Blood Transfusion

Question 1

What blood products are available?

Answer 1

Packed red cells
Platelet concentrate
Fresh frozen plasma
Cryoprecipitate
Human albumin solution

Question 2

What are packed red cells used for?

Answer 2

Correct anaemia or blood loss
Chronic anaemia where infusions of large volumes of fluid may result in cardiovascular compromise

1U increases Hb by 10-15g/L

Rransfuse until Hb>80g/L

Question 3

What are platelets used for?

Answer 3

Usually only needed if beleding or count is < 20x10^9/L

1U should raise platelet count by >20x10^9/:

Question 4

What is FFP? What is is used for?

Answer 4

Clotting factors, albumin, immunoglobulin

Use to correct clotting defects:
DIC, warfarin overdose where vitamin K would be too slow, liver disease, thrombotic thrombocytopenic purpura

PT ratio or APTT raio >1.5
Can be used prophylactically in patients undergoing surgery with risk of significant bleed

Universal donor of FFP is AB blood because it lacks anti-A and antiB antibodies

Question 5

What is cryoprecipitate? What is it used for?

Answer 5

Fibrinogen source and factor VIII, von Willebrand factor, Factor XIII

Allows large concentration of factor VIII in small volume

Used to replace fibrinogen

DIC, liver failure

Question 6

What is human albumin solution? What is it used for?

Answer 6

Protein solution sued to replace protein

Question 7

What blood products are used in warfarin reversal?

Answer 7

Stop warfarin

Vitamin K (reversal within 4-24 hours)
- IV takes 4-6h to wrk

FFP
- Need to give at least 1L fluid in 70kg person
Need blood group
Only use if human prothrombin comlex is not available

Human Prothrombin Complex
Reversal within 1 hour
Give with vitamin K

Question 8

What is prothrombin complex concentrate?

Answer 8

Emergency reversal of anticoagulation in patients with severe bleeding or a head injury with suspected intracranial haemorrhage

Question 9

What is the transfusion threshold for patients without ACS? With ACS? Targets?

Answer 9

Without = 70g/L  Target 70-90g/L
With = 80g/L   Target 80-100g/L

Question 10

How should red cells be stored?

Answer 10

4 degrees C prior to infusion

Question 11

How long should a unit of red cells be transfused over?

Answer 11

Non-urgent = 90-120mins

Question 12

What are irradiated blood products for?

Answer 12

Avoid transfusion graft versus host disease caused by engraftment of viable donor T lymphocytes

Question 13

Indications for irradiated blood products?

Answer 13

Granulocyte transfusions
Intra-uterine transfusions
Neonates up to 28days post EDD
Bone marrow/stem cell transplants
Immunocompromised (chemotherapy, congenital)
Patients with/previous Hodgkin's disease

Question 14

Indications for CMV negative blood?

Answer 14

Granulocyte transfusions
Intra-uterine transfusions
Neonates up to 28 days post EDD
Pregnancy - elective transfusions during pregnancy (not during labour or delivery)