CICM SAQ 2012.2 Q1

Questions

A 43-year-old woman is transferred to your Intensive Care Unit from a regional hospital following a motor vehicle crash. She is in haemorrhagic shock secondary to abdominal and pelvic trauma and received 3L crystalloid and 8 units O Rh(D) negative blood prior to arrival in your hospital.

a) What are the risks of giving O negative uncrossmatched blood to this patient?
b) Indicate whether crossmatch is needed or not for each of the following blood products:

  • Packed red blood cells
  • Platelets
  • Fresh frozen plasma
  • Cryoprecipitate
  • Prothrombin concentrate
  • Granulocyte concentration
  • Intravenous immunoglobulin

Answers

Answer and interpretation

a) What are the risks of giving O negative uncrossmatched blood to this patient?

Risks common to all blood transfusions

  • infection, allergy, haemolysis, TRALI, fluid overload, dilutional coagulopathy, etc

Risks specific to O-ve uncrossmatched

  • Mixed field group and screen (unclear blood group)
  • Prolong group and cross match if specimen not taken before.
    Non-ABO, non Rh (D) antigens/antibodies leading to allo-immunisation (sensitization) and delayed haemolytic reactions

b) Indicate whether crossmatch is needed or not for each of the following blood products:

  • Packed red blood cells — YES
  • Platelets — NO
  • Fresh frozen plasma — NO
  • Cryoprecipitate — NO
  • Prothrombin concentrate — NO
  • Granulocyte concentration — YES
  • Intravenous immunoglobulin — NO

Exams LITFL ACEM 700

Examination Library

CICM

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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