Blood Transfusion Flashcards
Types of transfusion reaction
acute
chronic
What happens if you give an ABO incompatible blood transfusion?
massive intravascular haemolysis - can be fatal
What proportion of people have RhD +ve blood?
85%
What happens in an anti-D reaction?
delayed haemolytic transfusion rection
Other blood group markers than ABO and Rh
xxx
How many red cells anigens are there
100s
antibodies to red cells - what type?
IgG
Which patents are more likely to develop antibody against the other RBC antigens than ABO and RhD?
many transfusions
e.g. sickle cell disesae
How is blood grouped in hospitals?
automated blood grouping and antibody screening - safer and quicker than people doing it
IAT technique
???
G&S
group and save/screen
more info
Electronic crossmatch
selection and issue of red cell units where compatibility is determined by IR system without physical testing of donor cells against patient plasm,a
only for patient that had a negative antibody screen
How do you crossmatch blood if someone has antibodies?
serological crossmatch
types of crossmatch
electronic
serological
serological crossmatch - finding when not compatible
agglutination or haemolysis -> not crossmatch
What are donor RBCs labelled with?
- ABO nad D type
- Kell
- other Rh antigens
Pillars of patient blood management
- optimise haemopoiesis
- minimise blood loss and bleeding
- harness and optimises physiological tolerance of anaemia e.g. optimise cardiac outer, restrictive transfusion threshold
When can you use cell salvage?
- no cancer
- clean surgery i.e. not bowel
how long are transfusion records of patients kept in the UK?
30 y
How long in advance should you let the lab know when you need large amounts of blood for a planned surgery?
at least 24-48 h
post transplant or immunosuppression - what special requirements for blood transfusion?
irradiated components
can people with sickle cell trait donate blood?
yes
but this blood cannot be given to someone with a sickle cell crisis because it will not help them.
why are bacterial infection concerns higher for platelets than red cells?
platelets are kept at room temp rather than 4C
pts with fever post transfusion - mx
- take blood cultures
- treat with blood spectrum abx
FFP
need 20 mins to thaw out
can be kept at 4 degrees for 24h
transuse
….
trigger for blood transfusion in major blood loss
if >30% blood volume is lost
post chemo - trigger for transfusion
Hb <80 g/L
Indications to give platelets
Massive transfusion - aim puts > 75 x 10^9/L
prevent bleeding post chemo 0 if < 10 x 10^9/L (<20 if sepsis)
prevent bleeding (surgery - <50 x 10^9/L (<100 if critical site: eye, CNS, poly trauma)
when is platelet transfusion contraindicated?
HiTT (heparin induced thrombocytopenia thrombosis)
TTP
by how much does a unit of platelets increase the platelet count?
30-40
what is octoplast?
???
Indications for FFP
dosage for FFP
What is cryoprecipitate
has more fibrinogen than FFP
Doses of fibrinogen
autologous vs allogenic blood donation
autologous - own
allogenic - donor
is autologous blood donation e.g. prior to planned OP possible?
yes BUT not done in the uk
what is post op cell salvage?
collect blood lost post op into wound drain, filer and re-infuse
mainly used in orthodox surgery
does not have clotting faactors
When do you need CMV -ve blood?
intraunterine/ neonataal transfusions
irradiated blood
for highly uimmunsuppressed
TAA_GvHD
When do we used washed red cells?
xxx
WBIT
wrong blood in tube
can happen in labelling issues; can be detrimental/fatal for patient and career changing for healthcare professional
communists blood group in UK?
0 47%
how common is O, A, B and AB in
O - 47%
A - 42%
B - 8%
AB - 3%
Why is a rather than AB the universal donor for plasma?
Because AB is rare in the population in the UK
O- how much of population?
7%
what is the % demand for O- blood?
13.3%
What are some specific/special requirements for all blood?
What is the universal donor for plasma?
A RhD +
What are acute and chronic transfusion reactions?
acute within 24 h
chronic >24h
name some acute transfusion reactions
§xxx
name some chronic transfusion reactions/complicatosn
xxx
What is more common, TACO or TRALI?
TACO is 100x more common than TRALI
What is the name of a transfusion reaction affecting the lungs?
TACO
transfusion associated circulatory overload
what are the commonest causes of transfusion reaction
errors e.g. giving wrong group
How do you recognise an acute transfusion rct/
rise in pulse, temp
fall in BO
pain at side
fever
risgors
flushing
vomiting
loin pain
chest pain
urticaria
itching
headache
collapse
obs for transfusion
get baseline boss
repeat 15 mins after start of transfusion
repeat …
FNHTR
febrile non-haemolytic transfusion reCTION
1 degree rise in temp
chills
rigorss
common before leiucodelepted, now rare
slow/ stop the transfusion and give practemaol
allergic transfusion reaction
common, especially with planma
mild urticarial or itchy rash sometimes with a wheeze
during or after transfusion
treat with IV antihistamaiens
wrong blood reaction Sx
restlessness
chest loin pain
fever
vomiting
flushing
collapse
rise in HR
fall in BP
risse in temp
haaemoglobinuria (later)
commonest respiratory related complication of transfusion
TACO
Sx of transfusion of blood with bacterial contaamination
BO fall
HR and temp rise
bacterial growth can cause endotoxin prosucion which causes immediate collapses
How do we prevent bacterial contamination in transfusion?
clean arm of donor
ask if they had recent infections
test first 20mls for bacteria
look for abnormalities e.g. climbs, discolouration, debris
store at 4 degrees celsius, can be out of fridge for 30 mins
shelf life of platelets
7 days
commonest blood product associated with bacterial infection
platelets
anaphylaxis to blood products
shock
breathless
wheeze
often laryngeal &/or facial oedema
What are respiratory complications of transfusion?
TACO
TRALI
TAD
timeframe of TACO presentation
within 6h of transfision
how does TACO look clinically
like pulm oedema
SOB
….
who is at risk of TACO?
weigh less than 50kg
pulmonary oedema
liver disease
positive fluid balance/on IV fluid
…
What is TRALI?
SOB
decreased O2 stats
increased HR and BP
CXR finding in TRALI
infectons associated with transfusion
Hep B
Hep C
malaria
HIV 1, 2
HEV, HTLV1+2, Parvovirus,
CMV (reserved for pregnant women)
WNV, Zika
v-CJD
is there a test of v-CJD?
no
can you get COVID-19 from transfusion?
no
TTI
transfusion transmitted infectio
delayed haemolytic transfusion reactions
1-3%
…
day 7 post
raised bill, LDH, fall in Hb, +ve dat, Hb-uria and clears in subsequent days
caan cause renal problems
check if they developed a new antibody
TA-GvHD
rare, but always fatal (w-m post traaansfussion)
donor’s blood contains some lymphocytes (able to divide)
prevented by irradiating blood components, leucodepletion and HLA matched blood if necessary
Which antibodies cross placenta?
IgG
when in pregnancy do G&S?
at booking
at 28w
What to do if an antibody is present during pregnancy?
check father
monitor level of antibody
check ffDNA sample at around 28w
Where are intrauterine transfusions performed?
at highly specialised centres
What antibody most commonly causes HDFN?
Anti-D
when does anti-D have to be given in pregnancy?
within 72h of the sensitising event
sensitising vents during pregnancy
spontaneous miscarriage or surgical evacuation
abdominal trauma in pregnancy
delivery
CVS/amnioi
Doses of Anti-D
ata leas 250 ui before 20w
eat least 400 iu for any events after 20w, including delivery.
Kleihauer teste used to determine how much?
What other antibodies can cause HDFN?
anti-c
anti-Kell (stops erythropoiesis)
usually less severe than anti-D
