Blood transfusion

Question 1

when are red cells used?

Answer 1

symptomatic anaemia
haemorrhage
reduced haematocrit
Hb<70

Question 2

what is in fresh frozen plasma?

Answer 2

all clotting factors, VWF and fibrinogen.

Question 3

what is fresh frozen plasma used for?

Answer 3

coagulopathy with associated bleeding
need to monitor clotting screen
- DIC with bleeding
- TTP
- INR >6 and bleeding
- bleeding with known coagulation factor deficiency
- liver disease in presence of major bleeding or surgery
- reversal of warfarin when prothrombin complex isn’t available.

Question 4

what does cryoprecipitate contain?

Answer 4

FACTOR 8
VWF
FIBRINOGEN

Question 5

what is cryoprecipitate used for?

Answer 5

low fibrinogen levels
haemophilia A
DIC
Liver disease
VWF disease
after massive transfusion

Question 6

what are indications for platelet transfusion?

Answer 6

• thrombocytopenia
• platelet function defect
• active bleeding and platelet count <50
• active bleeding with platelet qualitive defect.
• Platelet count <10
• DIC with haemorrhage

Question 7

what are acute transfusion reactions?

Answer 7

acute haemolytic
febrile non haemolytic
urticarial
anaphylactic
TRALI
TACO

Question 8

what are delayed transfusion reactions?

Answer 8

delayed haemolytic
post transfusion purpura
iron overload

Question 9

what causes an acute haemolytic reaction?

Answer 9

ABO incompatibility is main cause causing an IgM mediated reaction.

Question 10

what causes febrile non haemolytic reaction?

Answer 10

antibodies in the patients plasma reacting against donors blood

Question 11

what is the management of febrile non haemolytic reaction?

Answer 11

stop transfuion

give antipyretic and piriton

Question 12

what is the features of febrile non haemolytic reaction?

Answer 12

fever, rigors 30-60 minutes after the start

Question 13

what are key differences between TRALI and TACO?

Answer 13

TRALI: due to plasma/platelets
TACO: due to any product

TRALI: onset within 2 hours
TACO: within 6 hours

TRALI: hypotension
TACO: hypertension

TRALI: pulmonary oedema with normal heart size
TACO: pulmonary oedema with cardiomegaly

TRALI: fluid challenege improves
TACO: fluid challenge worsens

Question 14

what are CI for packed red blood cells?

Answer 14

Refractory anaemia

Coagulation deficiency

Question 15

what are contraindications for platelet transfusion?

Answer 15

Autoimmune thrombocytopenia
TTP
HIT

Question 16

what are CI to fresh frozen plasma?

Answer 16

• Can’t be used to reverse heparin

- for use as a volume expander

Question 17

what are symptoms of an acute haemolytic anaemia?

Answer 17

Rapid onset fever, chills, nausea, pruritus, burning pain at IV site and dyspnoea
Patient appears UNWELL’

Question 18

what is the management of an acute haemolytic reaction?

Answer 18

Stop the transfusion

Check identity of patient

Send urine and blood- repeat cross match

Give NaCl and start cardiac monitoring

Question 19

what are symptoms of a febrile non haemolytic reaction?

Answer 19

Fevers and rigors developing after 30-60 minutes of the transfusion.

Patient is hot but not UNWELL.
Can develop fever, rash, chills and malaise

Question 20

what is the management of a febrile non haemolytic reaction?

Answer 20

stop transfusion

give paracetamol

Question 21

what blood products can cause TRALI?

Answer 21

Happens with platelets or fresh frozen plasma within 2 hours.

Question 22

what are signs of TRALI?

Answer 22

hypotension
fever
pulmonary oedema

Question 23

what is the management of TRALI?

Answer 23

fluid challenge

Question 24

what is TACO?

Answer 24

fluid overload due to blood products

Question 25

what are features of TACO?

Answer 25

pulmonary oedema
S3 gallop
venous distension
cardiomegaly

Question 26

what is the management of TACO?

Answer 26

diuretics and oxygen