Blood transfusion

Question 1

what reacts with normal and abnormal RBC antigens

Answer 1

IgG reacts with normal

IgM reacts with abnormal

Question 2

what are the pre-transfusion tests

Answer 2

Group and save (checks ABO group and plasma ab in pt blood, + Ab screen)
Cross matching checks pt vs donor blood specifically (pt plasma and donor RBCs incubated and spun)

Question 3

What is IAT

Answer 3

indirect antiglobulin testing 
pt serum plasma added to some donor reagent RBCs containing all important antigens 
add AHG (anti human golbulin) and watch for agglutination

Question 4

Transfusion time + storage RBCs

Answer 4

2-3hrs

store at 4 degrees, for 35d

Question 5

Transfusion time + storage platelets

Answer 5

20-30min

store at 20 deg for 7 days

Question 6

Transfusion time + storage FFP

Answer 6

20-30min

store at

Question 7

Transfusion time + storage cryoprecipitate

Answer 7

20-30min, store at

Question 8

transfusion indications for RBCs

Answer 8

major haemorrhage (>30%) or Hb <70

give alternative if possible - iron, B12, folate, EPO

Question 9

how much does 1 unit RBCs inc HB by

Answer 9

10g/L

Question 10

transfusion indications platelets

Answer 10

massive haemorrhage
bleeding post chemo/surgery
thrombocytopaenia

Question 11

transfusion indications FFP

Answer 11

massive haemorrhage
DIC with bleeding
liver disease

Question 12

transfusion indications cryoprecipitate

Answer 12

bleeding plus dec fibrinogen
DIC
liver D

Question 13

what blood would you give to intrauterine/neonatal/preg women

Answer 13

CMV neg

Question 14

what blood would you give if patient immunosupp

Answer 14

irradiated

Question 15

what blood would you give if IgA def pt

Answer 15

washed blood 
(avoid severe allergic reaction to plasma prot)

Question 16

3 main acute adverse reaction to transfusion

Answer 16

FAHR - febrile, allergic and hypotensive R
ABO incompatibility
BAc contam

Question 17

sympto and pathology of febrile acute adverse reaction to transfusion

Answer 17

WCs release cytokines in storage

-> fever chills, rigor

Question 18

tx for febrile acute adverse reaction to transfusion

Answer 18

paracetamol, slow/stop transfusion

Question 19

sympto of allergic acute adverse reaction to transfusion

Answer 19

urticaria -> wheeze -> anaphylaxis

Question 20

Tx for allergic acute adverse reaction to transfusion

Answer 20

antihistamines IV and slow/stop transfusion

Question 21

definition of hypotensive acute adverse reaction to transfusion

Answer 21

isolated fall in SBP in the absence of allergic/anaphylactic sympto

Question 22

what Ig mediates the adverse reaction in antibody incompatibility

Answer 22

IgM

Question 23

sympto of ABO incompatibility

Answer 23

restlessness, chest/loin pain, fever, vom, collapse

Question 24

blood finings in ABO incompatibility

Answer 24

dec BP, inc HR/temp, dec HB, inc billirubin/LDH, DAT+

Question 25

signs and sympto in bac contam after transfusion

Answer 25

sam sympto as ABO incompatibility normal HB/bilirubin/LDH DAT-

Question 26

signs/sympto in TACO

Answer 26

Transfusion assso circ overload SOB. dec sats, inc HR, inc BP, Inc JVP CXR - pulmo oedema and fluid overload

Question 27

signs/sympt in TRALI

Answer 27

T relted acute lung inj SOB, dec sats, inc HR, inc BP, fever, no raised JVP CXR - bilat pulmo infiltrates, no fluid overload

Question 28

response of TACO/TRALI to diruetics

Answer 28

TACO responds immediately | TRALI doesnt respond

Question 29

what antigens are involved in the delayed haemolytic reaction

Answer 29

duffy and kidd

Question 30

pathology of delayed haemolystic reaction

Answer 30

1 - alloimmunisation - abs form vs foreign RBC antigen | 2 - repeat transfusion -> extravasc haemolysis (-> dec Hb, inc bilirubin, inc reticulocytes, inc LDH, DAT+)

Question 31

Sympto of HDFN (resus R)

Answer 31

jaundice, hepatosplenomeg, foetal hydrops

Question 32

what should you give if there has been a sensitising event (HFDN)

Answer 32

prophylatic anti-D Ig withing 72hrs

Question 33

test for fetomaternal haemorrhage (HFDN)

Answer 33

kelihauer test

Question 34

what should you test if mother/father are resus D +Ve

Answer 34

ffDNA

Question 35

what will happen if immunosuppressed pt given normal blood

Answer 35

T asso GVHD

Question 36

when does post transfusion purpura occur

Answer 36

7-10 days post transfusion usually resolves but can cause life threatening bleeds

Question 37

Tx for post transfusion purpura

Answer 37

IV Ig infusion

Question 38

Tx for iron overload

Answer 38

occurs if >50 transfusions | Tx = iron chelation with ferritin