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Haematology and Immunology > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

Blood groups

A

Arise form antigens. Red cell antigens are expressed on the cell surface (proteins, sugars, lipids). These are determined genetically.

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2
Q

Type O

A

Absence of antigens

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3
Q

ABO blood group antigens

A

ABO gene encodes glycosyltransferase. Glycans added to proteins or lipids on Red Cells
A and B genes code for transferase enzymes
A antigen is N-acetyl-galactosamine
B antigen is galactose
‘O’ gene is non-functional allele
So A and B are (co-)dominant and O is recessive

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4
Q

Blood group antibodies

A

These can be due to immune tolerance or IgM (anti-A/B naturally occurring antibodies which are developed via gut bacteria in the first few weeks of life)

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5
Q

A

A

42%

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6
Q

B

A

9%

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7
Q

AB

A

3%

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8
Q

O

A

46%

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9
Q

Universal donor

A

Blood type O can be received by any patient

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10
Q

Universal recipient

A

Blood type AB

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11
Q

Universal donor of FFP

A

AB

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12
Q

Blood group O FFP

A

unsafe from all donors

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13
Q

RhD blood group system

A

RhD and RhCE (homologous to RhD) Next immunogenic system. A transmembrane protein which is very immunogenic. Acts as classic antigen. Will not make antibody unless you’ve seen it before. Large proportion of the population are Rhdd (RhD negative)

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14
Q

Anti-RhD

A

RhD negative individuals can make anti-D if exposed to RhD+ cells
Transfusion or pregnancy
Anti-D can cause transfusion reactions or haemolytic disease of the newborn

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15
Q

Blood donors

A

Extensive ‘behavioural’ screening
Sex, age, location…………
Tested for ABO and Rh blood groups
Screened for HepB, HepC, HIV, syphilis (sometimes screened for other infections depending on travel)

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16
Q

Plasma

A

Fresh frozen plasma (frozen, if require clotting factors this can be put in immediately)

Cyroprecipitate (rich in factor 8, mixed with alcohol, rich in fibrinogen)

Factor concentrates, immunoglobulin and albumin

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17
Q

Red Cells

A

Stored at 4oC
Shelf life 35 days
Transfuse over 2-4 hrs

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18
Q

Indications for tranfusion of red cells

A

Surgery, obstetric, trauma
Medical: GI haemorrhage, bone marrow failure, chemotherapy, severe anaemia refractory to other therapy
Other: HDN, sickle cell anaemia, thalassaemia etc etc

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19
Q

Platelets

A

Cool platelets from four donors together and stored for 5 days. Transfuse over 20-60 minutes.

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20
Q

Indications for platelets

A

Massive haemorrhage
(Keep platelet count above 75x109/l)

Bone marrow failure
(platelet count <10-15 × 109/litre
or <20 × 109/litre if additional risk, e.g. sepsis)

Prophylaxis for surgery
(Minor procedures 50x109/l;
More major surgery 80x109/l; CNS or eye surgery 100x109/l)

Cardiopulmonary bypass
(Platelets should be readily available, use only if bleeding)
21
Q

Fresh frozen plasma

A

1 unit from 1 unit of blood

Stored frozen, allow 30 minutes to thaw

22
Q

Indications for FFP

A

massive haemorrhage (use in 1:1 ratio?), coagulation factor replacement.
DIC with bleeding
Liver disease - in the presence of bleeding or prior to invasive procedures
Use prothrombin complex concentrate for warfarin reversal

23
Q

Lab test for FFP

A

PT and APTT

24
Q

Cryoprecipitate

A

2 pools if fib <1.0g/dl (1.5g/dl)

Stored frozen; allow 30 minutes to thaw

25
Q

Lab test for cyroprecipitate

A

Fibrinogen

26
Q

“Practical Blood Banking”

A

Blood sent to lab

‘Second sample’ now implemented

Group and Save

Cross match
-Tariff defined by ’MSBOS

Samples kept for 7 days
-but only valid for 2 days if recent transfusion

27
Q

Blood Grouping and Antibody Screening

A

ABO and RhD type

Checked against historical records

Screen for allo-antibodies in serum

28
Q

Coombs Test

A

Direct anti-globulin test, whether there is antibody attached to the surface of cells. Anti-human immunoglobulin is added.

29
Q

Direct Coombs Test

A

autoimmune haemolytic anaemia
passive anti-D
haemolytic transfusion reactions

30
Q

Indirect Coombs Test

A

Cross matching. Serum from the plasma and then the Coombs Reagents

31
Q

Red Cell Availability

A

Minutes – O RhD Neg red cells, AB plasma and group A plasma
Urgent – Type specific (ABO/ RhD)
Non-urgent – Full cross match, select correct ABO/RhD type. If allo-antibodies choose antigen negative blood.

32
Q

Massive Haemorrhage Policy

A

Immediate supply of:
6 units red cells
4 units FFP (cryoprecipitate?)
1 unit platelets

33
Q

Risk of Transfusion

A

Death or harm (transfusion or ABO incompatible components)

Tranfuscion associated cardiac overload (left ventricular failure)

Transfusion associated lung injury

Acute transfusion reaction

Febrile ractions

Allergic reactions

34
Q

Minor reactions to blood

A

Fever usually below 38 degrees, urticarial rash

Treat with paracetamol and antihistamine

1% of transfusions

35
Q

Major reactions to blood

A

Fever, urticaria, respiratory distress, hypotension, tachycardia, oliguria, bleeding and collapse

36
Q

Management of reactions

A

Stop transfusion

Check patient identity

Consider: anaphylaxis, circulatory overload (TACO), acute haemolytic transfusion reaction (AHTR), bacterial infection, lung injury (TRALI) (other…)

37
Q

Treatment of TACO

A

Slow rate, IV diuretic (20mg of furosemide) , and oxygen

38
Q

ABO Haemolytic Reactions (acute)

A

immediate, complement mediated lysis or IgM or IgG complement fixing

Shock, high fever, renal failure

Treat with O2, IV fluids, diuretics, inotropes, dialysis

39
Q

Delayed Haemolytic Reactions

A

Due to IgG antibodies. Anaemia and jaundice 7-10 days post-transfusion. Do positive direct anti-globulin test (COOMBS test)

40
Q

Bacterial Infection

A

Platelets. Treat with IV antibiotics, O2 and IV fluids.

41
Q

TRALI

A

Oxygen, respiratory support and IV fluids. Notify the blood service to investigate/initiate recalls.

42
Q

Prion Disease

A

Transmittable by blood transfusion from early in disease in sheep. New variant Creutzfeldt-Jakob disease.

43
Q

Development of Maternal AntiD antibodies

A

Haemolytic anaemia resulting from IgG crossing the placenta in subsequent pregnancies. Presents with anaemia and jaundice. Give Anti-D just before birth. All mothers screen, if they are negative they are tested for antibodies against it. Check dopplers, increased blood flow treated with RhD- cells

44
Q

Neonatal Alloimmune Thrombocytopenia similar process for platelets

A

bleeding and thrombocytopenia in the first few days after birht

45
Q

Leucapheresis

A

Bone marrow harvest, donor lymphocyte infusions.

46
Q

Process of of blood grouping

A

Red cell group is determined by suspending washed red cels with diluted anti-A, anti-B, anti-AB and anti-Rh(D). Agglutination indicates a positive test.

47
Q

Compatibility testing

A

This entails suspension of red cells from a donor pack with recipient serum, incubation to allow reactions to occur and examination for agglutination, including an indirect antiglobulin test to ensure that no reaction has occured.

48
Q

Indications for use of cyroprecipitate

A

DIC, liver disease, von Willebrand disease

Haematology and Immunology (20 decks)

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