Blood components

Question 1

When do you give red cell transfusion

Answer 1

To correct anaemia or blood loss

Question 2

When do you give platelet transfusion

Answer 2

Not used in ITP
If platelets are less than 10x109
Haemorrhage

Question 3

When do you give FFP transfusion?

Answer 3

To correct clotting defects
Eg. DIC, warfarin overdosage where giving Vit k would be too slow
Liver disease
TTP

Question 4

What happens in acute haemolytic reaction? Why does it happen

Answer 4

Eg due to ABO incompatibility

Agitation, fever rapid onset, hypotension, abdominal/chest pain, oozing venepuncture site, DIC

Question 5

What happens in anaphylaxis

Answer 5

Bronchospasm, cyanosis, hypotension, soft tissue swelling

Question 6

If bacterial contamination of transfusion

Answer 6

Rapid onset temperature, hypotension and rigours (start broad spectrum antibiotics)

Question 7

What is TRALI? Signs?

Answer 7

Transfusion-related acute lung injury
- ARDS due to anti leukocyte antibodies in donor plasma
Dyspnoea, cough, CXR White out

Question 8

What are dalteparin, enoxaparin, tinzaparin

Answer 8

Low molecular weight hepatoma
given sc
Once or twice daily

Question 9

SE of LMWH

Answer 9

Bleeding
Heparin induced thrombocytopenia
Osteoporosis with long term use

Question 10

Starting anticoagulation

Answer 10

Start with LMWH or unfractionated heparin and give warfarin in combination
Continue heparin until target INR reached (2-3) and until day 5 - as warfarin has initial prothrombotic effect

Question 11

UFH overdose treatment

Answer 11

Protamine sulfate counteracts UFH - give if bleeding

Question 12

Target INR if prosthetic metallic valves

Answer 12

3-4

Question 13

If INR 4.5-6

Answer 13

Reduce or omit warfarin and restart when

Question 14

If INR 6-8

Answer 14

Stop warfarin and restart when

Question 15

If INR >8 but no or minor bleed or epistaxis

And if bleed risk

Answer 15

Stop warfarin

If bleed risk 0.5-2.5mg of vitamin k

Question 16

Any major bleed when on warfarin

Answer 16

Stop warfarin
Give prothrombin complex concentrate 
(More rapid reversal of warfarin than FFP)
But If unavailable give FFP 
Give 5-10mg Vit k

Question 17

When do you do whole blood transfusions?

Answer 17

Rarely
Exchange transfusion
Grave exsanguination

Question 18

Tests if MCV >100

Answer 18

TFTs
LFTs
Reticulocytes
Vitamin b and folate

Question 19

When would you do Hb electrophoresis

Answer 19

Exploration of thalassemia diagnosis

Or sickle cell

Question 20

What does LMWH act on?

Answer 20

Activate antithrombin III - complex against Factor Xa

Question 21

Monitoring of LMWH

Answer 21

Not normally needed but if it is then Factor Xa

Question 22

Standard heparin MOA

Answer 22

Anti-multiple factors including Xa, IXa, XIa, XIIa

Question 23

Monitoring of heparin

Answer 23

APTT