CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries CRACKCast E007 - Blood Products
Feb 17, 2016
Explains ABO and Rh basics and who can donate to whom. Defines massive transfusion and common physiologic complications. Reviews indications and dosing for PRBCs, FFP, platelets and cryoprecipitate. Covers immune and nonimmune transfusion reactions and which products carry infection risk. Discusses PCCs, FEIBA, plasma types and uses of recombinant factor VII.
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Immediate Steps For Suspected Intravascular Hemolysis
- On suspected intravascular hemolytic transfusion reaction stop the transfusion, change tubing, give crystalloid, and urgently send blood samples and clerical checks to the lab.
- Expect signs like fever, hypotension, hemoglobinuria, back/chest pain, DIC and impending doom sensation.
Recognize And Manage TRALI Promptly
- If TRALI occurs (bilateral pulmonary edema within 6 hours), stop transfusion and provide respiratory support; diuretics are of limited value and most recover in ~4 days.
- Look for non-cardiogenic pulmonary edema, hypoxia, and fever soon after transfusion.
Manage Allergic And Febrile Transfusion Reactions
- Treat allergic transfusion reactions with antihistamines and anaphylaxis protocols for severe cases; stop the transfusion for most acute reactions.
- Be mindful of IgA deficiency patients who can develop severe anaphylaxis to blood products.