Transfusion Practicals

Question 1

What are symptoms of acute transfusion reactions?

Answer 1

Chills
Rigors
Rash
Flushing
Feeling of impending doom
Collapse
loin pain
Respiratory distress

Question 2

What are signs of acute transfusion reactions?

Answer 2

Fever
Tachycardia
Hypotension

Question 3

What should you do when wanting to treat all transfusion reactions?

Answer 3

Stop transfusion
Assess patient using ABCDE - BP, pulse, temp, oxygen sats, clinical examination

Recheck compatibility tag against patient details and inspect pack for evidence of contamination

Document event in medical notes

Question 4

What are differentials of severe acute transfusion reactions?

Answer 4

Acute haemolytic transfusion reaction
Bacterial contamination of blood component
Anaphylaxis

Question 5

What causes acute haemolytic transfusion reaction? What is the most dangerous transfusion?

Answer 5

Question 6

What is the pathophysiology of acute haemolytic reactions?

Answer 6

Question 7

How do we manage acute haemolytic transfusion reaction?

Answer 7

Stop transfusion and return unit to transfusion lab
Supportive measures - oxygen, fluids
Repeat transfusion blood samples
Bloods for FBC, coagulation screen, renal function and measures of haemolysis, blood cultures

Question 8

What are signs of mild reactions?

Answer 8

Isolated temp rise >38 and rise of 1-2 degrees or rash only

Question 9

How do we manage mild reactions?

Answer 9

Restart transfusion - consider slowing rate
Close monitoring of patient in case condition worsens
Consider paracetamol / antihistamine

No need for SHOT reporting

Question 10

What are causes of mild reactions?

Answer 10

1. Febrile non haemolytic transfusion reaction (consider pre-medication with paracetamol)
2. Mild allergic reaction (rash/itch but normal observations; treat with antihistamines)

Question 11

How do we treat moderate reactions?

Answer 11

Transfusion should be discontinued

Question 12

What are respiratory complications of transfusion reactions?

Answer 12

Transfusion associated circulatory overload (TACO)

Transfusion related acute lung injury (TRALI)

Question 13

What are clinical features of TACO?

Answer 13

Respiratory distress within 6 hours of transfusion
Raised BP
Raised JVP
Positive fluid balance

Question 14

What are risk factors for TACO?

Answer 14

Elderly
Cardiac failure
Low albumin
Renal impairment
Fluid overload

Question 15

How do we manage TACO?

Answer 15

Oxygen + supportive care
Diuretics
Consider slowing rate of further transfusions; consider diuretics with future transfusion

Question 16

What are delayed haemolytic transfusion reactions?

Answer 16

Patients mount delayed immune response to red cell antigen - usually IgG (positive DAT)

Extravascular haemolysis 5-10 days post transfusion

Transfused cells destroyed - Hb may drop, raised bilirubin, LDH