Blood Transfusion 2

Question 1

What are the critical points in transfusion?

Answer 1

Question 2

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

Answer 2

Question 3

What is the risk of dying from a transfusion?

Answer 3

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Question 4

How can acute reaction be detected early?

Answer 4

Question 5

Describe febrile non-haemolytic transfusion reaction (FNHTRY).

Answer 5

Question 6

Describe wrong blood.

Answer 6

Question 7

Make an ABO compatibility chart.

Answer 7

Question 8

Describe bacterial contamination.

Answer 8

Question 9

How do we prevent bacterial contamination?

Answer 9

Question 10

Answer 10

Question 11

Describe anaphylaxis

Answer 11

Question 12

What is the most common type of complication

Answer 12

Question 13

Describe TACO

Answer 13

Question 14

What is a TACO checklist?

Answer 14

Question 15

Describe TRALI.

Answer 15

Question 16

Describe infections.

Answer 16

Question 17

What transfusion transmitted infections are checked for?

Answer 17

Question 18

Which viruses should we be cautious of when transfusing?

Answer 18

Question 19

Describe delayed haemolytic transfusion reaction.

Answer 19

Question 20

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

Answer 20

Question 21

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

Answer 21

Question 22

Describe post transfusion purpura.

Answer 22

Question 23

Describe iron overload.

Answer 23

Question 24

Describe haemolytic disease of newborn.

Answer 24

Question 25

Describe the Mechanism of RhD sensitisation during pregnancy.

Answer 25

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

Question 26

What are the clinical features of HDFN?

Answer 26

* 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)

Question 27

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

Answer 27

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

Question 28

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

Answer 28

Anti-d

Question 29

How can prevention on sensitisation be done?

Answer 29

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

Question 30

What is the MOA of prophylactic anti-D immunoglobulin?

Answer 30

Question 31

Name sensitising events and what the consequences could be.

Answer 31

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

Question 32

What are the doses of anti-D given

Answer 32

Question 33

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

Answer 33

Question 34

What are the other antibodies that affect HDN

Answer 34

_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)

Question 35

Describe Non-invasive fetal genotyping for mothers with antibodies

Answer 35

* 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

Question 36

What is the use of ffDNA?

Answer 36