Outline the adverse effects which could occur following the rapid transfusion of ten (10) units of packed red cells.
BT_PO 1.116 Outline the composition, indications, and risks of use of the following blood components and products …. packed red cells ….
BT_RT 1.9 Describe physiological consequences of massive transfusion
As anaesthetists, it is our responsibility to direct the volume resuscitation of patients with major haemorrhage. Doing this well requires a sound knowledge of physiology in a number of areas, including the consequences of ‘massive transfusion’.
In response to a number of adverse outcomes related to blood transfusions, an excellent e-learning resource is now available. In addition, Miller 8th edition Chapter 61 (Patient Blood Management – Transfusion Therapy), and Oh 7th edition Chapter 95 (Blood Transfusion) will provide all the basic science background needed to answer this SAQ. The Australian Red Cross website also has excellent information.
In answering this SAQ, you need to consider both (i) the complications of any PRC transfusion, and (ii) the complications of rapidly giving 10 units.
T / F one definition of a “massive” transfusion is replacing the whole blood volume in 24 hours
T / F using O negative packed cells will avoid the risk of any haemolytic transfusion reactions
T / F the risk of transfusion-related acute lung injury (TRALI) correlates with the number of units of PRC given
T / F one unit of PRC contains about 10% of the normal amount of platelets, and 50% of the normal amount of clotting factors
T / F massive PRC transfusion can cause hyperkalaemia and hypercalcaemia
T / F blood is stored at 4 degrees C, so rapid transfusion will cause hypothermia unless the blood is warmed
T / F transfused red cells have a left shifted OHC causing impaired oxygen offloading due to depleted 2,3 DPG – it can take 24 hours for this to be corrected
T / F the risk of HIV transmission via a transfusion is estimated at less than 1 in 1 million in Australia
This is a good opportunity to remind yourself of the MTP in your hospital. How do you contact blood bank, and how do you activate the MTP? Are there wall charts in your OR’s reminding you of critical ratios of different blood products? Where do you get ‘Level 1’ pressure infusers and blood warmers? Have you observed a massive transfusion – what went well, and what didn’t?