blood transfusions Flashcards
What groups of people require CMV negative transufisons
Pregnant (except labour and delivery)
Neonates (28 dyas pp)
IUT
Granulocyte transfusions
Patients who need irradiated blood componenets
Patients who have had a stem cell or bone marrow transplant.
Patients who have Hodgkin’s disease.
Some patients with immunodeficiency syndromes.
Patients who are stem cell or bone marrow donors require irradiated components before or during harvest of their stem cells or bone marrow.
Some haematology patients who have been treated with a group of drugs called Purine Analogues.
Patients who carry an alert card for irradiated blood components - PAS BLOO and alert in medical record
What indicates irradiated blood bag
blue dot
How soon does transfusion need to be started and finished?
30 mins after removing from temp controlled storage
Transfusion needs to be completed within 4 hours
Rate RBC transfusion
90-120 mins
Rate of platelet transfusion
30-60 mins
Rate of FFP transfusion
30-60 mins
Cryo rate trasnfusion
30-60 mins
What needs to happen with RBCs that are transfused over less than 60 minutes
Blood warmer - risk of hypothermia
When should a blood warmer be used in transfusions
RBC under 60 mins
Cold agglutination disease
Risk of hypothermia otherwise
Should not delay for this in an emergency
Drop rate transfusions calculation
15 drops per ml of blood
12 x volume /time = drop rate/minute
270mls over 2 hours
15x270/120 = 34 drops per minute
When should obs be taken in a transfusion
After first 15 mins
At the end
More often if TACO risk
Monitor for 24 hours after
When should the blood giving set be chnaged
every 12 hours
after every 4 units trasnfused
Between different types of components
Acute vs delayed transfusion reaction
Acute = during or within 24 hours
delayed is over 24 hours after transfusion, up yo 14 days after
Symptoms of an acute transfusion reaction
Fever/rigors/chills
Pruritis, Urticaria
SOB, high RR, resp distress, drop O2 sats
Increase HR
Collapse
Anaphylaxis - angioedema, hypotension
hypertemsion
Red urine - haemoglobinuria
Flushing
Bone, muscle, chest, abdo pain
N+V
General unwell, feeling of dread
Pain at cannula site
Types of acute transfusion reactions
TACO
Allergic
Bacterial contamination -> sepsis
Simple febrile reactions - pyrexic in transufsion
Mixed febrile allergc reaction
TRALI - transfusion related acute lung injury
acute haemolytic reactions
What causes acute haemolytic reactions from transfusion
incompatible RBC - wrong blood unit
What characterises a TRALI
Hypoxia, non cardiogenic pulmonary oedema with cough and frothy pink sputum
up to 6 hrs post transfusion or during
Acute lung injury
What to do in acute transfusion reaction
STOP TRANSFUSION
Maintain IV acceass
Call for help
ABCDE
Check right blood componenet
Reassure and obs
Keep the bag
If mild may restart transfusion and treat symptomatically eg paracetemol and monitored more closely
What causes delayed reaction to transfusions
Antibpdes attack trasnfused REBC
Signs of delayed transfusion reaction
Unexplained drop in Hb after/ continued anaemia
Fever
chills/rigors
Back pain
Jaundice
Malaise
Haemoglobinuria
Ranl failure
Generalised pain
Emergnecy blood group
O
Major haemorrhage definition
> 1 blood volume within 24 hours eg around 70ml/kg, >5 L in 70kg adult
50% total blood volume lost in less than 3 hours
Bleeding >150ml/minute
risk factors for TACo
Low body weight. Patients weighing < 50 kg are at extremely high risk, those < 70 kg have increased risk
Pre-existing pulmonary oedema
Respiratory conditions and/or respiratory symptoms
Congestive cardiac failure
Aortic stenosis
Kidney failure
Pre-existing peripheral oedema
Positive fluid balance
Any IV fluids administered within the previous 24 hours
Low albumin levels
On a regular diuretic
Severe or long-standing anaemia
what is graft vs host disease
Graft versus Host Disease (GvHD) occurs when the donor’s T cells (the graft) attack and damage the patient’s healthy cells (the host) and is a common side-effect of stem cell or bone marrow transplantation
