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Yr5 Haematology > Emergency > Flashcards

Emergency Flashcards

(45 cards)

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1
Q

What are the blood product types?

A
  • Packed red ells
  • Platelets
  • Fresh Frozen plasma
  • Cryoprecipitate
  • Whole bloods
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2
Q

What are packed red cells used for?

A

Severe anaemia- should ↑Hb by ~1.25/dL

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3
Q

What are platelets used for?

A

Platelet count <50

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4
Q

When is FFP used?

A 
Clotting disorders
Vit K deficit
Liver disease
DIC
Prophylactically in patients undergoing surgery w/bleeding risk
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5
Q

What is cryoprecipitate used for?

A

Replace fibrinogen <1.5g/L

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6
Q

When is whole blood products used?

A

Exchange transfusions

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7
Q

What are the early transfusion reactions?

A 
WITHIN 24HOURS:
Febrile reactions
Bacterial contamination
Fluid overload (TACO)
Acute haemolytic reactions
Transfusion related acute lung injury (TRALI)
Anaphylaxis
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8
Q

What are the late transfusion reactions?

A 
>24HOURS, USUALLY 5-10DAYS POST-TRANSFUSION:
Infections
Graft vs Host disease
Post transfusion purpura
Iron overload
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9
Q

What should be done when a blood transfusion is initiated?

A

MONITOR patient closely

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10
Q

What are the Sx of a febrile reaction to a transfusion?

A

Fever
Chills
Pruritis
Urticaria

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11
Q

What causes a febrile reaction to a transfusion?

A

HLA Antibodies

Usually from: Multiparous women, prev transfusion

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12
Q

How is a febrile reaction to a transfusion treated?

A

Slow transfusion = Paracetamol

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13
Q

What are the Sx of bacterial contamination of a blood transfusion?

A

Raised temperature
Hypotension
Rigors

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14
Q

What type of product is most commonly associated with bacterial contamination?

A

Platelets as stored at higher temperature

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15
Q

How is a bacterial contaminated blood transfusion treated?

A

STOP transfusion
Call haematologist
Take blood cultures
START broad spec Abx

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16
Q

How does TACO present?

A 
SOB
Hypoxia
Tachycardia
Basal creps
↑JVP
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17
Q

How is TACO treated?

A

O2
IV Furosemide
Consider: Central line, exchange transfusion

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18
Q

Which patients are at risk of TACO?

A

Chronic anaemics

Heart failure

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19
Q

What are the Sx of an acute haemolytic reaction?

Study These Flashcards
A 
IN MINUTES
↑Temp
Agitation
Hypotension
Flushing
Abdo/Chest Pain
Oozing venepuncture sites
Can progress to DIC
20
Q

What is the cause of an acute haemolytic reaction?

Study These Flashcards
A

ABO/Rh incompatibility

NEARLY ALWAYS due to incorrect labelling

21
Q

How is an acute haemolytic reaction treated?

Study These Flashcards
A 
STOP transfusion
Resus: IV fluids
CHECK identity/name on unit and wristband
Keep IV line open
Send bloods &amp; giving set BACK TO LAB
22
Q

What bloods should be sent in an acute haemolytic reaction?

Study These Flashcards
A

FBC
U&E
Clotting
Cultures

23
Q

Other than blood sample what other bodily fluid should be checked in an acute haemolytic reaction?

Study These Flashcards
A

Urine sample – check for DIC

24
Q

What is the cause of TRALI?

Study These Flashcards
A

ARDS due to anti-leukocyte antibodies in plasma

25
What are the Sx of TRALI?
Dyspnoea + Cough Fine bilateral creps ↓Sats %
26
What investigations are done in someone with suspected TRALI?
CXR: White out Blood gas Bloods: Anti-luekocyte antibodies
27
How is TRALI treated?
Treat as ARDS: 100% O2 CPAP/ mechanical ventilation
28
What is the cause of anaphylaxis in blood transfusions?
IgE implicated (also could be IgG/IgA)
29
How does anaphylaxis present in relation to blood transfusions?
``` Cyanosis Bronchospasm/Stridor/SOB Soft tissue swelling Hypotension Urticaria ```
30
How is an anaphylactic reaction due to blood transfusion treated?
``` STOP transfusion Secure airway (call anaesthetist) Adrenaline 0.5mg (1:1000) IM Chlorphenamine 10mg Hydrocortisone 200mg Salbutamol Neb (up to 20mg) ```
31
In late transfusion reactions, what sort of organisms cause infections?
HIV Hep B&C Prions Protozoa
32
What causes graft vs host disease?
T lymphocyte reaction | Usually immunocompromised
33
What is a post-transfusion purpura?
Fall in platelets 5-7days post-transfusion
34
How is post-transfusion purpura treated?
IV immunoglobulins
35
How is iron overload post-transfusion treated?
Chelation therapy given to at risk groups
36
How is any transfusion reaction investigated?
``` Send UNIT to lab Call haematology Bloods: FBC, U&E, LFTs, Cultures, Clotting, IgA Urine: Haemoglobinuria CXR: TRALI (White out) ```
37
What can be done prophylactically to try and stop blood transfusion reactions occurring?
Pre-transfusion: Paracetamol/antihistamines Slow transfusion w/diuretics for HF pt Irradiate blood in high risk groups
38
Who should get CMV negative blood products?
Granulocyte transfusion Intra-uterine transfusions Neonates up to 28days post-EDD Pregnancy (elective procedures)
39
Who should get irradiated blood products?
``` Granulocyte transfusion Intra-uterine transfusions Neonates up to 28days post-EDD BM/ Stem cell transplants HIV Hodgkin’s disease ImmunoC ```
40
What is DIC?
Dysregulation of coagulation & fibrinolysis Leads to widespread clotting All coagulation factors are used up Results in massive haemorrhage
41
What are the causes of DIC?
``` Malignancy (Leukaemia) Sepsis Trauma Obstetric events (HELLP, amniotic fluid emboli, pre-eclampsia) APL syndrome ```
42
How does DIC present?
``` Large bruising Bleeding: >3 unrelated sites Skin: Petechiae, purpura, acral cyanosis, local infection, necrosis of limbs Renal failure ARDS ```
43
How is DIC investigated?
Bloods: ↑PT, ↑APTT, ↑bleeding time, ↓Platelets (used up) ↓Fibrinogen Blood Film: Broken RBCs- Shistocytes
44
What is the pathophysiology of DIC?
Release of tissue factor (TF) from trauma/vasc damage Exposed to circulation (not normally) Binds to coagulation factors Leads to activation of extrinsic pathway This triggers intrinsic pathway and activates thrombin and plasmin
45
How is DIC treated?
Platelet transfusion: <50 platelets FFP: Replace clotting factors Activated Protein C: Reduces mortality in sepsis/organ failure

Yr5 Haematology (6 decks)

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