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Y4 Cancer Care > 19 - Blood Transfusions > Flashcards

19 - Blood Transfusions Flashcards

1
Q

If a patient is O-ve what antigens and antibodies do they have?

A

Usually

  • No ABO antigens
  • No rhesus D antigen
  • Anti-D and Anti-A and Anti-B

Just because AB antigens doesn’t mean anti-A and anti-B so check

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2
Q

What are alloantibodies and why do they cause a reaction in incompatible blood transfusions or haemolytic disease of the newborn?

A
  • Immune antibodies that are only produced following exposure to foreign red blood cell antigens
  • Produced by exposure to foreign red cell antigens which are non-self antigens but are of the same species. They react only with allogenic cells
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3
Q

Are ABO autosomal dominant or recessive?

A
  • AB are codominant
  • O is recessive
  • Rhesus D is dominant
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4
Q

What blood type are universal donors?

A

O -ve

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5
Q

What is the most common blood transfusion error?

A

Wrong blood product transfused

(Most common cause of mortality is TACO)

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6
Q

How are RBC stored and how long is their shelf life?

A
  • Shelf life of 35 days (unless irradiated)
  • Must be stored at 2-6°C in an authorised blood fridge with audible alarm system and functional temperature recorder
  • Should be COMPLETELY transfused within 4 hours of removal from temperature controlled storage (TCS).
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7
Q

How are platelets stored and what is their shelf life?

A
  • Platelets are stored in the HTL at 20 - 24°C in an agitator. Never store them in the fridge, this causes the platelets to aggregate irreversibly
  • Platelets have a shelf life of 5 or 7 days
  • Platelet transfusion should be started as soon as possible after the component arrives in the clinical area.
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8
Q

How is FFP (clotting factors) and Cryoprecepitate (fibrinogen) stored and what is it’s shelf life?

A
  • Stored at -25°C for up to 3 years
  • Once a request is received the component is thawed in the laboratory at 37°C, which can take 15-30 minutes
  • These components should be transfused as soon as possible and must be completed within 4 hours of removal from TCS
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9
Q

What needs to be done when requesting blood from the blood bank in general terms?

A
  • Check informed consent from patient for blood transfusion
  • Check patient’s identity
  • Fill in blood collection form
  • Only collect one unit at a time
  • Ensure the patient has patent IV access
  • Undertake pre-transfusion observations (which must be taken within 60 minutes of the transfusion commencing)
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10
Q

Can FFP be re-frozen if unused?

A

No but return to hospital transfusion laboratory as may be able to reissue

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11
Q

When requesting blood from the blood bank on a blood form what do you need to write on the form?

A
  • Group and Save and Cross Match sample for pre-transfusion screening
  • Hand labelled sample
  • What type of blood product and how many units
  • Any special blood e.g irradiated
  • When you need the blood
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12
Q

When gaining informed consent for a blood transfusion, what information do you need to give the patient?

A
  • Why they need it
  • The risks if they don’t
  • The benefits if they do
  • Other options
  • Give them a PIL
  • Ask if they have any questions

e.g You need blood to replace that lost from your surgery. If you don’t you will be anaemic and become breathless etc. There is a small risk of infection but we screen all blood. Also a risk of a reaction but can do things to minimise this. You could also take iron tablets

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13
Q

What patients need CMV negative blood?

A
  • Neonates up to 28 days expected delivery date
  • Pregnant women
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14
Q

Which patients need irradiated blood products and what does irradiation do?

A

Inactivate any T lymphocytes that could lead to graft vs host disease

  • Previous stem cell transplant
  • Hodgkin’s Lymphoma
  • Pregnant women
  • Neonates
  • Immunodeficiency (SCID or Immunosuppressants)

Refer to Hospital Transfusion Laboratory (HTL) and BSH guidelines (202

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15
Q

What is the difference between a Group and Save and a Cross Match sample and how many of these are needed for a blood transfusion?

A

Patient should always be wearing and ID band at time this sample is taken and positive identity check

In the absence of an historical blood group (this can be checked on ICE), two EDTA samples are currently required for Group and Save/cross match. These samples must be collected over two separate phlebotomy episodes. Each sample must be accompanied by a separate request form. Where possible the 2 samples should be taken by two different individuals, this is to ensure that positive patient identification is carried out each time the sample is taken.

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16
Q

How long can plasma from a patient be held from a group and save for cross matching?

A

14 DAYS

If pregnant or had a transfusion in last 3 months then 3 days

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17
Q

How long does it take for blood to be issued if there is a group and save done and a blood request form?

A
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18
Q

How long does an average RBC and Platelet transfusion take?

A

RBC: 90-120 minutes

Platelets: 30 to 60 minutes

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19
Q

What scenarios does blood need to be warmed before transfusion?

A
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20
Q

Before each unit of blood is transfused what needs to be done by a nurse?

A
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21
Q

What are important points about the access for a blood transfusion?

A
  • Do not prime the line
  • Use an integral mesh filter to remove macroaggregrates
  • Change every 12 hours if ongoing transfusion
  • Never put platelets through if another blood product been in before
  • Never put other drugs/fluids through the same lumen
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22
Q

What pre transfusion observations are recorded?

A

Done within 60 minutes before transfusion

  • Temperature
  • Pulse
  • Blood pressure
  • Respiratory rate
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23
Q

What observations do you need to do during a blood transfusion and when?

A

PULSE, BLOOD PRESSURE, RESPIRATORY RATE, O2 Sats AND TEMPERATURE

Done 15 to 20 minutes after start of transfusion, 60 minutes after start and then for each new unit of blood

Monitor for up to 24 hours after for late reactions

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24
Q

When do most transfusion reactions happen and how may they present in a patient?

A

First 20 minutes

If any of these symptoms stop the transfusion immediately

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25
Q

What is the haemovigillence scheme in the UK called?

A

SHOT! Aim to reduce transfusion reactions e.g transfusion infections, ABO incompatibility

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26
Q

How is donated blood screened and deemed suitable for use?

A

Essential

  • HIV
  • Hep B and C
  • Syphillis
  • Hep E
  • HTLV

Case by Case basis

  • Malaria
  • West Nile Virus
  • CMV
  • T-Cruzi
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27
Q

What patients cannot donate blood?

A
  • If they have recieved blood donation before
  • HIV/HepB/HepC
  • Injected drugs
  • Sex workers (wait 3 months)
  • Recent tattoo
  • Illness in last 7 days or Antibiotics in last 14 days
  • Gay men with more than one partner in the last 3 months
  • Travel to particular areas
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28
Q

Before transfusion of any blood product what is the main thing to consider?

A

Risk Vs Benefit

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29
Q

What are the indications for a transfusion of red cells?

A

Hb<70, Acute blood loss >30%, Hb 70-90 and symptomatic

Transfusion is necessary to save life or prevent major morbidity

Alternatives to allogeneic red cells should be considered where appropriate

Document precise indication for transfusion in case notes

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30
Q

How can anaemia and red cell transfusion be avoided in the surgical area?

A
  • Take FBC and G+S before any elective surgery
  • Correct any iron deficiency anaemia with iron supplements
  • Consider Red Cell Salavage
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31
Q

How should non-symptomatic chronic anaemia be treated?

A

Consider EPO

32
Q

How much does one unit of red cells raise Hb by?

A

10

33
Q

What are the risks and benefits of a red cell transfusion?

A

Benefits

  • Prevent symptoms of anaemia
  • Provide adequate oxygen supply to brain and heart

Risks

  • Infection
  • VTE
  • Haemolytic transfusion reactions
  • TACO
34
Q

What are the different types of platelets, what is one bag of platelets referred to and how much does one bag raise a patients platelets by?

A
  • Apheresis - single donor
  • Pooled - whole blood derived (4 donations)
  • One bag is termed one Adult Therapeutic Dose (ATD)
  • One ATD should increase the platelet count by at least 20 x 109/L
  • All blood services in the UK screen for bacterial contamination routinely
35
Q

What are the risks and benefits of a platelet transfusion?

A

Risks

  • Allo-immunization
  • Transmission of infection
  • Allergic reactions
  • Transfusion-related acute lung injur

Benefits

  • Reducing morbidity associated with minor haemorrhage
  • Reducing morbidity/mortality resulting from major bleeding
36
Q

What are some indications for a platelet transfusion?

A
  • Active bleeding with associated thrombocytopenia
  • Prophylaxis for reversible bone marrow failure including allogeneic stem cell transplant and critical illness
  • Prophylaxis for chronic bone marrow failure if patient is receiving intensive treatment e.g chemotherapy. see image
37
Q

What are some contraindications of a platelet transfusion?

A
  • Autoimmune ITP
  • Thrombotic ITP (could cause micro thrombi)
38
Q

What are the different types of FFP and how much is one bag of FFP?

A

Pack volume varies from 200-300ml

Dose is 15 ml/kg if prophylactic, 20ml/kg if major haemorraghe– may need to be repeated after 4-6 hours if bleeding continues guided by coagulation tests.

  • Standard FFP for adults (from UK donors)
  • Solvent detergent-treated FFP called Octaplas (mainly used for plasma exchange in TTP and HUS)
39
Q

What are some indications or the use of FFP?

A

No use in patients not actively bleeding!!!!!

  • Inherited coagulation factor deficiency where no suitable factor concentrate is available, e.g. Factor V deficiency
  • Acute DIC with active bleeding
  • Thrombotic thrombocytopenic purpura (TTP): use solvent detergent FFP (SD-FFP)
  • Major haemorrhage
  • Prophylaxis before surgery/invasive procedure if abnormal coagulation test results AND one or more additional risk factors for bleeding:
    • Personal or family history of abnormal bleeding
    • Procedure associated with major blood loss
    • Procedure involves critical tissues such as eye, brain or spinal cord
    • Concurrent thrombocytopenia.
40
Q

What are the risks and benefits of an FFP transfusion?

A

Risks

  • Anaphylaxis
  • Transfusion related acute lung injury (TRALI)
  • Haemolysis from transfused antibodies, especially A and B

Benefits

  • Prevent life threatening bleeding
41
Q

FFP is often transfused incorrectly. What are some contraindications to FFP being used?

A
  • As a plasma expander to correct hypovolaemia.
  • For the reversal of warfarin anticoagulation, use vitamin K and PCC
  • To non-bleeding patients with liver disease
  • To critically ill patients with prolonged PT or APPT in the absence of bleeding
  • For patients with liver disease
42
Q

How is cryoprecipitate made?

A

Slowly thawing fresh frozen plasma at 4-6°C, followed by resuspension of factors FVIII, von Willebrand factor, FXIII, fibronectin and fibrinogen in 20-60 ml plasma

Single donor units are pooled into 5-donor packs, with volume 200-280 ml

Varying amount of fibrinogen in each

43
Q

What are the indications for cryoprecipitate and the dose?

A

I_ndications:_

  • Prophylaxis before surgery or other invasive procedure associated with significant bleeding risk in patients with fibrinogen level less than 1 g/l
  • DIC with bleeding and fibrinogen level less than 1 g/l
  • Major haemorrhage and fibrinogen level less than 1.5 g/l
  • Major obstetric haemorrhage and fibrinogen level less than 2 g/l

Two 5-donor pools contain 3-6 g of fibrinogen and should increase fibrinogen level by approximately 1 g/l in a non-bleeding average-sized adult of 70 kg

  • Adult dose: two 5 donor pools or one 10 donor pool
44
Q

What are some plasma derivatives also used for blood transfusions?

A
  • Albumin solutions
  • Fibrinogen concentrate
  • Prothrombin complex concentrate (PCC)
  • IV IgG (Immunoglobulins)
45
Q

What is PCC and what are indications for the use of PCC?

A

PCC is a freeze-dried concentrate of three or four inactivated clotting factors (II, IX and X or II, VII, IX, X) and Protein S and C anticoagulant factors

Immediate reversal of warfarin in acute bleeding

Octaplex or Beriplex

46
Q

How do you determine PCC dose?

A

Monitor INR

Also give Vit K alongside PCC

47
Q

What are the risk and benefits of blood transfusions you need to explain for informed consent?

A
48
Q

What is the definition of a massive haemorrhage and when should you activate the massive haemorraghe protocol ?

A

Activate this protocol if 4 or more units of red cells have been transfused within an hour and similar further transfusions are anticipated

49
Q

What are the steps in the massive haemorrhage protocol?

A

ALWAYS TRY TO STOP THE BLEEDING!

50
Q

What is the order that blood products are released in a massive haemorraghe?

A
51
Q

What are some of the complications of a massive transfusion?

A
52
Q

What are the alternatives to blood transfusion?

A
  • Iron tablets or injections
  • Tranexamic acid AND cell selvage
  • Erythropoietin
53
Q

What are the complications of blood transfusion?

A

Immunological

  • ABO Mismatch
  • Delayed haemolytic transfusion reactions
  • Transfusion-related acute lung injury (TRALI)
  • Anaphylaxis
  • Non-haemolytic febrile transfusion reactions

Non-Immunological

  • Transfusion-associated circulatory overload (TACO)
  • Transmission of infection
54
Q

Who need to be informed about a transfusion reaction?

A

Not reported if only mild

  • SHOT
  • MHRA
55
Q

How should any acute blood transfusion be managed?

A
  • Stop transfusion and do rapid A to E
  • Call senior
  • Check patient ID and blood compatibility
  • Commence oxygen therapy if needed
  • Monitor temp, pulse, RR, BP, sats, urine output
  • IM adrenaline if anaphylaxis
  • Inform blood laboratory immediately
  • Undertake investigations a
  • Treat any DIC
  • Report to SHOT
56
Q

When is a transfusion reaction considered mild so the transfusion can be restarted without senior review?

A
57
Q

Acute haemolytic reaction in a blood transfusion may be due to ABO incompatibility, bacterially contaminated or thermally damaged blood.

What are the signs and symptoms of ABO incompatibility and the complications of this?

A

Due to destruction of red blood cells by IgM antibodies

  • Fever
  • Abdominal pain
  • Hypotension
58
Q

How should an acute haemolytic reaction during a blood transfusion be managed?

A

• Stop transfusion
• Resuscitate patient with fluids
• Seek advice from Consultant Haematologist
• Return all blood packs and the drip set to the Blood Transfusion Laboratory
• Take samples for: FBC, Coagulation screen, LFTs, Haptoglobin, Blood culture, U&E, Re-group, antibody screen, direct anti-human globulin test, recross-matching

• Test all urine passed for haemoglobin

• Treat DIC

59
Q

How may a delayed haemolytic reactions present?

A
  • Fever
  • Fall in haemoglobin level.
  • Jaundice
  • Haemoglobinuria (8 days post-transfusion)
60
Q

What is the management of a delayed haemolytic reaction?

A

Take samples for:

  • FBC
  • LFT
  • Direct Antiglobulin Test (Coombs test)
  • Antibody screening

Inform Blood Transfusion Laboratory staff and discuss with senior haematology medical staff

61
Q

What is a TRALI caused by and how does it present?

A

Donor plasma contains antibodies to patient’s leucocytes, high mortality rate

Manifests as features of non-cardiogenic pulmonary oedema within 6 hours

  • Chill
  • Fever
  • Non-productive cough
  • Breathlessness
  • Hypoxia
  • Interstitial shadowing on chest x-ray
62
Q

How is TRALI managed?

A
  • Stop transfusion
  • Immediately seek advice from senior haematology and ITU
  • 100% Oxygen and supportive care
63
Q

What are Febrile Non-Haemolytic Transfusion Reactions (FNHTR) caused by?

A
  • Cytokines in blood components or patient antibodies to donor leucocyte antigens
  • Often occur towards the end of the transfusion and there are no clinical signs other than a rise in temperature and chills
  • Less common because of universal leucodepletion of blood components
  • FNHTRs are unpleasant but not life threatening
64
Q

How do FNHTRs present and how are they managed?

A
  • Slow transfusion
  • Paracetamol
  • Monitor
65
Q

How does a mild allergic reaction present with a blood transfusion, what is it due to and how is it managed?

A
  • Temporarily stop transfusion
  • Urticaria
  • Itching

Give chlorphenamine IV or hydrocortisone IV

66
Q

Why does anaphylaxis occur with some blood transfusions and how does it present?

A

Antibodies against IgA in patients who have severe IgA deficiency

67
Q

How is anaphylaxis due to a blood transfusion managed?

A
  • Stop transfusion
  • Maintain airway and give oxygen
  • Give IM Adrenaline 0.5 to 1.0 mg
  • Attach patient to cardiac monitor.
  • Hydrocortisone 100-200 mg IV to prevent late biphasic reaction
  • Nebulised Salbutamol +/- IV Aminophylline infusion for bronchospasm
  • Chlorphenamine
  • Seek senior advice and inform blood laboratory
68
Q

If a patient has anaphylaxis during a blood transfusion what should be done before future transfusions?

A

Washed cellular blood components or selected blood components from IgA deficient donors may be needed for future transfusion

69
Q

What is Transfusion Associated Circulatory Overload (TACO) and what patients are at risk of this?

A
  • Excessive rate of transfusion
  • When correcting chronic anaemia or those with pre-existing cardiac disease
  • Also a risk in Paediatric and Neonatal transfusion
  • All patients must be assessed for the risk of TACO prior to transfusion
70
Q

If someone has risk factors for TACO, what can be done to prevent this from happening?

A
  • Prophylactic diuretic
  • Transfuse one unit and reassess
  • Use body weight to work out dose of red cells
71
Q

How may TACO present and how is it managed?

A

Clinical features

  • Dyspnoea.
  • Tachycardia
  • Hypotension

Management

  • Stop transfusion
  • Give furosemide 40mg IV
  • Arrange chest X-ray and ECG
72
Q

How may sepsis due to contaminated blood transfusion present and how is it managed?

A

Extremely rare

73
Q

What are some late complications of blood transfusion?

A

Iron overload: Chelation therapy with Desferrioxamine may be needed

Graft versus host disease (GvHD): Rare but often fatal complication of transfusion caused by T-lymphocytes. It is prevented by irradiation of cellular blood components given to patients at risk

Post-transfusion purpura (PTP): Platelet-specific alloantibodies. Typically 5- 9 days after transfusion the patient develops an extremely low platelet count with bleeding

74
Q

What patients are at risk of Graft vs Host disease and need irradiated blood products?

A
  • Allogeneic bone marrow transplant
  • Foetal intrauterine transfusions
  • Hodgkin’s disease
  • specific chemotherapy including fludarabine, cladribine, clofarabine, campath (alemtuzumab), Deoxycoformycin
  • DiGeorge Syndrome
  • First or second degree relative’s blood
75
Q

What investigations should be done for any transfusion reaction?

A
76
Q

How can you tell the difference between TACO and TRALI?

A

Fever and Blood pressure!

Y4 Cancer Care (19 decks)

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