Transfusions

Question 1

What are the different types of blood products?

Answer 1

=> White blood
- Rarely used

=> Red cells

• Used to correct anaemia or blood loss
• I unit (1U) increases Hb by 10-15g/L
• Transfusion threshold 70g/L for when no ACS and 80g/L with ACS

=> Fresh Frozen Plasma -used to correct clotting defects seen in:

• Disseminated Intravascular Coagulation
• Warfarin overdose
• Liver Disease
• Thrombotic Thrombocytopenic Purpura (do not transfuse platelets in this case)

=> Platelets

• Moderate bleeding when platelet count < 30 x 10^9/L
• Severe bleeding when platelet count < 100 x 10^9/L
• If no bleeding, platelet count < 10 x 10^9/L
• DO NOT platelet transfuse in the following conditions:

Chronic Bone Marrow Failure
Autoimmune Thrombocytopenia
Heparin induced Thrombocytopenia
TTP

=> Human Albumin Solution
- Used to replace protein or as a replacement in abdominal paracentesis

Question 2

What are the indications for blood transfusions?

Answer 2

• Active sickle cell crisis
• Acute blood loss > 30% of blood volume
• INR ratio > 1.6
• Emergency reversal of Warfarin
• Major surgery or invasive procedure

Question 3

What are the contraindications of blood transfusions?

Answer 3

• Megaloblastic anaemia

- Iron deficiency anaemia

Question 4

What are the different blood transfusion complications?

Answer 4

• Acute haemolytic reaction
• Febrile non-haemolytic reaction
• Allergy/Anaphylaxis
• Infection
• Transfusion Related Acute Lung Injury (TRALI)
• Transfusion Associated Circulatory Overload (TRACO)
• Others: hyperkalaemia, iron overload, clotting

Question 5

What is Acute Haemolytic Transfusion Reaction?

Answer 5

• Mismatch blood group
• Severe intravascular haemolysis due to IgM red blood cell destruction
• Symptoms begin within minutes: fever, abdominal pain, chest pain, hypotension, agitation

=> Treatment:

• Stop transfusion immediately
• Generous fluid resuscitation
• IV saline

Question 6

What is non-haemolytic febrile reaction?

Answer 6

• Febrile reaction due to white blood cell HLA antibodies

=> Treatment:
- IV/PO Paracetamol

Question 7

What is Allergic/ Anaphylaxis reaction?

Answer 7

• Symptoms starts within minutes, ranging from urticaria to complete anaphylaxis

=> Treatment:

• Simple urticaria is treated by temporarily stopping the transfusion and giving anti-histamine
• More severe anaphylaxis is treated by permanently stopping transfusion, IM Adrenaline, corticosteroids and bronchodilators

Question 8

What is TRALI?

Answer 8

• Rare but severe form of blood transfusion complication that develops within 6 hours, and is characterised by hypoxia and ARDS

Question 9

What is TACO?

Answer 9

• Common, presents as pulmonary oedema

Question 10

What is the infective complication of blood transfusion?

Answer 10

• vCJD

- All donation should remove white blood cells and FFP should be used for children