Workup
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Infections screened for: HBV, HCV, HIV1/2, Syphillis + CMV in immunocompromised
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Adult blood volume = 70mls/kg
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Paediatric blood volume = 80mls/kg
|
Product |
Storage / Half-life | Notes | Indications |
| Packed red cells | 280mls Stored at 2-6'C 35 days (normal red cell life is 120 days) |
Additive solutions: suspend cells CAPD: citrate-adenine-phosphate-dextrose SAMG: saline-adenine-mannitol-glucose Dosing: 4ml/kg raises [Hb] by 1g/dl |
Anaemia Restore circulatory volume Improve tissue oxygen perfusion (by maintaining oxygen carrying capacity) |
| Platelets | Stored at room temperature on agitator (prevents clumping) 5-7 day life |
Platelets are pooled as one donation normally contains ~55 x109 Risk of infection Rhesus sensitisation |
Thrombocytopenia < 50 x 10 9 |
| Cryoprecipitate / FFP | Stored at -30'C 12 month shelf-life |
Factors V / VII are most labile to temperature Dosing: 10-15mls/kg |
Reversal of warfarin Post massive transfusion DIC / loss of clotting factors |
| Human Albumin | 4.5% or 20% solution | Ascities / portal hypertension Oedema due to hypoalbuminaemia Plasma expander |
Complications of transfusion
- Immediate
- Temperature changes - from pyrogens (from dead polymorphs, endotoxins)
- Immune reactions
- Type I: Immediate - Anaphylactic reaction
- Type II: Cytotoxic -
- Type IV: Delayed
- Infection - gram -ve organisms (coliforms, pseudomonas)
- Metabolic - hyperkalaemia (haemolysis); hypocalcaemia (citrate antocoagulation), acidosis
- Circulatory - hypervolaemia: massive transfusion reaction = "transfusion equalliny patient's blood volume within 24 hours"
- Bleeding diathesis - deficient in platelets (thrombocytopenia) and clotting factors
- Delayed
- Sensitisation to antigens
- Infection from unscreened blood - HBV, HCV, HIV, CMV, syphilis, malaria
- Fe-overload: heart, pancreas
Or
- Massive transfusion: Transfusion equallying patients blood volume within 24 hours
- Volume overload - Pulmonary oedema
- Thrombocytopaenia
- Coagulation factor deficiency
- Hypothermia
- Hypocalcaemi: chelation by citrate in additive solution
- Hyperkalaemia: progressive potassium leakage
- Repeated transfusion
- Infective complications
- HBV, HCV, HIV
- Syphilis
- Yersinia enterocolitca -
- Immune reactions
- Febrile reactions: white cell antigens, reaction within one hour
- Acute haemolytic reaction: ABO incompatability
- Delayed haemolytic reaction: immunised to foreign red cell antigen due to previous exposure. Leads to jaundice/haemolysis later
- Post transfusion purpuric reaction
- Graft vs host disease
- Anaphylactic reactions
Management
- Stop transfusion
- Resuscitate
- Repeat G+S
- Perform direct anti-globulin test (Coomb's test) on post-transfusion sample; antibodies against surface antigens
- Check for haemolysis (bili, K); DIC (FDPs, haemoglobinuria)
- Blood cultures