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Cancer Care > Transfusions > Flashcards

Transfusions Flashcards

1
Q

What are the indications for packed red cells?

A

Hb <70g/L

Hb <80g/L if ACS

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2
Q

How quickly is packed red cells transfused?

A

1 unit over 2 hours

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3
Q

What are the indications for platelet transfusion?

A

What are the indications for platelet transfusion?

platelet count <30
platelet count <100 if critical bleeding site such as cranial

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4
Q

What are the indications for FFP?

A

INR >1.5

Prolonged PT

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5
Q

What is cryoprecipitate?

A

Factors 8, 13, Von-Willebrand and fibrinogen

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6
Q

What are the indications for cryoprecipitate?

A

Hypofibrinogenemia <1.5g/L
Massive haemorrhage
DIC
Bleeding in liver failure

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7
Q

When is PCC used?

A

Warfarin associated haemorrhage

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8
Q

What are the benefits of transfusions?

A

Symptom relief
Prevent long term complications of anaemia eg heart failure
Prevent bleeding

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9
Q

What does irradiated blood mean? When is it indicated?

A

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

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10
Q

What are the indications for CMV negative blood?

A

Neonates

Pregnancy

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11
Q

What are some complications of blood transfusions?

A 
Acute haemolytic transfusion reaction 
Febrile non-haemolytic transfusion reaction 
TRALI
TACO
Anaphylaxis 
Infection 
Transfusion associated graft vs host
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12
Q

How would febrile non-haemolytic reaction present?

How should it be managed?

A

Fever and rigors

Slow/stop transfusion + paracetamol

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13
Q

How is a mild allergic reaction to blood products managed vs anaphylaxis?

A

Mild: slow/ stop transfusion and give antihistamine

Anaphylaxis: stop transfusion and give IM adrenaline

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14
Q

How does acute haemolytic reaction present?

How is it managed?

A

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

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15
Q

How does TACO present?

How is it managed?

A

Hypertension
Pulmonary oedema: dyspnoea
Raised JVP

Slow transfusion
Furosemide

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16
Q

How does TRALI present?

How is it managed?

A

Hypotension
Dyspnoea and hypoxia
Fever

O2

17
Q

What is the process of a blood transfusion?

A

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

18
Q

What are the types of immediate transfusion reactions?

A

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)

19
Q

What are the types of delayed transfusion reactions?

A 
Immune
Delayed haemolytic transfusion reaction
Febrile non haemolytic transfusion reaction
Post transfusion purpura
Graft versus host disease

Non immune
Viral infections
Malaria
Prions

20
Q

What is ABO incompatibility?

A

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

21
Q

What is a TRALI?

A

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

22
Q

What is DHTR?

A

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

23
Q

What is FNHTR?

A

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

24
Q

What causes post transfusion purpura?

A

Body produces all-antibodies to the introduced platelet’s antigens, these destroy the patient’s platelets leading to thrombocytopenia.

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