Blood transfusion: Difference between revisions

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== Platelets ==
== Platelets ==


* [[Platelet transfusion]]
* Caution in prothrombotic thrombocytopenia syndromes like [[HIT]], [[TTP]], and catastrophic [[antiphospholipid syndrome]]
* Of limited utility in [[ITP]]

=== Indications ===

* In non-immune thrombocytopenia, it is reasonable to maintain platelets over 10
* For procedures with low risk of blood loss (e.g. appendectomy, cholecystectomy, vaginal delivery)
** Platelets less than 20: transfuse 1 dose
** Platelets 20 to 50: transfuse 1 dose if significant bleeding occurs
* For procedures with high risk of blood loss, transfuse 1 dose for platelets less than 50
* For neurosurgery, ophthalmologic procedures, or significant head trauma with high risk of [[intracranial hemorrhage]], maintain platelets above 100 (may need multiple doses)
* For bleeding from platelet dysfunction (e.g. post-cardiopulmonary bypass, or congenital platelet defect), transfusion may be required regardless of platelet count


== Plasma ==
== Plasma ==
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* Not useful when INR less than 1.8, when used 1:1 with RBCs, if there is no pending surgery or bleeding, for the reversal of [[warfarin]], for the reversal of other anticoagulants, or as nutritional support
* Not useful when INR less than 1.8, when used 1:1 with RBCs, if there is no pending surgery or bleeding, for the reversal of [[warfarin]], for the reversal of other anticoagulants, or as nutritional support


== Reactions ==
== Transfusion Reactions ==
{| class="wikitable"
{| class="wikitable"
!Risk
!Risk
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|Transmission of [[HIV]]
|Transmission of [[HIV]]
|}
|}

* Other transmissible infections include:
** Viruses: [[parvovirus B19]], [[hepatitis A virus]], [[hepatitis E virus]], [[Zika virus]], [[dengue virus]], and [[chikungunya virus]]
** Protozoa: [[malaria]], [[Chagas disease]], [[toxoplasmosis]], [[leishmaniasis]], [[babesiosis]]
** Helminths: [[filariasis]]
** Spirochetes: [[syphilis]], [[Lyme disease]]
** Rickettsiae: [[Rocky Mountain spotted fever]], [[Coxiella burnetii]], and [[Ehrlichia]]


=== Fever ===
=== Fever ===

Latest revision as of 17:25, 22 October 2024

Red Blood Cells

Group & Screen and Crossmatch

  • ABO blood type (O, A, B, or AB)
    • Most important antigen group
  • RhD group (positive or negative)
    • Second most important antigen group
  • There are more than 30 minor blood group antigens, including Kell (K and k), Kidd (Jk^a^ and Jk^b^), Duffy (Fy^a^ and Fy^b^) and MNS (S and s)
  • Group and screen
    • Group tests recipient for ABO and RhD status
    • Screen tests the recipient plasma for unexpected and clinically significant minor antigen incompatibility
    • Takes about 45 minutes, but if the screen is positive then can take days to determine which specific antibodies are causing the problem
  • Crossmatch confirms that a specific unit of RBCs is safe to give to the recipient
    • If screen was negative, an abbreviated crossmatch is done either as immediate spin or as electronic
    • If screen was positive, then a full antiglobulin crossmatch is done

Basics

  • Each unit is about 300 mL with a hematocrit of 65 to 70%, and raises the recipient's hemoglobin by about 10 g/L
  • Usually transfused over 2 hours
    • Can do up to 3 or 3.5 hours in elderly over 70 years old, heart failure, LV dysfunction, prior MI, renal dysfunction, or volume overload (usually with concurrent diuretics at the start of the transfusion)

Indications

  • Acute blood loss
    • Maintain hemoglobin above 70 g/L during active bleeding
    • Maintain hemoglobin higher (e.g. above 80 g/L) during active bleeding in patients with:
      • Unstable or acute coronary syndrome
      • Coronary artery disease
      • Uncontrolled or unpredictable bleeding
  • Anemia
    • Consider for hemoglobin below 70 g/L in stable patients
    • Consider for hemoglobin below 80 g/L in patients undergoing orthopedic or cardiac surgery or with cardiovascular disease

Platelets

Plasma

  • Each unit has a volume of 250 mL and requires 30 minutes to thaw
  • It must be ABO compatible
  • The usual dose is 10 to 15 mL/kg (3 to 4 units for average human)
  • Units are transfused over 30 minutes to 2 hours (maximum 3.5 hours)
  • A single dose (10 to 15 mL/kg) should normalize the INR and PTT if within 1.3 to 1.8 times normal, and lasts 6 hours (the half-life of factor VII)

Indications

  • Before a procedure or during active bleeding where the INR, PT, or PTT is at least 1.8 times normal, and no other therapies are available
  • During massive transfusion protocols (6 to 10 units of RBCs expected within 6 hours)
  • Before a procedure or during active bleeding in patients with severe liver disease and INR greater than 2 times normal
  • Not useful when INR less than 1.8, when used 1:1 with RBCs, if there is no pending surgery or bleeding, for the reversal of warfarin, for the reversal of other anticoagulants, or as nutritional support

Transfusion Reactions

Risk Event
1 in 13 Red cell sensitization, increasing risk of hemolytic transfusion reaction and hemolytic disease of the fetus and newborn
1 in 20 Febrile non-hemolytic transfusion reaction, per pool of platelets
1 in 100 Transfusion-associated circulatory overload
1 in 100 Minor allergic reaction (urticaria)
1 in 300 Febrile non-hemolytic transfusion reaction, per unit of RBCs
1 in 7,000 Delayed hemolytic transfusion reaction
1 in 10,000 Transfusion-related acute lung injury (TRALI)
1 in 10,000 Symptomatic bacterial infection, per pool of platelets
1 in 40,000 ABO mismatch, per unit of RBCs
1 in 40,000 Anaphylaxis
1 in 100,000 Post-transfusion purpura
1 in 200,000 Death from bacterial infection, per pool of platelets
1 in 250,000 Symptomatic bacterial infection, per unit of RBCs
1 in 500,000 Death from bacterial infection, per unit of RBCs
<1 in 1,000,000 Transmission of West Nile virus
1 in 4,000,000 Transmission of Chagas disease
1 in 7,500,000 Transmission of hepatitis B virus
1 in 7,600,000 Transmission of HTLV
1 in 13,000,000 Transmission of hepatitis C virus
1 in 21,000,000 Transmission of HIV

Fever

Dyspnea

Allergic Reactions

Minor Allergic Reactions

  • Minor reactions may include urticaria, flushing, erythema, pruritis, cough, wheeze, nausea, vomiting, abdominal pain, and diarrhea
  • For minor reactions
    • Stop the transfusion
    • Give diphenhydramine 25 to 50 mg p.o. or IV
    • If urticarial rash is less than 2/3 BSA and no other concerning symptoms, restart the transfusion slowly
  • For recurrent urticarial reactions, consider premedication with diphenhydramine, cetirizine, and/or steroids

Anaphylaxis

  • Anaphylaxis usually starts immediately or up to 45 minutes of starting the transfusion
  • Symptoms include:
    • Urticaria and flushing are usually present
    • May have airway obstruction with dyspnea, chest pain, wheezing, and stridor
    • Hypotension
    • Nausea and vomiting
  • For severe allergic reactions:
    • Stop the transfusion and do not restart
    • Diphenhydramine 25 to 50 mg IV
    • For anaphylaxis, epinephrine and steroids

Cytopenias