Blood transfusion

Question 1

Guideline threshold

Answer 1

70 g/L for those who need red blood cell transfusions (without any major haemorrhage or acute coronary syndrome) and a haemoglobin concentration target of 70-90 g/L after transfusion

Question 2

Group and save

Answer 2

Group and Save (G&S) – determines the patient’s blood group (ABO and RhD) and screens the blood for any atypical antibodies. The process takes around 40 minutes and no blood is issued. A G&S is recommended if blood loss is not anticipated, but blood may be required should there be greater blood loss than expected.

Question 3

crossmatch

Answer 3

involves physically mixing the patient’s blood with the donor’s blood, in order to see if any immune reaction takes places. If it does not, the donor blood is issued and can be transfused in to the patient. This process also takes ~40 minutes, in addition to the 40 minutes required to G&S the blood (which must be done first). A X-match is done if blood loss is anticipated, but the surgeon will usually inform you of this.

Question 4

Requesting blood

Answer 4

Using 3 points of identification to check you are with the correct patient (name, Date of Birth (DOB), and patient number).
Consent the patient appropriately – many transfusion request forms will now have a script on them, which you should read to the patient. A consent form (as you would use for consent for any procedure) is completed.
Labeling the bottle at the bedside (pre-printed stickers for blood transfusion are usually not allowed in many countries, including the UK)
Completing the transfusion request form at the bedside. Before you put the blood bottle into the request bag, check with the patient that they are happy you have labelled things correctly.

Question 5

Cannula

Answer 5

green (18G) or grey (16G) cannula otherwise the cells haemolyse due to sheering forces in the narrow tube.

Question 6

Red Cells

Answer 6

Major constituents– Red blood cells
Indications– (i) Acute blood loss; (ii) Chronic anaemia, where the Hb ≤70g/L (or ≤100g/L in those with cardiovascular disease) or symptomatic anaemia
Duration over which it is administered –2-4 hours. It must be completed within 4 hours of coming out of the store

1 unit of blood should increase a patient’s haemoglobin by around 10g/L.

Question 7

Platelets

Answer 7

Major constituents: Platelets
Indications – (i) Haemorrhagic shock in a trauma patient; (ii) Profound thrombocytopenia (<20 x 109/L; normal range 150 – 400); (iii) Bleeding with thrombocytopenia; (iv) Pre-operative platelet level <50 x 109/L
Duration over which it is administered – 30 minutes
1 ATD (adult therapeutic dose) of platelets should increase platelet levels by around 20-40 x 109/L.

Question 8

FFP

Answer 8

Major constituents– Clotting factors
Indications– (i) Disseminated Intravascular Coagulation (DIC); (ii) Any haemorrhage secondary to liver disease; (iii) All massive haemorrhages (commonly given after the 2ndunit of packed red cells)
Duration over which it is administered– 30 minutes

Question 9

Cryoprecipitate

Answer 9

Major constituents – Fibrinogen, von Willebrands Factor (vWF), Factor VIII and fibronectin
Indications – (i) DIC with fibrinogen <1g/L; (ii) von Willebrands Disease; or (iii) Massive haemorrhage
Duration over which it is administered – Stat