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Questions and Answers
Clotting abnormalities can occur due to a concentration effect of packed red cells transfused.
Clotting abnormalities can occur due to a concentration effect of packed red cells transfused.
False
Administrating fresh frozen plasma and platelets concurrently can reduce the risk of clotting impairment.
Administrating fresh frozen plasma and platelets concurrently can reduce the risk of clotting impairment.
True
Hypocalcaemia is caused by an increase in serum calcium level.
Hypocalcaemia is caused by an increase in serum calcium level.
False
The most common cause of acute haemolytic reaction is ABO blood group incompatibility.
The most common cause of acute haemolytic reaction is ABO blood group incompatibility.
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Patients with acute haemolytic reaction may present with urticaria and hypotension only.
Patients with acute haemolytic reaction may present with urticaria and hypotension only.
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Hyperkalaemia is caused by a decrease in intracellular potassium.
Hyperkalaemia is caused by a decrease in intracellular potassium.
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A positive Direct Antiglobulin Test (DAT) confirms the diagnosis of acute haemolytic reaction.
A positive Direct Antiglobulin Test (DAT) confirms the diagnosis of acute haemolytic reaction.
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Blood products are always at body temperature by the time of transfusion.
Blood products are always at body temperature by the time of transfusion.
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Transfusion Associated Circulatory Overload (TACO) is a common problem in patients with cardiac failure.
Transfusion Associated Circulatory Overload (TACO) is a common problem in patients with cardiac failure.
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Rapid transfusion of blood products can lead to an increase in the patient's core temperature.
Rapid transfusion of blood products can lead to an increase in the patient's core temperature.
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Transfusion-specific complications can only occur after the transfusion has been completed.
Transfusion-specific complications can only occur after the transfusion has been completed.
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Furosemide is prescribed prophylactically during the transfusion to prevent acute haemolytic reaction.
Furosemide is prescribed prophylactically during the transfusion to prevent acute haemolytic reaction.
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Transfusion Related Acute Lung Injury (TRALI) is a cardiogenic cause of pulmonary oedema.
Transfusion Related Acute Lung Injury (TRALI) is a cardiogenic cause of pulmonary oedema.
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Massive Transfusion Protocol is a set of guidelines that vary between hospitals.
Massive Transfusion Protocol is a set of guidelines that vary between hospitals.
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Patients with mild allergic reactions may present with dyspnoea and fever.
Patients with mild allergic reactions may present with dyspnoea and fever.
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Transfusion Associated Circulatory Overload (TACO) is treated with high-flow oxygen and diuretic therapy.
Transfusion Associated Circulatory Overload (TACO) is treated with high-flow oxygen and diuretic therapy.
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Study Notes
Complications of Packed Red Cell Transfusions
- Clotting abnormalities can occur due to dilution effect, especially in trauma patients
- To reduce the risk of clotting impairment, fresh frozen plasma and platelets should be administered concurrently, typically for patients receiving more than 4 units of RBCs
Electrolyte Abnormalities
- Hypocalcaemia: chelation of calcium by the calcium binding agent in the preservative results in reduced serum calcium level
- Hyperkalaemia: due to partial haemolysis of the red blood cells and the resultant release of intracellular potassium
Hypothermia
- Rapid transfusion of blood products kept at cool temperatures can lead to a drop in the patient's core temperature
- Regular monitoring of core body temperature is required during blood product transfusion
Transfusion-Specific Complications
Acute Transfusion Complications
- Acute Haemolytic Reaction: a serious reaction caused by transfusion of the incorrect blood type, the most common cause being ABO blood group incompatibility
- Symptoms include urticaria, hypotension, fever, haemoglobinuria, and evidence of haemolysis
- Diagnosis confirmed by reduced Hb, low serum haptoglobin, high LDH and bilirubin, and a positive Direct Antiglobulin Test (DAT)
- Treatment involves urgently informing the blood bank, stopping the transfusion, and providing supportive measures like fluid resuscitation and oxygen supplementation
- Transfusion Associated Circulatory Overload (TACO): presents with dyspnoea and features of fluid overload
- Treatment involves oxygen and diuretic therapy, with 20mg furosemide prophylactically prescribed during the transfusion to prevent overload
- Transfusion Related Acute Lung Injury (TRALI): a form of Acute Respiratory Distress Syndrome (ARDS), a non-cardiogenic cause of pulmonary oedema
- Treatment involves high flow oxygen and urgent chest radiograph, with specialist and intensive care input urgently required
Other Complications
- Mild Allergic Reaction: patient complains of pruritus (itching), treated with an anti-histamine
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Description
Learn about the complications that can arise from packed red cell transfusions, including clotting abnormalities and electrolyte abnormalities. Understand how to mitigate these risks in patients.
