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Year 4 - Cancer Care > 2.03 - Blood Transfusion > Flashcards

2.03 - Blood Transfusion Flashcards

1
Q

Main divisions of blood.

A
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2
Q

What is the difference between plasma and serum?

A

Plasma has clotting factors.

Serum has no clotting factors and contains:
- proteins (ie. immunoglobulins)
- electrolytes
- glucose

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3
Q

What is a blood product?

A

Any part of the blood collected from a donor for use in a blood transfusion.

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4
Q

NICE guidelines recommend a Hb concentration threshold of __ g/L for those who need red blood cell transfusions.

A

70g/L

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5
Q

What are the important blood groups?

A
  • ABO group
  • Rhesus D group
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6
Q

What is the significance of the Rhesus D blood group?

A

A RhD-ve patient with make a RhD antibody if they are given RhD+ve blood.

This has the potential to cause problems during pregnancy:
- anti-D antibodies can cross the placenta
- anti-D antibodies bind to foetal RhD antigens on RBC surface membrane
- foetal immune system targets RBCs with anti-D antibodies bound, leading to fetal anaemia.

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7
Q

What antibodies are found in plasma for the following blood groups?

a) A

b) B

c) AB

d) O

A

a) anti-B

b) anti-A

c) none

d) anti-A; anti-B

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8
Q

What antigens in erythrocytes are found for the following blood groups?

a) A

b) B

c) AB

d) O

A

a) A antigen

b) B antigen

c) A and B antigen

d) no antigens

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9
Q

Blood types compatible in an emergency for the following blood groups?

a) A

b) B

c) AB

d) O

A

a) A, O

b) B, O

c) A, B, AB, O

d) O

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10
Q

What blood tests can be performed prior to blood transfusion?

A
  • group and screen
  • crossmatch
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11
Q

What is the difference between group and screen, and crossmatch?

A

Group and screen (G&S): determines the patients ABO and RhD status, and screens the blood for atypical antibodies.

Crossmatch: physically mixing the patient’s blood with the donor’s blood, in order to see if any immune reaction takes place. If it doesn’t, the blood can be transfused to the patient.

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12
Q

What procedures are in place to prevent the patient being given incorrect blood?

A
  • using 3 points of identification
  • consent the patient appropriately
  • labelling the bottle at the bedside (pre-printed stickers are not allowed)
  • completing the transfusion request form at the bedside
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13
Q

What type of blood product must be given to women during pregnancy, and neonates?

A

CMV negative blood products.

CMV is a congenital infection that can lead to sensorineural deafness and cerebral palsy.

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14
Q

What are irradiated blood products?

A

Blood products that have been treated with radiation (ie. x-rays) to prevent transfusion-associated graft-versus-host disease (TA-GvHD).

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15
Q

Which groups of patients should receive irradiated blood products?

A
  • those receiving blood from a first or second-degree family member
  • patients with Hodgkin’s lymphoma
  • recent haematopoietic stem cell transplant
  • ATG or Alemtuzumab therapy
  • purine anologue chemotherapy
  • intra-uterine transfusions
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16
Q

What are the observation timings when administering blood products?

A
  • before the transfusion starts
  • 15 mins
  • 1 hour
  • at completion
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17
Q

What cannula should blood products be administered through?

A

18G or 16G cannula; otherwise the cells haemolyse due to sheering forces in the narrow tube.

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18
Q

What are the types of blood product?

A
  • packed red cells
  • platelets
  • fresh frozen plasma
  • cryoprecipitate
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19
Q

Major constituents of packed red blood cells (pRBCs).

A

Red blood cells.

A negligible amount of plasma is retained, meaning the only antigens of the product need to be considered when determining compatability.

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19
Q

Compatibility of pRBCs.

a) O patients

b) A patients

c) B patients

d) AB patients

A

a) O pRBCs

b) A and O pRBCs

c) B and O pRBCs

d) A, B, AB and O pRBCs

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19
Q

Duration over which packed red cell transfusion is delivered.

A

2-4 hours; it must be completed within 4 hours of coming out the store.

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19
Q

Indications of packed red cell transfusion.

A
  • acute blood loss
  • chronic anaemia (Hb ≤70g/L)
  • symptomatic anaemia
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20
Q

1 unit of packed red cells increases a patients haemoglobin by approximately how much?

A

10g/L

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21
Q

Major constituents of fresh frozen plasma (FFP).

A

Clotting factors.

No antigens are being transfused, and only red cell antibodies need to be considered.

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22
Q

Compatibility of FFP.

a) O patients

b) A patients

c) B patients

d) AB patients

A

a) O, A, B and AB FFP

b) A and AB FFP

c) B and AB FFP

d) AB FFP

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23
Q

Indications for fresh frozen plasma transfusion.

A
  • DIC
  • any haemorrhage secondary to liver disease
  • all massive haemorrhages (given after 2nd unit of pRBCs)
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24
Q

Duration over which fresh frozen plasma is transfused.

A

30 minutes

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25
Q

Main constituents of platelet transfusion.

A

Platelets

26
Q

Indications of platelet transfusion.

A
  • haemorrhagic shock in trauma
  • profound thrombocytopenia
  • bleeding with thrombocytopenia
  • pre-operative thrombocytopenia
27
Q

Duration over which platelets are transfused.

A

30 minutes.

28
Q

1 adult therapeutic dose (ATD) of platelets transfused should increase platelet levels by how much?

A

20-40 x10^9/L

29
Q

Major constituents of cryoprecripitate.

A
  • fibrinogen
  • vWF
  • Factor VIII
  • fibronectin

Like FFP, cryoprecipitate contains only donor plasma, so the rules for FFP compatibility can be followed.

30
Q

Indication of cryoprecipiate transfusion.

A
  • DIC with fibrinogen <1g/L
  • von Willebrand’s disease
  • massive haemorrhage
31
Q

Duration over which cryoprecipitate is transfused.

A

Stat.

32
Q

What are the acute complications of transfusion.

A
  • acute haemolytic transfusion reaction
  • infective shock
  • transfusion-related acute lung injury (TRALI)
  • fluid overload
  • anaphylaxis
  • non-haemolytic febrile reactions to transfusion of platelets and red cells
33
Q

Pathophysiology of acute haemolytic transfusion reaction.

A

Incompatible transfused red cell react with the patients own anti-A or antiB antibodies, or other alloantibodies.

This causes acute haemolysis and the complement system can be activated, leading to disseminated intravascular coagulation (DIC).

34
Q

Mortality of acute haemolytic transfusion reaction.

A

10%

35
Q

Infective shock transfusion reaction pathophysiology.

A

Bacterial contamination of a blood component causes an acute onset of:
- hypertension
- hypotension
- rigors
- collapse

This is a rare but severe transfusion reaction.

36
Q

Why is infective shock transfusion reaction most closely associated with platelet transfusion?

A

Platelets are stored at room temperature, so bacteria is more likely to colonise.

37
Q

Pathophysiology of transfusion-related acute lung injury (TRALI).

A

Donor plasma containing antibodies against the patients leukocytes results in an acute respiratory distress.

38
Q

TRALI presentation.

A
  • transfusion <6 hours
  • nonproductive cough
  • breathlessness
  • hypoxia
  • frothy sputum
  • fever
  • rigor
39
Q

CXR findings consistent with TRALI.

A
  • multiple perihilar nodules
  • infiltration of lower lung fields
40
Q

What is transfusion associated cardiac overload (TACO)?

A

Occurs when too much fluid is transfused, or it is transfused too quickly.

This leads to pulmonary oedema and acute respiratory failure.

41
Q

Patients groups at risk of TACO.

A
  • chronic anaemia
  • cardiac failure
42
Q

TRALI vs TACO.

A
43
Q

What is a non-haemolytic febrile reaction?

A

Patient antibodies to transfused white cells can cause fever and rigors.

44
Q

Patient groups at risk of non-haemolytic febrile reactions.

A
  • multiparous women
  • multiple previous transfusions
45
Q

Symptoms of blood transfusion reaction.

A
  • feeling of apprehension
  • flushing
  • chills
  • pain at venepuncture site
  • myalgia
  • nausea
  • pain in the abdomen, flank or chest
  • shortness of breath
46
Q

Signs of transfusion reaction.

A
  • fever
  • hypo-/hypertension
  • tachycardia
  • respiratory distress
  • haemoglobinaemia
  • haemoglobinurea
47
Q

Investigations of blood transfusion reactions.

A
  • FBC and clotting
  • group and screen
  • crossmatch
  • antibody sccreen
  • urinalysis (?Hb)
  • mast cell tryptase
  • blood cultures
  • ABG
48
Q

Management of acute transfusion reaction.

A
  • stop the transfusion
  • vital signs and respiratory status
  • check the patient’s identity and recheck against details on blood unit and compatability label / tag
  • give oxygen and fluid support
  • monitor urine output
  • consider inotropes if hypotensive
  • inform hospital transfusion department
49
Q

What are some delayed complications of transfusion?

A
  • delayed haemolysis
  • alloimmunisation
  • post-transfusion purpura
  • graft-vs-host disease (GvHD)
  • iron overload
  • infection
  • immunomodulation
50
Q

Pathophysiology of delayed haemolysis of transfused red cells.

A

In those who have previously been immunised to a red cell antigen during pregnancy or by transfusion, the level of antibody to the blood group antigen may be so low as to be undetectable in the pre-transfusion sample.

However, after transfusion of red cells bearing that antigen, a rapid, secondary immune response raises the antibody level drastically, leading to the rapid destruction of transfused cells.

5-10 days post-transfusion, patients present with fever, falling Hb (or unexpectedly poor rise in Hb), jaundice and haemoglobinuria.

A rise in bilirubin and positive DAT will also be present.

51
Q

Pathophysiology of alloimmunisation.

A

Transfusion of red cells of a different phenotype to the patient’s will cause alloimmunisation - for example, development of anti-RhD in RhD-negative patients who have received RhD-positive cells.

This is dangerous if the patient later receives a red cell transfusion, and can cause haemolytic disease of the newborn (HDN).

52
Q

Pathophysiology of post-transfusion purpura.

A

This is a rare but serious complication caused by platelet-specific alloantibodies, more often seen in female transfusion recipients.

It usually occurs 5-9 days following transfusion.

Bleeding associated with a very low platelet count develops.

High-dose IV Ig is the current treatment of choice.

53
Q

Pathophysiology of iron overload transfusion reaction.

A

Each unit of blood contains 250 mg of iron and those receiving red cells over a long period may develop iron accumulation in cardiac and liver tissues.

Chelation therapy (with desferrioxamine) is used to minimise iron accumulation in those most at risk.

54
Q

Infectious diseases that can be transmitted via blood transfusion.

A

Blood borne viruses such as:
- HIV
- HBV
- HCV

Since there is always the potential for unrecognised or unknown infection to be spread via transfusion, all non-essential transfusions should be avoided.

55
Q

Pathophysiology of immunomodulation transfusion reaction.

A

Concerns have been raised that tumour recurrence rates and postoperative infection rates are raised after transfusion of allogeneic red blood cells, platelet concentrates, or plasma units in cancer patients.

There is increasing clinical evidence that this may actually lead to negative clinical outcomes by affecting patients’ immune defence, stimulating tumour growth, tethering, and dissemination.

There is no question that critically ill patients with life-threatening low blood cell counts or bleeding need transfusion. However, until clinical trials provide further evidence, the routine use of transfusion in critically ill cancer patients should be considered on an individual basis, and the risks and benefits evaluated as with any other treatment.

56
Q

What is GvHD?

A

A rare complication when T-cells in the donated blood attacks the recipient’s own body cells.

It is almost always fatal and there is no effective treatment.

It is more common in immunodeficient patients.

57
Q

How can GvHD be prevented?

A
  • irradiation of cellular blood products
  • immunocompromised patients given a card stating the need for irradiated blood
58
Q

How can the need for transfusion be reduced?

A
  • EPO to stimulate erythropoiesis
  • hypotensive surgery to reduce intra-operative bleeding
  • cell-salvage machines
59
Q

Alternatives to blood transfusion.

A
  • iron replacement therapy
  • cell salvage
  • erythropoietin injections
  • doing nothing
60
Q

Blood transfusion consent:

What are the possible risks of blood transfusion?

A

“Blood transfusion is very safe, but as is the case with any medical procedure, there are some risks.”

“Donated blood is carefully tested and processed, so the risk of infection due to bacteria or viruses like hepatitis or HIV is tiny – less than 1 in a million. We have to check carefully that we match the right blood for you, so you need to wear an ID band and you will be asked to state your name and date of birth before starting. Occasionally, people develop a reaction during the transfusion, such as a temperature or a rash. Rarely, these can be serious. There is a small risk that fluid could build up in your circulation, making you feel short of breath.”

“Events such as these are unlikely and we will check you regularly during the transfusion. It is very important to tell a member of staff if you feel unwell at any point, so we can deal with any problems quickly. Sometimes, after one transfusion your immune system can make antibodies against the donor blood cells. These won’t affect you, but they can make it harder for us to find blood that is a match for you if you needed another transfusion.”

61
Q

Blood transfusion consent:

What does a blood transfusion involve?

A

“Before the transfusion, a small sample of your blood needs to be obtained to check your blood group. This will be sent to a lab for testing. A small needle called a cannula will be put into a vein in your arm or hand. You will be asked to give your name and date of birth and this will be checked against your ID band and the details on the bag of donor blood selected for you.”

“The blood will flow slowly from the bag via a plastic tube into your vein. It usually takes 2 to 4 hours for each bag of blood to be transfused. Your temperature, blood pressure and pulse will be checked before, during and after the transfusion.”

62
Q

What is SHOT?

A

Serious Hazards of Transfusion (SHOT) is a national, anonymous scheme for reporting adverse blood incidents or ‘near miss’ incidents.

SHOT analyses the data sent in each year and produced annual reports along with recommendations for changes in future practice.

63
Q

Each unit of donated blood is subjected to rigorous tests and further processing.

A

Testing: screen for HIV, HBV, HCV, HTLV, Syphilis.

Leucodepletion: removal of white cells to reduce the risk of various transfusion reactions.

Centrifugation: separation of red cells, platelets and plasma, allowing the processing of while blood into various blood components.

64
Q

Why are platelets stored at room temperature?

A

If platelets are refrigerated it may cause them to irreversibly aggregate.

NB: As stored at room temperature, higher risk of bacterial colonisation.

65
Q

Contraindications to platelet transfusion.

A
  • thrombotic thrombocytopenic purpura (TTP)
  • heparin-induced thrombocytopenia (HIT)

Year 4 - Cancer Care (13 decks)

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