Article: Clinical Transfusion practice update: haemovigilance, complications, patient blood management and national standards

Question 1

Infectious hazards of transfusion

Answer 1

• HIV, HCV, HBV very low: donor screening & serological nucleic acid testing
• Sepsis from bacterial contamination most common: routine pre-release screening of Plts
• Vigilance Emerging infectious diseases (EID): VCJD (UK), West Nile Virus (americas), dengue, chikungunya viruses, malaria, babesiosis, trypanosoma cruzi

Question 2

Non Infectious hazards of transfusion

Answer 2

• Transfusion associated cardiac overload
• TRALI: reduced with Male donors b/c less anti HLA antibodies
• TRIM: combination immunosuppressive & proinflammatory effects of transfusion (linked to cancer recurence, post op bacterial infection, multiorgan failure)

Question 3

Patient Blood management

Answer 3

aim minimise transfusion requirement
6 National PBM guidelines for 6 settings
1. Critical bleeding & massive transfusion
2. Perioperative care
3. acute & chronic medical conditions
4. Critical care
5. Obstetrics
6. Paediatrics

Question 4

PBM Massive transfusion

Answer 4

insufficient evidence specific ratios

MTP work
reduce mortality without significant increase blood product use
streamlining of communication & processes

Question 5

MTP & coagulopathy

Answer 5

• coagulopathy in trauma- increas mortality
• early trauma coagulopathy b/c: tissue injury & hypoperfusion, hyperfibrinolysis, Tissue factor activation
• • haemodilution, consumptive coagulopathy
• decreased clotting factor function b/c hypothermia & acidosis

Question 6

MTP & coagulopathy

Answer 6

• keep px warm & normal pH
• minimize crystalloids
• ? role of point of care thromboelastography devices

Question 7

Blood component ratios

Answer 7

• military FFP:RBC= 1:1
  higher FFB:RBC ratio advantages but no evidence on fixed ratios

Lack of RCTs & survivor bias

Question 8

Tranexamic acid

Answer 8

• Clinical Randomization of an Antifibrinolytic in Significant Haemorrhage CRASH-2
• reduced all cause mortality & death due to bleeding
• Given within 3 hrs- works + no increase adverse events

Question 9

Recombinant activated factor VII

Answer 9

only considered if conventional methods not working in a situation with a credible outcome

• overall no significant benefit with increased risk arterial thromboembolism

Question 10

Obstetric haemorrhage

Answer 10

• frequent early development of DIC
  Closely monitor fibrinogen levels
• fibrinogen levels elevated in pregnancy thus DIC can be present with normal levels
• Cryoprecipitate or fibrinogen concentrates if fib level <2g/L
• primary prevention: ID risk factors & correct antepartum anemia