FRCPath Haem Part 1 MCQ-Transfusion 435

A 38-year-old man, Jehovah’s Witness, is admitted after a high-speed road traffic accident.

He has:

• Right mid-shaft femoral fracture

• No other injuries

Observations:

• HR: 125 bpm

• BP: 90/60 mmHg

• RR: 24/min

• O2 sat: 94%

Investigations:

• Hb: 82 g/L

• Platelets: 210 × 10⁹/L

• PT/APTT: normal

• Lactate: 4.2 mmol/L

• Blood gases: mild metabolic acidosis

Patient refuses all allogeneic blood transfusions. He has a blood refusal card/advance directives for all circumstances.

The orthopaedic team plans urgent surgical fixation.

Which of the following is the most appropriate immediate and peri-operative management strategy for this patient?

A.      Give urgent packed red cell transfusion to stabilise Hb, then proceed to surgery

B.      Optimise patient with IV fluids, tranexamic acid, consider cell salvage, and plan surgery with meticulous haemostasis

C.     Delay surgery until Hb rises spontaneously above 100 g/L

D.     Proceed immediately to surgery by using modern technology

E.      Give Prothrombin complex concentrates before surgery to reduce bleeding risk

F.      Give Novoseven before Surgery