Haem - Clotting

Question 1

Treatment for DIC

Answer 1

Heparin
Activated Protein C concentrate

FFP
Platelet Transfusion

Question 2

Target APTT ratio?

Answer 2

1.5-25

Question 3

When would you monitor LMWH?

Answer 3

Renal Failure
Late pregnancy
Other specifics

Question 4

Tartet INR ratio?

Answer 4

2.0-4.5

Question 5

How many RBC mls of foetal blood can 500iu anti-D ‘neutralise’?

Answer 5

4mls (in RBCs), 8mls total blood

Question 6

What other test should be done to test level of foetal blood mixing?

Answer 6

Kleihauer test

Tests for foetal Hb cells - can calculate how much has mixed in

To be used whenever you suspect you will get >4mls foetal RBC mixed.

Question 7

How much anti-D is given before and after 20 weeks gestation?

Answer 7

250iu for <20 weeks
500iu and Kleihauer test >20 weeks

Given during 3rd trimester at 28 and 34 weeks due to ‘silent bleeds’ that happen

Question 8

What are the 2 main causes of immediate serious reaction to blood transfusion?

Answer 8

ABO incompatability

Bacterial contamination

Question 9

Pt immediately feels restless and oppressed, with chest and abdominal pain after you administer transfusion. There is vomiting and they are flushed.

Answer 9

Immediate haemolytic transfusion reaction due to ABO incompatible blood

Haemoglobinuria would indicate severe haemolysis

Question 10

Pt develops sudden onset fever, but shows no signs of haemolysis

Answer 10

Febrile non-haemolytic transfusion reaction

Donor wbc meets host anti-donor wbc antibody - now quite a rare reaction as blood products are usually leucodepleted nowdays

Question 11

Pt develops urticaria and anaphylaxis

Answer 11

Allergic Reaction

Donor plasma protein meets host IgE. Usually a mild reaction, can give antihistamine and continue transfusion if not too severe

Question 12

Pt develops fever, chills, dry cough and breathlessness and has signs of cardiac failure

Answer 12

Transfusion related acute lung injury (TRALI)

Donor antibodies react with host wbcs. Sorta the opposite way round to febrile non-haemolytic.

Uncommon, cardiac failure more likely to arise from fluid overload than TRALI

Question 13

Pt develops delayed onset jaundice, anaemia and haemogloburia

Answer 13

Delayed haemolytic transfusion reaction

Other antibody reactions other than ABO, such as anti-D would cause this

Question 14

Pt has been given lots of transfusions

Answer 14

Iron overload

Need to chelate to prevent damage

Question 15

Special considerations to make

female of child bearing age

Answer 15

k neg

anti-k can cause haemylotic disease of newborn

Question 16

When is it appropriate to do an indirect antiglobulin technique?

Answer 16

Always, except emergency. Takes 40 minutes - too long.

Will detect any antigen-Ab interaction that there might be between donor and Pt

Question 17

When is it appropriate to do an immediate spin test?

Answer 17

Only in emergency. Basically you mix Pt and donor blood in some saline and see if there’s any reaction. Takes 5 minutes but ABO is the only thing you can check for.

Question 18

SPecial requirements

Babies and pregnant mums

Answer 18

CMV negative

Question 19

Special requirements

Immunosupressed

Answer 19

Irradiated so donor blood has no white cells

Question 20

Special requirements

Hyper allergic people

Answer 20

Washed - so the donor blood is rid of any allergens in the plasma

Question 21

What would be a RBC transfusion indication?

Answer 21

> 30% volume blood loss

Peri-Op/Crit care - Hb<7
Post Chemo - Hb<8

Symptomatic anaemia - breathlessness