Blood Transfusion Flashcards
What are the main blood group phenotypes?
A
B
O
AB
What do the A and B blood antigen genes code for?
Transferase enzymes
What is the A blood antigen?
N-acetly-galactosamine
What is the B blood antigen?
Galactose
What is the O blood gene?
Non-functional allele
What blood group is the universal donor?
O
What blood group is the universal recipient?
AB
What can those who are RhD negative do?
Individuals can make anti-D if exposed to RhD+ cells (transfusion or pregnancy)
What is the effect if anti-D?
Can cause transfusion reactions or haemolytic disease of the newborn
What are blood donors screened for?
HepB HepC HIV Syphilis HepE West Nile virus HTLV1
What is the shelf life of red cells?
35 days
Over what time period should red cells be transfused?
2-4 hours
What are the indications for red cells?
Anaemia Surgery, obstetric, trauma GI haemorrhage Bone marrow failure Chemotherapy HDN Sickle cell anaemia Thalassaemia
What is the shelf life of platelets?
5 days
Over what period of time are platelets transfused?
20-60 minutes
What are the indications for platelets transfusion?
Massive haemorrhage
Bone marrow failure
Prophylaxis for surgery
Cardiopulmonary bypass
What are the components of plasma?
Fresh frozen platelets (FFP)
Cyroprecipitate
What are the indications for FFP?
Massive haemorrhage
DIC with bleeding
What blood group are the universal donor for FFP?
AB
What blood group are the universal recipient for FFP?
O
What steps have to be taken when blood is given at a blood bank?
Blood sent to lab
Group and save
Crossmatched
Samples kept for 7 days
What is a direct Coombs test used for?
Autoimmune haemolytic anaemia
Passive anti-D
Haemolytic transfusion reactions
What is an indirect Coombs test used for?
Cross matching
What red cells should be available within minutes of request?
O RhD neg red cells, AB plasma
What red cells should be available urgently?
Type specific
What red cells should be available as a non-urgent request?
Full cross match
What should be in immediate supply during a massive haemorrhage?
6 until red cells
4 units FFP
1 unit platelets
What volumes of blood products should be transfused in neonates and young children?
Red cells 15ml/kg
FFP 15-20ml/kg
Platelets 15ml/kg
What are the minor reactions to blood transfusion?
Fever usually <38c
Urticarial rash
What are the major reactions to blood transfusion?
Fever Urticaria Respiratory distress Hypotension Tachycardia oliguria Bleeding Collapse
What are the management options for a minor reactions to blood transfusions?
Slow down transfusion
Antihistamine (urticaria)
Paracetamol (febrile non haemolytic transfusion reaction)
What are the management options for a major reactions to blood transfusions?
Stop transfusion
Check patient identity against component label
Consider anaphylaxis, circulatory overload, acute haemolytic transfusion reaction, bacterial infection, lung injury (TRALI)
What are the clinical signs of anaphylaxis?
Wheeze
Increased pulse
Decreased BP
Laryngeal/facial oedema
What is the treatment for anaphylaxis?
Oxygen IM adrenaline Bronchodilator Fluid challenge IM/IV hydrocortisone Antihistamine
What is the treatment for transfusion associated circulatory overload (TACO)
Slow rate, IV diuretic
Oxygen
What are the clinical signs of an acute haemolytic reaction?
Shock
High fever
Renal failure
What is the treatment for acute haemolytic reaction?
Oxygen IV fluids Diuretics Inotropes Dialysis Notify blood service to investigate, send blood back
What are the clinical signs of delayed haemolytic reaction?
Anaemia and jaundice 7-10 days post-transfusion
How would you test for delayed haemolytic reaction?
Positive direct antiglobulin test (DAT)
What is the treatment for bacterial infection?
IV antibiotics
Oxygen
IV fluids
Notify blood service to investigate/ initiate recalls
What is transfusion related acute lung injury?
Transfused anti-leukocyte Abs in donor plasma interact with patient’s WBC
What is post transfusion purpura?
HPA 1 negative patients forms antibodies after transfusion or pregnancy
What are the clinical signs of haemolytic disease of the newborn?
Positive DAT at birth
Anaemia
Jaundice
Stillbirth
How is HDN prevented?
Prophylactic anti-D
What is the treatment for HDN?
Antibody titres
Doppler USS
Intrauterine transfusions
What is used for warfarin reversal?
Prothrombin complex concentrate
What is the Coombs test?
Direct antiglobulin test
Tests if there are any antibody stuck to the surface of the red cells
What can be given to manage a minor blood reaction?
Paracetamol
Antihistamine
What is neonatal alloimmune thrombocytopenia (NAIT)?
Similar process to HDN but with platelets
