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Yr5 Haematology > Emergency > Flashcards

Emergency Flashcards

1
Q

What are the blood product types?

A
  • Packed red ells
  • Platelets
  • Fresh Frozen plasma
  • Cryoprecipitate
  • Whole bloods
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2
Q

What are packed red cells used for?

A

Severe anaemia- should ↑Hb by ~1.25/dL

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3
Q

What are platelets used for?

A

Platelet count <50

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4
Q

When is FFP used?

A 
Clotting disorders
Vit K deficit
Liver disease
DIC
Prophylactically in patients undergoing surgery w/bleeding risk
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5
Q

What is cryoprecipitate used for?

A

Replace fibrinogen <1.5g/L

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6
Q

When is whole blood products used?

A

Exchange transfusions

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7
Q

What are the early transfusion reactions?

A 
WITHIN 24HOURS:
Febrile reactions
Bacterial contamination
Fluid overload (TACO)
Acute haemolytic reactions
Transfusion related acute lung injury (TRALI)
Anaphylaxis
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8
Q

What are the late transfusion reactions?

A 
>24HOURS, USUALLY 5-10DAYS POST-TRANSFUSION:
Infections
Graft vs Host disease
Post transfusion purpura
Iron overload
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9
Q

What should be done when a blood transfusion is initiated?

A

MONITOR patient closely

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10
Q

What are the Sx of a febrile reaction to a transfusion?

A

Fever
Chills
Pruritis
Urticaria

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11
Q

What causes a febrile reaction to a transfusion?

A

HLA Antibodies

Usually from: Multiparous women, prev transfusion

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12
Q

How is a febrile reaction to a transfusion treated?

A

Slow transfusion = Paracetamol

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13
Q

What are the Sx of bacterial contamination of a blood transfusion?

A

Raised temperature
Hypotension
Rigors

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14
Q

What type of product is most commonly associated with bacterial contamination?

A

Platelets as stored at higher temperature

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15
Q

How is a bacterial contaminated blood transfusion treated?

A

STOP transfusion
Call haematologist
Take blood cultures
START broad spec Abx

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16
Q

How does TACO present?

A 
SOB
Hypoxia
Tachycardia
Basal creps
↑JVP
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17
Q

How is TACO treated?

A

O2
IV Furosemide
Consider: Central line, exchange transfusion

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18
Q

Which patients are at risk of TACO?

A

Chronic anaemics

Heart failure

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19
Q

What are the Sx of an acute haemolytic reaction?

A 
IN MINUTES
↑Temp
Agitation
Hypotension
Flushing
Abdo/Chest Pain
Oozing venepuncture sites
Can progress to DIC
20
Q

What is the cause of an acute haemolytic reaction?

A

ABO/Rh incompatibility

NEARLY ALWAYS due to incorrect labelling

21
Q

How is an acute haemolytic reaction treated?

A 
STOP transfusion
Resus: IV fluids
CHECK identity/name on unit and wristband
Keep IV line open
Send bloods &amp; giving set BACK TO LAB
22
Q

What bloods should be sent in an acute haemolytic reaction?

A

FBC
U&E
Clotting
Cultures

23
Q

Other than blood sample what other bodily fluid should be checked in an acute haemolytic reaction?

A

Urine sample – check for DIC

24
Q

What is the cause of TRALI?

A

ARDS due to anti-leukocyte antibodies in plasma

25
Q

What are the Sx of TRALI?

A

Dyspnoea + Cough
Fine bilateral creps
↓Sats %

26
Q

What investigations are done in someone with suspected TRALI?

A

CXR: White out
Blood gas
Bloods: Anti-luekocyte antibodies

27
Q

How is TRALI treated?

A

Treat as ARDS:
100% O2
CPAP/ mechanical ventilation

28
Q

What is the cause of anaphylaxis in blood transfusions?

A

IgE implicated (also could be IgG/IgA)

29
Q

How does anaphylaxis present in relation to blood transfusions?

A 
Cyanosis
Bronchospasm/Stridor/SOB
Soft tissue swelling
Hypotension
Urticaria
30
Q

How is an anaphylactic reaction due to blood transfusion treated?

A 
STOP transfusion
Secure airway (call anaesthetist)
Adrenaline 0.5mg (1:1000) IM
Chlorphenamine 10mg
Hydrocortisone 200mg
Salbutamol Neb (up to 20mg)
31
Q

In late transfusion reactions, what sort of organisms cause infections?

A

HIV
Hep B&C
Prions
Protozoa

32
Q

What causes graft vs host disease?

A

T lymphocyte reaction

Usually immunocompromised

33
Q

What is a post-transfusion purpura?

A

Fall in platelets 5-7days post-transfusion

34
Q

How is post-transfusion purpura treated?

A

IV immunoglobulins

35
Q

How is iron overload post-transfusion treated?

A

Chelation therapy given to at risk groups

36
Q

How is any transfusion reaction investigated?

A 
Send UNIT to lab
Call haematology
Bloods: FBC, U&amp;E, LFTs, Cultures, Clotting, IgA
Urine: Haemoglobinuria
CXR: TRALI (White out)
37
Q

What can be done prophylactically to try and stop blood transfusion reactions occurring?

A

Pre-transfusion: Paracetamol/antihistamines
Slow transfusion w/diuretics for HF pt
Irradiate blood in high risk groups

38
Q

Who should get CMV negative blood products?

A

Granulocyte transfusion
Intra-uterine transfusions
Neonates up to 28days post-EDD
Pregnancy (elective procedures)

39
Q

Who should get irradiated blood products?

A 
Granulocyte transfusion
Intra-uterine transfusions
Neonates up to 28days post-EDD
BM/ Stem cell transplants
HIV
Hodgkin’s disease
ImmunoC
40
Q

What is DIC?

A

Dysregulation of coagulation & fibrinolysis
Leads to widespread clotting
All coagulation factors are used up
Results in massive haemorrhage

41
Q

What are the causes of DIC?

A 
Malignancy (Leukaemia)
Sepsis
Trauma
Obstetric events (HELLP, amniotic fluid emboli, pre-eclampsia)
APL syndrome
42
Q

How does DIC present?

A 
Large bruising
Bleeding: >3 unrelated sites
Skin: Petechiae, purpura, acral cyanosis, local infection, necrosis of limbs
Renal failure
ARDS
43
Q

How is DIC investigated?

A

Bloods: ↑PT, ↑APTT, ↑bleeding time, ↓Platelets (used up) ↓Fibrinogen
Blood Film: Broken RBCs- Shistocytes

44
Q

What is the pathophysiology of DIC?

A

Release of tissue factor (TF) from trauma/vasc damage
Exposed to circulation (not normally)
Binds to coagulation factors
Leads to activation of extrinsic pathway
This triggers intrinsic pathway and activates thrombin and plasmin

45
Q

How is DIC treated?

A

Platelet transfusion: <50 platelets
FFP: Replace clotting factors
Activated Protein C: Reduces mortality in sepsis/organ failure

Yr5 Haematology (6 decks)

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