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Y2 Transfusion Science > Alternatives to transfusion > Flashcards

Alternatives to transfusion Flashcards

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1
Q

What are the risks of blood in clinical areas?

A 
Serious Adverse Reactions
Serious Adverse Events
Sustainability of the blood supply
Cost
Immunomodulation
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2
Q

What is Immunomodulation?

A

A change in the body’s immune system, caused by agents that activate or suppress its function.

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3
Q

What and do bioactive lipids cause immunomodulation after or during transfusion?

A

Polyunsaturated fatty acids accumulate in blood units during storage and may play a role in inflammation and transfusion-related acute lung injury.

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4
Q

What and do extracellular vesciles cause immunomodulation after or during transfusion?

A

Tiny microvesicles, exosomes and other components increase during blood storage and may cause both inflammation and immunosuppression.

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5
Q

How do white blood cells cause immunomodulation ?

A

Most get removed during blood processing, but white cells and their components (such as cytokines) may increase infection, inflammation and immunosuppression risk.

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6
Q

How do red blood cells cause immunomoduation?

A

The influx of blood may tax the body’s monocytes and macrophages. This overload may trigger inflammation and immunpsupression by changing the balance of oxygen, iron and haemoglobin.

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7
Q

How does storage and processing of transfusion blood lead to immunomodulation?

A

Stored red blood cells develop storage lesions over time, impacting everything from pH to how cells use oxygen and itron.

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8
Q

How do platelets cause immunomodulation?

A

Microparticles derived from platelets can suppress or activate immune cells.

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9
Q

How does transfusion affect survival and why?

A

The more units of transfusion you have had, the lower the survival rate is expected to be.

This is thought to be because immunomodulation is caused by transfusion.

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10
Q

Write what is on the patient blood management scheme in terms of a transfusion?

A

It is important to discuss the risks, benefits and alternatives with patients in order to gain informed consent.

Inappropriate use of transfusion must be avoided.

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11
Q

What is the patient blood management scheme?

A

Evidence-based approach to optimise the care of patients who might need a blood transfusion.

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12
Q

What are the recommendations of the patient-blood management scheme?

A

Reducing number and frequency of blood tests.

Ensuring blood sample results are reliable.

Identify and treat anaemia prior to elective surgery.

Avoid transfusion if alternatives are available.

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13
Q

In what types of people is reducing the frequency of blood tests important and why?

A

For very young or old people and people with underlying health conditions such as anaemia. Frequent blood transfusions could negatively effect these people.

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14
Q

Why shouldn’t patients who are being given a drip not have blood samples taken?

A

This may dilute the sample and give fake results.

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15
Q

Why have we now moved on from not allowing 1 unit of blood to be given?

A

1 unit of blood was previously seen as a risk. However, we now know that 1 unit of blood can increase Hb sufficiently and allow patients to be discharged.

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16
Q

What is an autologous blood transfusion?

A

Collection and rein fusion of the patients own red blood cells.

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17
Q

Why is autologous blood rarely used?

A

There have been concerns about viral transmission of donor blood, especially during the HIV epidemic.

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18
Q

What is acute normovolemic haemodilution and when is it performed?

A

It is performed immediately before surgery and involves the removal of whole blood from a patients and replacement of circulating blood volume with collid and or crystalloid solutions.

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19
Q

What is contained within the blood of acute normovolemic haemodilutions?

A

Functional platelets and clotting factors

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20
Q

What is the overall purpose of acute normovolemic haemodilution?

A

Minimises red cell loss overall during the transfusion.

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21
Q

In what type of patients is acute normovolemic haemoldilution used?

A
  • Used in adult patients undergoing surgery in which substantial blood loss is anticipated - this will minimise the blood they use.
  • Also used in patients wh refuse donor blood such as Jehovas’ witnesses.
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22
Q

Is acute normovolemic haemodilution used alone?

A

It can be used alone or in combination with other patient blood management strategies.

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23
Q

What people shouldn’t be given normovolemic haemodilution and why?

A

People with anaemia because they won’t have sufficient red cells to support the procedure.

People who have had renal failure or significant heart disease as these issues could be exacerbated.

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24
Q

What is inoperative cell salvage?

A

Collection and rein fusion of blood spilled during surgery.

25
Q

What steps must happen in inoperative cell salvage before the blood can be re-infused?

A

Blood lost in the surgical field is aspirated into a collection reservoir after filtration to remove particle debris.
It is then anti coagulated with herapin or citrate to stop it clotting.
The blood is then produced in a cell saver machine and can then be rein fused afterwards.

26
Q

What % loss of donor exposure does inoperative cell salvage offer?

A

20%

27
Q

What are the issues with using inoperative cell salvage as a transfusion alternative?

A

This requires trained staff and specific equipment.

Can cause dilution of clotting factors and thrombocytopenia if used in large volumes.

28
Q

What is post operative cell salvaging?

A

Blood is collected from wound drains and then either filtered or washed in an automated system before rein fusion into the patient.

29
Q

What are orthopaedic procedures?

A

Procedures of the bones, joints, ligaments, tendons and muscles.

30
Q

What types of patients are postoperative cell salvages the most common option as an alternative to transfusion?

A

Orthopaedic patients especially after knee or hip replacements and in correction of scoliosis.

31
Q

What is Tranexamic acid used for?

A

It inhibits fibinolysis by reducing the conversion of plasminogen to plasmin.

32
Q

What is fibrinolysis?

A

The breakdown of blood clots.

33
Q

What are the benefits of the drug Tranexamic acid?

A

It is low cost
It can be used by the oral or intravenous route.
It reduces the risk of blood transfusion and the need for further surgery due to re-bleeding.

34
Q

What does the drug ‘Recombinant activated factor VIII’ do?

A

Directly activates blood-clot formation at sites of exposed tissue factor in damaged blood vessels, bypassing other clotting pathways.

35
Q

When is the drug ‘Recombinant activated factor VIII’ used?

A

In patients with haemophilia A or B.

In major haemorrhage situations.

In cardiac surgery.

In liver or abdominal surgery.

36
Q

What are the issues with recombinant activated factor VIII?

A

Extremely expensive.

Acidosis can be caused which is common in traumatic haemorrhage. This reduces the effectiveness and levels of fibrinogen that are needed for clot formation.

37
Q

What are the purposes of Fibrinogen concentrate?

A

Replaces absent or low fibrinogen.

Serves as a physiological substrate of thrombin which converts soluble fibrinogen to insoluble fibrin.

38
Q

How does fibrin aid blood clotting under the influence of factor XIIIa?

A

When under the influence of factor XIIIa, fibrin strands are cross-linked to provide strength and stability to the blood clot.

39
Q

What are the issues with Fibrinogen Concentrate drug?

A

Can cause anaphylactic reactions and thrombotic events.

Very expensive.

Often only stored in bigger hospitals.

40
Q

What are the benefits of the drug Fibrinogen Concentrate?

A

Has a long shelf life

41
Q

Where is Erythropoietin produced and what is its purpose?

A

In the kidneys.

Increases red blood cell production in the bone marrow in response to reduced oxygen delivery to the tissues.

42
Q

What are the indication that Erythropoiesis stimulating agents are required or why may it be used?

A

Anaemia of renal failure.

Treating anaemia and reducing transfusion requirements in some cancer patients undergoing chemotherapy.

Increasing the yield of blood in PAD programmes.

Reducing exposure to donor blood in adults undergoing major orthopaedic surgery.

43
Q

What are the disadvantages of using Erythropoiesis stimulating agents?

A

Higher hematocrits may cause thromboembolic complications.

Expensive.

44
Q

What is the order of treatment options for people with iron deficient anaemia?

A

1) Eat a more iron rich diet.
2) Oral iron tablets.
3) IV iron

45
Q

What are the issues with oral iron tablets for people with iron deficient anaemia?

A

Many users experience GI side effects and compliance with treatment is poor.

46
Q

What are the indicators for IV iron being needed or when is it used?

A

Iron deficient anaemia with intolerance of oral iron, especially in inflammatory bowel disease, or when oral iron is ineffective.

To support the use of erythropoiesis stimulating agents.

As an alternative to blood administered in 15 mins transfusion when a rapid increase in Hb is required.

47
Q

What are the risks with IV iron ?

A

There is a low risk of hypersensitivity anaphylactic shock.

48
Q

What should be included when discussing transfusion with patients to ensure information consent is obtained?

A

Risks

49
Q

Why is autologous transfusion no longer popular?

A

There is a risk of serious adverse events.

50
Q

Intraoperative cell salvage can reduce donor blood by how much?

A

20%

51
Q

Tranexamic acid inhibits fibrinolysis, true or false?

A

True

52
Q

Does Riastap contain less fibrinogen than cryoprecipitate?

A

No

53
Q

Do both Riastap and Erythropoeitc cause thrombotic effects?

A

Yes

54
Q

Do Jehovah’s witnesses discount blood as a viable medical treatment?

A

No

55
Q

Do Jehovah’s witnesses have nay specific disagreement with other, none-religious people giving blood?

A

No

56
Q

Do Jehovah’s witnesses eat meat?

A

Yes

57
Q

What is the Jehovah’s view on organ donation and why?

A

It is patient choice because this is not mentioned in the bible.

58
Q

Who decides the medical treatment of Jehovah’s witnesses children?

A

The medical team before the age of 18.

Y2 Transfusion Science (10 decks)

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