TRANSFUSION

Question 1

Indications for pRBC transfusion in the non-bleeding adult

Answer 1

Hgb < 60: 1-2 U Recommended

Hgb < 70: 1 U appropriate

Hgb < 80: 1 U appropriate in CAD

Hgb < 90: If signs and symptoms of impaired tissue oxygen delivery

Question 2

Indications for pRBC transfusion in the bleeding adult; targets for normal vs. CAD patients

Answer 2

Acute blood loss of 30% blood volume (1500 ml)

Acute Hemorrhage

Unstable trauma with inadequate response to 2 L IVF or 40 ml / kg children

Low risk patient : maintain > 70 while actively bleeding

CAD patient: maintain > 80 while actively bleeding

Question 3

How much will 1 unit pRBC increase Hgb by

Answer 3

250 mL Unit will raise Hgb by
10 g / L

Question 4

What is the risk of large amounts of pRBC transfusion

Answer 4

Dilutional coagulopathy

Question 5

6 complications of blood transfusion

Answer 5

Anaphylaxis
Acute intra-vascular Hemolysis
Febrile non-hemolytic reactions
Mild Allergy
Delayed extravascular hemolytic reaction
Transfusion related acute lung injury (TRALI)
Transfusion Associated Circulatory Overload (TACO)

Infection

Question 6

Transfusion Complication Risk Ratios

Answer 6

Febrile: 1:100
Minor Allergic: 1:100
TACO: 1:700
Delayed Hemolytic: 1:1000
Acute Hemolytic: <1:250,000
TRALI: 1:5000

CMV: Common
HBV: 1:220,000
HCV: 1:1,600,000
HIV: 1:1,800,000
Bacteria:1:500,000

Question 7

Acute Intravascular Hemolytic Reaction: Signs & Symptoms, Management, Workup

Answer 7

S&S:
Fever
Chills
Back Pain
Flushing
Dyspnea
Tachycardia
Shock
Hemoglobinuria

Management:
Immediately stop transfusion
IV hydration to maintain diuresis
+/- diuretics

Workup:
retype and repeat cross match
direct and indirect coombs
CBC
Cr
PT / INR
aPTT
Haptoglobin
LDH
Urine (for hemoglobin)

Question 8

Allergic reaction: Clinical features, Management, Evaluation

Answer 8

Clinical Features:
Mild: Urticaria
Severe: Dyspnea, bronchospasm, hypotension, tachycardia, shock

Management:
Stop transfusion
Mild: Antihistamine, restart transfusion once symptoms resolve
Severe: Treat as anaphylaxis

Evaluation:
Hemolytic workup for severe

Question 9

TACO: Clincal Features, Management

Answer 9

Clinical Features:
Acute onsute dyspnea
HTN

Management:
Slow transfusion rate
Diuretics
O2
+/- nitrates
+/- PPV

Question 10

Febrile nonhemolytic reaction: Signs & Symptoms, Management, Workup

Answer 10

S&S:
Fever
Chills

Management:
Immediately stop transfusion
Treat fever and chills with acetaminophen

Workup as hemolytic reaction:
retype and repeat cross match
direct and indirect coombs
CBC
Cr
PT / INR
aPTT
Haptoglobin
LDH
Urine (for hemoglobin)

Question 11

Indication for plt transfusion

Answer 11

1 platelet pool for:

<100: peri-neurosurgery, head trauma or CNS bleeding, extreme life threatening injury

<50: significant bleeding, major surgery, lumbar puncture, pre-invasice procedure a/w significant blood loss

<30: therapeutic anti-coagulant that can’t be stopped

<10: Non-immune & immune thrombocytopenia

<100: Antiplatelet agent and CNS bleeding

Question 12

How much does one pool (4 units) of donor platelets raise serum platelet count by?

Answer 12

15-25 x 10>9 / L

Question 13

Indications for plasma transfusion

Answer 13

massive hemorrhage, microvascular bleeding: 2 Units per 4 units pRBC

Significant bleeding and INR > 1.8: 3-5 Units

Question 14

Indications for cryoprecipitate

Answer 14

Extreme life threatening hemorrhage & fibrinogen < 2

Microvascular bleeding & fibrinogen < 1

Question 15

Indications for PCC

Answer 15

urgent reversal of Warfarin and NOACs