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Haematology > Blood Transfusion 2 > Flashcards

Blood Transfusion 2 Flashcards

1
Q

What are the critical points in transfusion?

A
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2
Q

How do we classify adverse reactions to transfusions? What form them?

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3
Q

What is the risk of dying from a transfusion?

A

1/135705

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4
Q

How can acute reaction be detected early?

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5
Q

Describe febrile non-haemolytic transfusion reaction (FNHTRY).

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6
Q

Describe wrong blood.

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7
Q

Make an ABO compatibility chart.

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8
Q

Describe bacterial contamination.

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9
Q

How do we prevent bacterial contamination?

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10
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11
Q

Describe anaphylaxis

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12
Q

What is the most common type of complication

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13
Q

Describe TACO

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14
Q

What is a TACO checklist?

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15
Q

Describe TRALI.

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16
Q

Describe infections.

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17
Q

What transfusion transmitted infections are checked for?

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18
Q

Which viruses should we be cautious of when transfusing?

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19
Q

Describe delayed haemolytic transfusion reaction.

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20
Q

How do patients with delayed haemolytics transfusion present? How should they be managed?

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21
Q

Describe Transfusion Associated Graft-Versus-Host Disease (TaGVHD).

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22
Q

Describe post transfusion purpura.

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23
Q

Describe iron overload.

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24
Q

Describe haemolytic disease of newborn.

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25
Q

Describe the Mechanism of RhD sensitisation during pregnancy.

A

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

26
Q

What are the clinical features of HDFN?

A
  • 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)
27
Q

What is the Treatment of pregnancy when mother already has red cell antibody

A

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

28
Q

What is the most common and important antibody seen causing HDFN?

A

Anti-d

29
Q

How can prevention on sensitisation be done?

A

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

30
Q

What is the MOA of prophylactic anti-D immunoglobulin?

A
31
Q

Name sensitising events and what the consequences could be.

A
  1. Give anti-D at delivery if baby is RhD positive
  2. 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
32
Q

What are the doses of anti-D given

A
33
Q

What is the routine antenatal anti-D prophylaxis (RAADP)?

A
34
Q

What are the other antibodies that affect HDN

A

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)
35
Q

Describe Non-invasive fetal genotyping for mothers with antibodies

A
  • 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
36
Q

What is the use of ffDNA?

A

Haematology (16 decks)

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