Blood Transfusion Flashcards
When are red packed cells used?
transfusion in chronic anaemia
cases where infusion of large volumes of fluid may result in cardiovascular compromise
How are red packed cells obtained?
Product obtained by centrifugation of whole blood.
When is Platelet rich plasma used?
plasma Usually administered to patients who are thrombocytopaenic and are bleeding or require surgery.
How is Platelet rich plasma obtained?
obtained by low speed centrifugation.
When is Platelet concentrate used?
patients with thrombocytopaenia.
How is Platelet concentrate obtained?
high speed centrifugation
What does Fresh frozen plasma consist of?
clotting factors, albumin and immunoglobulin.
How is fresh frozen plasma prepared?
single units of blood
How much is in one unit of fresh frozen plasma? What is the usual dose?
200 to 250ml
12-15ml/Kg-1.
When is fresh frozen plasma used?
Usually used in correcting clotting deficiencies in patients with hepatic synthetic failure who are due to undergo surgery.
most suited for ‘clinically significant’ but without ‘major haemorrhage’ in patients with a prothrombin time (PT) ratio or activated partial thromboplastin time (APTT) ratio > 1.5
can be used prophylactically in patients undergoing invasive surgery where there is a risk of significant bleeding
fresh frozen plasma is first line for hypovolaemia
NOOOOOO
it should not
Cryoprecipitate contains what?
Factor VIII:C, von Willebrand factor, fibrinogen, Factor XIII and fibronectin
Clinically it is most commonly used to replace fibrinogen
made from supernatant of FFP.
Cryoprecipitate is
used for?
most suited for patients for ‘clinically significant’ but without ‘major haemorrhage’ who have a fibrinogen concentration < 1.5 g/L
example use cases include disseminated intravascular coagulation, liver failure and hypofibrinogenaemia secondary to massive transfusion. It may also be used in an emergency situation for haemophiliacs (when specific factors not available) and in von Willebrand disease
can be used prophylactically in patients undergoing invasive surgery where there is a risk of significant bleeding where the fibrinogen concentration < 1.0 g/L
Giving cryoprecipitate allows allows which factor to be given at what rate?
large concentration of factor VIII to be administered in small volume.
What is SAG-Mannitol blood?
Removal of all plasma from a blood unit and substitution with: Sodium chloride Adenine Anhydrous glucose Mannitol
How is SAG-Mannitol administered?
Up to 4 units of SAG M Blood may be administered.
Thereafter whole blood is preferred.
After 8 units, clotting factors and platelets should be considered.
Which blood products must be cross matched?
Packed red cells Platelets
Fresh frozen
Cryoprecipitate
Whole blood
Which blood products can be given to ABO incompatible in adults
Platelets
What are cell saver devices? What types?
collect patients own blood lost during surgery and then re-infuse it.
There are two main types:
Those which wash the blood cells prior to re-infusion. These are more expensive to purchase and more complicated to operate. However, they reduce the risk of re-infusing contaminated blood back into the patient.
Those which do not wash the blood prior to re-infusion.
What is the main advantage of cell saver devices? When are they contra-indicated?
may reduce risk of blood borne infection
may be acceptable to Jehovah’s witnesses.
It is contraindicated in malignant disease for risk of facilitating disease dissemination.
In some surgical patients the use of warfarin can pose specific problems and may require the use of specialised blood products
true
major bleeding
Outline steps in warfarin reversal for immediate or urgent surgery in patients taking warfarin(
- Stop warfarin
- Vitamin K
Human Prothrombin Complex
Fresh frozen plasma (Used less commonly now as 1st line warfarin reversal, Only use if human prothrombin complex is not available)
How long does Vitamin K take to reverse warfarin? (oral and IV)
IV takes 4-6h to work (at least 5mg)
Oral can take 24 hours to be clinically effective
When prescribing FFP for warfarin reversal, what do you need to remember?
Prescribe 30ml/kg-1
Need to give at least 1L fluid in 70kg person (therefore not appropriate in fluid overload)
Need blood group
Only use if human prothrombin complex is not available
Human Prothrombin Complex can reverse the effects of Warfarin within?
1 hr
What is the brand name of Human Prothrombin Complex? How much should you give? What should you give it with?
Bereplex 50 u/kg
Rapid action but factor 6 short half life, therefore give with vitamin K
What is the transfusion threshold and the target AFTER transfusion for patients WITH ACS?
Transfusion threshold: 80 g/L
Target after transfusion: 80-100 g/L
What is the transfusion threshold and the target AFTER transfusion for patients WITHOUT ACS?
Transfusion threshold: 70 g/L
Target after transfusion: 70-90 g/L
When should thresholds for blood transfusion not be used?
patients with ongoing major haemorrhage or patients who require regular blood transfusions for chronic anaemia.
red blood cells should be stored at what prior to infusion
4°C
in a non-urgent scenario, a unit of RBC is usually transfused over how long?
90-120 minutes
What is the universal donor for FFP?
AB blood because it lacks any anti-A or anti-B antibodies
When is prothrombin complex concentrate used?
used for the emergency reversal of anticoagulation in patients with either severe bleeding or a head injury with suspected intracerebral haemorrhage
can be used prophylactically in patients undergoing emergency surgery depending on the particular circumstanc
Cytomegalovirus (CMV) is transmitted in
leucocytes
As most blood products (except granulocyte transfusions) are now leucocyte depleted CMV negative products are rarely required.
true
Irradiated blood products are depleted of
T-lymphocytes
Why are irradiated blood products used?
used to avoid transfusion-associated graft versus host disease (TA-GVHD) caused by engraftment of viable donor T lymphocytes.
Irradiated products can be used in which situations?
Granulocyte transfusions
Intra-uterine transfusions
Neonates up to 28 days post expected date of delivery
Bone marrow / stem cell transplants ✓
Immunocompromised (e.g. chemotherapy or congenital) ✓
Patients with/previous Hodgkins Disease
CMV negative products can be used in which situations?
Granulocyte transfusions
Intra-uterine transfusions
Neonates up to 28 days post expected date of delivery
Pregnancy: Elective transfusions during pregnancy (not during labour or delivery)
Blood product transfusion complications may be broadly classified into the following?
immunological: acute haemolytic, non-haemolytic febrile, allergic/anaphylaxis
infective
transfusion-related acute lung injury (TRALI)
transfusion-associated circulatory overload (TACO)
other: hyperkalaemia, iron overload, clotting
Acute haemolytic transfusion reaction results from?
mismatch of blood group (ABO) which causes massive intravascular haemolysis. This is usually the result of red blood cell destruction by IgM-type antibodies.
In Acute haemolytic transfusion reaction symptoms begin in?
minutes after the transfusion
Acute haemolytic transfusion reaction what symptoms?
fever, abdominal and chest pain, agitation and hypotension.
How do you treat acute haemolytic transfusion reaction?
immediate transfusion termination
Confirm diagnosis
check the identity of patient/name on blood product
send blood for direct Coombs test, repeat typing and cross-matching
generous fluid resuscitation with saline solution and informing the lab
What are the complications Acute haemolytic transfusion
disseminated intravascular coagulation, and renal failure
What causes Non-haemolytic febrile reaction?
Thought to be caused by antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage
due to white blood cell HLA antibodies
often the result of sensitization by previous pregnancies or transfusions
What are the features of Non-haemolytic febrile reaction?
Fever, chills
Red cell transfusion (1-2%) Platelet transfusion (10-30%)
How do you manage Non-haemolytic febrile reaction?
Slow or stop the transfusion
Paracetamol
Monitor
What causes Allergic/anaphylaxis reaction
hypersensitivity reactions to components within the transfusion
What are the features of Allergic/anaphylaxis reaction
Symptoms typically arise within minutes of starting the transfusion and severity can range from urticaria to anaphylaxis with hypotension, dyspnoea, wheezing, and stridor, or angioedema.
How do you treat Allergic/anaphylaxis reaction
Simple urticaria should be treated by discontinuing the transfusion and with an antihistamine. Once the symptoms resolve, the transfusion may be continued with no need for further workup.
More severe allergic reaction or anaphylaxis should be treated urgently. The transfusion should be permanently discontinued, intramuscular adrenaline should be administered and supportive care. Antihistamine, corticosteroids and bronchodilators should also be considered for these patients.
Transfusion-related acute lung injury (TRALI) is rare
true
A rare but potentially fatal complication of blood transfusio
What isTransfusion-related acute lung injury (TRALI) characterised by? How long does it take to present?
Characterised by the development of hypoxaemia / acute respiratory distress syndrome within 6 hours of transfusion.
pulmonary infiltrates on chest x-ray
What is TRALI’s symptoms?
hypoxia
fever
hypotension
What causes Transfusion-related acute lung injury (TRALI)
Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood
How do you manage Transfusion-related acute lung injury (TRALI)
Stop the transfusion
Oxygen and supportive care
What is Transfusion-associated circulatory overload (TACO)?
A relatively common reaction due to fluid overload resulting in pulmonary oedema.
What is the key difference betweenTRALI & TACO?
In TACO as well as features of pulmonary oedema the patient may also by hypertensive, a key difference from patients with TRALI.
What causes TACO?
Excessive rate of transfusion, pre-existing heart failure
How do you treat TACO?
Slow or stop transfusion
Consider intravenous loop diuretic (e.g. furosemide) and oxygen
What is a complication of blood transfusion in terms of infection?
although the absolute risk is very small, vCJD may be transmitted via blood transfusion
from late 1999 onward, all donations have undergone removal of white cells (leucodepletion) in order to reduce any vCJD infectivity present
true
from 1999, plasma derivatives have been fractionated from imported plasma rather than being sourced from UK donors. Fresh Frozen Plasma (FFP) used for children and certain groups of adults needing frequent transfusions is also imported
true
from 2004 onward, recipients of blood components have been excluded from donating blood
true
