Blood products Flashcards
What must be measured every 30mins when giving blood?
TPR
BP
What is the haematocrit of the red cells blood product?
70%
When are red cells used?
To correct anaemia or blood loss
How much does 1U of red cells raise the Hb by?
10-15g/L
Till what Hb should you transfuse red cells to in anaemia?
80g/l
When are platelets given?
When bleeding or thrombocytopenic (<20X10^9/L)
What should 1U platelets raise the Hb by?
> 20 X10^9/L
What is fresh frozen plasma used for?
To correct clotting abnormalities - DIC, warfarin overdose (vit K too slow), liver disease, thrombotic thrombocytopenic purpura)
What percentage concentrations of protein is human albumin solution produced at?
4.5%
20%
When can 20% human albumin solution be used?
In the hypoproteinaemic patient - liver disease and nephrosis who is fluid overloaded without giving excessive salt load
Replacement in abdominal paracentesis
What is cryoprecipitate?
Source of fibrinogen
When are coagulation concentrates used?
Self injected in haemophilia
List some early complications of transfusion
Acute haemolytic reaction Anaphylaxis Bacterial contamination Febrile reaction Allergic reaction Fluid overload Transfusion related acute lung injury (TRALI)
What is an acute haemolytic reaction caused by?
ABO or Rh incompatibility
Give the clinical features of acute haemolytic reaction
Agitation Increased temp Decreased BP Flushing Abdo/chest pain Oozing venepuncture sites DIC
How do you treat acute haemolytic reaction?
Stop transfusion Tell haematology Check name and identity on unit Send unit and FBC, U&E, clotting, cultures, urine (haemoglobinuria) to lab Keep IV line open with 0.9% saline Treat DIC
What are the clinical features of anaphylaxis to blood products?
Hypotension
Bronchospasm
Cyanosis
Soft tissue swelling
How do you manage anaphylaxis
Stop transfusion
Maintain airway and give o2
Contact anaesthetist
What are the clinical features of bacterial contamination from blood products
Increased temp
Decreased BP
Rigors
How do you manage bacterial contamination from blood products?
Stop transfusion
Check name and identity of patient and compare to the unit
Tell haematology
Send unit & FBC, U&E, clotting, cultures and urine to lab
Start broad spectrum antibiotics
Describe the features of transfusion related acute lung injury
Dyspnoea
Cough
CXR - white out
How do you treat TRALI?
Stop transfusion
Give 100% O2
Treat as ARDS
Donor should be removed from the donor panel
What are the symptoms of non-haemolytic febrile transfusion reaction
Shivering and fever usually 30mins-1hr after starting transfusion
How do you treat non-haemolytic febrile transfusion reaction?
Slow or stop the transfusion
Give anti-pyretic (eg. paracetamol 1g)
Monitor closely
If recurrent, used WBC filter
What symptoms does allergic reaction to blood products present as?
Urticaria and itch
How do you treat allergic reaction to blood products?
Slow or stop the transfusion
chlorphenamine 10mg slow IM/IV
Monitor closely
What are the features of fluid overload from a transfusion?
Dyspnoea, hypoxia, tachycardia, increased JVP and basal crepitations
How do you treat fluid overload from a transfusion?
Slow/stop the transfusion
Give O2 and a diuretic eg. furosemide IV 40mg
Consider CVP line
What is massive blood transfusion?
Defined as replacement of an individuals entire blood volume >10U within 24hr
What are the complications of a massive blood transfusion?
Hyperkalaemia Hypothermia Hypocalcaemia Decreased platelets Decreased clotting factors
What blood should be used in acute haemorrhage?
universal donor group O Rh -ve until cross matched blood is available
When should blood product be given to those with HF?
When Hb <50g/L
What blood product should be given to those with HF
Packed red cells
Describe how red cells should be given to someone with HF
Give 1 unit slowly over 4 hrs with 40mg slow IV/PO furosemide with alternate units
What must you check for when giving red cells to those with HF
Increased JVP
Basal crackles
Describe autologous transfusion
Where the patient receives their own blood
EPO given to harvest high yield of blood pre-op or intraoperative cell salvage and retransfusion
What post-transfusion complication does low IgA increase the risk of?
Anaphylaxis
