Administration of transfusion and reactions Flashcards
What do you need to think about with IV lines and pumps when transfusing
- must use an inline filter or blood giving set.
- separate IV for transfusion (not to contact any calcium containing fluids or drugs)
- infusion pump has to be piston not perstalitic or rotary (or use drip rate method)
How do you calculate the rough amount of cells needed
- PRBC 1ml/kg to raise PCV by 1%
- WB 2ml/kg raises PCV by 1%
-usually run at 1ml/kg/hr then if no reaction the rest of the unit can be delivered over 4-6hrs
What is the typical speed of plasma transfusions
- depends on use but 4 - 6ml/kg/hr standard
- should be administered in 4 - 6 hrs
- coagulation factors have a short half life so may need repeacted if coagulopathy is the indication
What is monitired during transfusion
- Baseline temp, pulse and resp
- ressassed for every 5 min for 1st 30min then every 30 - 60min until finished
- other signs of potential reaction are vomiting, urticaria and pigmenturia
How are transfusion reactions traditionally classified
- immunologic or non immunologic
- acute or delayed
maybe less clinically useful
What are general treatment recommendations for a mild transfusion reaction
- Stop
- Double check blood product and type match, check the date, appearance of bag.
administer antihistamines eg chloramphenime - most can be restarted once the reaction is subsided
What would be some general treatment recommendations for a severe transfusion reaction
- as for mild stop, product check, antihistamine
- CV monitoring, BP, continuous ECG
- shock treated immediately (fluid bolus)
- if anaphylaxis present consider adrenaline and use of pressors
What is a febrile non haemolytic transfusion reaction
- a temperature rise to >39 and more that 1 degree from baseline during or within 4 hours of a transfusion.
- common, usually non life threatening
What respiratory complications/reactions can be seen following transfusion?
- Fluid overload: assess pocus +/- NTproBNP, fruesmide and O2
- Transfusion related acute lung injury (TRALI) if fluid overload ruled out and suddenly hypoxic. Frues unhelpful needs O2 support +/- vent
TRALI common mortality in people less seen in animals
What type of allergic (hypersensitivity) reactions occur to transfusions in dogs?
- Type 1 hypersensitivity
- Urticaria and vomiting
- Antihistamines and supportive care
What is an acute haemoltyic reaction to transfusion?
What might you see
- Rapid lysis of transfused cells
- clinical and lab changes are similar to IMHA(icterus, hyperbilirubinaemia, sphereocytosis, pigmenturia)
- severe forms are very rare with good transfusion protocols but can cause DIC, MODS, death
what is a delayed serologic reaction
Recipient develops antibodies to transfused cells leading to early destruction. (4 - 14 days)
only notable sign is a sudden drop in PCV and no specific treatment.
What are some uncommon transfusion complications not specifically related to reaction to the cells.
- infectious disease transfer )cats mainly in uk as FIV/felv more common than anaplasma/erlichia/canine blood born.
- bacterial contamination
- anticoagulant toxicity = hypocalcaemia.
- hyperammoniaemia (NH3 increases in stored blood, encephalopathy).
What are the bread types of transfusion reaction that can be seen
- Febrile non hanemolytic.
- respiratory
- acute haemolytic
- delayed serologic.
- allergic
What are the non haematological risks of autotransfusion
- sepsis and decemination of metatstasis
- neither reported in animals
- use leukoreduction filter to reduce risk of mets
What are the haematological risks of autotransfusion
- haemolysis, coagulopathy and hypocalcaemia
- haemolysis a worry as free haemoglobin potential to cause AKI
- large volutes of anticoaguated blood - coagulopathy
- citrate anticoagulants (monitor for hypocalcaemia)
WHat are the benefits of an autotransfusion
- rapid collection and do not have to wait for typing or cross matching in an emergency
- low cost
- risk of reaction and disease transmission zero
- less red cell storage lesions
Should you use an anticoagulant for autotransfusion
yes. Blood becomes defibrinated after around 1 hour in a body cavity so shouldnt clot. but hard to know haw long it has been there and to rule out ongoing bleeding so safer to add.
How are PRBC given to a cat as a xenotransfusion haemolysed
- high numbers haemolysed in 1 - 4 days and may require a feline typed transfusion at this stage.
- 25% have acute haemolysis within 24 hour
