blood transfusions

Question 1

classifications of blood transfusion complications

Answer 1

immunological: acute haemolytic, non-haemolytic febrile, allergic/anaphylaxis
infective
transfusion-related acute lung injury (TRALI)
transfusion-associated circulatory overload (TACO)
other: hyperkalaemia, iron overload, clotting

Question 2

cause of non-haemolytic febrile reaction

Answer 2

antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage

Question 3

cause of allergic reaction

Answer 3

foreign plasma proteins

Question 4

cause of anaphylaxis

Answer 4

patients with IgA deficiency who have anti-IgA antibodies

Question 5

cause of acute haemolytic reaction

Answer 5

ABO-incompatible blood

Question 6

cause of transfusion-associated circulatory overload

Answer 6

excessive rate of transfusion, pre-existing heart failure

Question 7

cause of transfusion related acute lung injury

Answer 7

non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood

Question 8

what type of haemolysis does acute haemolytic transfusion reaction cause

Answer 8

intravascular
usually result of red blood cell destruction by IgM-type antibodies

Question 9

peson with fever, abdominal and chest pain, hypotension minutes after transfusion

Answer 9

acute haemolytic transfusion reaction

Question 10

management of acute haemolytic transfusion reaction

Answer 10

immediate transfusion termination
generous fluid resus with saline solution
inform the lab

Question 11

complications of acute haemolytic transfusion reaction

Answer 11

DIC
renal failure

Question 12

patient with fever chills after transfusion (commonly already had a transfusion or pregnancy)

Answer 12

non-haemolytic febrile reaction

Question 13

management of non-haemolytic febrile reaction

Answer 13

slow or stop the transfusion
paracetamol
monitor

Question 14

urticaria, hypotension, dyspnoea, wheezing, stridor, angioedema within minutes of transfusion

Answer 14

allergic/anaphylaxis reaction

Question 15

management of anaphylaxis reaction

Answer 15

transfusion stopped
IM adrenaline
antihistimes, corticosteroids and bronchodilators considered

Question 16

hypoxaemia and acute respiratory distress within 6 hours of transfusion

Answer 16

Transfusion-related acute lung injury

Question 17

features of transfusion related acute lung injury

Answer 17

hypoxia
pulmonary infiltrates on chest XR
fever
hypotension

Question 18

patient with pulmonary oedema and hypertensive

Answer 18

transfusion associated circulatory overload

Question 19

management of TACO

Answer 19

slow or stop transfusion
consider IV loop diuretic (furosemide)

Question 20

management of TRALI

Answer 20

stop the transfusion
oxygen and supportive care

Question 21

when would you give packed red cells

Answer 21

transfusion of chronic anaemia and cases where infusion of large volumes of fluid may result in cardiovascular compromise

Question 22

when would you give platelet rich plasma

Answer 22

patients who are thrombocytopaenic and are bleeding or requiring surgery

Question 23

when would you give FFP

Answer 23

first line in hypovolaemia