Blood Transfusion Flashcards
what blood product is given to a severe burn patient
albumin
what must be included from blood donors blood
infective risk
- bacterial, viral, protozoal infection
risk of transmitting disease
- malignancy, neurological conditions (MS)
HIV
HEP C
HEP B
Syphillis
what are the 4 blood groups and what differentiates them
A - RBC membrane carries A antigen
B - RBC membrane carries B antigen
AB - RBC membrane carries A and B antigen
O - RBC membrane does not carry A or B antigen
what blood can be given to any recipient
group O
i.e. universal donor
what blood group can receive blood from any other donor ABO group
AB recipient
i.e. universal recipient
if the body was to launch an autoimmune attack against a wrong ABO transfusion, what antibodies would be seen
IgG
IgM - majority
what chromosome codes for our blood group
chr 9
what are the phenotype of the blood groups
O gene = silent
A gene = dominant
B gene = dominant
what would you need to be an O blood group
OO
what would you need to be an A blood group
AA or AO
what would you need to be a B blood group
BB or BO
what would you need to be a AB blood group
AB
what is chromosome is responsible for Rh(D) grouping
Chromosome 1
what determines your Rh(D) status
The presence or absence of the Rh(D) protein on the surface of one’s red cells determines whether one is Rh(D) positive or Rh(D) negative
what is the phenotype of Rh(D) and what are the combinations of this
D - dominant
d - recessive
DD = Rh(D) positive Dd = Rh(D) positive dd = Rh(D) negative
what reaction in the lab do we rely on to determine blood group
agglutination
what blood group is the following patient:
red cells + Anti-A = no agglutination
red cells + Anti-B = no agglutination
red cells + Anti-AB = no agglutination
red cells + Anti-D = agglutination
Group O
RhD positive
what colour is anti A and what colour is anti B
anti A = blue
anti B = yellow
what are indications for red cell transfusion
1 - anaemia (severe)
2 - acute blood loss
what are indications for fresh frozen plasma
1 - bleeding or surgery in liver disease with impaired coagulation
2 - coagulopathy following massive transfusion
3 - DIC
what are potential side effects of blood transfusion
1 - immediate haemolytic transfusion reaction
2 - delayed haemolytic transfusion reactions
3 - febrile non-haemolytic transfusion reaction
4 - urticarial reactions
5 - circulatory overload
6 - bacterial infection
7 - viral infection
what happens in immediate haemolytic transfusion reaction
i.e. say A blood is transfused to a group O recipient
1 - group A red cells reach the recipient’s circulation
2 - IgM anti-A binds to the cells
3- activates complement cascade
4 - formation of membrane-attack complex (MAC)
5 - release of C3a and C5a
6 - act on blood vessels to cause leakage and dilatation
7 - fluid leaks into circulation
8 - BP drops
what are the net effects of immediate haemolytic transfusion reaction
systemic hypotension DIC renal vasoconstriction formation of renal intravascular thrombi shock renal failure - OFTEN FATAL
what are Sx a patient will complain of in immediate haemolytic transfusion reaction
pyrexia / rigors faintness / dizziness tachycardia / tachypnoea / hypotension pallor / sweating headaches / chest or lumbar pain local pain at infusion site cyanosis patient may say “something is wrong”
what is the Mx of immediate haemolytic transfusion reaction
stop transfusion
start iv fluids to maintain BP and urine output
obtain blood samples
- for transfusion lab - FBC and blood film - coagulation screen
- biochemistry
- blood cultures
- serum haptoglobin
what are features of delayed haemolytic transfusion reactions
symptoms / signs similar to, but less acute than, a IHTR
unexplained fall in Hb value as transfused red cells are destroyed
appearance of jaundice, renal failure or biochemical
features associated with IHTRs
what are lab features of a delayed haemolytic transfusion reactions
anaemia, spherocytic red cells on blood film
elevated bilirubin and LDH
positive DAGT and/or appearance of red cell allo-antibody
+/- a degree of renal failure
what are features of a febrile non-haemolytic transfusion reaction
rapid temp rise 1-2 degrees
chills
rigors
what causes a febrile non-haemolytic transfusion reaction
recipient has anti-HLA antibodies that bind to residual white cells within the component being transfused
or as a result of vasoactive and pyrogenic substances being released from white blood cells during storage of blood components
what causes a urticarial reaction in a blood transfusion reaction
mast cells releasing IgE in response to infused plasma proteins
Sx of a urticarial reaction
Rash / weals within few minutes of starting transfusion
Tx of a urticarial reaction
Slow the transfusion
Consider anti-histamines
who is at risk of circulatory overload from a blood transfusion
people with circulatory impairment
- elderly, CCF
what is the main Sx of circulatory overload
pulmonary oedema
what are Sx of a bacterial infection caused by blood transfusion
fever
immediate collapse
shock
DIC
Fever, chills, vomiting, tachycardia, hypotension
how should an acute bacterial infection caused by blood transfusion be treated
same as immediate-type haemolytic transfusion reaction
once lab shows patient has not had an ABO-incompatible transfusion then broad spectrum antibiotics should be started
