Peri-op Care: Blood Transfusions Flashcards
In which situations are packed red cells used?
Substantial haemorrhage
Severe anaemia
What is FFP and in which situations is it used?
Fresh frozen plasma = plasma separated from fresh whole blood and frozen, containing clotting factors
Used to:
- during major haemorrhage
- replace def of coag factors in continued bleeding, e.g. liver disease, DIC, thrombotic thrombocytopenia purpura
In which situations are platelet concentrates used?
Indicated if platelet count <50 x 10^9/L:
- platelet exhaustion during major haemorrhage
- thrombocytopenia
In which situations are cryoprecipitate, fibrinogen and other specific clotting factor concentrates used?
In various coagulation deficiencies, e.g. haemophilia, hypofibrinogenaemia
Which blood groups are the universal donors? The universal receivers?
Universal donors = O-
Universal receivers = AB+
What would you give a patient with <30% blood volume loss?
Requires only crystalloids/colloids
What would you give a patient with 30-40% blood volume loss?
Requires red cell transfusion
What would you give a patient with >40% blood volume loss (>2L)?
Requires rapid volume replacement with crystalloids/colloids + urgent provision of blood and blood products
Define massive blood loss. What is the clinical manifestation of this?
Haemorrhage of 50% blood volume in 3hrs, >1x blood volume in 24hrs or >150ml/min
Leads to a systolic pressure <90mmHg or HR >110bpm
Describe the massive blood loss protocol
- Immediate resuscitation with 4 units RBCs (O-)
- If bleeding continues: further RBCs + FFP
- Platelet concentrates given to maintain levels >100 x 10^9/L
- Repeat coag screens after every 4 units to determine need for other blood products
- If bleeding persists, recombinant activated factor VII occasionally recommended.
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?
FEBRILE NON-HAEMOLYTIC TRANSFUSION REACTION
- Ae: leukocyte incompatibility
- common in multi-transfused or parous women
- Sx subside after stopping transfusion for 15-30min and administering anti-pyretics and anti-histamines
A patient receiving a blood transfusion develops a haemolytic transfusion reaction. Why does it occur?
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
What are the symptoms of a haemolytic transfusion reaction? How would you confirm diagnosis?
Symptoms:
- pyrexia
- 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
How should a haemolytic transfusion reaction be managed?
Transfusion must be halted immediately and patient resuscitated
Oliguria treated by osmotic diuresis, e.g. mannitol +/- loop diuretic
A patient having had a blood transfusion develops an acute and rapid onset SOB and cough. What is the diagnosis? How is this managed?
TRANSFUSION-RELATED ACUTE LUNG INJURY
- donor Abs reacting with Pt’s leucocytes
- especially occurs in transfusion of plasma-containing products
- usually requires intensive care and mechanical ventilation
- typically a ‘white-out’ on CXR
