Blood Groups, Donation Flashcards
What are the red cell antigens
Proteins found on the surface of the membrane of red cell of 400 different type
Two main antigen n red cell
ABO
Rh
Components of blood group antigens
Carbohydrates and
On which structure of the red cell membrane are the blood group antigens present on
The glycolipids and glycoproteins
Which type of antigens is found on the carbohydrate chains of the membrane glycolipid
ABO
Hh
Li
P systems
Antigens present on glycoproteins band 3
ABO
Hh
Li
Antigens present on glycoproteins glycophorin A
MN
Antigens present on glycophorin B
Ss
U
Events that stimulate antibodies
Blood transfusion
Fetal antigen in maternal circulation
Environmental factors
What does the h gene code for
A sugar fucose that’s added to terminal sugar of precursor substance
Precursor substance of rbc in order
Glucose - galactose - n acetylglucosamine - galactose
What structure added due to enzyme coded transferase by A GENE
N acetylglucosamine
Substance added enzyme coded by gene B
D galactose
WHAT IS THE BOMBAY PHENOTYPE
people lack Hh antigen which prevents attachment of group A and B
Bombay phenotype
O
Bombay serum
Anti A
Anti B
Anti AB
anti H
Dominant antigens of rh system
C D E
Recessive antigens of Rh system
c d e
Strongest antigen effect for for rh system
Antigen D
So if D present -> rh pos
If D absent -> rh neg
What are the concept of blood safety
Appropriate and low risk donors
screening test for markers of infection
elimination of any pathogens residual
optimize blood usage
When should you transfuse
Only when necessary
What substances should you use in deficiency anemia’s
Hemanitics
What should you use in aplastic anemia or renal failure
Erythropoietin to stimulate the marrow
When should you use crystalloids like normal Saline or colloid like dextran 70
When you want to increase intravascular volume
What percentage of blood loss should you use crystalloids or colloids
Between 21% to 30%
At what percentage of blood loss should you transfuse blood
Above 30
What is a autologous blood transfusion
Collection of blood from a single patient and retransfusion back to the same patient when required
When do you do autologous blood transfusion
Pre-operative deposit
Hemodilution
Intra-operative blood salvage
What are some principles used for bloodless Surgery
Meticulous surgery
Tourniquet
Diathermy
Who is the best donor
Voluntary repeated donor
What are the different types of blood donors
Voluntary non-remunerated donors
Family replacement donors
commercial donors
autologous donors
What are the immunologic transfusion risks
Immune hemolytic reaction febrile non-hemolytic reaction’s anaphylactic reaction urticarial reaction posttransfusional Purpura GVHD Graft versus host disease TRALI Transfusion related acute lung injury
non-immunology transfusion risks
Physical thermal injury
Chemical injury with calcium potassium citrate iron toxicity
Viruses bacteria helminthes protozoa prions infections
Acute hypotensive reactions bradykinin induced
Acute life-threatening transfusion reactions
Acute hemolytic reaction acute anaphylactic reaction transfusion related sepsis transfusion related acute lung injury Iacute hyperkalemia and hypocalcemia acute hypervolemia
Nonlife threatening acute transfusion reactions
Febrile non hemolytic transfusion reaction
urticarial
What is acute hemolytic transfusion reaction
Hemolysis of transfused red cells due to pre-existing antibody in recipients serum
When does acute hemolytic transfusion reaction mostly occur
Mostly in ABO incompatibility especially in group O receiving non O blood
Most common form of transfusion reaction
Acute hemolytic transfusion reaction
Symptoms and signs of a cute hemolytic transfusion reaction
Heat Pain in vein throbbing headache fever chest tightness dyspnea myalgia lung pain Hypotensiom
Immunoglobulin involved in acute hemolytic transfusion reaction
IgM Which mediates complement activation Intravascular hemostasis and the activation of coagulation cascade
Complications of acute hemolytic transfusion reaction
Shock
disseminated intravascular coagulation
acute renal failure
Management of acute hemolytic transfusion reaction
Stop transfusion alert blood bank immediately maintain blood pressure and diuresis with normal-saline Clerical checks Samples to blood bank Cardiac monitoring Full blood counts coagulation test - Platelets ,fibrinogen ,APTT, D dimers chemistries of renal and liver function urinalysis
How to prevent acute hemolytic transfusion reaction
Meticulous compatibility test
proper patient identification from sample collection to blood administration
Is acute anaphylactic reaction in blood transfusion a medical emergency
Yes
Symptoms and signs of a cute anaphylactic reaction in blood transfusion
Fever
chills
urticaria
hypotension
Management of a cute anaphylactic reaction
Stop transfusion
supportive care
antihistamines steroids epinephrine
What is the cause of transfusion related Sepsis
Asymptomatic bacteremic donors
Bacteremic venipuncture during collection of blood
Is transfusion related services commoner in platelets or red cell transfusion
Platelets transfusion
Common organism in traduction related sepsis
Yersinia E. coli Pseudomonas Staph Strep
Symptoms and signs of transfusion related sepsis
Fever Hypotension Shock DIC complement activation
Management of transfusion related sepsis
Stop transfusion
Agressive IV broad spectrum antibiotics
Blood culture
What is TRALI
Non cardiogenic pulmonary edema
Cause of TRALI
HLA antibodies of donor reacting with recipients neutrophils antigens leading to complement activation
Symptoms of TRALI in 1h
Dyspnea
Tachypnoea
Tachycardia
Hypotension
CXR of TRALI
Patchy alveolar infiltrate
Management of TRALI
supportive care
Mechanical ventilation
Diuretics
Acute metabolic the arrangements in transfusion
Hyperkalemia
hypocalcemia
When do you have a hyperkalemia in transfusion
Massive red cell transfusion
exchange transfusion in infants
renal failure
irradiated blood
Risk of hyperkalemia
Cardiac arrest
Management of hyperkalemia
ECG Management
Calcium gluconate
Insulin glucose
Hypocalcemia causes
Massive transfusion of plasma products
Symptoms of Hypocalcemia
Tetany
Convulsions
Hypotension
Management of Hypocalcemia
Calcium
Patient at risk of acute hypervolemia
Poor cardiac status
Old patient with décompensation
Acute hypervolemia signs and symptoms
Shortness of breath
Crépitation lung base
Management acute hypervolemia
Furosemide
Cause of febrile non hemolytic rxn
HLA antibodies against contaminating white cells and inflammatory cytokines and transfused products
Symptoms of febrile non hemolytic rxn
Chills
nausea
vomiting
myalgia
Management of febrile none hemolytic reaction
Stop transfusion
exclude acute hemolytic transfusion reaction
repeats GXM
coombs test
Delayed transfusion rxn
Delayed hemolytic transfusion
Transfusion associated graft vs host disease
Post transfusion purpura
Transfusion transmitted Protozoa
Cases where there is delayed hemolytic transfusion reaction
Pregnancy
previous transfusion
Cause of post transfusion Purpera
Antibodies against HPA1a
Signs and symptoms and labs of post transfusion purpura
Low platelets
evident mucocutaneous bleeding
In which cases do you mostly have post transfusion purpura
In cardiac bypass surgery
Treatment of POST transfusion PURPURA
Immunoglobulin Iv
Steroids
plasma exchange
Can you do platelet transfusion in post transfusion purpura
No
Implicated protozoa in transfusion transmitted protozoa
Plasmodium species
Babesia species
Where do you see transfusion associated graft versus host disease
In immunocompromise patients
Presentation of transfusion associated graft versus host
Skin liver git symptoms
Bone marrow aplasia
Prevention of transfusion associated graft versus host
Grant gamma irradiation
Leucodepletion
Late complications of transfusion
Transfusion Haemosiderosis
Transfusion transmitted infections
Allo immunization
What is transfusion Haemosiderosis
Iron overload in patients with high red cell transfusion requirements
In which conditions requiring hi red cell transfusion is there a transfusion Haemosiderosis
Thalassemia major
aplastic anemia
refractory anemia
Amount of iron per unit of blood
250 mg
At what amount of blood is there organ damage
20 units
Risks of transfusion hemosiderosis
Cardiomyopathy
Cirrhosis
Endocrine dysfunction
skin hyperpigmentation
Prevention of transfusion Haemosiderosis
Iron chelation
Virus is present in allogeneic leukocytes only
Cytomegalovirus Epstein bar virus human T lympha traffic virus human herpesvirus type six human herpesvirus type 8
Viruses present in both allogeneic leukocytes and as virions in plasma so transmitted by all type of blood products
Human immunodeficiency virus
Viruses present in plasma only as free virions
Hepatitis A hepatitis B hepatitis C hepatitis D hepatitis E hepatitis G b19 parvovirus
Pathogens present in red cells
Yersinia enterolotica
pseudonomas fluoresces
salmonella species
Pathogens present in platelets
Staphylococci
salmonella and serratia species
b cereus
Miscellaneous of blood
T pallidum syphilis
borrelia Lyme disease
waterbath or platelet back contamination
Protozoa in blood
Plasmodia malaria Trypanosoma cruzi Chagas disease Brancrofti babesiosis L donovani African leischmaniasis T Gambiense Trypanosomiasis T gondi toxoplasmosis
Helminths in blood
W bancrofti filariasis
What is allo immunization
Development of antibodies to red cell and HLA antigens within weeks of transfusion
What are the principles of donor selection
Blood donation should not harm the donor
Donated blood should be replaced rapidly and completely
The bloods should not harmed the recipients
What are the sites of donation
Walk in donations at blood center
Mobile blood donation for targeted and untargerted population group
What type of blood donors
Voluntary donors
replacement donors
commercial donors
Type of screening test of bloods collected at blood center
HIV one and two hepatitis B hepatitis C syphilis blood grouping
What are the constituent of blood separated from whole blood
Packed red blood cells fresh frozen plasma cryoprecipitate platelet concentrates granulocytes other plasma derived product
What is the transfusion chain
Request for transfusion
collection of blood sample from pre-transfusion compatibility testing
collection of blood component from blood banks to the word administration of blood components with documentation monitoring management
type of information important in a request for transfusion
Patient identification
type of component required
number of units or volume required
unmatched in emergency situations
Information required in sample taking
Patient identification especially on the sample
date and time of collection
name of the person who took the sample
Three test meet at the blood bank
ABO/RH
Antibody detection and identification
Cross matching
Dangerous blood donor
group O because anti a and b in blood which causes hemolysis of rbc
Indications for whole blood
’ Hb rise & volume replacement needed
Acute massive blood loss
Severe anemia
Exchange blood transfusion of neonates
Whole blood dosage in children
Reavined Hb rise x child’s weight
Adult owhole blood dosage
1 unit for 1g/dl Hb
Concentrated red cells
Whole blood centrifuged which separates red cell from plasma components
1 unit has 150-200ml cvolume
Concentrated red cell indication
Acute anemia ( blood loss, trauma, surgery, DIC, acute hemolysis)
Chronic anemia ( malnutrition, renal impairment, chronic disease, bone marrow d failure)
Contra indication of concentrantes Red cela
Never volume replacement or other disease than the ones indicated
Dosage concentrantes Red cell in children
Hb x 3 x child’s weight
Adult dosage concentrated red cell
One unit for 1g/dl hb
Platelets concentrâtes
Platelet suspende in 20-50mls of original plasma
R amont of platelet per unit
’ 55x10^9
Indication of platelet transfusion
Bleeding in thrombocytopenia
Prevention of spontaneous bleeding
Impending surgery or invasive procedures involving the central nervous system the eye or the spine
Open heart surgery with microvascular bleeding and platelet count lower than 150x109
Treatment of platelet function defect
What is fresh frozen plasma
Blood products made from the liquid portion of whole blood
William a fresh frozen plasma per unit
To 200 -250 mL
Is crossmatch necessary in fresh frozen plasma
No
Is fresh frozen plasma transfusion ABORH specific
Yes
Indication for fresh frozen plasma
Treatment of clotting deficiencies
Liver disease DIC warfarin overdose
Coagulation factor depression in massive transfusion thrombotic
thrombocytopenic Purpera e
Hemolytic uremic syndrome
Components of cryoprecipitate
factor VIII
fibrinogen
factor XIII
vWF
Is cryoprecipitate group specific or crossmatch
No crossmatch but group specific
Indication of cryoprecipitate
Hemophilia a
fibrinogen source in DIC
Von Willebrand factor deficiency
Factors 13 deficiency
When should you check for vital sign and document it
Within one hour prior to transfusion
after first 15 minutes of transfusion
every hour during transfusion
one hour after transfusion