Blood Transfusion and Blood Products Flashcards
Packed red blood cells
-when is it used
-how is it obtained
Transfusion in chronic anemia
Where infusion of large volumes of fluid may result in cardiovascular compromise
Centrifuge whole blood
Blood transfusion
-thresholds for transfusion for patients with and without ACS
-how quickly should we infuse in a non-urgent situation
Without ACS
Threshold - U70g/L
Target - 70-90
With ACS
Threshold - U80g/L
Target - 80-100
These thresholds not used if
-ongoing major hemorrhage
-regular transfusions needed for chronic anemia
Non-urgent - 1 unit transfused over 90-120mins
Acute hemolytic transfusion reaction
-what is it
-presentation
-management
-complications
ABO incompatible blood => RBC destruction by IgM => massive intravascular hemolysis
Minutes after transfusion started
-fever
-abdo, chest pain
-agitation
-low BP
Stop transfusion
Confirm diagnosis
-patient ID, name on blood product
-send blood for direct Coombs test
-repeat typing and cross matching
Supportive - fluid resus
Complications
-disseminated intravascular coagulation
-renal failure
Non hemolytic febrile reaction
-what is it
-presentation
-management
AB reacting with white cell fragments in blood product
-often the result of sensitisation by previous pregnancies/transfusions
Fever, chills
Slow/stop transfusion
Paracetamol and monitor
Allergic/anaphylactic reaction
-what is it
-presentation
-management
Hypersensitivity reaction to transfusion components
-minutes within starting transfusion
Hives <=> anaphylaxis (lowBP, SOB, wheeze, stridor, angiodema
Hives
-stop transfusion and antihistamine
-can restart transfusion once resolved
Anaphylaxis
-permanently stop transfusion
-IM adrenaline, O2, fluids
-consider antihistamine, CS, BD
Transfusion-related acute lung injury (TRALI)
-what is it
-presentation
-management
Host neutrophils activated by substances in donor blood => increased vascular permeability => pulmonary edema
Within 6hrs of transfusion
-Hypoxia
-Pulmonary infiltrates on CXR
-Fever
-LowBP
Stop transfusion
Supportive - O2
Transfusion associated circulatory overload (TACO)
-what is it
-presentation
-management
Excess rate of transfusion, pre-existing heart failure => pulmonary edema
Pulmonary edema
HTN
Stop or slow transfusion
-consider furosemide IV, O2
Infective complications from blood transfusion
-causative organism
-safeguards
vCJD transmitted via blood transfusion
From 1999 onwards
-all donations are leucodepleted to reduce infectivity
-plasma derivates fractionated from imported plasma
From 2004
-recipients of blood components excluded from donating blood
CMV negative blood
-why is this important
-who uses this blood
CMV transmitted in WBC
-granulocyte transfusions (in severe neutropenia with bacterial/fungal infection unresponsive to antimicrobial therapy)
-intrauterine transfusions
-neonates up to 28days post expected date of delivery
-elective transfusions during pregnancy (not labour or delivery)
Irradiated blood products
-why is this important
-who uses this blood
-presentation of transfusion associated GVHD
Depleted of T cells => avoid transfusion associated graft vs host disease
-granulocyte transfusions
-intrauterine transfusions
-neonates up to 28days post expected delivery date
-bone marrow/stem cell transplants
-immunocompromised
-patients with/past Hodgkin lymphoma
4-30days post transfusion
-fever
-erythroderma
-desquamation
-diarhhoea
-abnormal LFTs
Manage with CS
Warfarin management of high INR
-major bleeding
-INR 8+ and minor bleeds
-INR 8+ and no bleeds
-INR 5-8 and minor bleeds
-INR 5-8 and no bleeds
Major bleed
-stop warfarin
-IV VitK 5mg + PCC
INR 8+ and minor bleeding
-stop warfarin
-IV VitK 1-3mg
-repeat dose if INR too high after 24hrs
-restart when INR U5
INR 8+ and no bleeds
-stop warfarin
-PO VitK 1-5mg
-repeat dose if INR too high after 24hrs
-restart when INR U5
INR 5-8 and minor bleed
-stop warfarin
-PO VitK 1-5mg
-restart when INR U5
INR 5-8 and no bleeds
-hold 1-2 doses
-reduce maintenance dose
