transfusion Flashcards
what electrolyte abnormality ca you get with blood transfusions
hyperkalaemia (risk is higher when receiving multiple units)
also get hypocalcaemia due to citrate in. blood products which chelates it
what are the components of cryoprecipitate
FIBRINOGEN, factor VIII, vWF
what are the uses for cryoprecipitate
DIC, liver disease, major haemorrhage, bleeding related to haemophilia A
storage of cryoprecipitate
same as FFP
what is the use of prothrombin complex
it is used in the emergency reversal of anticoagulation in patients with fatal bleeding like intracranial haemorrhage or vatical bleed
what must prothrombin complex be administered with
IV vit K (as prothrombin has a short half life and will wear off after 6 hours, which is when vit K starts to work)
what is the universal donor of FFP
AB
what is the storage of FFP
has to be stored at -18. has a one year shelf life and needs 45 mins to thaw
what level of platelets do you transfuse at if someone has clinically significant bleeding
<30 x 10(9)
if there is no active bleeding, at what level do you transfuse platelets
10x10(9)
2 conditions where you would not transfuse platelets
thrombotic thrombocytopenia purport and chronic bone marrow failure
shelf life of platelets
5 days
when is a pregnant mum tested for her rhesus status
at booking appointment
if a mum is rh -, when is anti D given in pregnancy
there are two regimes - one dose at 28 weeks or two doses, one at 28 weeks and one at 34 (if there is a sensitising event - do kleihauer test and then give anti D)
how long does it take blood to be crossmatched in an emergency situation
45 mins
what is electronic issue and when is it appropriate
when blood is issues without a crossmatch. It is appropriate only if antibody negative and if patients current blood group matches the one on the system.
what kind of antibody causes ABO incompatibility reaction
IgM (hence why it cannot cross the placenta)
when are observations done in a blood transfusion
at the start of a transfusion, within 15 mins and then on completion
who needs CMV neg blood
pregnant women and neonates up to 28 days
how does a TAGVHD present
10 days post transfusion, rash, fever, diarrhoea
what happens in TAGVHD (why certain people need irradiated blood products)
the donor cells can engrafted into the host as they cannot be recognised as non self and then they react to the host
4 alternatives to transfusion
intraoperative cell salvage, iron transfusion, EPO, tranexamic acid
how long should blood products be traceable for
30 years
Storage of red blood cells
-stored at 4 degrees and transfusion needs to be started within 30 minutes of removal from fridge
-usually transferred over 90-120 minutes
-shelf life 35 days from collection
-can be stored in a blood bank validated cooler for 6 hours
-in practise should use one unit and then recheck Hb
what is the limit for platelets in surgery
<50 x 10(9)
what is the coagulopathy you get in liver disease
reduced production of platelets, fibrinogen and clotting factors
what is the coagulopathy you get in ESRF
get high uraemia which promotes platelet abnormalities (increased bleeding time)
what is a major haemorrhage defined as
loss of more than one blood volume in 24 hours, 50% of total blood volume lost in 3 hours, bleeding in excess of 150ml/min but in practise its based on signs : systolic < 90 and HR > 110
what do blood bank prepare when major haemorrhage protocol is activate
2FBC,2FFP, 1 platelet
what is the lethal triad in major haemorrhage
hypothermia, acidosis and coagulopathy
what is TIBC like in an iron deficiency anaemia
high
when might ferritin be falsely elevated in an iron deficienecy anaemia
it is an acute phase protein so may be elevated in inflammatory conditions
how often do you need the pneumococcal vaccine in hyposplenism
5 yearly
how often do you need pneumococcal in diabetes or chronic respiratory
once
contraindications to a platelet transfusion
chronic bone marrow failure, heparin induced thrombocytopenia, autoimmune thrombocytopenia
what causes febrile reactions
due to white blood cell HLA antibodies, normally from previous sensitisation in pregnancy
