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1
Q

When can a blood sample taken be used for transfusion (time limit)

A

Within three months unless pregnant or recent transfusion in which case within 3 days

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2
Q

How long on leaving a fridge can blood products be used?

A

Use within 4 hours (finished in this time!)

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3
Q

How long are rbc and platelets typically given over?

A

Rbcs - 2-3 hrs

Plat - 30 mins

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4
Q

Do all blood products have to match abo?

A

Sometimes platelets, ffp and cryo dont match

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5
Q

Through what kit should a blood transfusion be given?

A

Specific blood giving set and any size of cannula

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6
Q

When should a blood giving set be replaced?

A

Using a different blood product
After 2 units or 8 hours
If blocked

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7
Q

When should blood be warmed? What shouldnt ever be done to warm blood?

A

If transfusing fast, during exchange transfusion or during operation
Should not use a radiator or non blood specific fluid warmer etc as will cause haemolysis

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8
Q

When should monitoring occur during blood transfusion? What should be checked

A 
Prior to collecting
After 15 mins
After 1 hour 
On completion 
Temp, resps, pulse, bp
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9
Q

What is a proportionate response to a patient on blood transfusion who develops a fever of 38.5 and a mild rash?

A

Initially stop then once assessed:
Slow transfusion rate
Administer paracetamol and antihistamine

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10
Q

Acute complications of a blood transfusion

A 
Haemolytic transfusion reaction
Febrile non haemolytic transfusion reaction
Sepsis 
Allergy
Transfusion related acute lung injury 
Fluid overload
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11
Q

Long term complications of blood transfusion

A

Iron overload
Infection
Graft vs host
Delayed haemolytic transfusion reaction

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12
Q

Cause of febrile non haemolytic transfusion reaction? Tx?

A

Cytokines in blood

Paracetamol

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13
Q

Cause of transfusion related acute lung injury

A

Antibodies in donor blood attacking host lymphocytes

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14
Q

Cause of graft vs host in blood transfusion. How to stop?

A

Donor t lymphocytes in blood attacking host

Use irradiated blood in at risk popn (certain immunmodeficient states)

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15
Q

At what hb should transfusion be considered in
Asymptomatic
Symptomatic
Haematological malignancy

A

70
90
100

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16
Q

When should transfusion be considered in acute blood loss?

A

Stage 3 shock

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17
Q

How long would it take a lab to group blood in an emergency? Crossmatch?

A

20mins

45mins

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18
Q

When can rhd+ blood be used in rhd- patients

A

In an emergency with males >16 and females >50

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19
Q

At what point would someone start to get spontanious serious bleeding with low platelets?

A

Under 10

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20
Q

Contraindications to platelet transfusion?

A

TTP

HIP

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21
Q

What level should you aim for platelets to be for major surgery? What about lumbar puncture or liver biopsy

A

100

50

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22
Q

When should platelets be considered in massive transfusion?

A

If 2x blood volume transfused likely platelets will drop

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23
Q

Are platelets useful in itp? What can be used?

A

Not usually but can give

Use steroids and or ivig

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24
Q

Roughly how much will one dose of platelets raise platelets by ?

A

20-40

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25
Indications for ffp
Multifactor deficiencies with bleeding eg DIC | Emergency Warfarin reversal with beriplex contraindicated
26
Indications for cryoprecipitate
Fibrinogen
27
Indications for major haemorrhage protocol activation
=\> 4 units given in one hour and expected to continue at this rate Bleeding rate >150ml/min 50% blood lost in 3 hrs Haemorrhagic shock with bp
28
Difference between g+s and crossmatch
G+s looks at blood grouping | Crossmatch tests donors blood agains recipients preparing for donaton
29
What neutrophil count triggers neutropenic sepsis pathway activation. What else is needed?
Neutrophils
30
Causes of neutropenic sepsis
``` Chemo - 5-10 days post Extensive radio Haematological neutropenia Drugs Infections Autoimmune Hereditory. ```
31
Common agents in neutropenic sepsis
80% unknown, but often commensal eg. Staph aureus or strep
32
What should be examined during a neutropenic sepsis exam
Systems Lines Mouth Wounds/surgical sites
33
What should be investigated in a case of neutropenic sepsis
Blood cultures - central, peripheral Urine cultures Swabs - lines, wounds Imaging - consider cxr, axr, ct
34
Appropriate abx for neutropenic sepsis
Tazocin, meropenem, ciprofloxacin
35
Management other than abx for neutropenic sepsis
Fluids Catheter Consider gcsf
36
What percentage of spinal cord compression is a first presentation of cancer?
20%
37
Commonest cancer causes of spinal cord compression
``` Breast Lung Prostate Kidney Haem ```
38
Quality of pain in metastatic spinal cord compression
Severe progressive nocturnal and band like | Associated with neuro deficite
39
Investigation in metastatic spinal cord compression
Whole spine MRI | - whole as there are usually multiple areas involved
40
Emergency treatment for metastatic spinal cord compression
16mg dexamethasone stat then 8mg BD WITH PPI!!! Immobilise
41
Long term management of metastatic spinal cord compression
Radiotherapy Chemo Surgery
42
What can causes superior vena cava obstruction?
Extrinsic - lung tumour, mediasteinal lymphadenopathy, aneurysm, goitre Intrinsic - thrombus, tumour, indwelling catheter
43
Presentation of superior vena cava obstruction
``` Swollen head/neck Distended veins SOB Headache Lethargy Injected conjunctiva ```
44
Investigations in superior vena cava obstruction
CXR Contrast CT chest Angiography
45
Treatment of superior vena cava obstruction
``` Consider steroids (though poor evidence) Chemotherapy Radiotherapy Stent Anticoagulation ```
46
Malignant causes of hypercalcaemia
PTHrP Calcitrol production Lytic bony disease
47
Presentation of malignant hypercalcaemia
``` Nausea Anorexia Polydispia polyurea Constipation Confusion Drowsyness ```
48
Required investigations in suspected malignant hypercalcaemia
Calcium, albumin, phosphate PTH PTHrP Malignancy screen
49
Treatment of malignant hypercalcaemia (inc specific drug)
Fluids Pamidronate Calcitonin or steroids rarely
50
Cancers that lead to high risk of tumour lysis syndrome
``` High grade lymphoma Acute leukaemia Myeloma Small cell lung Inflammatory breast ```
51
Factors released in tumour lysis syndrome
Uric acid Phosphate Potassium
52
Comlications of tumour lysis syndrome
AKI | Electrolyte imbalance
53
Patients at risk from complications of tumour lysis syndrome
Preexisting renal damage Hypovolaemia Urinary tract obstruction High pretreatment LDH
54
How to decrease risk of tumour lysis syndrome
Prehydration Allopurinol Rasburicase
55
Complications of leukostasis
``` Blurred vision Tia/cva Headache Dysponea Priapism ```
56
Treatement of leukostasis
Leukopheresis
57
What tissues are likely to show up on a pet scan? What could be missed?
Kidneys, heart | Aggressive tumours only, indolent tumours have a slow metabolic rate!
58
Advantage of single agent chemo
Convenience | Tollerence
59
Advantage of multi agent chemo
Efficacy Decreased resistance Decreased toxicity
60
Causes of chemo resistance
Decreased drug uptake Increased drug efflux Altered target Catabolism
61
Side effects of chemo
``` Myelosuppression Mucositis Gastritis Diarrheoa N+V+D Alopecia AKI Infertility Peripheral neuropathy Teratogenic Tumour lysis Pulmonary fibrosis Allergy Lethargy Dvt Gout ```
62
What infections are people on chemo at particular risk of?
Oral thrush Aspergillioma Hepatic candidia
63
Three catagories of novel agent in cancer treatment and examples with use
Signal transduction pathway inhibitors - imatinib - CML by inhibition of BCR:ABL Monoclonal antibodies - rituximab - lymphoma by binding CD20 on Bcells Immunotherapy - BCG - bladder cancer by provoking immune reaction
64
How can hair loss from cancer be reduced?
Cold capping
65
What anaemia is most common in chemo patients? When may the other types be seen?
Normocytic Micro with blood loss or poor nutrition Macro with agents that inhibit dna synthesis

FPE (11 decks)

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