transfusion

Question 1

4 types of components that can be transfused

Answer 1

RBC
platelets
fresh frozen plasma
cryoprecipitate

Question 2

4 indications for RBC transfusion

Answer 2

1. cardiorespiratory symptoms of anaemia
2. acute significant blood loss
3. irreversible symptomatic anaemia e.g. bone marrow failure
4. RBC disorders e.g. thalassaemia major, some sickle cell patients

Question 3

why are platelets given

Answer 3

prevent or treat bleeding associated with thrombocytopaenia or platelet dysfunction

Question 4

indications for platelet transfusion

Answer 4

inherited and acquired platelet disorders e.g. decreased production due to BM failure, increased platelet destruction due to DIC/ITP

Question 5

levels of platelets to maintain in bleeding or major surgery

Answer 5

> 50x10^9/L

Question 6

levels of platelets to maintain in sepsis

Answer 6

> 20x10^9/L

Question 7

what does FFP contain

Answer 7

clotting factors

Question 8

4 indications for FFP transfusion

Answer 8

1. DIC with bleeding
2. liver disease with bleeding
3. TTP
4. massive blood transfusion

Question 9

what is used for warfarin reversal

Answer 9

prothrombin complex concentrate

vitamin K

Question 10

what is cryoprecipitate and what does it contain

Answer 10

made by slow thawing of FFP

high in factors VIII, XIII, fibrinogen and vWF

Question 11

when is cryoprecipitate used

Answer 11

in massive transfusions

Question 12

what is a group and save

Answer 12

find which ABO group and if there are atypical antibodies in blood
rhesus grouping

Question 13

what is a crossmatch

Answer 13

mix patient’s serum with red cells from each donor unit to ensure compatibility - requesting blood
have to have done a G&S previously

Question 14

bloods to order in transfusion reaction

Answer 14

FBC
U&E
LFT
LDH
coagulation screen
fibrinogen
blood culture

Question 15

4 differentials for fever after transfusion

Answer 15

1. bacterial sepsis/contamination
2. acute haemolytic reaction
3. febrile non-haemolytic transfusion reaction
4. transfusion related acute lung injury

Question 16

5 differentials for dyspnoea after transfusion

Answer 16

1. transfusion related acute lung injury
2. transfusion associated circulatory overload
3. anaphylaxis
4. acute haemolytic transfusion reaction
5. bacterial sepsis/contamination

Question 17

2 differentials for urticaria after transfusion

Answer 17

1. anaphylaxis

2. minor allergic reaction

Question 18

3 differentials for hypotension after transfusion

Answer 18

1. acute haemolytic transfusion reaction
2. bacterial sepsis/contamination
3. anaphylactic shock

Question 19

how many mL in 1 unit of packed RBC

Answer 19

350mL

Question 20

how is major haemorrhage defined (x3)

Answer 20

1. loss of >1 blood volume within 24 hours (70mL/kg)
2. 50% of total blood volume lost in less than 3 hours
3. bleeding in excess of 150mL/minute

Question 21

stepwise approach to managing major haemorrhage

Answer 21

1. put out 2222 major haemorrhage call
2. ABC assessment
3. oxygen
4. IV access
5. baseline bloods: FBC, crossmatch 4 units, clotting screen, fibrinogen, U&E, LFT
6. IV fluids until blood available
7. give O neg blood and FFP until matched blood available

Question 22

coagulation screen pattern in DIC

Answer 22

low platelets
long PT
long APTT

Question 23

blood products to use in DIC

Answer 23

RBC (6 units)
platelet concentrate
FFP
source of fibrinogen e.g. cryoprecipitate