Blood Transfusion Flashcards
Indications for CMV negative blood
Neonates
CMV negative patients with haematological or other disease who are likely to receive allogenic bone marrow transplant
Elective transfusions during course of pregnancy
Intra-uterine infections
Indications for irradiated blood
BMT allograft recipient
Autograft recipient with TBI conditioning
Hodgkin’s disease
Suspected/confirmed congenital cellular immune deficiency
Neonate due to receive red cell exchange
Previously received intra-uterine transfusion
Prescribing blood products
One unit per line
RBCs must be transfused within 4 hrs from leaving blood bank - give over 2-3 hours
- STAT if bleeding out - (5mins for exams)
Check Hb post each unit
Mx of mild allergic reaction to blood products
Give chlorphenamine 10mg slowly IV
Restart transfusion at slower rate and observe frequently
Signs of mild allergic reaction
Urticaria
Features of febrile non-haemolytic transfusion reaction
Mild fever
Mx of febrile non-haemolytic transfusion reaction
If temp rises less than 1.5 and obs are stable - give paracetamol
Restart infusion at slower rate and observe more frequently
Mx of ABO incompatibility
Take down unit and giving set Commence IV saline infusion Inform transfusion department Monitor urine output - maintain at > 100 ml/hr - give furosemide Treat DIC Return bag and giving set to blood bank Seek haem advice
Features of severe allergic reaction to blood products
Bronchospasm
Angioedema
Abdo pain
Hypotension
Mx of severe allergic reaction to blood products
Discontinue transfusion
Return blood pack and giving set to blood bank
Give chlorphenamine 10mg slowly IV
Commence oxygen
Give nebulised salbutamol - 2.5-5mg
Give IM adrenaline 0.5mg - 0.5ml of 1:1000 solution
Send 10ml clotted sample to blood bank
Use saline washed blood components in future
Mx of of haemolytic reaction/bacterial infection
Return giving set and bag Take blood cultures, repeat blood group, FBC, coag screen Monitor urine output Commence broad spec IV antibiotics Commence O2 and fluid support
Mx of fluid overload
Stop infusion
Give O2 and furosemide 40-80mg IV
Features of transfusion related acute lung injury (TRALI)
Dyspnoea
CXR - whiteout
Mx of TRALI
Discontinue transfusion
Give 100% O2
Treat ARDS
Ventilate if hypoxia indicates
Risks of blood transufiosn
Viral infection - hepatitis, HIV Allergic reaction Blood incompatibility Bacterial infection vCJD Haemolysis
How to order blood
Use blood transfusion request form
See if previous group and save on the system - if so only need one sample
2 samples taken by different people at different times
Must fill in special requirements or neither
Don’t tick anything in test required if requesting sample
- group and save for 1st sample
- DAT - if previous transfusions
Most common hazards of transfusion
Patient receiving incorrect blood
Key features of ABO blood group
Individuals produce antibodies against antigens that are not present on their own red cells
- group O have antibodies to A and B
- group AB do not have either antibodies
Key features of matching blood groups
Patients should receive own group wherever possible
In emergency group A can be given to all groups
Key features of Rhesus group
D positive patients can receive any D type blood
D negative patients should receive D negative blood
D negative patients can make anti-D if they are exposed to D positive cells through transfusion or pregnancy
D negative females of child bearing potential SHOULD NEVER be transfused with D positive cells
Alternatives to blood transfusion for surgery patients
Erythropoietin
IV or oral iron
Cell salvage
Tranexamic acid
Threshold for red blood cell transfusion
Threshold of 70gl/litre Hb with a target of 70-90 post transfusion
- not bleeding
For those with ACS threshold of 80 aiming for 80-100 post transfusion
Set individual targets for those with chronic anaemia
Doses of RBC
Consider single unit for adults who are not actively bleeding
After each unit reassess and check haemoglobin levels
Give further transaction if needed
Thresholds for platelets
Bleeding - platelet count below 30x10^9 per litre - 100x10 if severe bleeding or bleeding in critical sight such as CNS Not bleeding - 10x10/L Invasive procedures - 50x10
When are prophylactic platelet transfusions not indicated
Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopenia
Thrombotic thrombocytopenic purpura
Doses of platelets
Single dose
Reassess and see if second needed
Thresholds for FFP
Consider for patients with significant bleeding but without major haemorrhage and abnormal coagulation
Do not offer FFP to
Patients who are not bleeding
Need reversal of a vitamin K antagonist
Thresholds for cryoprecipitate
Significant bleeding and fibrinogen below 1.5g/L
Consider if below 1g/L and having invasive procedures/surgery
Doses of cryoprecipitate
Adult dose of 2 pools
Thresholds for prothrombin complex concentrate
Emergency reversal of warfarin
- severe bleeding
- head injury with suspected intracerebral haemorrhage
Consider warfarin reversal if undergoing emergency surgery
