Transfusion Medicine

Question 1

Indication for platelet transfusion

Answer 1

5 day shelf life

• Thrombocytopaenia (prior to surgery)
• Thrombo plus haemorrhage
• Consumptive coagulopathy (DIC, haemorrh)
• Prophylactic transfusion (Bone marrow failure, chemotherapy, radiotherapy)
• Genetic disorder

Question 2

Fresh frozen plasma and cryoprecipitate

Answer 2

• Contains all coagulation factors

Cryoprecipitate can be produced from this and is rich in FVIII, XIII, fibrinogen and vWF (e.g. DIC)

Question 3

Indications for FFP

Answer 3

• Coagulation factor deficiency
• DIC
• Large blood transfusion
• TTP
• Clotting disorder

NOT in: hypovolaemia, plasma exchange, immunodeficiency

Question 4

FVIII use

Answer 4

Haemophilia A and vWF disease

FIX

Question 5

F IX

Answer 5

Contains FIX, X and XI
Haemophilia B
deficiency of X and XI

Question 6

Complications of blood transfusion (Early)

Answer 6

Early and Late

Early complications:

• Incompatible red blood cells (haemolysis)
• white blood cells (pyrexia)
• platelets (purpura)
• plasma (anaphylaxis)
• Fluid overload
• TRALI

Question 7

Immediate haemolytic transfusion reactions

Answer 7

Most often due to ABO incompatibility
Rigors, substernal pain, resltess
Fever, hypotension, bleeding, haemogloinuria, oliguria and jaundice

Question 8

Delayed Haemolytic Transfusion

Answer 8

5-10 days after transfusion
Secondary response-previous transfusion or pregnancy
Minimal signs: pyrexia, jaundice, anaemia and urobilinogenuria

Blood film will show spherocytoksis/reticulocytosis
direct antiglobulin test

Question 9

Incompatible white cells

Answer 9

Febrile reaction
Often in pts with previous transfusions
facial flushing and fever shortly after starting transfusion
Donor and recipient leucocyte reaction causes release of cytokines etc
Respond to slowing transfusion, paracetamol of aspirin

Question 10

Post transfusion purpura

Answer 10

following previous transfusion

Question 11

Plasma reaction

Answer 11

Urticaria results from IgE reaction-often responsive to antihistamine and slowing transfusion

Question 12

TRALI

Answer 12

Donor abs and recipient granulocytes reaction
similar to ARDS
30min-few days
fever, SOB and cough
CXR may show peri-hilar and lower lung field shadowing

Question 13

Late Complications

Answer 13

Infection
Massive transfusion
Citrate
Acidosis
Hypocalcaemia
Hyperkalaemia
Hypothermia
Clotting
Repetitive transfusion