 Charis > Haem - mx > Flashcards

Haem - mx Flashcards

1
Q

Indications for RBC transfusion

A
  • Catastrophic haemorrhage - major trauma, associated hypotension
  • No safer alternative available - massive bleeding + plain fluids not sufficient
  • Anaemic (iron/folate/B12 not appropriate)
  • Hb <70g/L + signs of compromise (tachycardia, low BP, narrow pulse pressure, cold peripheries, syncope,dyspnoea)if no signs of compromise try to address underlying issue
  • Hb <80g/L + pt >65 y/o + signs of compromise or Hx of IHD/severe respiratory disease
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2
Q

Indications for platelet transfusion

A
  • Active bleeding +
  • Plt <50 x 10^9/L (Normal 150-400 x 10^9/L)
  • DIC
  • Bone marrow failure (plt <10 x 10^9/L)
  • If low platelets before surgery
  • If cardiac bypass surgery needed + patient is on anti-platelets
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3
Q

Indications for FFP transfusion

A 
* Fibrinogen <1g/L
or
* INR >1.5
* Reversal of warfarin if pt is bleeding
* Bleeding from excessive anti-coagulation
* Bleeding + abnormal coagulation test results
   TTP
   Isolated factor deficiencies
   Antithrombin III deficiency
   Immunodeficiencies

NOT to just replace volume loss
NOT to reverse warfarin if pt is not bleeding

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4
Q

What does a cryoprecipitate transfusion include?

A

Very concentrated form of fibrinogen
Fibronectin F8, F13
VWF

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5
Q

Indications for cryoprecipitate transfusion

A
  • Massive bleeding + low fibrinogen
  • Hypofibrinogenemia / afibrinogenemia
  • DIC
  • Reversal of anti-coagulation (FFP preferred)
  • Haemophilia - emergency back up when factor concentrate not available
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6
Q

What does a prothrombin complex concentrate transfusion include?

A

Factors 2, 7, 9, 10

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7
Q

Indications for prothrombin complex concentrate transfusion

A
  • Reversal of warfarin
  • Reversal of other vitamin K antagonist anti-coagulants
  • Pt with deficiency of one of the included factors (2, 7, 9, 10) (congenital, liver disease, haemophilia)
  • Significant bleeding in people with coagulopathy
  • Rapid anti-coagulation reversal before surgery (better than FFP)
  • Contra-indicated in pt with DIC
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8
Q

Sickle cell anaemia - acute painful crisis mx

A

Fluids, Oxygen, analgesia

Saturate (Oxygen)
Abx if needed
Pain relief
Cannula (IVF)

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9
Q

Sickle cell anaemia - stroke mx

A

Manage as a stroke

Give an exchange blood transfusion

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10
Q

Sickle cell anaemia - sequestration crisis/recurrent episodes of splenic sequestration mx

A

Splenectomy

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11
Q

Sickle cell anaemia - chronic cholecystitis mx

A

Cholecystectomy

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12
Q

Sickle cell anaemia mx

A

Conservative
Trigger avoidance

Medical
Prophylactic abx
Vaccinations - Haemophilus Influenzae type B, Streptococcus pneumoniae, Meningococcus, Hep B
o Oral penicillin prophylaxis started at dx and continued until 5 years of age
Regular blood transfusions - Common prophylactic treatment to maintain HbS below 30%

Hydroxyurea (increases BM ability to make HbF which doesnt have the problematic β gene)

Surgical
MB stem cell transplant (curative)

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13
Q

Risks of blood transfusion

A

Over-transfusion (hyperviscosity, volume overload)
Transfusion reactions (acute, septic, febrile, and allergic)
Alloimmunisation to red cell antigens
Iron overload
Transfusion-transmitted diseases (hepatitis B and C, HIV, and other agents).

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14
Q

Which transfusion is used in DIC?

A

Cryoprecipitate (rich in fibrinogen)

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15
Q

Sickle cell trait management

A
  • Adequate hydration
  • Avoidance of excessive fluid loss
  • Avoidance of severe heat
  • Recurrent splenic sequestration is an indication for splenectomy
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16
Q

Vasocclusive/sickle cell crisis management (7)

A 
•	Avoid cold, fever, dehydration, stress
•	Analgesia
o	Paracetamol used to treat mild pain
o	NSAIDs used to treat mild to moderate pain – used with caution in patients with mild hepatic/renal impairment 
o	Codeine to treat moderate pain

• Supportive care + correction of cause
o Oxygen
o IVF
o Deep breathing exercises

• Abx if there is evidence of infection
• Blood transfusion – indicated for life-threatening vaso-occlusive events, symptomatic anaemia, acute organ dysfunction
• Hydroxycarbamide (hydroxyurea)
o Can reduce the frequency of painful crises in sickle cell disease
o Given if there are 6+ episodes of vaso-occlusive crisis per year
• Folic acid – in severe haemolysis or pregnancy

17
Q

Chronic sickle cell disease management

A

• Supportive care – prevention of complications
o Routine vaccinations - Haemophilus Influenzae type B, Streptococcus pneumoniae, Meningococcus, Hep B
o Oral penicillin prophylaxis started at dx and continued until 5 years of age

• Hydroxycarbamide (hydroxyurea)
o Considered in patients aged >2 years with sickle cell anaemia
o Increase in HbF
o Decreases the frequency of sickle cell crises, reduces transfusion requirements, decreases risk of acute chest syndrome

• Repeated blood transfusions
o Common prophylactic treatment to maintain HbS below 30%
o Required for severe anaemia or to reduce the proportion of HbS if there are lung or CNS complications, severe symptoms refractory to treatment (haemodynamic instability due to hypovolaemic shock)
o Iron overload is a common complication – chelation should be started in all children receiving regular blood transfusions (SC deferoxamine, oral deferasirox, oral deferiprone)

• Bone marrow transplantation
o 2nd line, considered in children with severe complications of sickle cell anaemia (e.g. stroke, recurrent acute chest syndrome) who are unresponsive to first-line therapies

• Stroke
o Transcranial Doppler US performed annually in children aged 2-16 years
o Regular blood transfusions considered in those with abnormal findings on transcranial Doppler US

18
Q

Acute chest syndrome as a result of vasocclusive crisis in sickle cell disease management

A
  • Oxygen, incentive spirometry, continuous positive airways pressure
  • Analgesia
  • Hydration
  • Abx (macrolide + IV cephalosporin)
  • Transfusion/exchange blood transfusion
  • Hydroxycarbamide
Macrolides = azithromycin, erythromycin, claritromycin 
Cephalosporins = cefuroxime, ceftriaxone, cefaclor
19
Q

Priapism as a result of vasocclusive crisis in sickle cell disease management

A
  • Emergency
  • Hydration + analgesia
  • Minor episodes – bladder emptying, exercise, warm baths, analgesia
  • Prolonged episode – aspiration + irrigation of corpora cavernosa with adrenaline or etilefrine
20
Q

What is an acute transfusion reaction + mx?

A

• Acute transfusion reaction
o Immune system attacking foreign platelets, white cells, serum proteins
o Febrile patient + urticarial skin rash (erythema, hives, itching)

o Confirm blood transfusion, stop temporarily, give paracetamol + anti-histamines, resume transfusion at a lower rate

21
Q

What is anaphylaxis + mx?

A

• Anaphylaxis
o Due to IgA deficient patients – they have anti-IgA antibodies attacking the IgA in the transfused blood
o Breathless + hypotensive patient

o Adrenaline (IM), chlorphenamine, corticosteroids, fluids

22
Q

What is a haemolytic transfusion reaction + mx?

A

• Haemolytic transfusion reaction
o Mismatch of ABO alleles- immune destruction of transfused RBC attacked by the recipient’s antibodies
o Cold, feverish, nauseated, chest/flank pain, dark red urine from haemolysis

o Stop the blood transfusion, anticipate shock + DIC, use IV fluids + IV mannitol to flush out the products of haemolysis

23
Q

What is a transfusion associated lung injury + mx?

A

• Transfusion associated lung injury (TRALI)
o Antibodies in the transfused blood cause the patient’s WBC to aggregate + clog up the pulmonary capillaries
o Breathlessness

o Respiratory support

24
Q

What is a delayed haemolytic reaction + mx?

A

• Delayed haemolytic reaction
o Mismatch of alleles of non-ABO blood groups (e.g. Duffy Kell, Kidd, Rhesus factor)
o Malaise, jaundice, fever

o Supportive treatment, symptoms are self-limiting

25
Q

What is alloimmunization?

A

• Alloimmunization
o The more transfusions a patient has, the more likely they are to develop antibodies to rarer blood groups (Duffy, Kell) + the harder it becomes to find blood that is compatible with the patient’s serum antibodies

26
Q

What is a post transfusion purpura + mx?

Who is more likely to get it?

A

• Post-transfusion purpura
o Antibodies against residual platelets in the red cell transfusion - these Ab destroy the patient’s own platelets - purpura

o Treatment is by IVIG infusion or plasmapheresis

o More likely in women who give birth (+ thus potentially been exposed to platelets with different antigens (from the baby))

27
Q

Give 3 non immune complications of blood transfusions

A

• Transfusion-associated circulatory overload (TACO)
o Due to unnecessary over-transfusion + overly aggressive fluid resuscitation
o Typically in elderly patients

• Coagulopathy
o Massive transfusion of RBC - dilutes clotting factors + platelets - blood unable to clot
o Treated by transfusing platelets +/or FFP

• Transfusion-transmitted infection
o Septicaemia/septic shock
o Stop transfusion, IV Abx, IV fluids, Oxygen

Y3 Charis (35 decks)

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