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IMED2002 > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

How much blood is collected in blood transfusions?

A

400 mL

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2
Q

What is done to the collected blood?

A

It is anti-coagulated ​

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3
Q

​

What is the donor blood tested for?

A

ABO blood group​

Rh(D) blood group ​

Antibody screening​

Infectious agent testing to minimize TTI (transfusion-transmissible infections)​

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4
Q

​

Which are transfusion-transmissible infections that must be tested for?

A

​

HIV, Hepatitis B, C, syphilis, HTLV-1​

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5
Q

​

The blood is fractionated into what components?

A

Packed red cells and plasma

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6
Q

When are transfusions done?

A

When there is a clinical need, and the patient is in need of blood product support

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7
Q

How are red blood cells used?

A

To treat clinically significant anaemia

Symptomatic deficit of oxygen carrying capacity

Unstable anaemia in medical patients

Replacement of traumatic, surgical blood loss

Anaemia secondary to bone marrow failure

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8
Q

In pre-transfusion testing what is being tested?

A

Forward group: to determine the A, B, D antigens/blood group on the red cells

Reverse group: test patient plasma for anti-A and B antibodies

Add patient red cells to the monoclonal antibodies in the forward group

In the reverse group, add A1 and B red cells
and then add the patient plasma

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9
Q

Why is an antibody screen performed?

A

Antibodies in the patient’s plasma can cause haemolysis if the transfused donor cells carry the relevant blood group

Hence we perform an antibody screen

detects unexpected antibodies in patient plasma that may cause a transfusion reaction

antibodies other than anti A and B (like anti D, anti K)

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10
Q

What is the crossmatch?

A

It is the compatibility test of the donor and the patient

It is a laboratory test of donor red cells to be transfused, and the patient’s plasma to ensure the donor red cells are compatible with the patient, recipient plasma (antibodies)

ABO, Rh(D) match or compatibility

Failsafe method of preventing incompatibilities

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11
Q

Is whole blood transfused?

A

No

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12
Q

What are the blood products that are transfused?

A 
Components of blood are transfused like: 
Packed red blood cells 
Platelets
Fresh frozen plasma
Cryoprecipitate

Fractionated blood products include:
Albumin
Coagulation factor concentrates
Immunoglobulins

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13
Q

Which is the commonest blood component used in transfusions?

A

Packed red blood cells

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14
Q

How are packed red blood cells stored? (what temp, how long, how much)

A

At 2-8 degrees
For 42 days
250-300 mL

the ratio of the volume of red blood cells to the total volume of blood = haematocrit

60 - 70% is haematocrit

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15
Q

Packed red blood cells are…

A

Leucodepleted (WBCs are removed)

they only carry oxygen carrying capacity

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16
Q

What are some indications for usage of packed red blood cells?

A

In haemorrhage
In symptomatic anaemia
In anaemia and urgent surgery
In bone marrow dysfunction or failure

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17
Q

How are platelets stored (at what temp, for how long, how much)

A

At 20 - 24 degrees
For 7 days
In 200 ml plasma which contains anti-B and A (depending upon the donor group)

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18
Q

Are ABO & Rh groups important to identify, even if only administering platelets?

A

Yes they are as platelets are in 200 ml of plasma, which contains anti-A or B depending on the donor

The platelets themselves don’t contain AB antigens

But the platelets must be ABO and Rh compatible, but cross matching is not necessary

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19
Q

When are platelets needed, and how much is given?

A

needed in thrombocytopenia & bleeding & surgery

also in prophylaxis

200-400 x 10 to the power of 9/unit given

to increase platelet count by 30-40 x 10 to the power of 9/L

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20
Q

What is fresh frozen plasma

A

It is plasma only, contains antibodies

Contains all plasma proteins

21
Q

How is fresh frozen plasma stored?

A

At -30 degrees
for 1 year
200 ml

22
Q

How much FFP is given to donor?

A

10-15 ml/kg

it is thawed before use

23
Q

When is FFP given?

A

it is given in coagulopathic bleeding

Coagulopathy (also called a bleeding disorder) is a condition in which the blood’s ability to coagulate (form clots) is impaired. This condition can cause a tendency toward prolonged or excessive bleeding, which may occur spontaneously or following an injury or medical and dental procedures.

massive haemorrhage / transfusion

Should be ABO compatible
But testing not necessary

AB is the universal donor of plasma

24
Q

What is cryoprecipitate

A

It is plasma, prepared from FFP

it contains anti-A and B antibodies

25
Q

How is cryoprecipitate stored?

A

Below -25 degrees

in a 30-40 mL bag

26
Q

What does cryoprecipitate contain?

A

Factor VIII, von Willebrand factor, fibrinogen

27
Q

When is cryoprecipitate given?

A

In fibrinogen deficiency and dysfibrinogenaemia

28
Q

What should cryoprecipitate be compatible with?

A

ABO, testing isn’t required

Should be compatible with the recipient red cells

29
Q

Which blood factors are manufactured from blood

A 
Plasma derived 
Albumin 
Immunoglobulin 
Factor concentrates
testing reagents
30
Q

What are types of early adverse transfusion reactions?

A

Early:

This is when there is a haemolytic transfusion reaction (ABO incompatible)

Sepsis: when there is a bacterial contaminated blood product

Transfusion-associated circulatory overload

Transfusion-related acute lung injury

Febrile non-haemolytic transfusion reaction

Urticarial (allergic) reactions

31
Q

What is intermediate adverse transfusion reactions?

A

occur 7-10 days afterwards

These are delayed haemolytic transfusion reactions

32
Q

What is late adverse transfusion reaction?

A

As a result of viral infection, immune sensitisation (immune system produces antibodies in response to a substance), iron overload

33
Q

What is acute haemolytic transfusion reaction? What does it do? How is it caused?

A

It is a medical disaster, causes significant mortality
due to ABO incompatibility

it causes acute haemolysis

usually due to a clerical, labelling or collection error

avoided by paying attention to each step in the transfusion process​

Correct pre-transfusion sample​
Laboratory quality systems​
Bedside check prior to setting up the transfusion​

34
Q

Bacterial contamination of blood products risk

A

1:75,000

more common with platelets than RBC

35
Q

How does the blood product get contaminated with bacteria?

A

During collection, or preparation (including water baths for FFP thaw)

36
Q

Symptoms and effects of bacterial contamination of blood products
What should we do?

A

Fever, chills, circulatory collapse, (during or soon after transfusion)

Can be fatal –> must immediately stop the transfusion

37
Q

Transfusion related lung injury chance

A

Rare

1:5,000 to 1:100,000

38
Q

How long after the transfusion does the respiratory distress occur

A

After less than 6 hours

39
Q

What happens in TRALI

A

Donor antibodies react with the patient’s neutrophils

Pulmonary oedema

Pulmonary edema is a condition caused by too much fluid in the lungs. This fluid collects in the many air sacs in the lungs, making it difficult to breathe. In most cases, heart problems cause pulmonary edema.

40
Q

How common is TACO (transfusion associated circulatory overload)

A

1% of transfusions

41
Q

How does transfusion associated circulatory overload work?

A

The volume overload leads to cardiac failure

42
Q

Within 6 hours of transfusion what happens?

A 
Acute respiratory distress
Tachycardia
Increased blood pressure
Acute or worsening pulmonary oedema
Evidence of positive fluid balance
43
Q

Who is at greatest risk for transfusion associated circulatory overload

A

Neonates and the elderly

44
Q

How common are febrile and allergic reactions? Why?

A

1% (1:50,000)

The incidence is low because the red cell units are leucodepleted

45
Q

What can febrile and allergic reactions to blood transfusions do?

A

Can cause severe anaphylaxis

Recipient antibodies react with donor white cells or proteins

46
Q

How to manage febrile & allergic reactions?

A

Through antihistamines

47
Q

What does anaphylaxis do?

A

It is a severe allergic reaction, causes tissue swelling

Rare and medical emergency

48
Q

What is patient blood management about?

A

Blood transfusion is a temporary transplant

we must optimise bone marrow haemopoisis

Correct any causes of anaemia

And transfuse only for clinical benefit
in untreatable symptomatic anaemia
in thrombocytopenic bleeding
in coagulopathic bleeding

avoid transfusions/use alternatives if possible

49
Q

What are the 3 pillars to patient blood management

A

1st pillar) Optimise haematopoiesis
2nd pillar) Minimize blood loss & bleeding
3rd pillar) Manage anaemia

Improves patient outcomes, through ways which boost and conserve the patient’s own blood –> to avoid transfusions and associated complications

IMED2002 (12 decks)

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