Blood Transfusion

Question 1

Who needs CMV -‘ve blood?

Answer 1

Neonates up to 28 days post-delivery

Pregnant women

Question 2

Who needs irradiated blood?

Answer 2

Neonates
Hodgkins lymphoma
Immunosupressed - SCID, DiGeorge syndrome

Question 3

Name three early transfusion reactions

Answer 3

1) Anaphylaxis
2) Acute haemolytic transfusion reaction
3) Non-haemolytic febrile reaction

Question 4

Name two middle transfusion reactions

Answer 4

1) TRALI

2) Post transfusion purpura

Question 5

Name two late transfusion reactions

Answer 5

1) Transfusion associated graft vs host

2) Infections

Question 6

What is the risk of giving a patient the wrong unit of blood?

Answer 6

Acute haemolytic transfusion reactions - incompatible transfused red cells react with the patient’s own anti-A or anti-B antibodies to red cell antigens. Infusion of ABO incompatible blood arises from errors in labelling. Non-ABO red cell antibody haemolytic less severe

Question 7

What blood test do you need to confirm autoimmune haemolytic anaemia?

Answer 7

DAT

Question 8

How can haemolysis be categorised?

Answer 8

Hereditary:
• Red cell membrane – Hereditary Spherocytosis Hereditary Elliptocytosis
• Red cell enzymopathies –
G6PD
Pyruvate Kinase defy
• Abnormal Hb –
unstable Hbs, Sickle Cell Disease, thalassaemia
Acquired:
• Alloimmune - HDN, incompatible transfusion
• Autoimmune - Warm AIHA (1°, CLL, drugs, SLE), Cold AIHA (mycoplasma, EBV), CHAD, lymphoma, PCH
• Non-immune – MAHA, TTP, HUS, hypersplenism, prosthetic heart valves, sepsis, malaria, PNH

Question 9

Management of AIH

Answer 9

Corticosteroids 
Other immunosupressants (rutiximab, cyclophosphamide, azathioprine) 
Splenectomy
Folate
Transfuse

Question 10

How is haemolysis monitored in outpatient setting?

Answer 10

LDH - marker of red cell breakdown
Reticulocyte - will go up temporarily, then stabilise
Urine colour - getting less dark
Jaundice

Question 11

TRALI management

Answer 11

Give high-concentration oxygen, IV fluids and inotropes (as for acute respiratory distress syndrome).
Monitor blood gases, serial CXR and CVP/pulmonary capillary pressure.
Ventilation may be urgently required - discuss with ICU.

Question 12

Outline Graft versus Host

Answer 12

Acute GvHD begins between day 4 and day 30 following transfusion, with high fever and diffuse erythematous skin rash progressing to erythroderma, diarrhoea and abnormal liver function. Patients deteriorate with bone marrow failure and death occurs through overwhelming infection.

Question 13

How to manage ABO incompatibility

Answer 13

Keep the intravenous (IV) line open with saline.
Give oxygen and fluid support.
Monitor urine output, usually following catheterisation. Maintain urine output at more than 100 ml/hour, giving furosemide if this falls.
Consider inotrope support if hypotension is prolonged.
Treat DIC appropriately - seek expert advice early and transfuse platelets/fresh frozen plasma (FFP) guided by the coagulation screen and bleeding status.
Inform the hospital transfusion department immediately.