24 Questions
What is a complication of packed red cell transfusions that becomes more likely with increasing transfusion volume?
Clotting Abnormalities
Why is it necessary to administer fresh frozen plasma and platelets concurrently with packed red cells?
To prevent clotting abnormalities
What is a cause of hypocalcaemia in blood transfusions?
Chelation of calcium by a calcium-binding agent
What is a consequence of transfusing blood products that are not at body temperature?
Hypothermia
What is a potential complication of trauma that can occur independently of blood transfusion?
Trauma-induced coagulopathy
What is the typical threshold for administering fresh frozen plasma and platelets concurrently with packed red cells?
4 units of RBCs
What is a consequence of partial haemolysis of red blood cells during transfusion?
Hyperkalaemia
Why is it necessary to monitor core body temperature during blood product transfusion?
To monitor for hypothermia
What is the most common cause of acute haemolytic reaction?
ABO blood group incompatibility
What is the typical presentation of a patient with acute haemolytic reaction?
Urticaria, hypotension, and fever
What is the primary goal of initial management in a patient with suspected acute haemolytic reaction?
Stopping the transfusion and supportive measures
What is the diagnosis of Transfusion Associated Circulatory Overload (TACO) typically confirmed by?
Urgent chest radiograph
What is the primary treatment for Transfusion Associated Circulatory Overload (TACO)?
Oxygen and diuretic therapy
What can be prescribed prophylactically to prevent Transfusion Associated Circulatory Overload (TACO)?
20mg furosemide
What is the term for the destruction of donor red blood cells by the recipient's preformed antibodies?
Haemolysis
What is the term for the transfusion-specific complications that occur soon after the transfusion has been started?
Acute transfusion complications
What type of respiratory distress syndrome is Transfusion Related Acute Lung Injury (TRALI) a form of?
Acute Respiratory Distress Syndrome (ARDS)
What is the treatment for a mild allergic reaction caused by a blood transfusion?
Continue the transfusion and administer an anti-histamine
What is the primary symptom of anaphylaxis in the context of a blood transfusion?
Hypotension
What is the primary concern when a patient exhibits hypotension without anaphylactic symptoms during a blood transfusion?
Infective shock
What is a theoretical risk associated with blood transfusions?
Infection with Hepatitis B, Hepatitis C, HIV, syphilis, malaria, or vCJD
What occurs due to an HLA mismatch between donor and recipient in the context of transfusion medicine?
Graft vs. Host Disease (GvHD)
What is the initial treatment for Transfusion Related Acute Lung Injury (TRALI)?
Start the patient on high-flow oxygen and obtain an urgent chest radiograph
What is characteristic of Non-Haemolytic Febrile Reactions?
Fever, but is usually non-life threatening
Study Notes
Transfusion-Specific Complications
- Can be divided into acute and delayed complications
- Acute complications occur soon after transfusion starts
Acute Transfusion Complications
- Acute Haemolytic Reaction
- Caused by transfusion of incorrect blood type (ABO incompatibility)
- Donor red blood cells are destroyed by recipient's preformed antibodies, resulting in haemolysis
- Presents with urticaria, hypotension, and fever, and may have evidence of haemoglobinuria
- Diagnosis confirmed by reduced Hb, low serum haptoglobin, high LDH and bilirubin, and positive Direct Antiglobulin Test (DAT)
- Treatment: Stop transfusion, begin supportive measures, and seek specialist advice
- Transfusion Associated Circulatory Overload (TACO)
- Presents with dyspnoea and features of fluid overload
- Often a problem in those who are already overloaded, such as those with cardiac failure
- Treatment: Oxygen and diuretic therapy
- Prevention: Prescribe 20mg furosemide prophylactically during transfusion in patients at risk
- Transfusion Related Acute Lung Injury (TRALI)
- Form of Acute Respiratory Distress Syndrome (ARDS)
- Presents with dyspnoea and features of pulmonary oedema
- High mortality rate
- Treatment: High flow oxygen, urgent chest radiograph, and specialist input
- Other Complications
- Mild Allergic Reaction: Pruritus, treated with anti-histamine and close observation
- Non-Haemolytic Febrile Reactions: Unpleasant but non-life threatening, treated with antipyretics and anti-histamines
- Anaphylaxis: Presents with hypotension and anaphylactic symptoms, treated as for anaphylaxis
- Infective/Bacterial Shock: Hypotension without anaphylaxis, treated with basic resuscitation, IV antibiotics, and senior help
Delayed Transfusion Complications
- Infection: Theoretical risk of developing Hepatitis B, Hepatitis C, HIV, syphilis, malaria, or vCJD
- Graft vs. Host Disease (GvHD): Occurs due to HLA-mismatch between donor and recipient
- General Complications
- Clotting Abnormalities: Due to dilution effect, can be reduced by administering fresh frozen plasma and platelets concurrently
- Electrolyte Abnormalities
- Hypocalcaemia: Due to chelation of calcium by preservative
- Hyperkalaemia: Due to partial haemolysis of red blood cells and release of intracellular potassium
- Hypothermia: Due to rapid transfusion of cool blood products, requires regular monitoring of core body temperature
This quiz covers the acute and delayed complications that can occur due to blood transfusions, including acute haemolytic reactions and ABO blood group incompatibility.
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