Transfusion reactions

Question 1

what are contraindications to a platelet transfusion?

Answer 1

heparin-induced thrombocytopenia

thrombotic thrombocytopenic purpura

chronic bone marrow failure

autoimmune thrombocytopenia

Question 2

at what platelet count would you consider a platelet transfusion in a patient who isn’t actively bleeding or awaiting surgery?

Answer 2

< 10 x10(9)

Question 3

at what platelet count would you consider a platelet transfusion in a patient with grade 2 bleeding?

Answer 3

platelet < 30 x 10(9)

Question 4

at what platelet count would you consider a platelet transfusion in a patient who had grade 3 bleeding or bleeding into a critical site i.e. CNS?

Answer 4

platelet < 100 x 10(9)

Question 5

at what platelet count would you consider prophylactic platelet transfusion in a patient before surgery?

Answer 5

< 50 x 10(9)
50-75 x 10(9) in high risk
< 100 x 10(9) if surgery at critical site

Question 6

apart from transfusion reactions, what other complications can occur with blood transfusions?

Answer 6

hyperkalaemia
iron overload
ARDS
clotting 
fever

Question 7

what is a risk factor for anaphylaxic transfusion reaction?

Answer 7

IgA deficiency

donor forms antibodies against the host IgA which triggers an immune response

Question 8

what is the cause of an acute haemolytic transfusion reaction?
how would you manage this?

Answer 8

ABO incompatibility
human error

stop transfusion
confirm diagnosis with direct coombs test and checking identification of patient and blood products

Question 9

hypertension is associated with what transfusion reaction?

Answer 9

TACO

Question 10

what puts a patient at risk of TACO?

Answer 10

co-existing heart failure

rapid rate of transfusion

Question 11

patient has a fever, abdominal pain and hypotension shortly following a blood transfusion.
what is the diagnosis?

Answer 11

acute haemolytic reaction due to ABO incompatibility

Question 12

patient presents with fever, hypotension and hypoxia shortly following a blood transfusion.
what is the diagnosis?

Answer 12

TRALI

Question 13

what is the pathophysiology of TRALI?

Answer 13

activation of host neutrophils by substances in donors blood
causes increased vascular permeability resulting in non-cardiogenic pulmonary oedema

Question 14

increased risk of bacterial infection is highest with what type of transfusion and why?

Answer 14

platelet transfusion as they are stored at room temperature

perfect environment for colonisation of bacteria