Blood Transfusion

Question 1

What are the transfusion threshold for haemoglobin and the dose?

Answer 1

70g/L in normal patients but 80g/L in patients with acute coronary syndrome. Ignore if undergoing major haemorrhage or chronic anaemia.
Give 1 unit then reasses

Question 2

What are the transfusion threshold for platelets?

Answer 2

For those who are bleeding - give platelets if count is below 30
For those who are not actively bleeding - give if count is below 10
For those about to have invasive procedures - give if count is below 50

Question 3

When do you give FFP?

Answer 3

Patient is significantly bleeding and who have abnormal coagulation

Question 4

When should you give cryoprecipitate?

Answer 4

if patient without major haemorrhage is actively bleeding and has a fibrinogen level below 1.5g/L. Give 2 pools

Question 5

What can be given to haemorrhage patients on warfarin?

Answer 5

Prothrombin complex concentrate and vitamin K

Question 6

What are the different blood transfusion reactions?

Answer 6

Immunological (Acute haemolytic, non-haemolytic febrile, allergic or anaphylactic)
Infective
Transfusion-related acute lung injury
Transfusion associated circulatory overload
Other: Hyperkalaemia, iron overload or clotting

Question 7

What are the features and management of non-haemolytic febrile reaction?

Answer 7

• Fevers and chills.
  Thought to be caused by antibodies reacting with the WC fragments and cytokines that have leaked from blood during storage.
• Stop or slow infusion and give paracetamol then monitor

Question 8

What are the features and management of major allergic reaction?

Answer 8

• Pruritus and urticaria.
  Thought to be caused by foreign plasma proteins.
• Temporarily stop transfusion, give antihistamines then monitor

Question 9

What are the features and management of anaphylaxis?

Answer 9

• Hypotension, dyspnoea, wheezing and angioedema.
  Can be caused by patients with an IgA deficiency who have anti-IgA antibodies
• Stop the transfusion and give IM adrenaline.
  Give ABC support with oxygen and fluids

Question 10

What are the features and management of acute haemolytic reaction?

Answer 10

• Fever, abdominal pain and hypotension. Symptoms start minuets after transfusion begins. Can result in DIC and renal failure
  Caused by ABO incompatibility which causes massive intravascular haemolysis
• Stop the transfusion and confirm diagnosis (check blood/patient identity and send blood for direct coombs test)
  Give fluid resus

Question 11

What are the features and management of Transfusion - associated circulatory overload (TACO)

Answer 11

• Pulmonary oedema and hypertension.
  Caused by an excessive rate of transfusion or pre-exisiting heart failure
  -Stop or slow transfusion and consider given IV loop diuretic and oxygen

Question 12

What are the features and management of transfusion related acute lung injury?

Answer 12

• Hypoxia, hypotension, fever and pulmonary infiltrates on chest x-ray which occurs within 6 hours of transfusion
  Non-cardiogenic pulmonary oedema secondary to increased vascular permeability caused by neutrophils activated by substances in donated blood
• Stop the transfusion and give oxygen and supportive care

Question 13

What are some later transfusion related complications?

Answer 13

Delayed haemolytic transfusion reactions (5 days post transfusion), transfusion associated graft versus host disease, iron overload (managed with subcut desferrioxamine)

Question 14

What are the recommended adrenaline doses?

Answer 14

Anaphylaxis: 0.5ml of 1:1000 IM
Cardiac arrest: 1ml of 1:1000 IV