Peri-op Care: Blood Transfusions Flashcards

1
Q

In which situations are packed red cells used?

A

Most common transfusion product:

  • substantial haemorrhage
  • severe anaemia
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2
Q

What is FFP and in which situations is it used?

A

Fresh frozen plasma = plasma separated from fresh whole blood and frozen, containing near normal amounts of clotting factors and other plasma proteins.

Used to:

  • replaced clotting factors exhausted during major haemorrhage
  • replace deficiencies of coagulation factors in continued bleeding when necessary factors are unavailable, e.g. liver disease, DIC, thrombotic thrombocytopenia purpura
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3
Q

In which situations are platelet concentrates used?

A

Indicated if platelet count <50 x 10^9/L:

  • platelet exhaustion during major haemorrhage
  • thrombocytopenia (avoid in ITP exp. if life-threatening haemorrhage)
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4
Q

In which situations are cryoprecipitate, fibrinogen and other specific clotting factor concentrates used?

A

In various coagulation deficiencies, e.g. haemophilia, hypofibrinogenaemia

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5
Q

Which blood groups are the universal donors? The universal receivers?

A

Universal donors = O-

Universal receivers = AB+

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6
Q

What would you give a patient with <30% blood volume loss?

A

Requires only crystalloids/colloids (exc. in pre-existing anaemia)

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7
Q

What would you give a patient with 30-40% blood volume loss?

A

Requires red cell transfusion

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8
Q

What would you give a patient with >40% blood volume loss (>2L)?

A

Requires rapid volume replacement with crystalloids/colloids + urgent provision of blood and blood products

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9
Q

Define massive blood loss. What is the clinical manifestation of this?

A

Haemorrhage of 50% blood volume in 3hrs, >1x blood volume in 24hrs or >150ml/min.

Leads to a systolic pressure <90mmHg or HR >110bpm.

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10
Q

Describe the massive blood loss protocol.

A
  1. Immediate resuscitation with 4units RBCs (O- blood if blood group unknown).
  2. If bleeding continues, further RBCs should be given with FFP to prevent coagulopathy.
  3. Platelet concentrates given to maintain levels >100 x 10^9/L.
  4. Repeat coagulation screens after every 4 units to determine need for other blood products.
  5. If bleeding persists, recombinant activated factor VII occasionally recommended.
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11
Q

A patient who has received a blood transfusion immediately has a temp rise >1 degree and starts shivering. What is the likely diagnosis? How would you manage?

A

Febrile non-haemolytic transfusion reaction

  • usually caused by leukocyte incompatibility
  • more common in multi-transfused or parous women
  • symptoms usually subside after stopping transfusion for 15-30min and administering anti-pyretics and anti-histamines
  • rarely life-threatening and rare since universal leucodepletion of blood products
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12
Q

A patient receiving a blood transfusion develops a haemolytic transfusion reaction. Why does it occur?

A

Occurs due to: blood group incompatibility (mostly due to human error). If major ABO incompatibility, massive haemolysis may be fatal. Incompatibility of minor determinants causes lesser degree of haemolysis.

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13
Q

What are the symptoms of a haemolytic transfusion reaction? How would you confirm diagnosis?

A

Symptoms:

  • rapidly developing pyrexia at transfusion onset
  • dyspnoea and constrictive feeling in chest
  • intense headache
  • hypotension
  • severe loin pain and acute oliguric renal failure with haemoglobinuria (obstruction of tubules with haemoglobin causing ATN)
  • jaundice (hrs-days later)
  • DIC with spontaneous bruising and haemorrhage

Diagnosis confirmed by blood test:

  • hyperbilirubinaemia
  • positive Coomb’s test
  • new antibody
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14
Q

How should a haemolytic transfusion reaction be managed?

A

Transfusion must be halted immediately and patient resuscitated.

Oliguria treated by osmotic diuresis, e.g. mannitol +/- loop diuretic.

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15
Q

A patient having had a blood transfusion develops an acute and rapid onset SOB and cough. What is the diagnosis? How is this managed?

A

TRANSFUSION-RELATED ACUTE LUNG INJURY

  • caused by donor antibodies reacting with Pt’s leucocytes, especially occurs in transfusion of plasma-containing products (implicated donors usually multifarious women so FFP now sourced almost entirely from male donors)
  • usually requires intensive care and mechanical ventilation
  • typically a ‘white-out’ on CXR
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16
Q

1 week after a blood transfusion, a patient develops thrombocytopenia and bleeding. What is the diagnosis? How is this managed?

A

POST-TRANSFUSION PURPURA

  • caused by platelet-specific alloantibodies, potentially fatal (rare)
  • most common in women
  • treated with high dose IV immunoglobulins (favourable resp in 85%)