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Haematology > 1: Transfusions > Flashcards

1: Transfusions Flashcards

1
Q

What is a whole blood transfusion

A

Contains donor blood

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2
Q

When is a whole blood transfusion indicated

A

Major transfusion protocol - for severe haemorrhage

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3
Q

What is a massive blood transfusion

A

Replacement entire bodies circulation in 24h

Or replacement 50% in 4-hours

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4
Q

What are packed RBC

A

Donor RBC

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5
Q

What are the 3 indications for packed RBC

A
  • Hb <70 or <80 if ACS
  • Hb <100 and risk MI
  • Hb <100 and major bleed
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6
Q

What is fresh frozen plasma

A

plasma with cellular components removed

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7
Q

What are the indications for FFP

A
  • Platelets <10
  • Platelets <20 and high-risk (fever, neutropenia, IC haemorrhage)
  • Platelets <50 and active bleeding/ invasive procedure
  • Platelets <80 and opthalmic or neurosurgery
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8
Q

What is human albumin solution used for

A

Protein - nephrotic syndrome or liver disease

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9
Q

What does cryoprecipitate contain

A

VWF, F8, F13, Fibrinogen, Fibronectin

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10
Q

When is cryoprecipitate given

A
  • DIC
  • Haemophilia
  • VWF
  • Fibrinogen less-than one and bleeding
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11
Q

What investigations do individuals need prior to transfusion

A

G+S and Cross-Match

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12
Q

What blood product is a cross-match and G+S not required for

A

Platelets - can be ABO incompatible

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13
Q

What are the two main classification systems looked at prior to giving blood transfusion

A

ABO and Rhesus

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14
Q

What does the ABO system refer to

A

Glycoproteins present on RBC

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15
Q

What glycoproteins does group A blood have

A

A

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16
Q

What glycoproteins does group B blood have

A

B

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17
Q

What glycoproteins does type AB have

A

AB

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18
Q

What glycoproteins does type O have

A

No glycoproteins

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19
Q

Explain antibody production in ABO system

A

Antibodies are produced to glycoproteins that the blood group does not have

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20
Q

What does type A blood produce antibodies to

A

B antibodies

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21
Q

What does type B blood produce antibodies to

A

A antibodies

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22
Q

What antibodies does type AB blood have

A

No antibodies!

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23
Q

What is type AB blood referred to as and why

A

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.

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24
Q

What antibodies does type O blood have

A

AB antibodies

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25
Q

What is type O blood known as and why

A

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.

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26
Q

What is rhesus positive

A

Contains rhesus antigen

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27
Q

What is rhesus negative

A

No rhesus antigen

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28
Q

What antibodies do rhesus positive have and what does this mean

A

Rhesus positive individuals have no antibodies - can receive blood from rhesus positive or negative

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29
Q

What antibodies do rhesus negative haven what does this mean

A

Rhesus negative blood groups have antibodies against rhesus. This means they can only receive blood from other rhesus negative individuals

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30
Q

What rhesus blood cannot be given to which patient

A

Rhesus positive cannot be given to rhesus negative

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31
Q

Explain development rhesus antibodies and its implications

A

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.

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32
Q

What is the incidence of blood group O

A

45%

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33
Q

Who can blood group O donate to

A

Group A
Group B
Group AB
Group O

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34
Q

Who can blood group O receive blood from

A

Group O

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35
Q

What is the incidence of blood group A

A

40%

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36
Q

Who can blood group A donate to

A

group A

group AB

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37
Q

Who can blood group A receive from

A

group A

group O

38
Q

What is the incidence of group B blood

A

10%

39
Q

Who can group B donate to

A

Group B

Group AB

40
Q

What can group B receive from

A

Group B

Group O

41
Q

What % of blood is AB

A

10

42
Q

Who can group AB donate to

A

AB

43
Q

Who can group AB receive blood from

A

A
B
O
AB

44
Q

What % of individuals are rhesus positive

A

85

45
Q

What antibodies do rhesus positive have

A

No antibodies

46
Q

Who can rhesus positive donate to

A

Rhesus positive

47
Q

Who can rhesus positive receive from

A

Rhesus +ve

Rhesus -ve

48
Q

What antigens do rhesus negative individuals have

A

No antigens

49
Q

What antibodies do rhesus negative individuals have

A

Rhesus antibodies

50
Q

Who can rhesus negative receive blood from

A

Rhesus negative

Or rhesus positive on first exposure

51
Q

What is the limit for transfusing in heart failure

A

<50 transfusion with packed RBC

52
Q

What should be given with each unit of blood in HF

A

40mg furosemide

53
Q

Define massive blood transfusion

A

Transfusion individuals entire blood volume (10-units) in 24h

54
Q

What arrest complications of massive blood transfusion

A
  • Iron overload
  • Low platelets
  • Hypothermia
  • Hypocalcaemia
  • Hyperkalaemia
55
Q

How can complications of blood transfusion initially be divided

A
  1. Early

2. Late

56
Q

What is an early transfusion reaction

A

Within 24 hours

57
Q

What are the 3 early immune-mediated transfusion reactions

A
  1. Transfusion associated lung injury
  2. Acute haemolytic transfusion reaction
  3. Anaphylaxis
58
Q

What are the 2 non-immune mediated transfusion reactions

A
  1. Bacterial infusion

2. Transfusion-associated circulatory overload

59
Q

What is a mnemonic to remember 5 early transfusions reactions

A

ATBAT

60
Q

What are the 5 early transfusion reactions

A 
Anaphylaxis 
TRALI 
Bacterial infection 
Acute haemolytic reaction 
TACO
61
Q

What defines a delayed transfusion reaction

A

More than 24-hours

62
Q

What are the 4 immune-mediated delayed transfusion reactions

A
  • Graft versus host disease
  • Post transfusion purpura
  • Febrile non-haemolytic transfusion reaction
  • Delayed Haemolytic transfusion reaction
63
Q

What are 3 infectious causes of delayed transfusion reaction

A
  • Hep B, C, HIV
  • Malaria
  • Prion disease
64
Q

What causes an acute haemolytic transfusion reaction

A

ABO incompatibility

65
Q

What are the 3 early features of acute haemolytic transfusion reaction

A
  • Fever
  • Hypotension
  • Red coloured urine
66
Q

What is a later feature of acute haemolytic transfusion reaction

A
  • DIC
  • Hypotension
  • Bleeding
67
Q

Outline management of acute-haemolytic transfusion reaction

A
  • Stop transfusion
  • Check patient identity
  • Inform Haematologist (FBC, U+E, Clotting, Cultures)
  • 0.9% Saline
68
Q

What causes TRALI

A

donor’s blood has antibodies to recipients HLA antigens

69
Q

How does TRALI present clinically

A

Within 6h of transfusion:

  • Sudden-onset dyspnoea
  • Fever
  • Hypotension
70
Q

How is TRALI managed

A

Stop transfusion

100% oxygen

71
Q

What causes anaphylaxis

A

Patient is allergic to protein components of donors blood

72
Q

How does anaphylaxis present

A
  • Bronchospasm: dyspneoa, stridor

- Angioedema

73
Q

How is anaphylaxis managed

A

Stop transfusion

Secure airway

74
Q

How many ml does a unit of blood increase plasma volume by

A

450ml

75
Q

Who is at particular risk of TACO

A

HF and elderly

76
Q

How does TACO present

A
  • Dyspneoa
  • Hypoxia
  • Bi basal crackles
  • Raised JVP
  • Tachycardia
77
Q

How can TRALI be distinguished from TACO

A
  • TRALI = fever (TACO = no fever)

- TACO = bi-basal crackles (TRALI = no bi-basal crackles)

78
Q

How is TACO managed

A

Stop transfusion
Oxygen
IV Furosemide

79
Q

How does bacterial infusion present clinically

A

Fever
Rigor
Hypotension

80
Q

How is bacterial infusion managed

A
  • Stop transfusion
  • Tell haematologist
  • FBC, U+E, Culture
  • IV antibiotics
81
Q

What is graft vs. host disease

A

Immune cells in donors tissue recognise recipients as foreign and mount an immune attack

82
Q

What causes delayed haemolytic transfusion reaction

A

Antibodies to minor antigens such as rhesus and Kidd

83
Q

What time-frame does delayed haemolytic transfusion reaction occur

A

3-14 days

84
Q

How does delayed haemolytic transfusion reaction present clinically

A
  • Drop in Hb
  • Fever
  • Jaundice
  • Haemaglobinuria
85
Q

What causes a febrile non haemolytic transfusion reaction

A

Recipient has antibodies to donors HLA antigens

86
Q

Explain TRALI

A

Donor has antibodies to recipients HLA antigens

87
Q

How does a febrile non-haemolytic transfusion reaction present clinically (FNHTR)

A
  1. 5h:

- Fevers and Shivering

88
Q

When are febrile non-haemolytic transfusion reactions more common

A

If multiple transfusions or pregnancy

89
Q

How is FNHTR managed

A

Stop transfusion

Paracetamol

90
Q

What causes post-transfusion purpura

A

Body produces alloantibodies to introduced platelets causing thrombocytopenia and purpura

91
Q

What time frame does post-transfusion purpura occur

A

5-12 days

92
Q

What is a prion disease

A

CJD

Haematology (19 decks)

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