Blood Transfusion 2 Flashcards
What are the critical points in transfusion?
How do we classify adverse reactions to transfusions? What form them?
What is the risk of dying from a transfusion?
1/135705
How can acute reaction be detected early?
Describe febrile non-haemolytic transfusion reaction (FNHTRY).
Describe wrong blood.
Make an ABO compatibility chart.
Describe bacterial contamination.
How do we prevent bacterial contamination?
Describe anaphylaxis
What is the most common type of complication
Describe TACO
What is a TACO checklist?
Describe TRALI.
Describe infections.
What transfusion transmitted infections are checked for?
Which viruses should we be cautious of when transfusing?
Describe delayed haemolytic transfusion reaction.
How do patients with delayed haemolytics transfusion present? How should they be managed?
Describe Transfusion Associated Graft-Versus-Host Disease (TaGVHD).
Describe post transfusion purpura.
Describe iron overload.
Describe haemolytic disease of newborn.
Describe the Mechanism of RhD sensitisation during pregnancy.
1st pregnancy - red cells from foetus crossing over to mother so mother forms anti-D. Mother and foetus fine
2nd pregnancy - anti-D (IgG antibodies) crosses placenta and destroyed foetus
What are the clinical features of HDFN?
- Only IgG antibodies can cross the placenta.
- If mother has high levels of IgG antibody - it can destroy fetal red cells, if they are positive for the corresponding antigen
- Fetal anaemia (haemolytic)
- Haemolytic disease of newborn (anaemia plus high bilirubin - which builds up after birth as no longer removed by placenta)
What is the Treatment of pregnancy when mother already has red cell antibody
All pregnant women have G&S at around 12 weeks (booking) and again at 28 weeks to check for RBC Antibodies. If antibody present:
- check if father has the antigen (so baby could inherit it)
- monitor level of antibody (high or rising - more likely to affect fetus)
- Check ffDNA sample
- If have antigen: Monitor fetus for anaemia – MCA Doppler ultrasound
- Deliver baby early, as HDN gets a lot worse in last few weeks of pregnancy
If necessary, intra-uterine transfusion can be given to fetus
- Specialised centres, highly skilled - needle in umbilical vein
- At delivery - monitor baby’s Hb and bilirubin for several days as HDN can get worse for few days
- Can give exchange transfusion to baby if needed to increase bilirubin and increase Hb; plus phototherapy to decrease bilirubin
Note: subsequent pregnancies usually worse
What is the most common and important antibody seen causing HDFN?
Anti-d
How can prevention on sensitisation be done?
always transfuse RhD negative females of child bearing
potential with RhD negative blood. Can give intra-muscular injection of anti-D immunoglobulin, at times when mother is at risk of a fetomaternal bleed e.g. at delivery
What is the MOA of prophylactic anti-D immunoglobulin?
Name sensitising events and what the consequences could be.
- Give anti-D at delivery if baby is RhD positive
- Give anti-D Ig for ‘sensitising events’ during pregnancy, where FMH is likely to occur**
- spontaneous miscarriages if surgical evacuation needed and therapeutic terminations
- amniocentesis and chorionic villous sampling
- abdominal trauma (falls and car accidents)
- external cephalic version (turning the fetus)
- stillbirth or intrauterine death
What are the doses of anti-D given
What is the routine antenatal anti-D prophylaxis (RAADP)?
What are the other antibodies that affect HDN
Anti-c and anti-Kell can cause severe HDN
- usually less severe than anti-D
- Kell causes reticulocytopenia in fetus as well as haemolysis
IgG Anti-A and anti-B antibodies from Group O mothers can cause mild HDN
- usually not severe (phototherapy)
Describe Non-invasive fetal genotyping for mothers with antibodies
- NHSBT offers fetal genotyping - support for routine maternity and transfusion services both nationally and internationally.
- A rapid, non-invasive, convenient and reliable service for prediction of fetal D, C, c, E and K status, using cell-free fetal DNA in maternal blood for women who have allo- antibodies.
- Upon identification, mothers can then be informed and prepared for further careful monitoring during their pregnancy.
- Also identifies pregnant women who have antigen-negative fetuses and who therefore are not at danger from HDFN
What is the use of ffDNA?
