Blood Transfusions + Major Haemorrhage Flashcards
(34 cards)
What temperature are red cells stored at and for how long?
4 degrees for 35 days
What temperature is FFP stored at and for how long?
-30 degrees for 3 years
What temperature are platelets stored at and for how long?
22 degrees for 7 days (with agitation)
Which chromosome are the ABO genes found on?
Chromosome q
Which blood groups are dominant?
A + B are co-dominant over O (O is silent)
Which blood group is the universal donor?
O –> can be given to anyone
Which blood group is the universal reciever?
AB –> can receive blood from any other group
Which antigen on RBCs is next most important after ABO?
RhD
How is ABO/RhD grouping determined?
- Test patient’s red cells with anti-A, anti-B and anti-D
- direct agglutination - Test patient’s plasma against red cells of group A and group B
- -> define blood group - Antibody screening: patient’s plasma + red cells with a range of antigens
- indirect antiglobulin test (add anti-human Ig)
What are the indications for a red cell transfusion?
SYMPTOMATIC anaemia Hb < 70 (< 80 if cardiac disease)
Major bleeding
What are the indications for a platelet transfusion?
Prophylaxis in patients with bone marrow failure + very low platelets
Treatment of bleeding in thrombocytopenic patient
Prophylaxis prior to surgery in thrombocytopenic patient
What is the difference between platelets and FFP?
Platelets = primary homeostasis FFP = clotting factors from coagulation cascade = secondary homeostasis
What are the indications for FFP transfusion?
Treatment of bleeding or surgical prophylaxis in patient with coagulopathy (PT ratio > 1.5)
Management of massive haemorrhage
What are the symptoms and signs of an acute transfusion reaction?
Symptoms: - chills, rigors - rash, flushing - feeling of impending doom - collapse - loin pain - respiratory distress Signs: - fever - tachycardia - hypotension
What is the differential for an acute transfusion reaction?
Acute haemolytic transfusion reaction
Bacterial contamination of blood products
What are the principles of management for all acute transfusion reactions?
- STOP the transfusion
- Assess patient with ABCDE
- Re-check compatibility tag against patient details and inspect bag for evidence of contamination
- Document event in medical notes
What causes an acute haemolytic transfusion reaction?
ABO incompatible blood transfusion (most dangerous) or other antigen
Binding of IgM anti-A or anti-B to their corresponding antigens
–> intravascular haemolysis of transfused red cells + release of inflammatory cytokines
What are the features of an acute haemolytic transfusion reaction?
Shock Increased vascular permeability DIC Renal failure --> often fatal
Which type of blood product is most likely to contain bacterial contamination?
Platelets (stored at warmest temperature)
How should a suspected bacterial contamination transfusion reaction be managed?
Stop transfusion ABCDE Culture patient + remains of unit Broad spectrum antibiotics Need to inform transfusion lab so that other units can be quarantined
What are the features of transfusion related circulatory overload (TACO)?
Respiratory distress within 6 hours of transfusion
Raised BP and raised JVP
Positive fluid balance
What are the risk factors for TACO?
Elderly Cardiac failure Low albumin Renal impairment Fluid overload
How should a patient with TACO be managed?
Oxygen + diuretics
Slow rate of further transfusions
Only transfuse minimum volume required
–> identify patients at risk before transfusion
Give two examples of mild transfusion reactions?
Febrile non-haemolytic transfusion reaction
Mild allergic reaction
