Blood Transfusion

Question 1

What are the main blood group phenotypes?

Answer 1

A
B
O
AB

Question 2

What do the A and B blood antigen genes code for?

Answer 2

Transferase enzymes

Question 3

What is the A blood antigen?

Answer 3

N-acetly-galactosamine

Question 4

What is the B blood antigen?

Answer 4

Galactose

Question 5

What is the O blood gene?

Answer 5

Non-functional allele

Question 6

What blood group is the universal donor?

Answer 6

O

Question 7

What blood group is the universal recipient?

Answer 7

AB

Question 8

What can those who are RhD negative do?

Answer 8

Individuals can make anti-D if exposed to RhD+ cells (transfusion or pregnancy)

Question 9

What is the effect if anti-D?

Answer 9

Can cause transfusion reactions or haemolytic disease of the newborn

Question 10

What are blood donors screened for?

Answer 10

HepB 
HepC 
HIV 
Syphilis 
HepE 
West Nile virus 
HTLV1

Question 11

What is the shelf life of red cells?

Answer 11

35 days

Question 12

Over what time period should red cells be transfused?

Answer 12

2-4 hours

Question 13

What are the indications for red cells?

Answer 13

Anaemia 
Surgery, obstetric, trauma 
GI haemorrhage 
Bone marrow failure 
Chemotherapy 
HDN 
Sickle cell anaemia 
Thalassaemia

Question 14

What is the shelf life of platelets?

Answer 14

5 days

Question 15

Over what period of time are platelets transfused?

Answer 15

20-60 minutes

Question 16

What are the indications for platelets transfusion?

Answer 16

Massive haemorrhage
Bone marrow failure
Prophylaxis for surgery
Cardiopulmonary bypass

Question 17

What are the components of plasma?

Answer 17

Fresh frozen platelets (FFP)

Cyroprecipitate

Question 18

What are the indications for FFP?

Answer 18

Massive haemorrhage

DIC with bleeding

Question 19

What blood group are the universal donor for FFP?

Answer 19

AB

Question 20

What blood group are the universal recipient for FFP?

Answer 20

O

Question 21

What steps have to be taken when blood is given at a blood bank?

Answer 21

Blood sent to lab
Group and save
Crossmatched
Samples kept for 7 days

Question 22

What is a direct Coombs test used for?

Answer 22

Autoimmune haemolytic anaemia
Passive anti-D
Haemolytic transfusion reactions

Question 23

What is an indirect Coombs test used for?

Answer 23

Cross matching

Question 24

What red cells should be available within minutes of request?

Answer 24

O RhD neg red cells, AB plasma

Question 25

What red cells should be available urgently?

Answer 25

Type specific

Question 26

What red cells should be available as a non-urgent request?

Answer 26

Full cross match

Question 27

What should be in immediate supply during a massive haemorrhage?

Answer 27

6 until red cells 4 units FFP 1 unit platelets

Question 28

What volumes of blood products should be transfused in neonates and young children?

Answer 28

Red cells 15ml/kg FFP 15-20ml/kg Platelets 15ml/kg

Question 29

What are the minor reactions to blood transfusion?

Answer 29

Fever usually <38c | Urticarial rash

Question 30

What are the major reactions to blood transfusion?

Answer 30

``` Fever Urticaria Respiratory distress Hypotension Tachycardia oliguria Bleeding Collapse ```

Question 31

What are the management options for a minor reactions to blood transfusions?

Answer 31

Slow down transfusion Antihistamine (urticaria) Paracetamol (febrile non haemolytic transfusion reaction)

Question 32

What are the management options for a major reactions to blood transfusions?

Answer 32

Stop transfusion Check patient identity against component label Consider anaphylaxis, circulatory overload, acute haemolytic transfusion reaction, bacterial infection, lung injury (TRALI)

Question 33

What are the clinical signs of anaphylaxis?

Answer 33

Wheeze Increased pulse Decreased BP Laryngeal/facial oedema

Question 34

What is the treatment for anaphylaxis?

Answer 34

``` Oxygen IM adrenaline Bronchodilator Fluid challenge IM/IV hydrocortisone Antihistamine ```

Question 35

What is the treatment for transfusion associated circulatory overload (TACO)

Answer 35

Slow rate, IV diuretic | Oxygen

Question 36

What are the clinical signs of an acute haemolytic reaction?

Answer 36

Shock High fever Renal failure

Question 37

What is the treatment for acute haemolytic reaction?

Answer 37

``` Oxygen IV fluids Diuretics Inotropes Dialysis Notify blood service to investigate, send blood back ```

Question 38

What are the clinical signs of delayed haemolytic reaction?

Answer 38

Anaemia and jaundice 7-10 days post-transfusion

Question 39

How would you test for delayed haemolytic reaction?

Answer 39

Positive direct antiglobulin test (DAT)

Question 40

What is the treatment for bacterial infection?

Answer 40

IV antibiotics Oxygen IV fluids Notify blood service to investigate/ initiate recalls

Question 41

What is transfusion related acute lung injury?

Answer 41

Transfused anti-leukocyte Abs in donor plasma interact with patient's WBC

Question 42

What is post transfusion purpura?

Answer 42

HPA 1 negative patients forms antibodies after transfusion or pregnancy

Question 43

What are the clinical signs of haemolytic disease of the newborn?

Answer 43

Positive DAT at birth Anaemia Jaundice Stillbirth

Question 44

How is HDN prevented?

Answer 44

Prophylactic anti-D

Question 45

What is the treatment for HDN?

Answer 45

Antibody titres Doppler USS Intrauterine transfusions

Question 46

What is used for warfarin reversal?

Answer 46

Prothrombin complex concentrate

Question 47

What is the Coombs test?

Answer 47

Direct antiglobulin test | Tests if there are any antibody stuck to the surface of the red cells

Question 48

What can be given to manage a minor blood reaction?

Answer 48

Paracetamol | Antihistamine

Question 49

What is neonatal alloimmune thrombocytopenia (NAIT)?

Answer 49

Similar process to HDN but with platelets