Blood Transfusions in practise. Flashcards
What are the indications for a blood transfusion?
Red cells - anaemia.
Platelets - thrombocytopenia.
Fresh frozen plasma - low coagulation factors.
Cryoprecipitate - low fibrinogen.
What is important to remember when looking at patients for blood transfusion?
Treat patient not a number.
What are alternatives for transfusion in anaemia?
Pre-admission clinic - reversal of anaemia - iron / EPO.
IOCS - intra-operative cell salvage.
What is the rationale for red cell transfusion?
To prevent or correct severe acute anaemia that might otherwise cause organ damage.
To improve quality of life in a patient with otherwise uncorrectable anaemia.
To prepare a patient for surgery or speed up recovery.
To reverse damage caused by patient’s own red cells.
(Sickle Cell Disease)
What are the indications for platelet transfusion?
Prophylactically or therapeutically to stop bleeding. Dilutional thrombocytopenia. Cardiopulmonary bypass surgery. D.I.C if bleeding. Abnormalities of platelet function.
What are the indications for FFP use?
Replacement of coagulation factors due to major haemorrhage.
DIC in the presence of bleeding.
Thrombotic Thrombocytopenic Purpura.
Replacement of coagulation factor deficiencies where factor concentrate unavailable.
What is the prep and shelf life of cryoprecipitate?
Preparation -precipitate that forms by controlled thawing of FFP at 4 degrees, then frozen.
Shelf life 2 years -25
- contains coagulation factors - FVIII, vWF, Firbrinogen, F XIII.
What is the indication for use of cryoprecipitate?
Hypofibrinogenaemia secondary to massive transfusion.
DIC with bleeding and fibrinogen.
Bleeding associated with thrombolytic therapy causing hypofibrinogenaemia.
Renal or liver failure and abnormal bleeding.
Inherited hypofibrinogenaemia if fibrinogen concentrate unavailable.
Fibrinogen concentrate on its way.
What is done with the samples?
Group and screen/save. Cross match Group specific blood. Two sample policy 72 hour (10 day) validity.
Communication with blood bank is key.
What are the adverse reactions to a blood transfusion?
Febrile Allergic Anaphylactic Mixed allergy/febrile Hypotensive Unclassified Death - 1/10 mil - 1 in 100.000. Pulmonary complications - 53.7%. ABO-incompatible
What are some of the preventable errors?
Wrong blood in patient.
Delayed transfusion.
Handling and storage errors.
Treatment for Pyrexia (febrile non-hemolytic transfusion reactions)
Anti-pyretic
Treatment for Urticaria (mild allergic reactions, anaphylaxis)
Antihistamine
Treatment for Dyspnoea (Transfusion Associated Circulatory Overload, Transfusion Related Acute Lung Injury, Anaphylaxis)
Oxygen
Diuretic
Ventilation
Adrenaline
Treatment for Shock (Incorrect Blood Component Transfused, anaphylaxis, TRALI, TAS)
Adrenaline (IV hydrocortisone/antihistamine) IV fluid Ventilation Antibiotics FFP/Platelets if DIC
