Blood transfusion Flashcards
(27 cards)
How would you classify a massive haemorrhage?
50% loss of TBV in 3 hours
TBV <24 hours
150mls/minute
What are the different types of acute transfusion reaction?
Haemolytic TRALI Bacterial contamination Febrile non-haemolytic Massive transfusion reaction Allergic transfusion reaction Fluid overload
What is TRALI and what causes this
Transfusion related acute lung injury.
Caused by anti-WBC antibodies in the donor plasma.
How does TRALI present?
Shortness of breath, cough, lung infiltrates found on chest XR
How do you manage TRALI?
Stop the transfusion
Manage the acute respiratory distress syndrome accordingly.
How quickly do you expect the symptoms of a haemolytic transfusion reaction to arise?
Within minutes
What are the clinical features of a haemolytic transfusion reaction?
Agitated Fever Abdominal/chest pain Hypotensive DIC Renal failure
How do you manage a haemolytic transfusion reaction?
Stop transfusion
Inform laboratory
Treat DIC - plasma transfusions/VTE prophylaxis
How do you manage bacterial contamination of blood components?
Stop the transfusion
Inform the laboratory
IV Tazocin/Gentamicin
How does bacterial contamination within a blood transfusion present?
High grade fever and rigors
Hypotensive
How does a febrile non haemolytic transfusion reaction present?
Fever
Rigors
Chills
How do you manage a non haemolytic transfusion reaction (febrile)?
Slow the transfusion rate down
1g paracetamol
Management of an allergic transfusion reaction?
Slow the transfusion rate down or stop if necessary
IV Chlorphenamine 10mg
How does an allergic transfusion reaction present?
Urticaria
Angioedema
Anaphylaxis
What is the definition of a massive transfusion?
The whole volume of blood components are transfused within 24 hours (5L/10 units)
What is the reaction triad of a massive transfusion?
Hypothermia, coagulopathy and acidosis. Associated with a high mortality rate.
Electrolyte changes:
K high
Ca low
F5 and 8 low
How can a massive transfusion reaction be prevented
Maintaining a 1:1:1 ratio of packed red blood cells, platelets and FFP.
This increases survival.
At what time interval can a delayed transfusion reaction occur? What causes this?
Between 1-7 days
Caused by Anti-Rh antibodies.
How does a delayed transfusion reaction present?
Jaundice
Anaemia
Fever
Haemoglobinuria
What causes iron overload?
Haemochromatosis
Excessive blood transfusions due to haemotological conditions such as Thalassaemia major and sickle cell
Management for iron overload?
Therapeutic venepuncture in haemochromatosis
Desferrioxamine SC is an alternative option.
At what time interval does post-transfusion purpura occur?
How would this be managed?
within 7-10 days. Caused by alloantibodies.
Managed with IV immunoglobulins and platelet transfusions.
What are the clinical signs of graft vs host disease?
Diarrhoea
Skin rash
Liver failure
Pancytopenia
If a patient is actively bleeding when should a transfusion be offered?
If the platelet count is <30, if bleeding from a critical site then platelet transfusions should be offered if platelets are <100
