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10hb/30hct Rule
now outdated, restrictive
Preoperative/ICU setting
TRICC Study
Hb of 7 is good for outcomes
Heavy transfusing increases infections etc.
Overall Tranfusion at...
<6 = Beneficial
>10 = Benefit Unlikely
FOCUS Trial Transfuse to target v Individualised
Platelets:
<10 before risk of spontanoeus haemorrhage
Can do many procedure around 50
Multiple Traums Pts you want around 100
Spinal Cath want around 80
Give at X if
>10 Afibrile Non-Bleeding
>20 Febrile and Non-Bleeding
>50 Bleeding or Invaisive procedure
What are the main indications for blood tr >100 Neurosurgical procedures (spinal cath etc)
Societal (Costs, availability, donor selection)
Risk to Patients
Outline the costs of Transfusion
Over Transfusion
TACO
TRALI
Transfusion associated dyspnoea
Acute Haemolytic transfusion reaction
Febrile Non-Haemolytic transfusion reactions
Anaphylaxis/anaphylactoid reactions

Delayed Haemolytic transfusion reactions

Hypotensive transfusion reaction
Transfusion transmitted infection
SARs due to error
Unclassified
Name the potential adverse events followinTransfusion associated graft versus host disease
What is TACO?
tRAnsfusion Associated Circulatory Overload - Resp Distress - Presents as CCF - <
Acute v Delayed
Haemolysis v Non
Respiratory v
Febrile non-haemolytic reaction most common.
Categories of Transfusion Reactions

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Transfusion Associated Circulatory Overload
Most Common BloodTrans reaction
- Resp Distress
- Presents as CCF
- Acute <6hrs
Need 4/5 of the following
Acute respiratory distress
Tachycardia
Increased BP
Evidence of positive fluid balance
Acute or worsening pulmonary oedema on frontal CXR
Management
Avoid
- Look at patient
- Fluid Balance
- Weight
- Rate of Infusion
- Education
Treatment
Slow the transfusion
Give O2
Frusemide iV
Anticoagulant Reversal
- Vit K (optiplex) not fresh frozen plasma!
What is TACO? How does it Present? How

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Transfusion Related Acute Lung Injury
- Lung injury
- Within 6 hrs
Dx
Acute onset of symptoms
Hypoxaemia Spo2<90% RA
Bilateral infiltrates on frontal CXR
No evidence of circulatory overload
No pre existing ALI (otherwise 'possible TRALI)
No alternative risk factors for AL (alt=Possible TRALI)
Labs
BNP (pre/post comparison Raised suggests TACO)
Antibody Testing: Anti-HLA Anti-granulocyte Antibodies
Pathophys
Activation of white cells in pulmonary microvasculature
Endothelial injury, permeability and exudation
Ddx
Overload, bacterial infections, TADyspnoea
Risk
- Likely antibody mediated
- Multiparous womens
- Patients with multiple transfusions (recipients cannot donate)
- Most likely with plasma or platelets
Tx
Avoid diuretics
Fluid Replacement
Vasopressors
O2, ventilatory support
What is TRALI? How does it present? RiskSteroids (but no evidence)
Reporting of Adverse Effects
Mulit donor pooled

Rapid Alert Notification

Activate RANS
- Suspected bacterial infection
Viral parasitic or post transfusion
TRALI
Failure in blood processing (e.g. Irradiation)

Loss of one blood volume within 24hrs - 70mls/kg body weight adult - 80 - 90mls/
Loss of 50% of blood volume within 3hrs
Loss of blood > 150mls/min
What is the definition of Massive Haemorr Obstetric Haemorrhage >1500 mls or acute deterioration

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Order Labs
G & XM (x2)
FBC, PT, APTT
Fibrinogen
Biochemistry
Blood gasses
Order Blood
6 units and stay 6 units ahead
Immediate spin crossmatch required after 8 10units
Use blood warmer/rapid infuser
In male patient or post menopausal female consider O Rh Pos
Targets
Platelets = 100x10^9 fro multiple or CNS trauma
Otherwise 75x10^9
SD Plasma = 12-15ml/kg body weight
Thaw time = 30mins
Aim for PT and APTT of <1.5 mean control
Reverse Warfarin (Vit K)
Describe the hematological management oFibrinogen = >1.0g/l. Give Riastap
70kg Man
5 litres of Blood
- 1 in lungs
- 3 in systemic venous
Healthy individual
- 1 in heart and arterial
Acidosis
Cogulopathy
Name the elements of the Lethal Triangle Hypothermia

Temperature below 350C

Important contributor to coagulopathy
Reversible platelet dysfunction
Alters coagulation & enhances fibrinolysis
How does hypothermia contribute to coagupatient warming, use of rapid infusion and an in-line counter current warming sys

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d - Resp Distress - Presents as CCF - <6hrs - Treatment is slow the transfusion, give O2 and duirese with frusemide iV Avoid - Look at pat

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load

on frontal CXR

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TRALI)
sible TRALI)

sts TACO)
cyte Antibodies

rovasculature
tion

nts cannot donate)

mls/kg body weight adult - 80 - 90mls/kg body weight child

deterioration

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10units

consider O Rh Pos

auma

s
d an in-line counter current warming system for fluids and blood components

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with frusemide iV Avoid - Look at patietn - Fluid Balance - Weight - Rate of Infusion - Education Anticoagulant Reversal - Vit K (optiplex) n

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coagulant Reversal - Vit K (optiplex) not fresh frozen plasma

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