Blood Transfusions Flashcards
Name the different blood products that can be used in clinical practice
Whole blood - very rarely used!
Packed cells - used for major haemorrhage and treatment of anaemia. Increases Hb by 1g/dl per unit
Human albumin (5 or 20%) - mainly used in hypoproteinaemic states
Fresh frozen plasma - contains all the clotting factors. Dose is 10-15ml/kg. Used in reversal of warfarin, DIC, massive transfusion, and liver disease.
Cryoprecipitate - contains factors VIII, XIII, fibrinogen and vWf. It is pooled from 10-20 adults doners. Used in hypofibrinogenaemia, massive transfusion, DIC and haemophilia
Platelets - used in massive transfuions, DIC and thrombocytopaenia with active bleeding.
What are the alternatives to using stored blood products?
Autologous transfusion:
pre op autologous donation - blood is donated by patient pre op
acute normovolaemic haemodilution - blood is removed immediately prior to surgery and replaced with crystalloid.
perioperative red cell salvage
Pharmacological methods: Aprotinin - a serine protease inhibitor that inhibits fibrinolysis and has been shown to reduce blood loss in cardiac surgery Tranexamic acid - inhibits fibrinolysis Desmopressin - increases factor VIII Erythropoietin
What are the acute complications of blood transfusions?
Haemolytic transfusion reaction:
Secondary to ABO incompatibility - usually human error
Temp, SOB, rigors, loin pain, hypotension and oliguria. Jaundice and haemoglobinuria may occur.
If the patient is unconscious then a temp and BP drop > 10mmHg needs to cause concern,.
Manage: ABC, stop blood, check pts identity, the blood group of pt and donor. Take bloods for a haemolytic screen. Maintain diuresis with fluids and mannitol.
Allergic reaction:
itching, skin rashes and urticarial.
slow down or discontinue transfusion. give antihistamines.
Transfusion related acute lung injury:
Similar to ARDS. Due to the agglutination of WBCs due to HLA antibodies in the donor plasma. Usually occurs in multiparous women.
Non haemolytic febrile transfusion reaction:
fevers or rigors.
Due to prior sensitisation to WBC antigens (after pregnancy or previous transfusions).
Slow down and give paracetamol
Circulatory overload:
if have heart failure and need to transfuse give dose of furosemide with each unit g
What are the delayed complications of blood products?
Delayed haemolytic transfusion reaction:
Occurs when a patient has been exposed to red blood cell antigens (ie from previous transfusion). After 5-10days an immune response occurs and the transfused cells are destroyed. Fever, anaemia, jaundice, and haemoglobinuria.
Iron overload
Graft vs host disease:
Rare.
Donor lymphocytes engraft into the recipient’s marrow. They then recognize the recipient ads foreign and cause an immunological reaction.
Post transfusion purpura:
rare
occurs 5-10days after and is due to HLA antibodies in the recipient. presents with low platelets and bleeding.
What is a massive blood transfusion?
a transfusion equal to or greater than the whole blood volume in 24hrs.
Specifically can cause thrombocytopenia, decreased coagulation factors, hypothermia, hypocalcaemia, hyperkalaemia and acidosis.
Transfuse blood: FFP: platelets 1:1:1 is associated with improved survival.
What investigations do you do if a patient develops a fever, rigors, myalgia, nausea or loin pain during a transfusion?
FBC, LFTs, U&Es, urine dip for Hb
Sample for repeat compatibility testing, DAT (direct antiglobulin test), LDH and haptoglobin
Blood culutres Çoag screen
Return unit to lab
What investigations do you do if a patient gets mucosal swelling during a transfusion?
FBC, LFTs, U&Es, urine dip for Hb
Measure IgA. If
What investigations do you do if a patient develops dyspnoea, wheeze or features of anaphylaxis
FBC, LFTs, U&Es, urine dip for Hb
Sats and ABG
CXR
IgA if suspect allergy
