Blood Transfusions - in Practice

Question 1

What are the indications for transfusing red cells?

Answer 1

• Severe acute anaemia
• improve QOL in otherwise uncorrectable anaemia
• prepare for or recover from surgery
• Reverse damage by own red cells e.g. sickle cell

Question 2

What are the indications for platelet transfusion?

Answer 2

HAemorrhage
Bone marrow failure
Prophylaxis for surgery
Bleeding Cardiopulm bypass

Question 3

What are the indications for giving FFP?

Answer 3

Replace fluid in Massive HAemorrhage
DIC with bleeding (replaces clotting factors)
Prophylaxis

Question 4

What do you need to do before giving FFP?

Answer 4

Get it out early, stored frozen so takes a while to thaw

Test the PT & aPTT

Question 5

When do we use cryoprecipitate and what do we need to do before using it?

Answer 5

If they have a low fibrinogen

Stored frozen so give time to thaw and test fibrinogen

Question 6

When ordering blood (non-emergency) you send 2 samples to the blood bank, what do they do with them?

Answer 6

Group & screen 
Cross Match
Coomb's Test 
  - Direct = Autoimmune 
  - Indirect = Cross matching issue

Question 7

What do you do if you need blood immediately?

Answer 7

Ask for Type O RhD -ve red cells
Or AB plasma

If it’s urgent but not immediate you can ask for type specific and if it’s not urgent at all they will do a full cross match

Question 8

What do you do if a patient has a massive haemorrhage?

Answer 8

Dial 2222 (universal in uk)

It’ll get you an immediate supply of 6 units red cell, 4 units ffp & 1 unit platelets

Question 9

What are the major complications of a blod transfusion?

Answer 9

TACO - Transfusion associated circ overload
Fever
TRALI - Tranfusion associated lung injury
Acute Haemolysis
Infections
Anaphylaxis

Question 10

What do we do if someone has a reaction to a transfusion?

Answer 10

Stop it
Check patient identity against component label

Fever - give anti-pyretic & send back to lab for testing

Urticaria - give anti-histamine & monitor for anaphylaxis

Watch out for dyspnoea, shock etc.

Question 11

What is Haemolytic Disease of foetus & Newborn?

Answer 11

Mum with Anti-D Abs passes them on to Rhd +VE baby –> Haemolysis

Question 12

How do we prevent and treat HDFN?

Answer 12

Give mothers Anti-D at 28wks & at delivery, this should prevent baby developing RhD

Antibody titres & doppler US –> Intrauterine transfusion

Question 13

What is NAIT?

Answer 13

Neonatal Alloimmune Thrombocytopenia

Similar to HDFN but for platelets

Question 14

What other transfusion-type interventions can we do for other cells?

Answer 14

Leucapharesis
Bone marrow transplant
Lymphocyte infusions
Other banks e.g. milk, tendons, faecal etc
Gene therapies