EMQ: Transfusion (Special Transfusion Requirements)
- Jun 11, 2016
- 3 min read
Options:
A. Group O fresh frozen plasma (no additional pathogen inactivation steps)
B. Group B fresh frozen plasma (no additional pathogen inactivation steps)
C. Group A fresh frozen plasma (no additional pathogen inactivation steps)
D. Group AB fresh frozen plasma (no additional pathogen inactivation steps)
E. Methylene blue treated Group O fresh frozen plasma
F. Methylene blue treated Group O fresh frozen plasma + IV vitamin K
G. Methylene blue treated Group A fresh frozen plasma
H. Methylene blue treated Group A fresh frozen plasma + IV vitamin K
I. Methylene blue treated Group AB fresh frozen plasma
J. Methylene blue treated Group AB fresh frozen plasma + IV vitamin K
For each of the following scenarios (a-e), select the most appropriate blood product from the list above (a-l). Each option can be used once, more than once or not at all. The scenario assumes the patient is being treated in the United Kingdom under current UK Blood Service guidelines.
Question 1
A 13 year old with factor V deficiency due to undergo tonsillectomy. She is group A
Question 2
A 3 day old neonate bleeding secondary to haemorrhagic disease of the newborn
Question 3
A 30 day old neonate, blood group A, in ICU who has a coagulopathy due to have a laparotomy
Question 4
A 13 year old with factor V deficiency is bleeding following a fall. She is group AB. There is no AB fresh frozen plasma available in stock.
Question 5
A 40 year old with DIC who is bleeding. He is group O but no group O fresh frozen plasma is available in hospital stock. The next delivery will take 6 hours.
Answers:
A: Methylene blue treated Group A fresh frozen plasma
B: Methylene blue treated Group A fresh frozen plasma + IV vitamin K
C: Methylene blue treated Group AB fresh frozen plasma + IV vitamin K
D: Methylene blue treated Group A fresh frozen plasma
E: Group A fresh frozen plasma (no additional pathogen inactivation steps)
Explanation:
In the UK, all patients born after 1/1/1996 should receive group-matched Methylene Blue (MB) treated fresh frozen plasma (currently US sourced) as first choice. This is in order to avoid exposing patients to donor-derived vCJD, assuming that any person born before this date would have been exposed through the food chain during the BSE/vCJD epidemic. MB-treatment is a cost-effective and clinically effective pathogen inactivation process (solvent detergent treatment being an alternative) applied to imported plasma products which have therefore not been collected under the scrutiny of the UK National Blood Service's donor selection and testing processes.
In hemorrhagic disease of the newborn, fresh frozen plasma and vitamin K are required. If the blood group is not known/available, group AB is first choice. All paediatric patients require methylene blue treated fresh frozen plasma.
In neonatal coagulopathy where there is bleeding or a procedure is required fresh frozen plasma and vitamin K are required. If there is no bleeding, vitamin K alone should be used. All paediatric patients require methylene blue treated fresh frozen plasma which should be group matched.
In an emergency situation, available essential blood products should not be withheld, but clearly suboptimal matching of blood products is to be avoided where possible. If there is an underlying haemophilia diagnosis which may require repeat exposure, it is even more important that the appropriate product is used. In the case described in this question, the options are either to give group A methylene blue as a second choice blood group, or to give group AB not methylene blue treated (adult fresh frozen plasma). As the question states no AB fresh frozen plasma is available, the answer is therefore group A MB fresh frozen plasma.
Second choice group fresh frozen plasma for patients with blood group O is group A. The patient is an adult born after 1996, so methylene blue treated products are not indicated.
References:
Comments