Transfusion

Question 1

Major haemorrhage

Answer 1

50% blood loss within 3 hours or at a rate >150ml/minute.

Question 2

Consider cryoprecipitate if

Answer 2

clinically significant bleeding and
a fibrinogen level below 1.5 g/litre.
Replaces fibrinogen and makes clotting stable.
prophylactically is fibrinogen <1.5g/L

Question 3

Prothrombin complex concentrate

Answer 3

Replaces vitamin k dependent factors II, VII (7), IX(9) , X (10), given with vitamin K

dose is drug, INR and bodyweight dependent

Question 4

Platelets

Answer 4

Does not have to be ABO compatible
Offer platelet transfusions to patients with thrombocytopenia who have clinically significant bleeding (grade 2) and a platelet count below 30×109 per litre

Question 5

Fresh frozen plasma

Answer 5

Generally contains all factors however in low concentrations.
15ml/kg

Uses:
liver failure ( difficulty making factors)
Malnutrition ( difficulty making factors)
Trauma (loss of clotting factors)
derangement in coagulation eg prothrombin time ratio or activated partial thromboplastin time ratio above 1.5

Question 6

RBC transfusion indications

Answer 6

only indicated in those with a haemoglobin 70 or less g/L (or <80g/L in those with acute coronary syndrome)

Question 7

Post transfusion target for most patients

Answer 7

70-90g/L

Question 8

Post transfusion target for ACS patient

Answer 8

80-100g/L

Question 9

Potential signs/symptoms of transfusion reaction

Answer 9

Fever/chills/rigors
Tachycardia
Respiratory distress
Hyper/hypotension
Syncope
Nausea/General malaise
Flushing/urticaria
Pain:chest/abdominal/muscles

Question 10

Acute transfusion reactions

Answer 10

Allergic
Febrile non-hemolytic
Septic
Acute hemolytic
Transfusion-associated circulatory overload (TACO)
Transfusion-related acute lung injury (TRALI)

Question 11

Allergic

Answer 11

Attributed to hypersensitivity to a foreign protein in the donor product.
Presentation ranges from urticaria to angioedema and anaphylaxis.
Mx: stop the transfusion, give saline,antihistamines (such as diphenhydramine), and Adrenaline (if anaphylactic).

Question 12

Febrile non-hemolytic

reaction

Answer 12

Thought to be caused by cytokines released from blood donor leukocytes (white blood cells)
Presents with fever, rigors/chills, but patients are otherwise well.
Mx: slow the transfusion, give Paracetamol.

Question 13

Acute hemolytic transfusion reactions

Answer 13

Caused by giving an incompatible blood bag to a patient. Immune-mediated reactions are often a result of recipient antibodies present to blood donor antigens.
Early signs include fever, hypotension, and anxiety. Late complications include generalised bleeding secondary to disseminated intravascular coagulation (DIC).
Non-immune reactions are possible, and occur when red blood cells are damaged before transfusion (e.g., by heat or incorrect osmotic conditions).
Mx: stop the transfusion, give saline, treat DIC.

Question 14

Transfusion-associated circulatory overload (TACO)

Answer 14

Occurs when the volume of the transfused component causes hypervolemia (volume overload).
Presents with fluid overload.
Mx: slow transfusion, Furosemide.

Question 15

Transfusion-related acute lung injury TRALI

Answer 15

Acute lung injury is due to antibodies in the donor product (human leukocyte antigen or human neutrophil antigen) reacting with antigens in the recipient. The recipient’s immune system responds and causes the release of mediators that lead to pulmonary edema. Presents with pulmonary oedema and can cause acute respiratory distress syndrome (ARDS).
Mx: stop transfusion, give saline, treat ARDS.

Question 16

Late transfusion complications

Answer 16

Delayed haemolytic transfusion reaction
Transfusion-associated graft-versus-host disease

Question 17

Delayed haemolytic transfusion reaction (features)

Answer 17

Caused by an exaggerated response to a foreign antigen the patient has been exposed to before.
Patients present with jaundice, anaemia, and fever, usually day 5 post-transfusion.

Question 18

Transfusion-associated graft-versus-host disease

Answer 18

Caused by donor blood lymphocytes attacking the recipient’s body. Rare but high risk of mortality.

Question 19

Other transfusion complications:

Answer 19

hyperkalaemia, iron overload, clotting

Question 20

What to do if transfusion reaction suspected

Answer 20

senior help
transfusion should be immediately stopped
intravenous line should be kept open using appropriate fluids
clerical check should be performed by examining the product bag and confirming the patient’s identification.
patient’s vital signs should be monitored
post-transfusion blood sample should be drawn and sent to the lab
Treatment of specific transfusion reactions is most often supportive

Question 21

rapid reversal of dabigatran

Answer 21

Idarucizumab

Question 22

reversal of apixaban or rivaroxaban

Answer 22

Andexanet alfa