Blood Transfusion

Question 1

how are blood components obtained

Answer 1

centrifuging anti-coagulated blood

Question 2

which cells are the most dense

Answer 2

red blood cells

Question 3

which cells are the least dense

Answer 3

plasma

Question 4

which cells form the Buffy coat separating the RBC from plasma after centrifuging

Answer 4

white blood cells + platelets

Question 5

until what time after collection must plasma be frozen to be used as fresh frozen plasma

Answer 5

within 8 hours- will contain almost the same concentration of coagulation proteins as in the original donor

Question 6

how long can fresh frozen plasma be stored for

Answer 6

3 years

Question 7

who is fresh frozen plasma given to

Answer 7

Used to replace coagulation factors in people who:
have been depleted of their own ( e.g. have had massive blood loss)
who cannot make their own and are actively bleeding (e.g. due to liver disease)

Question 8

shelf life and storage temperature of:
RBCs
Platelets

Answer 8

RBCs 4 degrees, 35 days

Platelets room temperature, 7 days

Question 9

what blood product is given to a severe burn patient

Answer 9

albumin

Question 10

what are the 4 blood groups and what differentiates them

Answer 10

Group A- RBC membrane carries A antigen

Group B- RBC membrane carries B antigen

AB- RBC membrane carries A and B antigen

O- RBC membrane DOES NOT carry A or B antigen

Question 11

what blood group can be given to any recipient

Answer 11

Group O

Question 12

which blood group is least common

Answer 12

Group AB

Question 13

which blood group can receive blood from any other donor

Answer 13

Group AB

Question 14

If the wrong ABO transfusion was given, which antibody would be seen

Answer 14

IgM primarily

small proportion of IgG

Question 15

what chromosome codes for our blood group

Answer 15

chromosome 9

Question 16

which blood group alleles are dominant

Answer 16

A and B are both co-dominant

O is silent

Question 17

what would the genotype need to be to have blood group O

Answer 17

OO

as A and B are dominant

Question 18

what would the genotype need to be to have blood group A or B

Answer 18

AA or AO

BB or BO

Question 19

what would the genotype need to be to have blood group AB

Answer 19

AB

Question 20

what chromosome is responsible for Rh(D) grouping

Answer 20

Chromosome 1

Question 21

what determines your Rh(D) status

Answer 21

The presence or absence of the Rh(D) protein on the surface of RBCs

Question 22

what are the possible genotypes and their corresponding phenotypes for Rh(D)

Answer 22

D- dominant
d- recessive

DD= rhesus +ve
Dd = rhesus +ve
dd = rhesus -ve

Question 23

what Rh(D) phenotype is the majority of the population

Answer 23

Rh(D) +ve

Question 24

what reaction in the lab do we rely on to determine blood group

Answer 24

agglutination

i.e. addition of Anti-A antibody to group A RBCs will cause them to stick together

Question 25

what blood group is the following patient: red cells + Anti A = no agglutination red cells + Anti B = no agglutination red cells + Anti AB = no agglutination red cells + Anti D = agglutination

Answer 25

Group O

Question 26

what colour is anti- A and what colour is anit-B

Answer 26

Anti A = blue | Anti B = yellow

Question 27

indications for red cell transfusion

Answer 27

anaemia (severe) | acute blood loss that is unpredictable. (i.e. likely to lose a lot more)

Question 28

indications for fresh frozen plasma

Answer 28

bleeding or surgery in a patient with liver disease causing impaired coagulation Coagulopathy following massive transfusion Disseminated Intravascular Coagulation (DIC) - small blood clots throughout blood steam causing blockage of small blood vessels

Question 29

What antibody would we expect to find in the plasma in a patient with blood group A

Answer 29

Anti-B antibody

Question 30

what antibody would we expect to find in the plasma in a patient with blood group B

Answer 30

Anti-A antibody

Question 31

which antibodies might develop after previous exposure to red cells either by transfusion or pregnancy

Answer 31

``` Anti-D Anti-K Anti-c Anti E Anti- Fya ```

Question 32

technique used to detect irregular antibodies

Answer 32

indirect Coombs test

Question 33

potential side effects of blood transfusion

Answer 33

1. immediate haemolytic transfusion reaction 2. delayed haemolytic transfusion reaction 3. febrile non-haemolytic transfusion reaction 4. urticarial reactions 5. circulatory overload 6. bacterial/viral infection

Question 34

what happens in an immediate haemolytic transfusion reaction

Answer 34

I.e. say A blood is transfused to a group O recipient 1. group A red cells reach recipients circulation 2. IgM anti A binds to the cells 3. activates compliment cascade 4. formation of membrane attack complex (MAC) 5. release of C3a and C5a 6. act on blood vessels to cause leakage + dilatation 7. fluids leak into circulation 8. BP drops

Question 35

what are the effects of an immediate haemolytic transfusion reaction

Answer 35

OFTEN FATAL Systemic hypotension, renal vasoconstriction, formational of renal intravascular thrombi, renal failure, shock, DIC

Question 36

Symptoms of immediate haemolytic transfusion reaction

Answer 36

pyrexia, dizziness, tachycardia, tachypnoea, hypotension, pallor, chest pain, cyanosis

Question 37

Management of immediate haemolytic transfusion reaction

Answer 37

Stop transfusion start IV fluids to maintain BP + urine output Obtain blood samples for transfusion lab

Question 38

features of delayed haemolytic transfusion reaction

Answer 38

similar symptoms to acute but less severe Unexplained fall in Hb value[ transfused RBCs are destroyed Jaundice/renal failure

Question 39

lab features of delayed haemolytic transfusion reaction

Answer 39

anaemia, spherocytic red cells on blood film, elevated bilirubin

Question 40

features of febrile non-haemolytic transfusion reaction

Answer 40

rapid temperature rise chills rigors

Question 41

what causes a febrile non-haemolytic transfusion reaction

Answer 41

recipient has anti HLA antibodies that bind to residual cells within the component being transfused Or a result of vasoactive/pyrogenic substances being released from white blood cells during storage of blood components

Question 42

what causes an urticarial reaction in blood transfusion

Answer 42

mast cells releasing IgE in response to infused plasma proteins

Question 43

symptoms of urticarial rash

Answer 43

rash/weals within few minutes of starting transfusion

Question 44

treatment of urticarial reaction

Answer 44

slow the transfusion | consider anti-histamines

Question 45

who is at risk of circulatory overload from blood transfusion

Answer 45

people with circulatory impairment e.g. elderly/CCF

Question 46

main symptom of circulatory overload

Answer 46

pulmonary oedema

Question 47

symptom of bacterial infection caused by blood transfusion

Answer 47

fever, shock, chills, vomiting, tachycardia, hypotension, collapse