Blood transfusion complications Flashcards
(29 cards)
What should be done to reduce the risk of clotting impairment during blood transfusion?
FFPs + platelets administered concurrently
After 4 units of RBCs
Two main electrolyte abnormalities in blood transfusion + why
- hyperkalaemia: due to partial haemolysis of RBCs > release of intracellular K+
- hypocalcaemi: chelation of calcium by calcium binding agent in preservatives
Why is hypothermia a complications of blood transfusion?
Blood products are stored in fridges or thawed from frozen
They may not be up to body temp by time of infusion
Acute transfusions complications
- acute haemolytic reaction (ABO incompatibility)
- transfusion associated circulatory overload
- transfusion related acute lung injury
- mild allergic reaction
- anaphylaxis
- non-haemolytic febrile reactions
- infective/bacterial shock
Outline acute haemolytic reaction
- incompatibility of ABO
- donor RBCs are destroyed by recipients antibodies > haemolysis
- reduced Hb, high LDH + bilirubin
Features of acute haemolytic reaction
- occurs minutes after transfusion started
- fever
- urticaria
- hypotension
- abdominal pain
Diagnosis of acute haemolytic anaemia
Positive direct anti globulin test
Management of acute haemolytic reaction
- stop transfusion
- inform blood bank
- fluid resuscitation IV saline
- O2 if needed
Outline transfusion associated circulatory overload
- due excessive rate of transfusion
- causes pulmonary oedema
Features of transfusion associated circulatory overload
- dyspnoea
- hypertension
- features of fluid overload
Management of transfusion associated circulatory overload
- urgent CXR
- stop or slow transfusion
- IV loop diuretics
- O2
- patients at risk of overload can have 20mg furosemide prophylactically
Outline transfusion related acute lung injury
- form of acute respiratory distress syndrome
- non-cardiogenic cause of pulmonary oedema
- secondary to increased vascular permeability due to host neutrophils activated by donated blood
- occurs within 6 hours of transfusion
Features of transfusion related acute lung injury
- hypoxia
- pulmonary infiltrates on chest X-ray
- fever
- dyspnoea
- hypotension
How to differentiate between transfusion associated circulatory overload + transfusion related acute lung injury
TACO - hypertension
TRALI - hypotension
Management of transfusion related acute lung injury
- high flow O2
- urgent chest X-ray
- stop transfusion
- supportive care
Outline non-haemolytic febrile reactions -
- due to antibodies reacting with white cell fragments in blood products
Management of non-haemolytic febrile reactions
Stop transfusion
Paracetamol
Antihistamines e.g. clorphenamine
Presentation of minor allergic reaction to transfusion
Pruritus
Urticaria
Management of minor allergic reaction of transfusion
Temporality stop transfusion
Anti histamines e.g. Clorphenamine
Close monitoring
Features of anaphylaxis
Hypotension
Dyspnoea
Wheezing
Management of anaphylaxis due to transfusion
Stop transfusion
IM adrenaline 500microgram/0.5mg
Management of infective shock
Basic resuscitation measures
Blood cultures
Start IV abx
Why do platelets have an increased risk of bacterial proliferation?
Stored at room temperature
Delayed transfusion complications
- infection
- graft vs host disease
- iron overload
