1: Transfusions Flashcards
What is a whole blood transfusion
Contains donor blood
When is a whole blood transfusion indicated
Major transfusion protocol - for severe haemorrhage
What is a massive blood transfusion
Replacement entire bodies circulation in 24h
Or replacement 50% in 4-hours
What are packed RBC
Donor RBC
What are the 3 indications for packed RBC
- Hb <70 or <80 if ACS
- Hb <100 and risk MI
- Hb <100 and major bleed
What is fresh frozen plasma
plasma with cellular components removed
What are the indications for FFP
- Platelets <10
- Platelets <20 and high-risk (fever, neutropenia, IC haemorrhage)
- Platelets <50 and active bleeding/ invasive procedure
- Platelets <80 and opthalmic or neurosurgery
What is human albumin solution used for
Protein - nephrotic syndrome or liver disease
What does cryoprecipitate contain
VWF, F8, F13, Fibrinogen, Fibronectin
When is cryoprecipitate given
- DIC
- Haemophilia
- VWF
- Fibrinogen less-than one and bleeding
What investigations do individuals need prior to transfusion
G+S and Cross-Match
What blood product is a cross-match and G+S not required for
Platelets - can be ABO incompatible
What are the two main classification systems looked at prior to giving blood transfusion
ABO and Rhesus
What does the ABO system refer to
Glycoproteins present on RBC
What glycoproteins does group A blood have
A
What glycoproteins does group B blood have
B
What glycoproteins does type AB have
AB
What glycoproteins does type O have
No glycoproteins
Explain antibody production in ABO system
Antibodies are produced to glycoproteins that the blood group does not have
What does type A blood produce antibodies to
B antibodies
What does type B blood produce antibodies to
A antibodies
What antibodies does type AB blood have
No antibodies!
What is type AB blood referred to as and why
Universal recipient.
Group AB has no antibodies and therefore can receive blood from any of the blood groups.
It can only donate to AB blood group due to having AB antigens.
What antibodies does type O blood have
AB antibodies
What is type O blood known as and why
Universal donor.
Group O has no antigens and therefore can donate to any blood group without reaction. However, it has AB antibodies and therefore can only receive blood from Group O.
What is rhesus positive
Contains rhesus antigen
What is rhesus negative
No rhesus antigen
What antibodies do rhesus positive have and what does this mean
Rhesus positive individuals have no antibodies - can receive blood from rhesus positive or negative
What antibodies do rhesus negative haven what does this mean
Rhesus negative blood groups have antibodies against rhesus. This means they can only receive blood from other rhesus negative individuals
What rhesus blood cannot be given to which patient
Rhesus positive cannot be given to rhesus negative
Explain development rhesus antibodies and its implications
Rhesus antibody is not naturally occurring - it only develops following an exposure - therefore if an emergency situation rhesus positive blood could be given to a negative patient for the first time.
What is the incidence of blood group O
45%
Who can blood group O donate to
Group A
Group B
Group AB
Group O
Who can blood group O receive blood from
Group O
What is the incidence of blood group A
40%
Who can blood group A donate to
group A
group AB
Who can blood group A receive from
group A
group O
What is the incidence of group B blood
10%
Who can group B donate to
Group B
Group AB
What can group B receive from
Group B
Group O
What % of blood is AB
10
Who can group AB donate to
AB
Who can group AB receive blood from
A
B
O
AB
What % of individuals are rhesus positive
85
What antibodies do rhesus positive have
No antibodies
Who can rhesus positive donate to
Rhesus positive
Who can rhesus positive receive from
Rhesus +ve
Rhesus -ve
What antigens do rhesus negative individuals have
No antigens
What antibodies do rhesus negative individuals have
Rhesus antibodies
Who can rhesus negative receive blood from
Rhesus negative
Or rhesus positive on first exposure
What is the limit for transfusing in heart failure
<50 transfusion with packed RBC
What should be given with each unit of blood in HF
40mg furosemide
Define massive blood transfusion
Transfusion individuals entire blood volume (10-units) in 24h
What arrest complications of massive blood transfusion
- Iron overload
- Low platelets
- Hypothermia
- Hypocalcaemia
- Hyperkalaemia
How can complications of blood transfusion initially be divided
- Early
2. Late
What is an early transfusion reaction
Within 24 hours
What are the 3 early immune-mediated transfusion reactions
- Transfusion associated lung injury
- Acute haemolytic transfusion reaction
- Anaphylaxis
What are the 2 non-immune mediated transfusion reactions
- Bacterial infusion
2. Transfusion-associated circulatory overload
What is a mnemonic to remember 5 early transfusions reactions
ATBAT
What are the 5 early transfusion reactions
Anaphylaxis TRALI Bacterial infection Acute haemolytic reaction TACO
What defines a delayed transfusion reaction
More than 24-hours
What are the 4 immune-mediated delayed transfusion reactions
- Graft versus host disease
- Post transfusion purpura
- Febrile non-haemolytic transfusion reaction
- Delayed Haemolytic transfusion reaction
What are 3 infectious causes of delayed transfusion reaction
- Hep B, C, HIV
- Malaria
- Prion disease
What causes an acute haemolytic transfusion reaction
ABO incompatibility
What are the 3 early features of acute haemolytic transfusion reaction
- Fever
- Hypotension
- Red coloured urine
What is a later feature of acute haemolytic transfusion reaction
- DIC
- Hypotension
- Bleeding
Outline management of acute-haemolytic transfusion reaction
- Stop transfusion
- Check patient identity
- Inform Haematologist (FBC, U+E, Clotting, Cultures)
- 0.9% Saline
What causes TRALI
donor’s blood has antibodies to recipients HLA antigens
How does TRALI present clinically
Within 6h of transfusion:
- Sudden-onset dyspnoea
- Fever
- Hypotension
How is TRALI managed
Stop transfusion
100% oxygen
What causes anaphylaxis
Patient is allergic to protein components of donors blood
How does anaphylaxis present
- Bronchospasm: dyspneoa, stridor
- Angioedema
How is anaphylaxis managed
Stop transfusion
Secure airway
How many ml does a unit of blood increase plasma volume by
450ml
Who is at particular risk of TACO
HF and elderly
How does TACO present
- Dyspneoa
- Hypoxia
- Bi basal crackles
- Raised JVP
- Tachycardia
How can TRALI be distinguished from TACO
- TRALI = fever (TACO = no fever)
- TACO = bi-basal crackles (TRALI = no bi-basal crackles)
How is TACO managed
Stop transfusion
Oxygen
IV Furosemide
How does bacterial infusion present clinically
Fever
Rigor
Hypotension
How is bacterial infusion managed
- Stop transfusion
- Tell haematologist
- FBC, U+E, Culture
- IV antibiotics
What is graft vs. host disease
Immune cells in donors tissue recognise recipients as foreign and mount an immune attack
What causes delayed haemolytic transfusion reaction
Antibodies to minor antigens such as rhesus and Kidd
What time-frame does delayed haemolytic transfusion reaction occur
3-14 days
How does delayed haemolytic transfusion reaction present clinically
- Drop in Hb
- Fever
- Jaundice
- Haemaglobinuria
What causes a febrile non haemolytic transfusion reaction
Recipient has antibodies to donors HLA antigens
Explain TRALI
Donor has antibodies to recipients HLA antigens
How does a febrile non-haemolytic transfusion reaction present clinically (FNHTR)
- 5h:
- Fevers and Shivering
When are febrile non-haemolytic transfusion reactions more common
If multiple transfusions or pregnancy
How is FNHTR managed
Stop transfusion
Paracetamol
What causes post-transfusion purpura
Body produces alloantibodies to introduced platelets causing thrombocytopenia and purpura
What time frame does post-transfusion purpura occur
5-12 days
What is a prion disease
CJD
