Blood groups and transfusions

Question 1

What can neutrophil levels be affected by that are not pathological

Answer 1

ethnicity variation

Question 2

What colour is AntiA (type B) blood in lab

Answer 2

Blue

Question 3

What colour is AntiB (type A) in lab

Answer 3

yellow

Question 4

What blood type has anti-A and anti-B antibodies

Answer 4

O

Question 5

What blood type has neither Anti-A or AntiB anitbodies

Answer 5

AB 2

Question 6

Anaemia investigations

Answer 6

HB, MCV
Ferritin, B12, folae leves
U+Es, LFTs, TFTs,
Blood film
Reticulocyte count + haemolysis screen
Trend - new or old, fall quick or slow

Question 7

Why does speed of losing Hb matter

Answer 7

Patients may tolerate low Hb extremely well if slow over time and compensated
Rapid fall, sick quickly even if still mdertae levles

Question 8

Transfusion dependent patients how differ in managing anaemia

Answer 8

Transfuse based on individual Hb thershold established over time

Question 9

Why is transfusion carefully considered especially in women

Answer 9

Can make rhesus positive/some other antibodies

Question 10

Triggers for RBC transfusion - stable without acute blood loss

Answer 10

Hb<70g/L in otherwise fit
Hb<80g/L - elderly/cardiac/resp disease

Question 11

Target Hb for cirtical care patients

Answer 11

70-90g/L
Btter long term outcomes
Higher threshold ina cute spesis, neuro injury and ACS but dont excceed 90

Question 12

Chronic anaemia Hb target eg thalassemia

Answer 12

Just above lowest concentration ass with no symptoms
Hb 95g/L max

Question 13

Post chemo target Hb

Answer 13

80-90

Question 14

Radiotherapy target Hb

Answer 14

maintain >100 g/L

Question 15

What is recommended amount to transfuse adults in absence of blood loss

Answer 15

ONE unit of RBC at a time and reassess response Hb and clinica symtpoms

Question 16

What consider in low weight adults transufsion esp <50kg

Answer 16

Weight based volume transfusions eg 4ml/kg

Question 17

Risks of transfusion categories

Answer 17

Immunological
Circulatory - TACO
Infection

Question 18

Immunological transfusions

Answer 18

Febrile - common to be mildy
Allergic
Alloimmunisation eg rhesus
Less frequent - TRALI, others

Question 19

Infection risks transfusion

Answer 19

Bacterial
Viral - HEV
vCJD
unknown

Question 20

Reactions to trasnfusion

Answer 20

AHTR - acute transfusion reaction
DHTR - delayed
FNHTR -febrile non haemolytic trasnfusion reactions

Question 21

TACO risk factors

Answer 21

Already fluid overloaded
Known HF/other cardiac abnormalities
Chronic lung disease
Renal failure
Significant hypoalbuminaemia
Low body mass
Elederly

Question 22

Components of blood transfusion

Answer 22

FFP
Cryoprecipitate
Platelets
RBC

Question 23

When are platelets used

Answer 23

Low platelet levels
<30 for non severe bleeding
<50 if severe/life threatening

Question 24

What is FFP

Answer 24

Plasma from single donor, replaces clotting factors and fibrinogen
Frozen - 15 mins to thaw

Question 25

When use FFP

Answer 25

Bleeding patients lacking clotting factors
PT:APTT>1.5
Prophylactic major surgery risk of major bleed

Question 26

How much FFP needs to be given

Answer 26

4 units - 1L (15-25ml/kg)

Question 27

What is cryoprecipitate

Answer 27

Replace fibrinogen - more concentrated than FFP

Question 28

When cryoprecipitate used

Answer 28

In bleeding actively
Early in major haemorrhage

Question 29

Usual adult dose of Cryoprecipitate

Answer 29

2 pools - each of 5U

Question 30

What is prothrombin complex concnetrate

Answer 30

Vit K dpenedent clotting factors - II, VII, IX, X, protein C+S

Question 31

What is main indication for PCC use

Answer 31

Rapid reversal of warfarin therapy

Question 32

What is patient blood management

Answer 32

Alternative and conservation of blood supply - optimise circulation before need haemorrhage

Question 33

Patient blood amnagemnet pillars

Answer 33

Diagnose and manage anaemia (eg correct before surgery so blood loss doesnt affect as much)
Minimise blood loss - control bleeding eg take off anticaogs, tranexamic acid add
Avoid unnecessary transfusion

Question 34

When do you test for anaemia before operation

Answer 34

ASA 3 or 4 before intermediate surgery
Major surgery

Question 35

Intra operative strategies PBM

Answer 35

Intra operative cell salvage
Wash RBC -> return to patient

Question 36

What is a drug to treat haemorrhage especially major/obstetric

Answer 36

Tranexamic acid

Question 37

General PBM recommendations

Answer 37

Education
Restrcitive transfusion thresholds
1U then reassess
Active manage anaemia
Minimise vol of blood smaples taken
Active management of abnormal haemostasis
Empowerment of lab staff to challenge innapropriate requests

Question 38

What causes an acute haemolytic transfusion reaction

Answer 38

ABO incompatibulity eg human error
RBC destruction by IgM

Question 39

Features of AHTR

Answer 39

Reaction within minutes of starting transfusion
Fever, abdominal pain, hypotension
Can-> DIC, renal failure

Question 40

Treatment AHTR

Answer 40

Stop transfusion

Confirm diagnosis
check the identity of patient/name on blood product
send blood for direct Coombs test, repeat typing and cross-matching

Supportive care
fluid resuscitation

Question 41

TACO features

Answer 41

Excessive transfusion rate or HF -> pulm oedema, HTPTN

Question 42

TACO treatment

Answer 42

Slow or stop transfusion
Consider IV loop diuretic eg furosemide and ozygen

Question 43

TRALI features

Answer 43

Neutrophil activation ->
Hypoxia, pulmonary infiltrates on CXR, fever, hypotension
Within 6 hours of transfusion

Question 44

TRALI treat

Answer 44

Stop transfusion and oxygen and supportive care

Question 45

Febrile recation to transfusion what d0

Answer 45

Paracetamol
WBC HLA antibodies cause