Blood Transfusion in Practice

Question 1

What are the indications for RBC transfusion?

Answer 1

Anaemia

Question 2

What are the indications for FFP transfusion?

Answer 2

Low coagulation factors
Major haemorrhage
DIC (bleeding)
Thrombotic Thrombocytopenic Purpura

Question 3

What are the indications for cryoprecipitate transfusion?

Answer 3

Low fibrinogen

Renal/liver failure and abnormal bleeding

Question 4

Would you transfuse cells in this patient? Why?

76 year old with Hb 54 g/L and blood film consistent with megaloblastic anaemia

Answer 4

No - give B12 and folate

Question 5

Would you transfuse cells in this patient? Why?

48 year old lady admitted for a planned hysterectomy with Hb of 95 g/L

Answer 5

Patient likely has bleeding in the uterus, meaning this is Iron deficiency due to bleeding

Cancel operation and give Iron first

Question 6

What is the target Hb in transfusion patients?

Answer 6

70

Question 7

What are the alternatives to transfusion?

Answer 7

Reversal of anaemia - Iron/EPO

Intra-operative Cell Salvage

Question 8

What are the biggest causes of transfusion-related death?

Answer 8

Transfusion associated overload
Delays
Underuse

Question 9

A patient with blood group O (True/False for each):

1. can receive group A red cells safely
2. can receive group A fresh frozen plasma safely
3. can receive group A platelets safely
4. can have a group A child

Answer 9

1. False
2. True
3. True
4. True

Question 10

What are the indications for platelet transfusion?

Answer 10

Thrombocytopenia
To stop bleeding
Cardiopulmonary bypass (bypass machines damage RBC)
DIC (if bleeding)

Question 11

What FFP is used immediately in massive bleeds?

Answer 11

A+

Question 12

Would you transfuse FFP?

1. A bleeding patient with factor VIII deficiency?
2. A bleeding patient with factor V deficiency?
3. A bleeding patient on warfarin?
4. A bleeding patient on a DOAC?
5. A patient with DIC?
6. A bleeding patient with DIC?
7. A patient with massive haemorrhage but no coagulation results?
8. A hypotensive patient and albumin 16 g/L

Answer 12

1. No - give FVIII concentrate
2. Yes (there is no FV concentrate)
3. Yes (with vitamin K)
4. No - use direct inhibitors
5. No
6. Yes
7. Yes
8. No - don’t use FFP as a volume expander

Question 13

Give 2 causes of Hypofibrinogenaemia?

Answer 13

Thrombolytic therapy
Massive transfusion
Inherited
DIC + bleeding

Question 14

What samples should be taken before transfusion?

Answer 14

Group and Screen/save

Cross match

Question 15

What is needed in a transfusion prescription?

Answer 15

Volume to be transfused (1 unit = 1 donation)
Type
Date
Patient name
Normovolemic - 3-4hrs

Question 16

What risk is associated with transfusing ‘too fast?’

Answer 16

Circulatory overload

Question 17

How is risk of circulatory overload minimised?

Answer 17

Give with Furosemide

Give over 4hrs

Question 18

Why are blood products irradiated?

Answer 18

Prevent graft rejection