SU3.1-3 | Blood and Blood Components — Assignment

CLINICAL SCENARIO

A 34-year-old woman is admitted with a major postpartum haemorrhage following an emergency caesarean section. Her estimated blood loss is 2,500 mL. She is tachycardic (heart rate 124/min), hypotensive (blood pressure 86/52 mmHg) and confused. The massive transfusion protocol is activated, and over the next two hours she receives 6 units of packed red cells, 4 units of fresh frozen plasma, 1 adult dose of platelets and 2 pools of cryoprecipitate. Midway through the resuscitation she develops peri-oral tingling and the cardiac monitor shows a prolonged QT interval. As she stabilises, you must also plan to counsel her and her family about the transfusion she received and about future blood donation by her relatives.

1. Component therapy and indications

For each component this patient received (packed red cells, fresh frozen plasma, platelets, cryoprecipitate), state what it supplies, its storage conditions, and the specific deficit it corrects in major haemorrhage. Explain why component therapy is preferred over whole blood.

Guidance: Link each component to the physiological need it meets; mention storage temperatures and shelf life to show understanding of why components are separated.

2. Recognising the metabolic complication

Identify the complication signalled by the peri-oral tingling and prolonged QT interval. Explain its mechanism in the context of massive transfusion and state how you would confirm and treat it.

Guidance: Name citrate-induced hypocalcaemia and explain the citrate–calcium chelation mechanism; outline monitoring of ionised calcium and the role of IV calcium.

3. The four complications of massive transfusion

Beyond the complication above, enumerate and briefly explain the other major hazards of massive transfusion and how each is prevented or managed.

Guidance: Cover hyperkalaemia, hypothermia and dilutional coagulopathy alongside hypocalcaemia; mention blood warmers and laboratory monitoring.

4. Vigilance for acute reactions during resuscitation

Explain how you would distinguish a dangerous acute transfusion reaction (haemolytic, anaphylactic, septic, TRALI, TACO) from a benign febrile reaction in this rapidly transfusing patient, and what your immediate actions would be if one occurred.

Guidance: Emphasise timing, vital-sign patterns, and the universal first step of stopping the transfusion for any serious reaction while maintaining IV access.

5. Counselling for transfusion and donation

Outline how you would counsel this patient and her family about the transfusion she received and about voluntary blood donation, including consent, safety, infection screening and donation intervals.

Guidance: Use plain language; address informed consent, reassurance about the safety of the blood supply, and the encouragement of voluntary, non-remunerated donation.