Blood transfusion

Question 1

All products in blood transfusion:

Answer 1

Whole blood (RBC’s, WBC’s, platelets)

RBC’s (ex. in acute blood loss)

Platelets (ex. low platelets or platelet dysfunction)

Fresh frozen plasma (ex. in DIC)

Cryoprecipitate (ex. in Von Willebrand’s disease)

Question 2

Indications:

Answer 2

Hematocrit less than 30%
Hemoglobin less than 10g/dL

Indications for whole blood:
hemorrhage,
patients undergoing exchange transfusion,
patients who continue to bleed after receiving 4 units of packed RBCs

Indications for packed RBCs:
used when whole blood may overload the circulation e.g. in chronic anemia without hemorrhage, acute blood loss

Question 3

Describe crossmatch:

Answer 3

1 - Take blood sample
2 - Send it to blood bank
3 - Wait for the blood bank to prepare the needed units

Question 4

Steps of the procedure (beore the procedure):

Answer 4

Before the procedure:
1- Find current type and crossmatch
2 - Obtain informed consent and health history
3 - Obtain large bore IV access
4 - Assemble supplies
5 - Obtain baseline vital signs
6 - Obtain blood from blood bank

Question 5

Steps of the procedure (initiating the procedure):

Answer 5

1 - Verify blood product
2 - Educate the patient
3 - Assess and document the pstients status
4 - Start the transfusion

Question 6

Steps of the procedure (during the procedure):

Answer 6

1 - Look for signs of transfusion reactions (allergic, febrile, GVHD, transfusion related lung injury)

2 - If you suspect reaction - stop transfusing, disconnect tubing

3 - Tell doctor, blood bank, write everything

Question 7

Adverse reactions:

Answer 7

Febrile transfusion rxn - most common rxn -> acetominophen

Hemolytic transfusion rxn - most serious rxn - Immediate fever/chills, headache, N/V, hark urine, htn -> Crystalloids + diuretics to maintain urine output

Allergic rxn - urticaria or hives -> antihistamines

Transfusion-related acute lung injury - indistinguishable from ARDS - supportive

Delayed transfusion reaction - Fall in Hg, rise in bilirubin

Transfusion-associated graft versus host disease - Rash, LFT’s, pancytopenia - in immunocompromised individuals -> supportive

Question 8

Treatment in hemolytic transfusion reaction:

Answer 8

Stop transfusion -> crystalloid infusion -> give diuretics to maintain urine output

Question 9

Symptoms of incompatible transfusion:

Answer 9

• Immediate fever, chills
• Dark urine
• Nausea and vomiting
• Hypotension
• Headache

Question 10

Indications for whole blood:

Answer 10

1 - Hemorrhage - sudden loss of 25% or more blood volume
2 - Patients undergoing transfusion
3 - Patients who continue to bleed after receiving 4 units of packed red blood cells

Question 11

Indications for packed cell transfusions:

Answer 11

The blood is ccentrifuged at 3000revs/min and the supernatent plasma removed. 1 unit of packed cell increases the level of hemoglobin 1g/dl and hematocrit by 3%. Packed red cells are used when whole blood may overload the circulation

Examples:
1 - Symptomatic chronic anemia without hemorrhage
2 - Acute sickle crisis
3 - Cardiac failure
4 - Acute blood loss (30% or more)
5 - Perioperative anemia