blood transfusions

Question 1

What groups of people require CMV negative transufisons

Answer 1

Pregnant (except labour and delivery)
Neonates (28 dyas pp)
IUT
Granulocyte transfusions

Question 2

Patients who need irradiated blood componenets

Answer 2

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

Question 3

What indicates irradiated blood bag

Answer 3

blue dot

Question 4

How soon does transfusion need to be started and finished?

Answer 4

30 mins after removing from temp controlled storage
Transfusion needs to be completed within 4 hours

Question 5

Rate RBC transfusion

Answer 5

90-120 mins

Question 6

Rate of platelet transfusion

Answer 6

30-60 mins

Question 7

Rate of FFP transfusion

Answer 7

30-60 mins

Question 8

Cryo rate trasnfusion

Answer 8

30-60 mins

Question 9

What needs to happen with RBCs that are transfused over less than 60 minutes

Answer 9

Blood warmer - risk of hypothermia

Question 10

When should a blood warmer be used in transfusions

Answer 10

RBC under 60 mins
Cold agglutination disease
Risk of hypothermia otherwise
Should not delay for this in an emergency

Question 11

Drop rate transfusions calculation

Answer 11

15 drops per ml of blood
12 x volume /time = drop rate/minute

270mls over 2 hours
15x270/120 = 34 drops per minute

Question 12

When should obs be taken in a transfusion

Answer 12

After first 15 mins
At the end
More often if TACO risk
Monitor for 24 hours after

Question 13

When should the blood giving set be chnaged

Answer 13

every 12 hours
after every 4 units trasnfused
Between different types of components

Question 14

Acute vs delayed transfusion reaction

Answer 14

Acute = during or within 24 hours
delayed is over 24 hours after transfusion, up yo 14 days after

Question 15

Symptoms of an acute transfusion reaction

Answer 15

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

Question 16

Types of acute transfusion reactions

Answer 16

TACO
Allergic
Bacterial contamination -> sepsis
Simple febrile reactions - pyrexic in transufsion
Mixed febrile allergc reaction
TRALI - transfusion related acute lung injury
acute haemolytic reactions

Question 17

What causes acute haemolytic reactions from transfusion

Answer 17

incompatible RBC - wrong blood unit

Question 18

What characterises a TRALI

Answer 18

Hypoxia, non cardiogenic pulmonary oedema with cough and frothy pink sputum
up to 6 hrs post transfusion or during
Acute lung injury

Question 19

What to do in acute transfusion reaction

Answer 19

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

Question 20

What causes delayed reaction to transfusions

Answer 20

Antibpdes attack trasnfused REBC

Question 21

Signs of delayed transfusion reaction

Answer 21

Unexplained drop in Hb after/ continued anaemia
Fever
chills/rigors
Back pain
Jaundice
Malaise
Haemoglobinuria
Ranl failure
Generalised pain

Question 22

Emergnecy blood group

Answer 22

O

Question 23

Major haemorrhage definition

Answer 23

> 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

Question 24

risk factors for TACo

Answer 24

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

Question 25

what is graft vs host disease

Answer 25

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