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Peri-Operative Care [16] > Blood and Blood Product Transfusion in Surgical Patients > Flashcards

Blood and Blood Product Transfusion in Surgical Patients Flashcards

1
Q

What is a blood product?

A

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

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2
Q

Why should the decision to prescribe blood products be taken very seriously?

A
  • Transfusion reactions are relatively common, even those in appropriately cross-matched blood
  • Blood products are scarce, and therefore should only be used when necessary
  • Blood group incompatability is a rare but life threatening complication
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3
Q

What is the result of blood group incompatability being a life-threatening complication?

A

Blood products need to be appropriately cross-matched and checked to avoid severe consequences

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4
Q

What haemoglobin threshold do NICE recommend as an indication for RBC transfusion?

A

70g/L, without any major haemorrhage or ACS

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5
Q

What is the haemoglobin concentration target for after transfusion?

A

70-90g/L

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6
Q

How is the risk of transfusion reactions minimised?

A

The blood group of the donor and the recipient must be considered

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7
Q

What are the important blood groups in transfusion?

A
  • The ABO blood system
  • Group D of the rhesus system
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8
Q

What can a patients blood group be initially classified into?

A

RhD+ or RhD-

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9
Q

What does RhD+ or RhD- refer to?

A

The presence or absence of Rhesus D surface antigens on the RBCs

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10
Q

What % of the population is RhD+?

A

Approx 85%

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11
Q

What happens if a RhD- patient is given RhD+ blood?

A

They will made RhD antibody

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12
Q

What effect does the production of RhD antibody have on a RhD- patient?

A

None - the RhD antibody cannot attack their own RBCs, as they do not have RhD present on their RBC membrane

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13
Q

When can RhD grouping cause problems?

A

In pregnancy

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14
Q

Why can RhD grouping cause problems in pregnancy?

A

Because anti-D antibodies can cross the placenta

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15
Q

In what scenario will anti-D antibodies cause a problem in pregnancy?

A

If a woman has RhD- blood, and becomes pregnant by a RhD+ partner, producing a fetus that is RhD+. During childbirth, she comes into contact with the foetal (RhD+) blood, and develops antibodies to it. If she later becomes pregnant with another RhD+ child, the womans anti-D antibodies cross the placenta and enter the foetal circulation, which contains RhD+ blood, and binds to the foetus’ RhD antigens on its RBC surface membranes. This causes the foetal immune system to attack and destroy it’s own RBCs, leading to foetal anaemia. This is termed haemolytic disease of the newborn

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16
Q

What is the result of the risk of haemolytic disease of the newborn on transfusion?

A

RhD specific blood is given to women in order to avoid the scenario in the future

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17
Q

Can a male be given blood that does not match their own in terms of RhD status?

A

Yes - although it is preferable to give correctly cross-matched blood, it is possible to give a RhD- male some RhD+ blood if that is all that is available in an emergency setting

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18
Q

What does the ABO blood group refer to?

A

The presence of A and/or B antigens on the surface of RBCs

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19
Q

Who is the specific ABO blood group relevant too?

A

All individuals undergoing a potential blood transfusion

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20
Q

What is a universal donor?

A

Someone with O -ve blood

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21
Q

What is meant by universal donor?

A

The blood can be given to anybody, irrespective of the recipients blood group

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22
Q

Why can O-ve blood be given to anyone?

A

Because there are no AB or Rhesus antigens on the donor surface membrane, and so the recipient can have both A, B, and Rhesus antibodies in their circulation, but they will likely not reject the donor blood as there are no AB or Rh antigens to attack

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23
Q

What is a universal acceptor?

A

Someone with AB+ve blood

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24
Q

What is meant by universal acceptor?

A

You can give this recipient any donor blood, irrespective of the ABO or Rhesus status

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25
Q

Why can AB+ve recieve any type of blood?

A

Because they don’t have any anti-A, -B, or -Rhesus antibodies in their circulation, and therefore cannot mount an immune response to the donor blood

26
Q

What blood tests can be performed prior to blood transfusion?

A
  • Group and save
  • Crossmatch
27
Q

What happens in group and save?

A

The patients blood group is determined (ABO and RhD), and screened for atypical antibodies

28
Q

How long does G&S take?

A

Around 40 minutes

29
Q

Is blood issued in G&S?

A

No

30
Q

When is a G&S recommended?

A

When blood loss is not anticipated, but blood may be required should there be a greater blood loss than expected

31
Q

What does crossmatch involve?

A

Physically mixing the patients blood with the donor’s blood to see if any immune reaction takes place

32
Q

How long does crossmatching take?

A

About 40 minutes, in addition to 40 minutes required to G&S the blood (which must be done first)

33
Q

When is a crossmatch done?

A

If blood loss is anticipiated

34
Q

What is required at every stage of requesting blood products?

A

Strict adherence to procedures in place required to prevent the patient being given incorrect blood

35
Q

What procedures need to be adhered to when requesting blood products?

A
  • Using 3 points of identifcation to check you are with the correct patient (name, DOB, patient number
  • Appropriate consent
  • Labelling the bottle at the bedside (pre-printed stickers are not allowed in blood transfusion)
  • Completing transfusion request form at the bedside. Before you put blood bottle into request bag, check the patient is happy you have labelling things correctly
36
Q

What is CMV?

A

A common congential infection that may lead to sensorineural deafness and cerebral palsy

37
Q

Who needs to be given CMV negative blood?

A
  • Pregnant women
  • Intra-uterine transfusion
  • Neonates (up to 28 days)
38
Q

What is the purpose of irradiated blood products?

A

To reduce the risk of graft-vs-host-disease in at risk populations

39
Q

Who should recieve irradiated blood?

A
  • Those receiving blood from first or second degree family members
  • Patients with Hodgkin’s lymphoma
  • Recent haematopoietic stem cell transports
  • After anti-thymocyte globulin or alemtuzumab therapy
  • Those receiving purine analogues as chemotherapy
  • Intra-uterine transfusions
40
Q

Does each unit of blood need to be prescribed individually?

A

Yes

41
Q

What observation timings should be carried out in a patient receiving a transfusion?

A
  • Before the transfusion starts
  • 15-20 minutes after it has started
  • At 1 hour
  • At completion
42
Q

What cannula can blood products be administered through?

A

Green (18G) or grey (16G)

43
Q

Why should blood products only be administered through a 18G or 16G cannula?

A

Otherwise the cells haemolyse due to sheering forces in the narrow tube

44
Q

What happens to blood after it is harvested from donors?

A

It is separated into it’s constituent parts

45
Q

What equipment to blood products need to be administered through?

A

A blood giving set, rather than a normal fluid-giving set

46
Q

How do blood giving sets differ from normal fluid giving sets?

A

A blood giving set contains a filter in the chamber, whereas a normal fluid giving set doesn’t

47
Q

What are the different types of blood products?

A
  • Packed red cells
  • Platelets
  • Fresh frozen plasma
  • Cryoprecipitate
48
Q

What is the major constituent of packed red cells?

A

Red blood cells

49
Q

What are the indications for packed red cells?

A
  • Acute blood loss
  • Chronic anaemia, where the Hb is <70g/L, or <100g/L in those with cardiovascular disease, or symptomatic anaemia
50
Q

Over what duration are packed red cells administered?

A

2-4 hours (must be completed within 4 hours of coming out of the store)

51
Q

By how much should 1 unit of blood increase a patients Hb?

A

10g/L

52
Q

What might happen to patients given RBCs?

A

They may produce autoantibodies to donor surface antigens (of which there are many other than ABO and RhD)

53
Q

What is the result of the possibility of patients given RBCs developing autoantibodies to donor surface antigens?

A

A new G&S needs to be sent every time (unless last G&S was sent and processed within 3 days of most recent transfusion)

54
Q

What are the indications for administration of platelets?

A
  • Haemorrhagic shock in a trauma patient
  • Profound thrombocytopenia (<20 x 109/L)
  • Bleeding with thrombocytopenia
  • Pre-operative platelet level <50 x 109/L
55
Q

Over what duration are platelets administered?

A

30 minutes

56
Q

By how much should 1 ATD (adult therapeutic dose) increase platelet levels?

A

Around 20-40 x 109/L

57
Q

What are the major constituents of fresh frozen plasma?

A

Clotting factors

58
Q

What are the indications for fresh frozen plasma?

A
  • Disseminated intravascular coagulation
  • Any haemorrhage secondary to liver disease
  • All massive haemorrhages (commonly given after the 2nd unit of packed red cells)
59
Q

Over what duration is fresh frozen plasma administered?

A

30 minutes

60
Q

What are the major constituents of cryoprecipitate?

A
  • Fibrinogen
  • Von Willebrands factor
  • Factor VII
  • Fibronectin
61
Q

What are the indications for cryoprecipitate?

A
  • DIC with fibrinogen
  • Von Willebrands disease
  • Massive haemorrhage
62
Q

Over what duration is cryoprecipitate administered?

A

Stat

Peri-Operative Care [16] (20 decks)

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