HAEM/ONC
TRANSFUSION
PromptIndications for blood transfusion
ResponseHb <70
Symptomatic anaemia (SOB, Syncope, HF)
Significant comorbidities (Cardiac disease, malignancy)
Symptomatic anaemia (SOB, Syncope, HF)
Significant comorbidities (Cardiac disease, malignancy)
PromptList acute transfusion reactions
ResponseAllergic - Urticaria, wheezing, angiooedema
Volume Overload
TACO - Transfusion related circulatory overload (Volume overloade) - SOB, creps, raised JVP
Febrile non haemolytic: fevers, chills, no other signs, normal haemodynamics
ABO incompatibility (Acute haemolytic transfusion reaction) Fever, tachycardia, shock, DIC
TRALI - transfusion related acute lung injury - within 6 hours, fever, tachycardia, hypoxia, pulmonary oedema
+/- Bacterial sepsis
Appendix - See red cross transfusion reaction cards
Volume Overload
TACO - Transfusion related circulatory overload (Volume overloade) - SOB, creps, raised JVP
Febrile non haemolytic: fevers, chills, no other signs, normal haemodynamics
ABO incompatibility (Acute haemolytic transfusion reaction) Fever, tachycardia, shock, DIC
TRALI - transfusion related acute lung injury - within 6 hours, fever, tachycardia, hypoxia, pulmonary oedema
+/- Bacterial sepsis
Appendix - See red cross transfusion reaction cards
PromptList late transfusion reactions
ResponseBlood borne infection (HIV, HBV, HCB, vCJD, HTLV)
Alloimmunisation - (Transfusion >> generation of alloantiboties against 1 or more RBC antigents >> complicates subsequent transtusions)
Post transfusion purpura/thrombocytopaenia
Iron overload
Delayed haemolytic transfusion reaction
Transfusion related graft vs host
Alloimmunisation - (Transfusion >> generation of alloantiboties against 1 or more RBC antigents >> complicates subsequent transtusions)
Post transfusion purpura/thrombocytopaenia
Iron overload
Delayed haemolytic transfusion reaction
Transfusion related graft vs host
PromptList 4 safety measures to reduce risk of significant transfusion reactions
ResponseMultipoint identity checks in blood bank
Multiple nurising checks at bedsde
Frequent obs with onset of transfusion
Strict control of transport and storage (eg: temp, timeframes etc)
Multiple nurising checks at bedsde
Frequent obs with onset of transfusion
Strict control of transport and storage (eg: temp, timeframes etc)
PromptHaemolytic transfusion reaction complications
ResponseDIC
Renal failure
Pulmonary oedema
ARDS
Death
Renal failure
Pulmonary oedema
ARDS
Death
- Hint: Basically list multi organ failure of dying patient.
PromptTransfusion reaction management
ResponseImmediate
Stop transfusion
Assess the patient - Fever, resp distress, angiooedmea/hives, vitals etc.
Treat shock - ABC’s, oxygen/support ventilation. +/- Broad spectrum IVABx (if shock/febrile)
Maintain IV access (N/S, replace tubing, do NOT flush existing tubing)
Confirm correct details + product was transfused - Check patient ID, product labelling, look for discolouration/bubbles (May suggest bacterial contamination
Send investigations (see below)
Medium Term
Contact transfusion service
Clarify circumstances with staff
Open disclosure
Clarify need for ongoing transfusion
Document thoroughly in patient notes
Long term
Ongoing disclosure
M+M
Education (eg. inservice, reg teaching) - transfusion reactions
Liaise with blood bank to ensure safe storage etc
Crossmatch as per accepted guidelines
Stop transfusion
Assess the patient - Fever, resp distress, angiooedmea/hives, vitals etc.
Treat shock - ABC’s, oxygen/support ventilation. +/- Broad spectrum IVABx (if shock/febrile)
Maintain IV access (N/S, replace tubing, do NOT flush existing tubing)
Confirm correct details + product was transfused - Check patient ID, product labelling, look for discolouration/bubbles (May suggest bacterial contamination
Send investigations (see below)
Medium Term
Contact transfusion service
- Reaction form,
- investigate cause - return remaining blood product and new stab sent to patient for analysis (culture + new G+H as minimum)
- Blood bank to quarantine blood from same donor
Clarify circumstances with staff
Open disclosure
Clarify need for ongoing transfusion
Document thoroughly in patient notes
Long term
Ongoing disclosure
M+M
Education (eg. inservice, reg teaching) - transfusion reactions
Liaise with blood bank to ensure safe storage etc
Crossmatch as per accepted guidelines
PromptInvestigatoins in transfusion reaction
ResponseReaction form
G+H,
Haemolytic screen - FBC, LDH, Haptoglobin, bilirubin
General - EUC, Coags
Urinalysis
G+H,
Haemolytic screen - FBC, LDH, Haptoglobin, bilirubin
General - EUC, Coags
Urinalysis
PromptDiagnostic criteria for TRALI
ResponseAcute onset (<6h)
Hypoxaemia
Bilateral infiltrates on CXR
No evidence of circulatory overload/L atrial hypertension
No preexisting ALI/ARDS
ALI/ARDS risk factors at time of transfusion must be absent
Hypoxaemia
Bilateral infiltrates on CXR
No evidence of circulatory overload/L atrial hypertension
No preexisting ALI/ARDS
ALI/ARDS risk factors at time of transfusion must be absent
PromptClinical findings in TRALI
ResponseRespiratory distress + hypoxia
Fevers
Non cardiogenic pulmonary oedema (JVP not elevated0
CXR - bilateral infiltates
Normal BNP, transient leukopaenia
Fevers
Non cardiogenic pulmonary oedema (JVP not elevated0
CXR - bilateral infiltates
Normal BNP, transient leukopaenia