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Y3/ Haematology > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

Name the A and B antigens

A

A and B antigens are made by action of transferase enzymes on H, adding either
A = N acetyl galactosamine
B = galactose

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2
Q

For the following blood groups what are the antibodies in the plasma and the antigens in the RBC?
Group A, B, AB and O

A

Group A = anti-B antibodies, A antigen
Group B = anti-A antibodies, B antigen
Group AB = none, A and B antigens
Group O = anti-B and anti-A antibodies, none

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3
Q

What is the prevelance of each of the blood groups

A 
O = 45%
A = 43%
B = 9%
AB = 3%
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4
Q

What are the ‘other’ blood groups

A 
Rh 'rhesus' 
Kell 
Duffy
Kidd 
M N S s
Antibodies usually only form in response to transfusion or pregnancy
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5
Q

Red cells

  • storage instructions
  • shelf life
  • transfusion time
  • other features
A

Stored at 4 degrees C
Shelf life 35 days
Trasnfusion over 2-3 hours
Plasma reduced, optimal additive solutions

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6
Q

Platelets

  • what is a dose?
  • storage instructions
  • shelf life
  • transfuse over…..
A
  • Dose = 1 unit (4 WB donations or 1 apheresis)
  • Stored at room temp (aggitator), shelf life 7 days
  • Transfuse over 30 to 60 minutes
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7
Q

Plasma
What is the dose?
Storage instructions

A

12-15ml/kg, 3 to 4 units per dose

stored frozen, allow 30 minutes to thaw

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8
Q

Who is universal donor for the following?

  • red cells
  • plasma (not cellular)
  • platelets
A
  • O RhD negative
  • AB (A)
  • AB RhD negative (A)
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9
Q

Who is the universal recipient of the following?

  • red cells
  • plasma (not cellular)
  • platelets
A
  • AB RhD pos
  • O
  • O RhD neg
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10
Q

What questions do you need to ask when deciding Does the patient need blood?

A
  • Why are they anaemic/thrombocytopaenic/coagulopathic?
  • What else can be done to correct it?
  • How long will that take?
  • Can they wait?
  • Are they bleeding?
  • Are you giving prophylaxis or treatment?
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11
Q

What is the dose of RBCs?

A
  • approx 10g/L per unit for an average 70kg adult
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12
Q

What are the triggers for transfusion of RBCs?

A
  • acute blood loss with haemodynamic instability
  • Hb <70g/L stable patient
  • Hb <80g/L if cardiovascular disease
  • chronic transfusion dependent anaemia
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13
Q

A platelet dose of 1 unit should increase platelet count by….

A

30

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14
Q

What are the triggers for transfusion of platelets

A
  • prophylactic platelet trasnfusion
  • prior to invasive procedure or therapy
  • therapeutic to treat significant bleeding
  • specific clinical conditions
  • platelet dysfunction
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15
Q

What is the dose of FFP?

A
  • Dose = 15ml/kg of body weight, often equivilant to 4 units in adults
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16
Q

What are the trigger for transfusion of FFP?

A
  • major haemorrhage
  • INR >1.5 with bleeding
  • INR >1.0 and pre-procedure
  • Liver disease with INR >2 and pre-procedure
17
Q

What is a dose of cryoprecipitate?

A
  • Dose - 2 pooled units, equivialnt to 10 individual units, will increase fibrinogen by approximately 1g/L
18
Q

What are the triggers for transfusion of cryoprecipitate?

A
  • clinically significant bleefing and fibrinogen <1.5g/l

- fibrinogen <1g/l and preprocedure

19
Q

Define major haemorrhage

A
  • loss of more than one blood volume within 24 hours (around 70ml/kg, >5litres in a 70kg adult)
  • 50% of blood volume lost in less than 3 hours
  • blleeding in excess of 150ml/minute
20
Q

What is appropiate dose of blood products in the major haemorhage protocol?

A

4 units RBCs

4 units FFB

21
Q

What are the immune complications/adverse effects of transfusion?

A
  • ABO incompatible
  • FNHTR - febrile non-haemolytic TR
  • DHTR - delayed haemolytic TR
  • allergic
22
Q

What are the infectious complications/adverse effects of transfusion?

A

Viral
Bacterial, syphliic
parasites
prions

23
Q

What are the ‘other’ complications/adverse effects of transfusion?

A

iron overload

fluid overload TACO

24
Q

What are the consequences of bacterial contamination?

HOw does it occur?

A

Bacterial sepsis - especially if endotoxin produced e.g. gram neg rods (E.coli)
Hypotension, tachcardia and fever within minutes of starting transfusion
ABcerita acquired from donor skin,
Risk reduced by - stringent cleaning, diver pouch, bacerial screening
CAN BE FATAL

25
Q

What is an acute haemolytic reaction due to?

Can be fatal because…

A

ABO mismatch
Can be fatal soon after transfusion
- immediate complement mediated cell lysis due to IGm and anti A and anti B
- hypotension, tachycardia, fever, renal failure, DIC, death
- As little as 10mls can be fatal

26
Q

HOw should an acute haemolytic reaction be managed?

A
  • STOP transfusion
  • IV fluids to maintain BP
  • FBC, coag screen, chemistry
  • repreatd blood group
  • return blood to blood bank
  • blood cultures
  • intensive care, treat DIC, dialysis
27
Q

Describe a DHTR

A

Delayed Haemolytic Transfusion Reaction

  • due to previously stimulated RBC antibodies (Rh, Kell, etc
  • 7 to 10 days post transfusion
  • Fall in Hv and jaundice
  • DAT positive (direct antiglobulin test)
28
Q

Describe FNHTR

A

Febrile Non-Haemolytic Tranfusion Reaction

  • during or soon after transfusion
  • fever and tachucardia
  • unpleasant but not life threating - must exclude wrong blood or bacterial infection
  • less since leucodepletion of blood and platelets
29
Q

Describe allergic reactions

A
  • urticarial rash +/- wheeze –> often not sevre, hypersensitivity to random protein
    Anaphylaxis
  • severe, life-threatening reaction soon after transfusion started
  • wheeze/asthma, tachycardia, hypotension
  • laryngeal/facial oedema
30
Q

Which patients are at risk of a TACO

A

Transfusion Associated Cardiac Overload

  • elderly
  • pre-existing heart disease
  • low weight patients
  • renal/liver impairment
  • concomitant IV fluids
  • diuretic use
31
Q

What is TRALI

A

Transfusion related Acute lung injury

- tranfused antibodies in donor plasma interact with patients white cells

32
Q

What are the 3 questions in the TACO checklist?

A
  1. Does the patient have heart disease?
  2. Do they have pulmonary oedeme
  3. Is fluid balance clinically significantly positive?

Y3/ Haematology (10 decks)

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