Blood products

Question 1

What must be measured every 30mins when giving blood?

Answer 1

TPR

BP

Question 2

What is the haematocrit of the red cells blood product?

Answer 2

70%

Question 3

When are red cells used?

Answer 3

To correct anaemia or blood loss

Question 4

How much does 1U of red cells raise the Hb by?

Answer 4

10-15g/L

Question 5

Till what Hb should you transfuse red cells to in anaemia?

Answer 5

80g/l

Question 6

When are platelets given?

Answer 6

When bleeding or thrombocytopenic (<20X10^9/L)

Question 7

What should 1U platelets raise the Hb by?

Answer 7

> 20 X10^9/L

Question 8

What is fresh frozen plasma used for?

Answer 8

To correct clotting abnormalities - DIC, warfarin overdose (vit K too slow), liver disease, thrombotic thrombocytopenic purpura)

Question 9

What percentage concentrations of protein is human albumin solution produced at?

Answer 9

4.5%

20%

Question 10

When can 20% human albumin solution be used?

Answer 10

In the hypoproteinaemic patient - liver disease and nephrosis who is fluid overloaded without giving excessive salt load
Replacement in abdominal paracentesis

Question 11

What is cryoprecipitate?

Answer 11

Source of fibrinogen

Question 12

When are coagulation concentrates used?

Answer 12

Self injected in haemophilia

Question 13

List some early complications of transfusion

Answer 13

Acute haemolytic reaction
Anaphylaxis 
Bacterial contamination
Febrile reaction
Allergic reaction 
Fluid overload
Transfusion related acute lung injury (TRALI)

Question 14

What is an acute haemolytic reaction caused by?

Answer 14

ABO or Rh incompatibility

Question 15

Give the clinical features of acute haemolytic reaction

Answer 15

Agitation 
Increased temp
Decreased BP
Flushing
Abdo/chest pain
Oozing venepuncture sites
DIC

Question 16

How do you treat acute haemolytic reaction?

Answer 16

Stop transfusion
Tell haematology 
Check name and identity on unit
Send unit and FBC, U&E, clotting, cultures, urine (haemoglobinuria) to lab
Keep IV line open with 0.9% saline
Treat DIC

Question 17

What are the clinical features of anaphylaxis to blood products?

Answer 17

Hypotension
Bronchospasm
Cyanosis
Soft tissue swelling

Question 18

How do you manage anaphylaxis

Answer 18

Stop transfusion
Maintain airway and give o2
Contact anaesthetist

Question 19

What are the clinical features of bacterial contamination from blood products

Answer 19

Increased temp
Decreased BP
Rigors

Question 20

How do you manage bacterial contamination from blood products?

Answer 20

Stop transfusion
Check name and identity of patient and compare to the unit
Tell haematology
Send unit & FBC, U&E, clotting, cultures and urine to lab
Start broad spectrum antibiotics

Question 21

Describe the features of transfusion related acute lung injury

Answer 21

Dyspnoea
Cough
CXR - white out

Question 22

How do you treat TRALI?

Answer 22

Stop transfusion
Give 100% O2
Treat as ARDS
Donor should be removed from the donor panel

Question 23

What are the symptoms of non-haemolytic febrile transfusion reaction

Answer 23

Shivering and fever usually 30mins-1hr after starting transfusion

Question 24

How do you treat non-haemolytic febrile transfusion reaction?

Answer 24

Slow or stop the transfusion
Give anti-pyretic (eg. paracetamol 1g)
Monitor closely
If recurrent, used WBC filter

Question 25

What symptoms does allergic reaction to blood products present as?

Answer 25

Urticaria and itch

Question 26

How do you treat allergic reaction to blood products?

Answer 26

Slow or stop the transfusion chlorphenamine 10mg slow IM/IV Monitor closely

Question 27

What are the features of fluid overload from a transfusion?

Answer 27

Dyspnoea, hypoxia, tachycardia, increased JVP and basal crepitations

Question 28

How do you treat fluid overload from a transfusion?

Answer 28

Slow/stop the transfusion Give O2 and a diuretic eg. furosemide IV 40mg Consider CVP line

Question 29

What is massive blood transfusion?

Answer 29

Defined as replacement of an individuals entire blood volume >10U within 24hr

Question 30

What are the complications of a massive blood transfusion?

Answer 30

``` Hyperkalaemia Hypothermia Hypocalcaemia Decreased platelets Decreased clotting factors ```

Question 31

What blood should be used in acute haemorrhage?

Answer 31

universal donor group O Rh -ve until cross matched blood is available

Question 32

When should blood product be given to those with HF?

Answer 32

When Hb <50g/L

Question 33

What blood product should be given to those with HF

Answer 33

Packed red cells

Question 34

Describe how red cells should be given to someone with HF

Answer 34

Give 1 unit slowly over 4 hrs with 40mg slow IV/PO furosemide with alternate units

Question 35

What must you check for when giving red cells to those with HF

Answer 35

Increased JVP | Basal crackles

Question 36

Describe autologous transfusion

Answer 36

Where the patient receives their own blood | EPO given to harvest high yield of blood pre-op or intraoperative cell salvage and retransfusion

Question 37

What post-transfusion complication does low IgA increase the risk of?

Answer 37

Anaphylaxis