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Year 2 - Haem > 11- Blood Transfusion > Flashcards

11- Blood Transfusion Flashcards

1
Q

How much blood and how frequently can one donor give?

A

1 unit (1 pint) every 4 months

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2
Q

What glycoprotein and fructose stem is common on the red cell membrane of all red blood cells in everyone?

A

H stem

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3
Q

What is present on the red cell membrane of someone with blood group O?

A

only the common H stem - not A or B antigens

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4
Q

What are A and B antigens?

A

The A and B antigens are made by the addition of a sugar residue onto the common glycoprotein and fructose stem (H stem)

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5
Q

What does the A gene encode?

A

An ENZYME that adds N-acetyl galactosamine to the H stem

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6
Q

What does the B gene encode?

A

An ENZYME that adds galactose to the H stem

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7
Q

Describe the inheritance pattern of the ABO blood groups.

A

A and B genes are codominant
O is ‘recessive’ because it doesn’t code for anything at all
So you need to be homozygous for O (OO) to be in blood group O

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8
Q

Describe which antibodies are present in people with different blood groups.

A

Antibodies are made against the any antigen that is NOT present on the red cells

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9
Q

Which antibodies would someone in blood group A possess? Why?

A

Anti-B antibodies because each person produces antibodies against any antigen that is NOT present on their own red cells.

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10
Q

What class of immunoglobulin are these antibodies?

A

IgM

They are naturally occurring (nearly from birth)

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11
Q

What would happen if someone with anti-B antibodies was given B-positive blood?

A

The anti-A/anti-B antibodies are complete antibodies meaning that it fully activates the complement cascade to cause haemolysis of red cells
This is often FATAL
It can lead to cytokine storm, lysis, cardiovascular collapse and death

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12
Q

In the laboratory, what would you see if you were to mix the plasma of someone of blood group A with the red cells of someone in blood group B?

A

Agglutination

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13
Q

What are the two most common blood groups in the UK?

A

A and O

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14
Q

What is done before transfusion to check that the donor blood and the recipient’s blood is compatible?

A

A blood sample is taken from the patient and the ABO blood group is determined (test with anti-A and anti-B antibodies)
Select a donor unit of the same group

CROSS-MATCH: patient’s serum is mixed with donor red cells – it should NOT react (if it reacts then it shows that it is incompatible)

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15
Q

Which rhesus antigen is the most important?

A

RhD

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16
Q

Describe the inheritance pattern of the RhD antigen.

A

Autosomal Dominant

RhD codes for the D antigen

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17
Q

What can happen when RhD negative people are exposed to RhD positive blood?

A

They become sensitised and can make anti-D antibodies

i.e. the antibodies don’t already exist in the blood, as they do for anti-A/B antibodies

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18
Q

What type of antibody are anti-D antibodies?

A

IgG

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19
Q

What are the implications on future transfusions of an RhD negative individual who has been sensitised to RhD following exposure?

A

In the future they must be transfused with RhD negative blood or the anti-D antibodies, generated from first exposure, will react with the RhD positive blood
This will cause a delayed haemolytic transfusion reaction resulting in anaemia, high bilirubin, jaundice etc.

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20
Q

What is haemolytic disease of the newborn?

A

If an RhD negative mother generates anti-D antibodies following pregnancy with a RhD positive foetus, then if the next foetus is RhD positive, the mother’s anti-D antibodies (IgG) can cross the placenta and cause haemolysis of foetal red blood cells.
If severe this can cause hydrops fetalis and death.

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21
Q

About 8% of transfused patients will form antibodies against antigens other than ABO and RhD. What are the implications of this?

A

Once they have formed antibodies against these other antigens, you must use corresponding antigen negative blood in future transfusions otherwise you risk a delayed haemolytic reaction.

22
Q

What must you always do before transfusion in such patients?

A

Before each transfusion you should test the patient’s blood sample for red cell antibodies.

So before transfusing a patient, as well as testing the ABO and RhD groups, you must do antibody screening of their plasma.

23
Q

Why is whole blood no longer routinely given to patients (i.e. it is separated into components)?

A

It is inefficient

Some components of the blood will degenerate quickly if it is stored as whole blood

24
Q

Why are the red cells concentrated and the plasma removed?

A

It allows you to avoid fluid overloading, which can precipitate heart failure, when giving someone red cells

25
Q

What three components is blood first separated into via centrifugation?

A

Plasma
Platelets (and white cells)
Red Cells

26
Q

What is fresh frozen plasma (FFP) and what does it contain?

A

Plasma is frozen within 6 hours of donation

This means that all coagulation factors are preserved

27
Q

How is cryoprecipitate produced and what does it contain?

A

Thawing FFP in a 4 degrees centigrade fridge over night produces Cryoprecipitate
Rich in fibrinogen and factor 8

28
Q

Explain what fractionation is and why it’s useful.

A

The plasma of multiple donors is pooled and put into a fractionating column. This means that various components such as albumin, haemophilia factors and anti-D antibodies can be pulled off.

NOT done in the UK

29
Q

How many donors does it take to make one unit of red blood cells?

A

1

30
Q

How are red blood cells stored and what is their shelf life?

A

They have the plasma removed and are stored in a 4-degree fridge
Shelf-life = 5 weeks

31
Q

How many donors does it take to make one unit of FFP?

A

1

32
Q

How is FFP stored and what is its shelf life?

A

Stored at -30 degrees

Shelf-life = 2 years

33
Q

How is FFP thawed?

A

Thawed at body temperature for 20-30 mins before use
If thawed at too high a temperature you could cook the coagulation proteins

You want to use it within half an hour of thawing because the coagulation factors can start to degenerate

34
Q

Why is it important to know the blood group of the patient before administering the FFP?

A

To make sure the antibodies in the FFP don’t react with the recipient’s RBC antigens.

If you give the wrong FFP it won’t kill the patient because the antibodies are quite dilute but it will haemolyse some of the red cells which is not ideal.

35
Q

What are the indications for FFP (i.e. when is it given)?

A

Bleeding and abnormal coagulation test results (PT and APTT)

Reversal of warfarin (e.g. for urgent surgery)

36
Q

How many donors does it take to make one standard dose of cryoprecipitate?

A

10 donors

37
Q

What are the indications of cryoprecipitate (i.e. when is it given)?

A

If massive bleeding and fibrinogen is very low

Rarely - hypofibrinogenaemia

38
Q

How many donors does it take to make one standard adult dose of platelets?

A

4 donors

39
Q

How are platelets stored and what is its shelf life?

A

They are stored at room temperature (22 degrees) and must be constantly agitated to prevent them from aggregating
Shelf-life = 5 days (because of risk of bacterial infection)

40
Q

Why is it important to give platelets of the same blood group to patients?

A

(There is no need to crossmatch between the donor and recipients blood but) you do need to give platelets of the same ABO blood groups because platelets have low levels of ABO.

The wrong group of platelets would be destroyed quickly.
Giving platelets of the wrong group could also cause RhD sensitization.

41
Q

What are the indications for giving platelets?

A
  • Most haematology patients with bone marrow failure
  • Massive bleeding
  • DIC
  • If very low platelets and the patient needs surgery
  • If cardiac bypass needed and the patient is on anti-platelet therapy
42
Q

If a patient is bleeding post-surgery and his platelet count is normal but he has a prolonged PT and APTT, which component(s) does he need?

A

FFP

43
Q

If a patient is bleeding post-surgery and his PT and APTT are long and his fibrinogen is low, which component (s) does he need?

A

FFP and cryoprecipitate

44
Q

State some commonly used fractionation products.

A

Factor 8 and 9 = used for haemophilia
Factor 8 – also used for von Willebrand’s disease
Immunoglobulins:
• IM: specific e.g. tetanus, anti-D and rabies
• IM: normal globulin – broad mix in the population

45
Q

What can IV Ig be used to treat?

A

Pre-op in patients with ITP (immune thrombocytopenic purpura – IVIg helps prevent the destruction of antibody coated platelets in the spleen and liver)
AIHA (autoimmune haemolytic anaemia)

46
Q

What is albumin used to treat?

A

4.5% = useful in burns, plasma exchanges etc.

20% (salt poor) = for certain severe liver and kidney conditions only.

47
Q

What measures are taken to ensure the safety of donated blood?

A

Exclude high-risk individuals

Test for infections

48
Q

REMEMBER

A

prion disease (variant Creutzfeldt-Jakob Disease) can be transferred via the blood

49
Q

The tests that are done on all donated blood:

A 
o	HIV 
o	Hep B
o	Hep C 
o	HTLV 
o	Syphilis
50
Q

To reduce the risk of vCJD through blood transfusion in the UK:

A

o Fractionation is no longer done

o All blood products are leucodepleted to remove

51
Q

To make cryoprecipitate, thaw FFP overnight and approximated 3% of the FFP forms a residue that fails to dissolve = cryoprecipitate

A

Cryoprecipitate is stored frozen in a small volume of plasma

Year 2 - Haem (10 decks)

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