Transfusions Flashcards
When does only 1 group and save need to be taken instead of 2?
If the patient has been already screened in the past
What are some pre-transfusion tests?
Group and save
- determines ABO and RhD
Blood/blood product issue
DAT (aka Coombs test) - AIHA
- Tests for haemolytic antibodies
Rh/K phenotyping
- Determines the type of antigens on RBC’s
Kleihauer - HDFN
- detects foetal cells, which contain HbF, in the maternal blood. If there was a maternal-foetal haemorrhage, then the mother and she will need anti-D prophylaxis before transfusion
How are atypical antibodies aquired?
Arise due to sensitisation with foreign red cell antigens caused either by previous blood transfusion or by pregnancy
What % of the population are RhD positive?
85%
When may RhD- people develop RhD+ antibodies?
When they get pregnant with a RhD+ baby or have a transfusion with RhD+ blood
What are some side effects of unnecessary blood transfusions?
- Increased rates of infection
- Increased length of hospital stay
- Complications associated with increased morbidity and mortality
What are the 3 pillars of patient blood management (PBM)?
- Optimise red cells: treating the cause of the anaemia and treating that
- Minimise blood loss
- Optimise anaemia tolerance: you treat the patient and not their blood test results
What is the infusion rate of red cells?
1.5 to 4 hours
What is the threshold for a blood transfusion?
General: 70
Acute coronary syndrome (ACS): 80
How do you know how much blood to give?
Adult with symptomatic anaemia: single unit transfusion and then test HB again
Child/ low body weight: calculated equivalent to volume
What is the infusion rate of platelets?
30-60min
1 pool raises count by 20-40g/L
What are the indications for transfusing platelets?
- Prevention/ treatment of bleeding
- Reversible bone marrow failure (Plt <10 x 109 /L)
- Sepsis/haemostatic abnormality/other bleeding risk factor (Plt <10-20 x 109 /L)
- Prior to invasive procedure/surgery
- Central venous line (Plt ≤20 x 109/L)
- Lumbar puncture/spinal anaesthesia (Plt ≤40 x 109/L)
- Liver biopsy/major surgery (Plt ≤50 x 109/L)
- Epidural anaesthesia (Plt ≤80 x 109/L)
- Critical site surgery e.g. CNS/Eye (Plt ≤100 x 109/L)
-Therapeutic use to treat bleeding
What are the contraindications for platelet transfusion?
Patients with thrombotic microangiopathies
Eg. haemolytic uraemic syndrome
What are the indications for FFP?
Treat coagulopathy in bleeding patient
What is the dose of FFP?
By weight
What are the indications for FFP?
- Major haemorrhage
- DIC & bleeding
- PT/INR >1.5 with bleeding
- Factor deficiency
- Liver disease
- Plasma exchange/TTP
What are the contraindications for FFP?
- Warfarin Reversal
- Non-bleeding patient with abnormal coagulation tests
- PT/INR between 1·5–1·9 (limited FFP impact)
- Prolonged PT likely to be due to acquired vitamin K deficiency
What is Cryoprecipitate?
Contains clotting proteins
What is the indication for cryoprecipitate?
Bleeding associated with hypofibrinogenaemia (<1g/L)
What is Fibryga?
Fibrinogen concentrate used for congenital/acquired fibrinogen deficiency
- Issued as part of major haemorrhage protocol
What is Nvoseven?
A preparation of factor VII
Used to treat deficiency caused by Alexander’s disease
What is octaplex?
Used for reversal of Warfarin
What is Praxbind used for?
Reversal of Dabigatran
What is Andexanet Alfa?
Reversal of apixaban or rivaroxaban if uncontrolled/life-threatening bleeding
What is Advate (FVIII) used for?
haemophilia A
What is Benefix (Factor IX) used for?
haemophilia B
What is Feiba (Factor VIII inhibitor) used for?
haemophilia A & B
What is Voncento (Factor VIII) used for?
Factor XI deficiency (rare)
What is Transfusion Associated Circulatory Overload (TACO)?
- Acute/worsening respiratory compromise
- Acute/worsening pulmonary oedema
- Evidence of positive fluid balance
- Tachycardia
- Increased blood pressure
What is irradiation?
Prevents the white cells in the blood to replicate to prevent graft vs host disease
Who needs irradiated blood products?
- Hodgkin’s Lymphoma (life-long)
- When taking purine analogues e.g. Bendamustine, Fludarabine
- ATG/Alemtuzumab
- Bone marrow transplant
- HLA matched components
- All granulocyte transfusions
- IUT /Neonatal exchange transfusions
- T-cell immunodeficiency
Who requires a cytomegalovirus (CMV) negative blood products?
- In pregnancy
- Intra-uterine transfusion (IUT)
- Neonates up to 28 days post expected date of delivery
What are some complications of transfusions?
Acute:
- Haemolytic – ABO incompatible
- Febrile
- Allergic
- Gram negative bacteraemia
Delayed:
- Delayed haemolytic reactions
- Graft vs host disease
- Transfusion transmitted infections
- Iron overload
TACO: Transfusion-associated circulatory overload
TRALI: Transfusion-related acute lung injury
What type of emergency blood is given to different people?
Childbearing potential under 50 years of age must receive O- blood
All under 18 years of age should receive O- blood
Non-childbearing potential over 18 years of age should receive O+ blood
What is the rotem test?
A method developed to monitor the clotting process
It is performed near the patient during surgery and can help differentiate between surgical bleeding and a clotting disorder
What is the treatment for a blood transfusion reaction?
If severe, transfusion needs to be stopped
But antihistamines can be given for mild reactions
When would FFP be used over platelets in major bleeds?
Depends on the persons INR as that tell you how many clotting factors their blood contains
With a high INR, the person needs FFP and the clotting factors within it, if INR is fine then platelets work
The more someone bleeds, the more clotting factors they use up, so longer bleeds will typically need FFP
What is ABO incompatibility?
ABO incompatibility results in anti-A/B antibodies activating the complement pathway and triggering the release of inflammatory cytokines.
Early clinical features:
Fever, hypotension, anxiety and red-coloured urine
Late clinical features:
Hypotension and widespread haemorrhage secondary to disseminated intravascular coagulation
What is Transfusion-related acute lung injury (TRALI)?
Pathophysiology is not understood
Typical presentation:
Sudden development of dyspnoea, severe hypoxaemia, hypotension and fever that develop within 6 hours after transfusion and usually resolve with supportive care within 48 to 96 hours
What are the presentations of anaphylaxis following a transfusion?
Occurs when the recipient is allergic to protein components present in the donor transfusion
Features:
Itchy rash, angioedema, shortness of breath, vomiting, light-headedness, and hypotension.
Anaphylaxis typically develops over minutes to hours and can quickly become life-threatening
What is delayed haemolytic transfusion reaction (DHTR)?
Delayed haemolytic reactions are caused by antibodies to antigens such as Rhesus or Kidd
Occurs between 3 to 14 days after the transfusion.
Features:
A sudden drop in haemoglobin level, fever, jaundice and haemoglobinuria
What are Kidd antigens?
They are present of the blood cells of most people and are responsible for delayed haemolytic transfusion reactions
What is Febrile non-haemolytic transfusion reaction (FNHTR)?
A fever during blood transfusion with no associated haemolysis
Caused by antibodies directed against donor leukocytes and HLA antigens
This is in contrast to transfusion-associated acute lung injury, in which the donor plasma has antibodies directed against the recipient HLA antigens, mediating the characteristic lung damage.
Develops in patients who have received multiple transfusions or in women who have had multiple previous pregnancies
What is Post-transfusion purpura (PTP)?
When the body produces alloantibodies to the introduced platelets’ antigens.
These alloantibodies destroy the patient’s platelets leading to thrombocytopenia.
Presents 5–12 days after transfusion
What is Graft versus host disease (GvHD)?
Immune cells (white blood cells) in the donated tissue (the graft) recognize the recipient (the host) as foreign (nonself). The transplanted immune cells then attack the host’s cells.
GvHD can occur after a blood transfusion if the blood products used have not been irradiated or treated with an approved pathogen reduction system
