Blood Products Flashcards
What must be done at every opportunity when prescribing a blood product, how many times should a group and save be done before blood can be given and what’s the difference between group and save and cross matching?
Blood transfusions are dangerous with common and rare complications that can be life threatening so only prescribe if absolutely necessary and no alternative.
Patients name, date of birth and address should be checked at every stage and as often as possible. When taking blood for group and save you MUST label it at the bed side at the time of taking it. If you have to leave at any point, then you must start again. Group and saves must be done twice, and the blood types must match and conform to previous blood typing. Cross matching directly checks for compatibility with another person’s blood by checking for antibodies.
What precautions should be taken when prescribing blood to someone with heart failure?
Giving blood to patients with heart failure must be done with care to prevent overload. Should give each unit over 4 hours and also prescribe furosemide with each alternate unit.
How are packed red blood cells stored?
Blood bags last a month and are kept at 4 degrees – there are 192 blood types.
What are packed red blood cells used for?
These are used to correct anaemia or blood loss. In anaemia transfuse until Hb is 80g/L. One unit of packed red blood cells increases haemoglobin by about 10-15g/L.
When should packed red blood cells be given?
Threshold for giving packed RBC is 70g/L unless the patient has ACS in which case it is 80g/L
How are platelets stored and ordered?
Platelets must be pre ordered and only last 5 days, takes 6 blood donations to make one adult dose and must be kept at 22.2 degrees.
When should platelets be given?
Should only really be administered if platelet count is less than 20 or patient is actively bleeding. One unit should increase count by >20g/L.
If surgery is planned, then get advice if platelets are less than 100g/L.
How is fresh frozen plasma stored?
Frozen Plasma can last 2 years and is kept at -30.
What is FFP given for?
This is used to correct clotting defects not related to platelets such as in DIC or warfarin overdose if vitamin k is too slow.
It is very expensive to make and should not be used as a volume enhancer.
What is cryoprecipitate?
A concentrated source of fibrinogen.
What early complications can occur from blood transfusions?
CAN OCCUR UP TO 24 HOURS AFTER TRANSUFION
Acute haemolytic reactions such as ABO or rhesus
Anaphylaxis
Bacterial contamination
Febrile reactions – HLA antibodies
Allergic reactions – itch, urticaria and mild fever
Fluid overload
Transfusion related acute lung injury (TRALI – ARDS due to antileukocyte antibodies)
What late complications can occur form blood transfusions?
OCCUR FROM 24 HOURS POST TRANSFUSION
Infections: viral (hep B/C, HIV), bacterial, protozoan and prions
Iron overload
Graft vs host disease (those at risk given irradiated blood)
Post transfusion purpura – potentially lethal platelet drops
What are the signs of acute haemolytic reaction?
Agitation, raised temperature rapidly, low BP, flushing, abdominal/chest pain, oozing venepuncture site and DIC
How should acute haemolytic reaction be managed?
- STOP transfusion
- Check right blood right patient.
- Inform haematologist
- Send unit for inspection
- Send routine bloods and culture
- Keep IV line and give generous boluses of 0.9% saline
- Treat DIC and renal failure
What are the signs of anaphylaxis following a blood transfusion?
Bronchospasm, cyanosis, low BP, soft tissue swelling
