Transfusion

Question 1

Give 6 whole blood fraction blood products.

Answer 1

1. Packed Red Cells (Chronic Anaemia, Cardiovascular Compromise).
2. Platelet Rich Plasma (Thrombocytopenic AND Bleeding/Surgery).
3. Platelet Concentrate (Thrombocytopenia).
4. Fresh Frozen Plasma (Correct Clotting Deficiency in Hepatic Synthetic Failure AND Surgery - PT/APTT > 1.5).
5. Cryoprecipitate (replace Fibrinogen - Fibrinogen < 1.5 g/L).
6. SAG-Mannitol Blood.
7. Prothrombin Complex Concentrate (emergency reversal of anticoagulation in patients with either severe bleeding or head injury with suspected intracerebral haemorrhage).

Question 2

When should Fresh Frozen Plasma not be used?

Answer 2

As first line therapy for hypovolaemia.

Question 3

What is Cryoprecipitate?

Answer 3

A rich source of Factor 8 and Fibrinogen formed from the supernatant of FFP, allowing a large concentration of Factor 8 to be administered in small volumes.
Indications : DIC, Liver Failure, Hypofibrinogenaemia, Emergency Haemophilia.

Question 4

Which blood products must be cross-matched?

Answer 4

1. Packed Red Cells.
2. Fresh Frozen Plasma.
3. Cryoprecipitate.
4. Whole Blood.

Question 5

What are Cell Saver Devices?

Answer 5

Collect patient’s own blood lost during surgery and reinfuse it (either washing it prior to re infusion or not).

Question 6

When are Cell Saver Devices contraindicated?

Answer 6

Malignant Disease - risk of facilitating disease dissemination.

Question 7

Thresholds for RBC Transfusion (2 - 2) (2).

Answer 7

1. Patients Without ACS - Threshold : 70 g/L and Target : 70-90 g/L.
2. Patients with ACS - Threshold : 80 g/L and Target : 80-100 g/L.
   * thresholds not to be used in patients with ongoing major haemorrhage or those who require regular blood transfusions for chronic anaemia.

Question 8

Practical Aspects of Red Blood Cell Transfusion (2).

Answer 8

1. Store at 4C prior to infusion.

2. Non-Urgent : 1 Unit transfused over 90-120 minutes.

Question 9

Why are Irradiated Blood Products used?

Answer 9

Depleted of T Lymphocytes - used to avoid TA-GVHD (Transfusion-Associated Graft Versus Host Disease) caused by engraftment of viable donor T Lymphocytes.

Question 10

What are Irradiated Blood Products?

Answer 10

CMV is transmitted in leucocytes so most blood products are leukocyte depleted.

Question 11

Platelet Infusion Indications.

Answer 11

1. Platelet Count < 30 with Clinically Significant Bleeding.
2. Higher Platelet Limit with Severe Bleeding or Bleeding at Critical Sites e.g. CNS.
3. Platelet Count < 10 (e.g. chronic bone marrow failure, autoimmune/heparin-induced thrombocytopenia or TTP).

Question 12

What is an important consideration with platelet transfusions?

Answer 12

Highest risk of bacterial contamination, compared to other types of blood product.

Question 13

Prophylactic Pre-Invasive Platelet Transfusion Targets (3).

Answer 13

1. > 50 for Most Patients.
2. 50-75 if High-Risk of Bleeding.
3. > 100 if Surgery at Critical Site.