Blood Transfusion

Question 1

Indications for CMV negative blood

Answer 1

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

Question 2

Indications for irradiated blood

Answer 2

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

Question 3

Prescribing blood products

Answer 3

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

Question 4

Mx of mild allergic reaction to blood products

Answer 4

Give chlorphenamine 10mg slowly IV

Restart transfusion at slower rate and observe frequently

Question 5

Signs of mild allergic reaction

Answer 5

Urticaria

Question 6

Features of febrile non-haemolytic transfusion reaction

Answer 6

Mild fever

Question 7

Mx of febrile non-haemolytic transfusion reaction

Answer 7

If temp rises less than 1.5 and obs are stable - give paracetamol
Restart infusion at slower rate and observe more frequently

Question 8

Mx of ABO incompatibility

Answer 8

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

Question 9

Features of severe allergic reaction to blood products

Answer 9

Bronchospasm
Angioedema
Abdo pain
Hypotension

Question 10

Mx of severe allergic reaction to blood products

Answer 10

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

Question 11

Mx of of haemolytic reaction/bacterial infection

Answer 11

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

Question 12

Mx of fluid overload

Answer 12

Stop infusion

Give O2 and furosemide 40-80mg IV

Question 13

Features of transfusion related acute lung injury (TRALI)

Answer 13

Dyspnoea

CXR - whiteout

Question 14

Mx of TRALI

Answer 14

Discontinue transfusion
Give 100% O2
Treat ARDS
Ventilate if hypoxia indicates

Question 15

Risks of blood transufiosn

Answer 15

Viral infection - hepatitis, HIV
Allergic reaction
Blood incompatibility
Bacterial infection
vCJD
Haemolysis

Question 16

How to order blood

Answer 16

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

Question 17

Most common hazards of transfusion

Answer 17

Patient receiving incorrect blood

Question 18

Key features of ABO blood group

Answer 18

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

Question 19

Key features of matching blood groups

Answer 19

Patients should receive own group wherever possible

In emergency group A can be given to all groups

Question 20

Key features of Rhesus group

Answer 20

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

Question 21

Alternatives to blood transfusion for surgery patients

Answer 21

Erythropoietin
IV or oral iron
Cell salvage
Tranexamic acid

Question 22

Threshold for red blood cell transfusion

Answer 22

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

Question 23

Doses of RBC

Answer 23

Consider single unit for adults who are not actively bleeding
After each unit reassess and check haemoglobin levels
Give further transaction if needed

Question 24

Thresholds for platelets

Answer 24

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

Question 25

When are prophylactic platelet transfusions not indicated

Answer 25

Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopenia
Thrombotic thrombocytopenic purpura

Question 26

Doses of platelets

Answer 26

Single dose

Reassess and see if second needed

Question 27

Thresholds for FFP

Answer 27

Consider for patients with significant bleeding but without major haemorrhage and abnormal coagulation

Question 28

Do not offer FFP to

Answer 28

Patients who are not bleeding

Need reversal of a vitamin K antagonist

Question 29

Thresholds for cryoprecipitate

Answer 29

Significant bleeding and fibrinogen below 1.5g/L

Consider if below 1g/L and having invasive procedures/surgery

Question 30

Doses of cryoprecipitate

Answer 30

Adult dose of 2 pools

Question 31

Thresholds for prothrombin complex concentrate

Answer 31

Emergency reversal of warfarin
- severe bleeding
- head injury with suspected intracerebral haemorrhage
Consider warfarin reversal if undergoing emergency surgery