blood transfusion

Question 1

what are the early complications of blood transfusion (within 24h) (6)

Answer 1

acute haemolytic reaction
anaphylaxis
bacterial contamination 
febrile reaction 
allergic reaction 
fluid overload 
transfusion related acute lung injury

Question 2

what are the late complications of blood transfusion (> 24h) (5)

Answer 2

infections (e.g. hepatitis, HIV, bacteria, protozoa, prions)
iron overload
graft vs host disease
post transfusion purpura

Question 3

define massive blood transfusion?

Answer 3

Replacement of entire body volume within 24h

Question 4

what are the complications of massive blood transfusion

Answer 4

low: platelet, calcium, clotting factors and hypothermia

hyperkalaemia

Question 5

what are the symptoms of acute haemolytic reaction

Answer 5

Agitation, t°↑ (rapid onset), ↓bp, flushing, abdominal/chest pain, oozing venepuncture sites, dic.

Question 6

what is the management of acute haemolytic reaction

Answer 6

STOP transfusion 
check if the correct sample was given 
inform haematologist 
fbc, u&e, clotting, cultures, & urine (haemoglobinuria)
Maintain IV line with 0.9% saline

Question 7

What is the clinical presentation of blood transfusion related anaphylaxis

Answer 7

Bronchospasm, cyanosis, ↓bp, soft tissue swelling.

Question 8

What is the management of anaphylaxis

Answer 8

stop transfusion, maintain airway and give oxygen, inform anesthetist

Question 9

what are the signs of bacterial contamination in blood transfusion

Answer 9

pyrexia rapid in onset decreased BP and rigors

Question 10

what is the management of bacterial contamination in blood transfusion

Answer 10

stop the transfusion. Check identity against name on unit; tell haematologist and send unit + fbc, u&e, clotting, cultures & urine to lab.
Start broad-spectrum antibiotics

Question 11

what are the signs of TRALI

Answer 11

(transfusion related acute lung injury ) Dyspnoea, cough; cxr ‘white out’

Question 12

What is the management of TRALI

Answer 12

stop transfusion; 100% O2, remove the donor from donor panel

Question 13

What are the symptoms/signs of Non-haemolytic febrile transfusion reaction

Answer 13

Shivering and fever usually ½–1h after starting transfusion.

Question 14

What is the mangement of Non-haemolytic febrile transfusion reaction

Answer 14

Slow or stop the transfusion. Give an antipyretic, eg paracetamol 1g. Monitor closely. If recurrent, use wbc filter.

Question 15

What is the presentation of allergic reaction in blood transfusion and how would you manage it

Answer 15

Urticaria and itching

slow or stop the transfusion; chlorphenamine 10mg slow iv/im. Monitor closely.

Question 16

what are the signs and symptoms of fluid overload

Answer 16

Dyspnoea, hypoxia, tachycardia, ↑jvp and basal crepitations.

Question 17

How would you manage fluid overload in blood transfusion

Answer 17

slow or stop the transfusion. Give oxygen and a diuretic, eg furosemide 40mg iv initially. Consider cvp line