16 Questions
What is the primary cause of acute haemolytic reaction?
ABO blood group incompatibility
What are the symptoms of acute haemolytic reaction?
Urticaria, hypotension, and haemoglobinuria
What is the treatment for acute haemolytic reaction?
Urgent blood bank notification and supportive measures
What is the purpose of prescribing 20mg furosemide during transfusion?
To prevent transfusion-associated circulatory overload
What is the characteristic of transfusion-related acute lung injury (TRALI)?
Non-cardiogenic cause of pulmonary oedema
What is the treatment for transfusion-related acute lung injury?
High-flow oxygen and urgent chest radiograph
What is the characteristic of mild allergic reaction?
Pruritus and urticaria
What is the consequence of untreated transfusion-related acute lung injury?
High mortality rate
What is the cause of clotting abnormalities in packed red cell transfusions?
Dilution effect due to lack of platelets and clotting factors in transfused cells
What is the recommended course of action to reduce the risk of clotting impairment in patients receiving more than 4 units RBCs?
Administering fresh frozen plasma and platelets concurrently
What is the cause of hypocalcaemia in blood transfusions?
Chelation of calcium by the calcium binding agent in the preservative
What is the result of the partial haemolysis of red blood cells during blood transfusions?
Hyperkalaemia
Why is regular monitoring of core body temperature required during a blood product transfusion?
To prevent hypothermia due to rapid transfusion of cool blood products
What is the main reason for hypothermia in blood transfusions?
Rapid transfusion of blood products
What is the classification of transfusion-specific complications that occur soon after the transfusion has been started?
Acute complications
What is the main factor that increases the risk of complications in packed red cell transfusions?
Increasing transfusion volume
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
This quiz covers the complications that arise from packed red cell transfusions, including clotting abnormalities and their causes.
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