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Haematology > blood transfusion > Flashcards

blood transfusion Flashcards

1
Q

Concepts in blood safety

A

Selection of appropriate, low risk donors
Screening tests for relevant markers of infection
Removal of any pathogens from final blood product

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2
Q

Optimizing blood usage

A

Rational blood usage policies
Alternatives to blood used
Bloodless surgery

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3
Q

Cardinal priciple in rational blood usage

A

Determine cause of anemia and take appropriate action

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4
Q

Rational for deficiency anemias

A

hematinics

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5
Q

Under rational; when do you transfuse

A

only when necessary

symptomatic esp in signs of cerebral anoxia, cardiac failure

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6
Q

In rational ; 3rd stage of labor is managed by

A

Giving medication to cause contraction and to reduce amount of blood being lost and hence no transfusion

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7
Q

Alternatives to blood

A

Crystalloids i.e normal saline
Colloids i.e dextran 70
Perfluorocarbons
Hb base substitutes

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8
Q

If blood loss less than 20%

A

Do nothing

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9
Q

If blood loss 21-30%

A

Give crystalloids or colloids

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10
Q

If blood loss greater than 30%

A

Transfuse blood

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11
Q

Types of autologous blood transfusion

A

Preoperative deposit- patient going to be operated on donates blood to be given back to him in case of an emergency in operation

Haemodilution- Intentionally removing RBC to lower hematocrit

Intra op blood salvage- Recovering blood lost during surgery and infusing into patient

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12
Q

In bloodless surgery

A

The surgeon has to be meticulous
Use of torniquets
Diathermy

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13
Q

Who is the best donor

A

Voluntary repeated donor

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14
Q

Types of blood donors

A

Voluntary non renumerated donors
Family replacement donors
commercial donors
autologous donors

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15
Q

Types of blood donors to avoid

A

Family replacement donors

Commercial donors

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16
Q

classifications of transfusion risks

A

immunologic

non immunologic

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17
Q

Immunologic classification of transfusion

A
  • immune hemolytic rxns- red blood cells transfused are destroyed by persons immune system
  • Febrile non hemolytic reactions - cytokines in transfused RBC causing fever,chills, etc
  • Anaphylactic reactions - transfusion releases flood of chemicals that can cause shock
  • urticarial reactions ; sin rash
  • Post transfusional purpura ; thrombocytopenia after blood transfusion causing bleeding
  • Graft vs host dx
  • Transfusion related acute lung injury
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18
Q

Non immunologic transfusion risk

A

Transfusion transmitted infections
Acute hypotensive reactions
Physical, thermal
Chemical i.e k, Ca, citrate, iron toxicity

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19
Q

Adverse effects may be

A

Acute- up to 4 hrs after transfusion
Delayed- > 24hrs-2wks after transfusion
Late - 2wks to 30 yrs

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20
Q

Life threatening acute transfusion rxns

A 
acute hemolytic reactions
Acute anaphylactic reaction
Transfusion related sepsis
TRALI
Acute hyperkalemia and hypocalcemia
Acute hypervoliemia
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21
Q

Non life threatening acute transfusion reactions

A

Febrile non hemolytic transfusion rxns

Urticaria

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22
Q

Why does acute hemolysis occur

A

Due to pre existing antibodies in recipients serum, it hemolyzes any foreign antigen in transfused blood

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23
Q

Most common transfusion rxn

A

Acute hemolytic transfusion rxn

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24
Q

Signs and symptoms of acute hemolytic transfusion rxn

A

Occurs within minutes

Heat and pain in vein
Throbbing headache
Fever
Chest tightness
Dyspnea
Myalgia- pain in muscle
Loin pain
Hypotension ; masked in anesthetised patients
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25
Q

What immunoglobulin mediates AHTR

A

It is an IgM mediated complement activation—->intravascular hemolysis—>activation of coagulation cascade

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26
Q

Complications of AHTR

A

Shock
DIC
Acute tubular necrosis–> Acute renal failure

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27
Q

Management of AHTR

A
  • Stop transfusion, alert blood bank immediately
  • In case of hypotension maintain BP and diuresis
  • Clerical checks
  • Cardiac monitoring cos patient can have hyperkalemia due to excessive hemolysis
  • FBC
  • Coagulation test - PT,APTT
  • LIVER FXN AND KIDNEY FXN TEST
  • Urinalysis
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28
Q

Prevention of AHTR

A

Meticulous compatibility testing

Proper patient identification- this is the correct person im supposed to give the blood to

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29
Q

Acute anaphylatic reaction symptoms

A

Fever
Chills
Urticaria
Hypotension

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30
Q

Management

A

Stop transfusuion
Supportive care— airway, breathing, cardiovascular
Antihistamines, steroids, epinephrine

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31
Q

TRansfusion related sepsis occurs because of

A

Asymptomatic bacterimic donors

Venipuncture

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32
Q

Common organisms that cause transfusion related sepsis

A 
Yersinia
E. coli
Pseudomonas
Staphylococcus
Streptococcus
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33
Q

Complications of transfusion related sepsis

A 
hypotension
DIC
Shock
High fever
Complement activation
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34
Q

Management of transfusion related sepsis

A

Stop transfusion
Aggressive IV antibiotics- broad spectrum
Blood culture

35
Q

Transfusion related acute lung injury is a form of

A

Non cardiogenic pulmonary edema

36
Q

TRILA may progress to

A

Acute respiratory distress syndrome

37
Q

How does it progress to ARDS

A

HLA antibodies of donor reacts with recipient neutrophil antigens—> complement activation and alveolitis–> pulmonary edema

38
Q

Symptoms of TRILA start

A

An hour to transfusion

39
Q

Symptoms of TRILA include

A

Dyspnea
tachypnea
Tachycardia
hypotension

40
Q

Chest XRAY of TRILA

A

Patchy alveolar infiltrates

41
Q

Management of TRILA

A

Supportivee-ABC
Mechanical ventilation
NO DIURETICS

42
Q

TRILA resolves

A

IN a few days

43
Q

When does hyperkalimea occur

A

Massive red cell transfusion
Exchange transfusuion in infants
Renal failure
Irradiated blood

44
Q

Hyperkalimea can result in

A

cardiac arrest

Stabilise cardiac myocytes with calcium gluconate, ECG monitoring, insulin?glucose

45
Q

Hypocalcemia is caused by

A

Massive transfusion of plasma products i.e FFP

46
Q

Symptoms of hypocalcemia

A

Tetany
Convulsions
Hypotension

47
Q

Acute hypervolimea caused by

A

circulatory overload

48
Q

Acute hypervolimea occurs mostly in

A

Patients with poor cardiac status

Elderly patients with decompensation- heart cant maintain circulation

49
Q

Symptoms of acute hypervolimea

A

Shortness of breath

crepitations at lung base

50
Q

Management of acute hypervolimea

A

furosemide

51
Q

Acute hypervolimea also called

A

Transfusion associated circulatory overload

52
Q

Febrile non hemolytic rxns characteristics

A

Mild
Asymptomatic
Lasts less than an hour
No sequale

53
Q

Pathophysiolofy of FNHR

A

HLA antibodies against contaminating white cells and inflammatory cytokines in transfused blood

54
Q

FNHR similar to

A

AHTR

55
Q

Management of FNHR

A

Discontinue transfusion
exclude AHTR
Coombs test

56
Q

Symptomatic treatment of FNHR

A

acitamenophen

57
Q

Prevent FNHR with

A

Leukodepletion

58
Q

Urticarial reactions caused by

A

Activation of IgE Leading to histamine release from mast cells and basophils

59
Q

Manage urticarial rxns by

A

Giving antihistamines

recommencing of transfusion slowly

60
Q

Acute transfusion rxns are

A

the commonest transfusion rxn

61
Q

Delayed transfusion reactions include

A

Delayed hemolytic transfususion rxn
Transfusion associated graft vs host dx
Post transfusion purpura
Transfusion transmitted purpura

62
Q

Causes of delayed HTR

A

Previous transfusion

pregnancy

63
Q

Clinical features of AHTR

A

Failure to achieve rise in Hb
Hyperbilirubinemia
rare intravascular hemolysis

64
Q

Post transfusion purpura

A

Due to antibodies produced against HPA1 alpha

65
Q

PTP clinical manifestation

A

low platelets

mucocutaneous bleeding

66
Q

PTP occurs in how many days

A

8-14

67
Q

PTP common in this condition

A

cardiac bypass surgery

68
Q

Management of PTP

A

IV immunoglobulins
Steroids
Plasma exchange

69
Q

What to avoid doing in PTP

A

Transfusion of platelets

70
Q

Transmission transmitted protozoa caused by these organisms

A

plasmodium

Babesia

71
Q

Symptoms of TTP

A

Malaria

72
Q

Transfusion associated GVHD is usually seen in

A

immunocompromised,
organ transplant patients
chemotherapy patients
HIV patients

73
Q

How does transfusion associated GVHD occur

A

donor lymphocytes attack recipient tissue

74
Q

Symptoms of transfusion GVHD

A

skin
liver
git symptoms

75
Q

Transfusion GVHD CAUSES

A

BONE MA RROW APLASIA- PRIMARY CAUSE OF DEATH

76
Q

Prevention of transfusion GVHD

A

gamma irradiation

leucodepletion

77
Q

Late complications of transfusion

A

Transfusion haemosiderosis
Transfusion transmitted infections
Alloimmunization

78
Q

iron overload after

A

transfusing 10 units of blood

organ damage after 20 units

79
Q

Transfusion hemosiderosis occurs in

A

patients who require high transfusion

AA
Thallasemia major
Refractory anemia

80
Q

Prevent transfusion hemosiderosis by

A

iron chelation– deferroxamine, deferipone

81
Q

Risks of transfusion hemosiderosis

A

cardiomyopathy
cirrhosis
endocrine dysfunction
hyperpigmentation of skin

82
Q

Alloimmunization

A

Development of antibodies to red cells within weeks of transfusion

silent

83
Q

Dangers of alloimmunization

A

transfusion reaction in future
risk of HDN
limit availability of compatible blood

Haematology (29 decks)

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