GeriQBank · Paper III · Q14
Blood Transfusion
- Chapter
- Haematology
- Years asked
- Not recorded in the source
- Frequency
- Set 1× in Paper III (2009–2025)
As set in the university paper
Blood transfusion.
Paper III · Haematology & Oncology · asked ×1 · 7-mark note · see in paper list
Detailed answer
Pro · free in betaAttempt it firstOutline your answer as a 7-mark note before revealing it — definition, causes, evaluation, management and the geriatric angle.Reveal answer
Partial coverage: No dedicated transfusion chapter, but elderly-specific PRACTICE is discussed substantially across Ch. 22 (CKD), Ch. 23 (DIC), Ch. 24 (platelet thresholds) and Ch. 26/27 (MDS transfusion support — the most detailed section).
High-Yield Points
Ageing does NOT change platelet count or coagulation tests — a low count/deranged clotting always reflects disease.
CKD: Hb<8 g/dL carried 2× mortality risk vs 10–11 g/dL — but do not normalise the target (thrombotic risk).
MDS/malignancy: threshold generally 8 g/dL, raised to 9–10 g/dL with cardiac/other comorbidities.
Transfusion SPEED should be SLOW to avoid volume overload — explicit Pathy's point.
Platelets: spontaneous ICH risk below 20,000/µL; MDS prophylactic threshold <10,000/mm³; curative-intent transfusion preferred over routine prophylaxis (alloimmunisation risk).
Leukoreduced and irradiated products recommended to reduce isoimmunisation, infection, febrile reactions.
Phenotyped RBCs for chronically transfused patients; 10–15% develop alloantibodies in MDS.
Iron Overload (detailed in Pathy's)
Each unit contains ~250 mg iron. Chelation indicated after 20–50 units AND ferritin >1000–2500 ng/mL.
Monitor with hepatic/cardiac MRI annually; deferoxamine SC or oral deferasirox; check ferritin 3-monthly.
Transfusion in DIC
Transfusion prevents death from bleeding, but not from multi-organ failure (microvascular thrombosis is the usual cause of death). ABO-incompatible transfusion is itself a rare DIC trigger.
Blood Products (supplemented)
Product Main indication
Packed red cells Symptomatic anaemia
Platelet concentrate Thrombocytopenia with bleeding or prophylaxis <10,000/µL FFP DIC, warfarin reversal, massive transfusion Cryoprecipitate Hypofibrinogenaemia, DIC Latest Updates (2023–Present)
AABB 2023: restrictive Hb<7 g/dL generally, <7.5 cardiac surgery, <8 orthopaedic/CVD; 2025 update suggests LIBERAL <10 g/dL in acute MI (MINT trial). TACO is now the LEADING cause of transfusion death (34–41% of fatalities); age ≥70 is a formally recognised independent risk factor, alongside CHF and renal failure. MHRA/SHOT Patient Safety Alert (April 2024): mandatory pre-transfusion TACO risk assessment for patients ≥70; "Code R7" mandates single-unit transfusion strategy for stable non-bleeding patients — reassess after each unit before ordering a second. Patient Blood Management now the global WHO/AABB standard framework. Iron overload monitoring refined with cardiac/hepatic T2* MRI.
Current Practice Update
Domain Pathy's (2022) Current evidence
Dedicated No transfusion chapter AABB 2023 guidelines; formal PBM frameworks coverage TACO Not discussed at all Leading cause of transfusion death; age ≥70 a formal risk factor Transfusion rate "Slow to avoid volume overload" — Validated — now formalised as core TACO mitigation explicit Single-unit policy Implicit in "personalise threshold" Explicitly mandated (2024) for TACO-risk patients MD Geriatrics – Haematology Compendium Page 28 of 34
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References
- PAPERS-2-3-4_COMBINED.pdf — page 867
- GeriQBank source PDF — p. 867
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