Blood Transfusions

Question 1

When is a FFP transfusion given?

Answer 1

Low coagulation factors and INR (prolonged PT)

Question 2

When is a cryoprecipitate transfusion given?

Answer 2

Low fibrinogen

Question 3

When is a platelet transfusion given?

Answer 3

Platelet count < 30 x10^9 with clinically significant bleeding

Surgery prophylaxis

• > 50 generally
• 50-75 if high risk of bleeding
• >100 if surgery at critical sight, such as CNS

Question 4

When is a packed cell transfusion given?

Answer 4

Hb <70 in patients without acute coronary syndrome

Hb <80 in patients with acute coronary syndrome

Question 5

What are the acute complications of blood transfusion?

Answer 5

Allergy

Acute haemolytic transfusion reaction

• Incompatible blood bag

Febrile non-haemolytic transfusion reaction

Transfusion-related acute lung injury

Transfusion-associated circulatory overload

Question 6

What are the late complications of blood transfusion?

Answer 6

Delayed haemolytic transfusion reaction

• Exaggerated response to a foreign antigen the patient has been exposed to before

Transfusion-associated graft-versus-host disease

Question 7

Give features of acute haemolytic transfusion reaction

Answer 7

Fever

Hypotension

Anxiety

Generalised bleeding secondary to DIC

Question 8

How is acute haemolytic transfusion reaction managed?

Answer 8

Stop the transfusion

Coombs test, repeat typing and cross matching

IV 0.9% NaCl

Teat DIC

Question 9

Give features of transfusion-associated circulatory overload (TACO)

Answer 9

HTN

Raised jugular venous pulse

Afebrile

S3 present

Question 10

How is transfusion-associated circulatory overload managed?

Answer 10

Slow or stop transfusion

IV loop diuretic/fuoresimide

Question 11

Give features of transfusion-related acute lung injury (TRALI)

Answer 11

Hypotension

Pyrexia

Normal/unchanged JVP

White out on CXR

Question 12

How is transfusion-related acute lung injury (TRALI) managed?

Answer 12

Stop the transfusion

Oxygen and supportive care

Question 13

Give features of anaphylactic reaction

Answer 13

IgA deficiency

Hypotesion

Dyspnoea

Wheezing

Angioedema

Question 14

How is anaphylactic reaction managed?

Answer 14

Stop the transfusion

Oxygen

Fluids

IM adrenaline

Antihistamines

Corticosteroids

Bronchodilators

Question 15

Give features of graft versus host disease

Answer 15

Painful maculopapular rash

Severe abdominal pain

Question 16

How is non haemolytic febrile reaction managed?

Answer 16

Slow or stop transfusion

Paracetamol

Monitor

Question 17

How is minor allergic reaction managed?

Answer 17

Temporarily stop the transfusion
Antihistamine
Monitor

Question 18

What is the universal FFP donor?

Answer 18

AB RhD -

Question 19

What blood product is given to prevent transfusion-associated graft versus host disease?

Answer 19

Irridated blood products instead of regular blood products

Question 20

How fast is a unit of RBC usually transferred over?

Answer 20

In a non urgent scenario, over 90-120 minutes

In patient with HF history, over 3 hours to prevent circulatory overload

In an urgent scenario, transferred STAT