Haematology Flashcards
What are the risks of blood transfusion?
Incorrect blood given/identification error
Transfusion reaction - mild = fever, rash, chills, severe = TRALI, acute haemolytic transfusion reaction (IgM causes), sepsis, anaphylaxis
Fluid overload
Contract BBV infection
Fe overload
Ab formation eg. Rh -ve
What are the types of blood products that can be given?
Red blood cells - sx anaemia or <70
White blood cells
Platelets - <10 or <20 w bleed, pre op <50
Fresh frozen plasma - used for bleeding in multiple CF def or def where there is no factor conc yet eg. Factor V, massive haem and DIC
Cryoprecipitate - fibrinogen, factor VIII, vWF
CF concentrate - specific CFs - safer than FFP and cryoprecipitate as no contamination
Human albumin solution - burns, pancreatitis, plasma exchange - replace plasma vol loss
Anti D
What is amyloidosis?
Extracellular deposits of abnormal insoluble protein leading to tissue and organ dysfunction, can affect anywhere in the body so CF are v vague - signs of the organ that is failing
What are some common causes of lymphadenopathy?
Reactive - viral infection eg. EBV, HIV, bacterial infection eg. TB
Neoplastic - lymphoma, mets, leukaemia, head and neck cancers
Systemic inflam eg. RA
Drug induced - allopurinol, phenytoin, trimethoprim
What are some causes of splenomegaly?
CML, CLL, HL
Myelofibrosis
Portal HTN (±Hep B and C)
Malaria, EBV, Schistomaniasis, TB
Haemolytic anaemia
Sickle cell (but most have atrophied spleen)
Spherocytosis
Splenic abscess
RA and SLE
What are some causes of hyposplenism?
Splenectomy
Sickle cell
Coeliac disease and dermatitis herpetiformis
SLE
Amyloid
What is the management of hyposplenism?
Vaccinations against encapsulated bacteria
Neisseria meningitidis
Haemophilus influenzae
S. pneumoniae
Flu jab
Abx prophylaxis - penicillin V, amoxicillin or erythromycin
Apart from VTE, whawt else can cause elevated D Dimer?
Pneumonia
Malignancy
HF
Surgery
Pregnancy
What are the ix into VTE?
D dimers but not specific
DVT - doppler US
PE - CTPA
What is the management of VTE?
Apixaban immediately when suspected
Long term - DOAC, warfarin (used if pt has antiphospholipid syndrome) or LMWH (used in pregnancy)
Cont for 3 months (apixaban or rivaroxaban) if reversible cause, beyond 3 months if unclear cause or recurrent, 3-6 months if active cancer
How do you ix unprovoked DVT?
Screen for antiphospholipid syndrome
Hereditary thrombophilias
What are some causes of pancytopenia?
Haem malignancy - ALL, AML, MDS
Meds - esp MTX
Folate and B12 def
Secondary mets to BM
Viral infections, esp in children
Severe sepsis
What are the benefits of blood transfusion?
Improve sx of anaemia
Keep pt out of hospital
Avoid complications of long term anaemia eg. HF
G+S vs crossmatch, how long does it take?
G+S - what the pt blood group is, takes 40 mins
Crossmatch - mix pt serum and donor blood to check its compatible, ask for date and time to get blood ready, takes an extra 40 mins (1 hour 20)
Who need special blood and what are the types?
CMV -ve = neonates, immunosuppressed pt, pregnant women, intrauterine transfusion (blood to babies while inside mums tummy)
Irradiate products - take out excess WBC, reduces the risk of immune reaction eg. host vs graft disease eg. HL
HbS -ve = can’t give to sickle cell pt ?
How is a pt monitored during their transfusion?
Check obs at 0 mins, 15 mins and after
How long will a blood transfusion run for?
Red cells = has to be given <3.5 hours, can run as quickly as possible but normally over ~2 hours
Cryoprecipitate = STAT
Plt = 30 mins
What is non haemolytic febrile reaction?
Fever and chills during blood transfusion, mostly in plt transfusion
How do you manage non haemolytic febrile reactions?
Slow or stop transfusion
Paracetamol
Continue monitoring obs
Minor allergic reaction vs anaphylaxis reaction to blood products
Minor allergic reaction - pruritis and urticaria
Anaphylaxis - hypotension, dyspnoea, wheeze, angioedema, pt have IgA def?
What is the management of allergic and anaphylactic reactions?
Allergic reaction - temporarily stop transfusion, antihistamine, monitor
Anaphylaxis - AtoE, stop transfusion, IM adrenaline 1:1000 500 mcg
What is an acute haemolytic transfusion reaction?
Cause - ABO incompatibility = massive IV haemolysis
Sx - mins after transfusion started = fever, abdo and chest pain, hypotension, agitation
What is the treatment of acute haemolytic transfusion reaction?
STOP TRANSFUSION
IV fluid resus
Inform lab - check ID of patient and blood product, repeat G+S and crossmatch
What is TACO?
Transfusion associated circ overload = transfusion too quick or have HF already
Sx - pulm oedema and HTN
What is the management of TACO?
Slow or stop transfusion
Consider - furosemide? O2?
What is TRALI?
Transfusion related acute lung injury - hypoxia, pulm infiltrates, fever, hypotension
What is the management of TRALI?
Stop transfusion
O2 and supportive care
TACO vs TRALI
TACO = HTN
How can you ensure safety and reduce risk of wrong blood when requesting blood products?
x3 points of ID
Consent pt appropriately
Label bottle at the bedside
Complete transfusion request form at the bedside
What cannula can you give blood products through?
Green - 18G
Grey - 16G
Otherwise mechanical haemolysis = sheering
How much should each blood product one unit increase FBC?
Red cells - +10g/L
Plt - +20-40
What are some general CF of anaemia?
Flow murmur - ejection systolic
Generalised and conjunctival pallor
Tachycardia and tachypnoea
Short term blood transfusion reactions
Haemolytic ABO incompatibility
Non haemolytic febrile reaction
Bacterial contamination
Anaphylaxis
Mild allergic reaction
TACO
TRALI
Long term blood transfusion reactions
Fe overload
BBV infection
Graft vs host disease
