Blood Transfusions

Transfusion Indications

-Acute Blood Loss

-Symptomatic Anemia

-Volume: 300mL

-Hgb under 7

Whole Blood

-Used in cardiac surgery with hemorrhage or massive hemorrhage

-Contains: RBC, Plasma, Platelets

Packed Red Blood Cells

-Most used

-Recommended transfusion trigger (Hgb 7-8)

-1 unit of PRBC raises the Hgb by 1

Autologous Red Blood Cells

-Patient own blood for an elective procedure

Preparations of Blood

-Washed/Leukoreduced: remove residual plasma, prevents severe allergic reaction, immunodeficiency

-Frozen: Rare blood

-Volume Reduced

-Irradiated: Immunodeficient

-CMV Negative

-Autologous Donations

What do you need form a patient?

-Type and Screen/Crossmatch

-Informed Consent

-Pre-medications (acteaminophen 650 mg and benadryl 25-50 mg)

Platelet Transfusions

-Indicated when risk of spontaneous bleeding (Platelet under 80,000)

-Indicated in risk of life-threatneing bleeding (platelet under 10,000)

-6 pack or 1 unit pheresed platelets

-1 unit increases platelet count by 50,60,000

-Lasts 2-3 days

Fresh Frozen Plasma

-200 mL of plasma containing all clotting factors, AT-III, Protein C and S

-Indications include factor deficiencies, thrombotic microangiopathies (TTP), correct/prevent coagulopathy with massive transfusion

Cryoprecipitate

-Cryoprecipitated antihemoplilic factor: thaw FFP and precipitate refrozen

-15-20 mL per unti containing fibrinogen, Factor VIII, Factor XIII, vWF

-Indications include acute DIC or low fibrinogen with bleeding or risk

-1 unit increases fibrinogen by 8

Acute Transfusion Reactions

-Complications that occur during or after a blood product is given

-Range in severity

-Can be major or minor

What is Urticarial Transfusion Reaction (UTR)?

A minor and common reaction that occurs during or up to 2 hours after a transfusion.

What causes Urticarial Transfusion Reaction (UTR)?

It is due to antigen-antibody interaction.

What are the clinical features of Urticarial Transfusion Reaction (UTR)?

Hives or pruritus.

How should a mild Urticarial Transfusion Reaction (UTR) be managed?

Do nothing or give antihistamines.

What is a Febrile Non-Hemolytic Transfusion Reaction?

A minor reaction that occurs up to 4 hours after transfusion.

What causes a Febrile Non-Hemolytic Transfusion Reaction?

Accumulation of cytokine in the donor blood causes an immune reaction.

What type of hypersensitivity reaction is a Febrile Non-Hemolytic Transfusion Reaction?

Type II Hypersensitivity reaction.

What do host antibodies target in a Febrile Non-Hemolytic Transfusion Reaction?

Donor leukocytes.

How can a Febrile Non-Hemolytic Transfusion Reaction be prevented?

By giving leukoreduced blood.

What are the clinical features of a Febrile Non-Hemolytic Transfusion Reaction?

Low grade fever, chills, headache, and malaise.

What is the management for a Febrile Non-Hemolytic Transfusion Reaction?

Stop the transfusion for 30 minutes, give acetaminophen for fever, and check CBC and bilirubin to rule out hemolysis.

What is Transfusion-associated circulatory overload (TACO)?

A critical reaction that occurs during or within 6 hours after transfusion.

What causes pulmonary edema in TACO?

Volume overload or circulatory overload.

What percentage of patients experience TACO?

Less than 1%.

Who is at risk for developing TACO?

Patients receiving a large volume over a short period of time, and those with a history of renal or cardiovascular disease.

What are the clinical features of TACO?

Sudden tachycardia, hypertension, and increased JVP.

What does a chest X-ray (CXR) show in TACO?

Bilateral infiltrates.

What is the management for TACO?

Stop the transfusion, diuresis, supplemental oxygen, or assisted ventilation.

What is TRALI?

Transfusion-related acute lung injury

What type of reaction is TRALI?

Critical reaction

When does TRALI occur?

During or up to 6 hours after transfusion

What causes acute lung injury in TRALI?

HLA antibodies in the donor blood trigger neutrophils and pulmonary endothelial cells to secrete proteolytic enzymes

What is the incidence rate of TRALI?

1 in 5,000 transfusions

What are the clinical features of TRALI?

Fever/chills, respiratory distress, hypotension

What does a CXR show in TRALI?

Pulmonary edema

What is the management for TRALI?

Stop the infusion, assisted ventilation or oxygen administration, IV steroids to aid with inflammation

What is an Acute Hemolytic Transfusion Reaction (AHTR)?

An emergency that occurs during or within 1 hour after transfusion.

What type of hemolysis occurs in an Acute Hemolytic Transfusion Reaction?

Acute intravascular hemolysis of transfused RBCs.

What is the most common cause of Acute Hemolytic Transfusion Reaction?

ABO incompatibility.

What is the incidence of Acute Hemolytic Transfusion Reaction?

1 in 76,000 transfusions.

What is the mortality rate associated with Acute Hemolytic Transfusion Reaction?

1 death in every 1.8 million transfused units.

What are some clinical features of Acute Hemolytic Transfusion Reaction?

Fever, flank pain, hematuria, tachycardia, tachypnea, hypotension, DIC, chills, headache, anxiety, cardiovascular collapse.

What is the first step in managing an Acute Hemolytic Transfusion Reaction?

Stop the transfusion.

What should be done after stopping the transfusion in an Acute Hemolytic Transfusion Reaction?

Provide aggressive IV hydration.

What should be confirmed after stopping the transfusion in an Acute Hemolytic Transfusion Reaction?

Confirm the correct transfusion.

What should be returned to the blood bank after an Acute Hemolytic Transfusion Reaction?

Return blood and equipment.

What tests should be performed after an Acute Hemolytic Transfusion Reaction?

Retype/crossmatch, check Coombs test (should be positive), check coag studies.

What should be administered if DIC occurs during an Acute Hemolytic Transfusion Reaction?

Administer FFP and platelets.

What is a common cause of Transfusion Associated Sepsis?

Bacterial contamination

When does Transfusion Associated Sepsis typically occur?

Within 1 hour of transfusion

What type of bacteria is usually involved in Transfusion Associated Sepsis?

Usually gram-negative bacteria

What are clinical features of Transfusion Associated Sepsis?

Fever/chills, hypotension

What is the first step in managing Transfusion Associated Sepsis?

Stop the infusion

What should be done with the blood of the recipient and donor in case of Transfusion Associated Sepsis?

Culture the recipient's blood and donor blood

What type of antibiotics are used in the management of Transfusion Associated Sepsis?

Broad-spectrum antibiotics

What is an Anaphylactic Transfusion Reaction?

A severe allergic reaction that can occur during or shortly after a blood transfusion.

When does an Anaphylactic Transfusion Reaction typically occur?

Right after the start of the transfusion but can be delayed up to 4 hours.

What are some features of an Anaphylactic Transfusion Reaction?

Angioedema, wheezing, hypotension, nausea, vomiting, cardiac arrest or shock.

What is the first step in managing an Anaphylactic Transfusion Reaction?

Stop the transfusion.

What are some management steps for Anaphylactic Transfusion Reaction?

Hemodynamic stabilization, airway management, epinephrine, steroids, antihistamines.