Blood products

Question 1

Red cells usage and dose

Answer 1

Correct anaemia/ blood loss
1 unit increased Hb by 10-15
Given over 90mins-2hrs in non-urgent situations, 3hrs for HF and STAT for emergency bleeds

Question 2

Platelets usage and dose

Answer 2

Only if bleeding or count <20
1 unit increased by >20
Most likely to harbour bacterial infection as stored warm

Question 3

FFP usage

Answer 3

Corrects clotting defects e.g. DIC, warfarin od, liver disease, TTP

Question 4

Human albumin solution usage

Answer 4

Replace protein e.g. in liver disease, nephrosis

Question 5

Cryoprecipitate contains

Answer 5

Fibrinogen
Factor VIII, XIII
vWF

Question 6

Transfusion complications acute (<24h)

Answer 6

Acute haemolytic reaction
Anaphylaxis/allergies
Bacterial contamination
Febrile reaction
Fluid overload
TRALI (causes acute resp distress syndrome)

Question 7

Transfusion complications delayed (>24h)

Answer 7

Infection
Iron overload
GVHD
Post-transfusion purpura - needs IVIg and platelets urgently

Question 8

Transfusing pt with HF

Answer 8

If Hb<50, give packed red cells so Hb 60-80 over 4h with furosemide (40mg slow IV/PO) with alternate units

Question 9

Acute haemolytic reaction management

Answer 9

Stop transfusion
Treat DIC
Keep IV line open with saline

Question 10

Acute haemolytic reaction signs

Answer 10

Temp increase
Decreased BP
DIC
Flushing
Abdo/chest pain
Agitation

Question 11

Anaphylaxis signs

Answer 11

Bronchospasm
Cyanosis
Decreased BP
Soft tissue swelling

Question 12

Anaphylaxis management

Answer 12

Stop transfusion
Maintain airway, O2
IM adrenaline

Question 13

Bacterial contamination signs

Answer 13

Rapid onset inc temp
Decreased BP
Rigors

Question 14

Bacterial contamination management

Answer 14

Stop transfusion
Check identity, send FBC, U+Es, clotting + cultures
Start broad-spec Abx

Question 15

TRALI signs

Answer 15

Dyspnoea
Cough
CXR white out

Question 16

TRALI management

Answer 16

Stop transfusion
Give 100% O2
Donors should be removed from panel

Question 17

Non-haemolytic febrile transfusion reaction signs

Answer 17

Shivering

Fever 1/2-1hr after starting transfusion

Question 18

Non-haemolytic febrile transfusion reaction management

Answer 18

Slow/stop transfusion
Antipyretic
Use WBC filter if recurrent

Question 19

Allergic reaction signs

Answer 19

Urticaria

Itch

Question 20

Allergic reaction management

Answer 20

Slow/stop transfusion

Chlorphenamine 10mg slow IV/IM

Question 21

Fluid overload signs

Answer 21

Dyspnoea
Hypoxia
Tachycardia
Inc JVP
Basal crepitations

Question 22

Fluid overload management

Answer 22

Slow/stop transfusion
Give O2 + diuretic e.g. furosemide 40mg IV
Consider CVP line

Question 23

Purpose of irradiation in blood transfusion

Answer 23

Removes T-lymphocytes when transfusing to immunocompromised pts

Question 24

Prothrombin complex concentrate use

Answer 24

Reverse anticoagulation in an emergency severe bleed/head injury