Transfusions Flashcards
What are the indications for packed red cells?
Hb <70g/L
Hb <80g/L if ACS
How quickly is packed red cells transfused?
1 unit over 2 hours
What are the indications for platelet transfusion?
What are the indications for platelet transfusion?
platelet count <30
platelet count <100 if critical bleeding site such as cranial
What are the indications for FFP?
INR >1.5
Prolonged PT
What is cryoprecipitate?
Factors 8, 13, Von-Willebrand and fibrinogen
What are the indications for cryoprecipitate?
Hypofibrinogenemia <1.5g/L
Massive haemorrhage
DIC
Bleeding in liver failure
When is PCC used?
Warfarin associated haemorrhage
What are the benefits of transfusions?
Symptom relief
Prevent long term complications of anaemia eg heart failure
Prevent bleeding
What does irradiated blood mean? When is it indicated?
T-lymphocytes have been removed with irradiation therefore preventing transfusion associated graft vs host reaction
Hodgkins, neonates, immunocompromised (chemotherapy), bone marrow or stem cell transplant
What are the indications for CMV negative blood?
Neonates
Pregnancy
What are some complications of blood transfusions?
Acute haemolytic transfusion reaction Febrile non-haemolytic transfusion reaction TRALI TACO Anaphylaxis Infection Transfusion associated graft vs host
How would febrile non-haemolytic reaction present?
How should it be managed?
Fever and rigors
Slow/stop transfusion + paracetamol
How is a mild allergic reaction to blood products managed vs anaphylaxis?
Mild: slow/ stop transfusion and give antihistamine
Anaphylaxis: stop transfusion and give IM adrenaline
How does acute haemolytic reaction present?
How is it managed?
Within minutes the patient develops:
- Fever
- Hypotension
- Agitation
- Chest or abdo pain
Stop the transfusion
Send the blood for direct coombs testing and resend a patient crossmatch
Fluid resuscitation
How does TACO present?
How is it managed?
Hypertension
Pulmonary oedema: dyspnoea
Raised JVP
Slow transfusion
Furosemide
How does TRALI present?
How is it managed?
Hypotension
Dyspnoea and hypoxia
Fever
O2
What is the process of a blood transfusion?
Collecting initial blood sample from patient - check patient ID, venipuncture, group and save, cross match
Consent patient to receive blood transfusion
Prescribe blood transfusion when blood type known
Check is safe for administration, check patient ID, check blood group and serial number, expiry date
Check for any signs of tampering, leaks, discolouration, clots
Set to be transfused e.g. 2-3 hours in non-emergency
Regular observations for early detection of reactions
What are the types of immediate transfusion reactions?
Occur within 24 hours of transfusion being administered
Immune
Acute haemolytic transfusion reaction - ABO incompatibility
Tranfusion-related acute lung injury (TRALI)
Anaphylaxis
Non-immune
Bacterial infection
Transfusion-associated circulatory overload (TACO)
What are the types of delayed transfusion reactions?
Immune Delayed haemolytic transfusion reaction Febrile non haemolytic transfusion reaction Post transfusion purpura Graft versus host disease
Non immune
Viral infections
Malaria
Prions
What is ABO incompatibility?
Results in acute haemolytic transfusion reaction
Anti A/B antibodies activating complement and triggering release of cytokines
Leads to fever, hypotension, anxiety, red coloured urine
Hypotension, widespread haemorrhage secondary to DIC
What is a TRALI?
Transfusion related acute lung injury
Antibodies to human neutrophil antigens
Human leukocyte antigens
Sudden dyspnoea, hyperaemia, hypotension, fever
Develops within 6 hrs after transfusion
Usually resolves with supportive care 48-96 hours
What is DHTR?
Delayed haemolytic transfusion reaction
Caused by antibodies to antigens e.g. Rhesus or Kidd
Can occur between 3-14 days after the transfusion
Sudden drop in Hb level, fever, jaundice, haemoglobinuria
What is FNHTR?
Febrile non haemolytic transfusion reaction
Fever during transfusion with no associated haemolysis
Antibodies directed against donor leukocytes
Typically develops in patients who have had multiple transfusions, women with multiple previous pregnancies
What causes post transfusion purpura?
Body produces all-antibodies to the introduced platelet’s antigens, these destroy the patient’s platelets leading to thrombocytopenia.
