Blood transfusion

Question 1

How would you classify a massive haemorrhage?

Answer 1

50% loss of TBV in 3 hours
TBV <24 hours
150mls/minute

Question 2

What are the different types of acute transfusion reaction?

Answer 2

Haemolytic
TRALI
Bacterial contamination
Febrile non-haemolytic
Massive transfusion reaction
Allergic transfusion reaction
Fluid overload

Question 3

What is TRALI and what causes this

Answer 3

Transfusion related acute lung injury.

Caused by anti-WBC antibodies in the donor plasma.

Question 4

How does TRALI present?

Answer 4

Shortness of breath, cough, lung infiltrates found on chest XR

Question 5

How do you manage TRALI?

Answer 5

Stop the transfusion

Manage the acute respiratory distress syndrome accordingly.

Question 6

How quickly do you expect the symptoms of a haemolytic transfusion reaction to arise?

Answer 6

Within minutes

Question 7

What are the clinical features of a haemolytic transfusion reaction?

Answer 7

Agitated 
Fever
Abdominal/chest pain
Hypotensive 
DIC
Renal failure

Question 8

How do you manage a haemolytic transfusion reaction?

Answer 8

Stop transfusion

Inform laboratory

Treat DIC - plasma transfusions/VTE prophylaxis

Question 9

How do you manage bacterial contamination of blood components?

Answer 9

Stop the transfusion

Inform the laboratory

IV Tazocin/Gentamicin

Question 10

How does bacterial contamination within a blood transfusion present?

Answer 10

High grade fever and rigors

Hypotensive

Question 11

How does a febrile non haemolytic transfusion reaction present?

Answer 11

Fever
Rigors
Chills

Question 12

How do you manage a non haemolytic transfusion reaction (febrile)?

Answer 12

Slow the transfusion rate down

1g paracetamol

Question 13

Management of an allergic transfusion reaction?

Answer 13

Slow the transfusion rate down or stop if necessary

IV Chlorphenamine 10mg

Question 14

How does an allergic transfusion reaction present?

Answer 14

Urticaria

Angioedema

Anaphylaxis

Question 15

What is the definition of a massive transfusion?

Answer 15

The whole volume of blood components are transfused within 24 hours (5L/10 units)

Question 16

What is the reaction triad of a massive transfusion?

Answer 16

Hypothermia, coagulopathy and acidosis. Associated with a high mortality rate.

Electrolyte changes:
K high
Ca low
F5 and 8 low

Question 17

How can a massive transfusion reaction be prevented

Answer 17

Maintaining a 1:1:1 ratio of packed red blood cells, platelets and FFP.

This increases survival.

Question 18

At what time interval can a delayed transfusion reaction occur? What causes this?

Answer 18

Between 1-7 days

Caused by Anti-Rh antibodies.

Question 19

How does a delayed transfusion reaction present?

Answer 19

Jaundice

Anaemia

Fever

Haemoglobinuria

Question 20

What causes iron overload?

Answer 20

Haemochromatosis

Excessive blood transfusions due to haemotological conditions such as Thalassaemia major and sickle cell

Question 21

Management for iron overload?

Answer 21

Therapeutic venepuncture in haemochromatosis

Desferrioxamine SC is an alternative option.

Question 22

At what time interval does post-transfusion purpura occur?

How would this be managed?

Answer 22

within 7-10 days. Caused by alloantibodies.

Managed with IV immunoglobulins and platelet transfusions.

Question 23

What are the clinical signs of graft vs host disease?

Answer 23

Diarrhoea

Skin rash

Liver failure

Pancytopenia

Question 24

If a patient is actively bleeding when should a transfusion be offered?

Answer 24

If the platelet count is <30, if bleeding from a critical site then platelet transfusions should be offered if platelets are <100

Question 25

If a patient has low platelets but no active bleeding nor plans for an invasive procedure when should a platelet transfusion be offered?

Answer 25

If the threshold falls below 10

Question 26

If a patient has plans for surgery what should their platelet level be?

Answer 26

> 50 for most patients >50-75 if there is a high risk of bleeding and >100 if surgery is at a critical site.

Question 27

Which type of transfusion has the highest associated risk of bacterial contamination?

Answer 27

Platelet transfusion