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3rd Year - Haematology > 2. Blood Transfusion > Flashcards

2. Blood Transfusion Flashcards

1
Q

Why might a Blood Transfusion occur?

A
  1. Bleeding (most common)
  2. Failure of Production
    Note - due to Anaemia by any cause
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2
Q

What forms different Blood Groups?

A

Antigens on the Surface of Red Blood Cells - something which provokes an immune response

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3
Q

What are the 2 categories of Blood Group Systems?

A
  1. ABO Blood Types

2. RhD Blood Types

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4
Q

What are the Features of the ABO Blood Type Categories?

A
  1. ABO Gene encodes for a Glycosyltransferase
  2. If someone has Type A Blood, they will have N-Acetyl-Galactosamine on their Red Blood Cells Surface
  3. If someone has Type B Blood, they will have Galactose on their Red Blood Cells Surface
  4. If someone has Type AB, they will have Both
  5. If someone has Type O Blood, they have no Sugars on their Red Blood Cell Surface
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5
Q

What is the Significance of the Sugars on the Surface of the Red Blood Cells?

A

If you are born with that antigen on the Red Blood Cell Surface (A/B/AB blood type), you will have immune tolerance to it, as the body will identify it as self-attacking

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6
Q

Who can a Patient with:

  1. Type A Blood, Receive Red Blood Cells from?
  2. Type B Blood, Receive Red Blood Cells from?
  3. Type AB Blood, Receive Red Blood Cells from?
  4. Type O Blood, Receive Red Blood Cells from?
A
  1. Type A Patient = Type A / Type O
  2. Type B Patient = Type B / Type O
  3. Type AB Patient = Type A / Type B / Type O
  4. Type O Patient = Type O
    Note - Think of the Antigen on the Surface of Each Type, and it being present in this Plasma - If you are Group A you will have Anti-B etc…
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7
Q

Who can a Patient with:

  1. Type A Blood, Receive Fresh Frozen Plasma from?
  2. Type B Blood, Receive Fresh Frozen Plasma from?
  3. Type AB Blood, Receive Fresh Frozen Plasma from?
  4. Type O Blood, Receive Fresh Frozen Plasma from?
A
  1. Type A Patient = Type A / Type AB
  2. Type B Patient = Type B / Type AB
  3. Type AB Patient = Type AB
  4. Type O Patient = Type A / Type B / Type AB / Type O
    Note - Think of the Antigen on the Surface of Each Type, and it being present in this Plasma - If you are Group A you will have Anti-B etc…
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8
Q

What is the RhD Blood Group System?

A

RhD is a Transmembrane Protein which is Immunogenic - You will not make Anti-D unless exposed to it
Note - RhD Negative individuals can make Anti-D if exposed to RhD Positive Cells (Transfusion / Pregnancy)

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9
Q

What can Anti-D cause in pregnancy?

A

Transfusion Reactions / Haemolytic Disease of the Newborn

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10
Q

What is Screened for in Blood Donors?

A
  1. Behavioural Screening - Sex / Age / Location
  2. ABO / Rh Blood Types
  3. Infections - Hepatitis B / Hepatitis C / HIV / Syphilis
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11
Q

What are the Different Blood Fractions?

A
  1. Red Blood Cells
  2. Platelets
  3. Plasma:
  4. a) Fresh Frozen Plamsa
  5. b) Cryoprecipitate
  6. c) Fractionate:
  7. c) i) Factor Concentrates (e.g. FVIII / FIX)
  8. c) ii) Immunoglobulin
  9. c) iii) Albumin
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12
Q

What are the Features of Red Blood Cells from Donors?

A
  1. Stored at 4 Degrees
  2. Shelf-Life of 35 days
  3. Transfuse over 2-4 Hours
  4. Indication for use = Anaemia - Surgery / Medical
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13
Q

What are the Features of Platelets from Donors?

A
  1. 1 unit of Platelets = 4 pooled / 1 Apheresis Donor
  2. Stored at 22 Degrees / Shelf Life of 5 days
  3. Transfuse over 20-60 minutes
  4. Indications - Massive Haemorrhage / Bone Marrow Failure / Surgery Prophylaxis / Cardiopulmonary Bypass
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14
Q

What are the Features of Fresh Frozen Plasma from Donors?

A
  1. 1 unit = 1 unit of Blood
  2. Stored at Frozen - allow 30 minutes to Thaw
  3. Indications - Massive Haemorrhage / Disseminated Intravascular Coagulation (DIC) with Bleeding
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15
Q

What Safety Measures are in place for Patient Safety in Blood Transfusions?

A
  1. Second Sample - 2 Samples from 2 Different Needles
  2. Group and Save - ABO and RhD Type (Coomb’s Test)
  3. Cross Match (Group and Save + Mix of Donor and Sample from Patient to Check for Reaction)
  4. Samples kept for 7 Days
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16
Q

What Red Blood Cell / Plasma Type would you send for if you only had Minutes?

A
  1. O RhD Negative Red Cells

2. AB Plasma

17
Q

What Red Blood Cell / Plasma Type would you send for if it was an Urgent Situation?

A

Type Specific (ABO / RhD)

18
Q

What Red Blood Cell / Plasma Type would you send for if it was a Non-Urgent Situation?

A

Full Cross Match:
1. Select Correct ABO / RhD Type
2. If Allo-Antibodies choose Antigen Negative Blood
Note - There are many possible Allo-Antibodies in Blood

19
Q

What are the Key Principles of the Massive Haemorrhage Protocol?

A

Definitive Management - Rapid Control of Bleeding. Immediate Supply of:

  1. 6 Units of Red Cells
  2. 4 Units of Fresh Frozen Plasam
  3. 1 Unit of Platelets
20
Q

What are the Risks associated with Transfusions?

A
  1. Transfusion of ABO incompatible components
  2. Transfusion Associated Circulatory Overload (TACO)
  3. Transfusion Associated Lung Injury (TrALI)
  4. Acute Haemolytic Transfusion Reaction (AHTR)
21
Q

When is a Red Blood Cell Transfusion Indicated?

A

When Haemoglobin falls Below 70

22
Q

What are the Major Reactions to a Blood Transfusion?

A
  1. Fever
  2. Urticaria
  3. Respiratory Distress
  4. Hypotension
  5. Tachycardia
  6. Oliguria
  7. Bleeding
  8. Collapse
23
Q

What are the Minor Reactions to a Blood Transfusion?

A
  1. Fever < 30 Degrees
  2. Urticarial Rash
    Note - Consider Paracetamol / Antihistamine
    Note - These are common
24
Q

How are Reactions to Blood Transfusions Managed?

A
  1. Stop the Transfusion
  2. Check the Identity against the Component Label
  3. Consider:
  4. a) Anaphylaxis
  5. b) Transfusion Associated Circulatory Overload (TACO)
  6. c) Acute Haemolytic Transfusion Reaction (AHTR)
  7. d) Bacterial Infection
  8. e) Transfusion Associaed Lung Injury (TrALI)
25
Q

What is the Management of a Transfusion Associated Circulatory Overload (TACO)?

A
  1. Slow Rate
  2. I.V. Diuretic
  3. Oxygen
26
Q

What are the Features of Haemolytic Reactions?

A
  1. Immediate Complement-Mediated Lysis

2. Shock / High Fever / Renal Failure

27
Q

What is the Management of Haemolytic Reactions?

A
  1. Oxygen
  2. I.V. Fluids
  3. Diuretics
  4. Inotropes
  5. Dialysis
  6. Notify the Blood Service to Investigate
28
Q

What is the Management of Bacterial Infection?

A
  1. I.V. Antibiotics
  2. Oxygen
  3. I.V. Fluids
  4. Notify Blood Service
29
Q

What is the Management of Transfusion Associated Lung Injury (TrALI)?

A
  1. Oxygen
  2. Respiratory Support
  3. I.V. Fluids
  4. Notify Blood Service to Investigate / Initiate Recalls
30
Q

When / How does Haemolytic Disease of the Fetus / Newborn (HDFN) occur?

A

Development of Maternal Anti-D Antibodies (Sensitisation):

  1. Mother is Rh Negative Blood Cell Type
  2. Foetus os RH Positive Blood Cell Type
  3. RHD + Cells can Cross the Placenta (into the Mother)
  4. Anti-D can cross into the Foetus
31
Q

How is Haemolytic Disease of the Newborn:

  1. Prevented?
  2. Treated?
A
  1. Prophylactic Anti-D - Sensitising Events
  2. a) Careful Monitoring - Antibody Titres / Doppler Ultrasound / Intrauterine Transfusions
  3. b) Leucapheresis (Bone Marrow Harvest) / Gene Therapies

3rd Year - Haematology (10 decks)

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