Examine the list of blood or plasma products listed in the table below. Indicate in your answer,
a) whether crossmatch is essential with the use of each of these products
b) one major indication for the use of each of these products.
Need for crossmatch |
One major indication for use |
|
Packed red blood cells |
||
Platelets |
||
Fresh frozen |
||
Cryo precipitate |
||
Prothrombin concentrate |
||
Granulocyte concentrate |
||
Intravenous immunoglobulin |
c) List one contraindication to the use of
i) Platelet transfusion
ii) IV immunoglobulin infusion
d) Very briefly, outline the role of erythropoietin in the management of anaemia of critical illness?
Examine the list of blood or plasma products listed in the table below. Indicate in your answer,
a) whether crossmatch is essential with the use of each of these products
b) one major indication for the use of each of these products.
Need for crossmatch |
One major indication for use |
|
Packed red blood |
Yes |
a) Acute blood loss |
Platelets |
No |
Platelets < 20,000 or <50,000 with bleeding, or pending interventional/surgicalprocedure, bone marrow failure - <10,000 in absence of risk factors, <20,000 in presence of risk factors |
Fresh frozen |
No |
Warfarin overdose, coagulopathy post transfusion, post bypass bleeding |
Cryo precipitate |
No |
DIC, coagulopathy post transfusion with low fibrinogen, hereditary hypofibrinogenemia, Hemophilia,Von willebrand’s disease |
Prothrombin |
No |
Warfarin overdose where FFP may be difficult to administer because of volume considerations |
Granulocyte |
Yes |
Neutropenic sepsis |
Intravenous |
No |
LGB syndrome, |
c) List one contraindication to the use of
i) Platelet transfusion -ITP . immune thrombocytopenia
ii) IV immunoglobulin infusion - Hereditary IgA deficiency
d) Very briefly, outline the role of erythropoietin in the management of anaemia of critical illness?
Anaemia of critical illness is characterised by blunted EPO production and altered iron metabolism. EPO use has been shown to reduce transfusion requirements, but there in no proven benefit in terms of clinical outcome. A potential benefit may exist in patients who are in ICU for > 1 wk, but data are lacking. Potential side effects include red cell aplasia, EPO resistance, thromboembolic complications and hypertension.
his question closely resembles other questions where one is expected to match a blood product with a need for transfusion.
These questions are:
However, in contrast, this one also demands indications. These can be dug out of the old 2001 NHMRC guidelines, or read about broadly in this article. More modern guidelines are available from the Australian Red Cross Blood Service website, and these were used to construct the list below.
In brief:
The following blood products require a crossmatch:
The indications are as follows:
As for the contraindications; there would probably be an excellent answer to this question somewhere in an article by Tomičić et al (2014), but it is in Croatian. Fortunately, the authors' native Russian armed him with the ability to discern that "trombocitne transfuzije kontraindicirane" probably means something about the contraindications to platelet transfusion, and from this poor quality translation the belowstated contraindications are derived.
And as for the anaemia of critical illness: there's an excellent article on that from Azare (2008), which is unfortunately paywalled. In short, this is a condition "hematologically similar to ...chronic anemia, except that the onset is generally sudden". A review by Rodriguez et al (2001) blames inappropriately blunted EPO secretion for this, although this is on the basis of small-scale studies. There also does not seem to be much good from EPO supplementation: Corwin et al (2002) found that though the total transfusion requirements decreased, the mortality did not. This may be another indicator that transfusion according to haemoglobin thresholds is not going to improve mortality. In answer to the college question, one would have to write that the routine use of EPO in the critically ill is not supported by robust evidence and that EPO use is not without its risks.
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