Blood Transfusions Flashcards
What is the transfusion threshold for Packed Red Cells?
No ACS - 70
ACS - 80
How are Packed Red Cells stored and administered?
Stored at 4 degrees
Given over 90 to 120 mins (unless emergency)
What is unique about platelets?
Does not require cross match
Highest risk of bacterial contamination
Describe the thresholds for platelet transfusion
Significant Bleeding <30
Severe bleeding or bleeding at vital site (eg intracranial) - <100
What does FFP contain?
Clotting Factors
Albumin
Immunoglobulins
When is FFP given?
When APPT ratio >1.5
What is the universal donor for FFP?
AB
What is Cryoprecipitate?
Further processing of FFP - FactorVIII and VWF
Very small volume
When is Cryoprecipitate given?
If Fibrinogen<1.5
eg DIC, Liver Failure, VWF, Hypofibrinogenaemia
What are the option for Warfarin Reversal?
1) Stop
2) IV or Oral Vit K (takes up to 24h)
3) Human Prothrombin Complex Conc (works within 1h but wears off - coadminister Vit K)
4)FFP
Name three immunological reactions to blood transfusions
Haemolytic
Non-Haemolytic
Anaphylaxis/Urticaria
What is an Acute Haemolytic reaction?
IgM reaction with ABO incompatible blood
How does Acute Haemolytic reaction present?
Fever
Abdo Pain
Hypotension
Late: DIC and renal failure
How is Acute Haemolytic reaction managed?
STOP transfusion
Fluids
Repeat haematology
What causes a Non-HAemolytic reaction?
Host antibodies reaction to white cells and cytokines within donated blood
Typically Platelets or RBC
How does Non-HAemolytic reaction present?
Fever and Chills
How is Non-HAemolytic reaction managed?
Stop/Slow
Paracetamol
Monitor
What causes an allergic response?
Reaction to proteins within donated blood
How is allergic response to blood managed?
Stopped and treated as per any other allergic stimuli
Why do platelet transfusions carry a higher risk of infection?
Stored at room temperature
What has been done in the UK to reduce risk of vCJD transmission?
Leucodepleted Blood
Imported FFP
Unable to donate blood if been transfused previously
What is TRALI?
Transfusion Associated Lung Injury
Non cardiogeneic pulmonary oedema due to increased permeability in reaction to donor blood components
How does TRALI present?
Hypoxia
Pulmonary Infiltrates
HYPOtension
How is TRALI managed?
Stop Transfusion
O2 and Supportive Care
What is TACO?
Transfusion Associated Circulatory Overload
WHen transfusion is at too high rate or pre-existing HF
How does TACO present?
HYpoxia
Pulmonary Infiltrates
HYPERtension
How is TACO managed?
Slow/ Stop transfusion
Oxygen
+/- Furosemide
Name three categories of people who receive CMV negative blood
Intrauterine
Neonates (<28d)
Pregnant
Name three groups of people who recieve Irradiated blood
Chemotherapy
Prev Hodgekins
Intrauterine
