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Year 3 > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

why transfuse blood?

A

mainly because of bleeding

failure of production

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2
Q

how do blood groups arise?

A

antigens

red cell antigens are expressed on cell surface

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3
Q

what is an antigen?

A

something that provokes an immune response

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4
Q

what can red cell antigens be made from?

A

proteins
sugars
lipids

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5
Q

the ABO gene codes for?

A

glycosyltransferase

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6
Q

with a graph describe the antibody response to antigens

A

see notes

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7
Q

what are glycans?

A

added to proteins or lipids on red cells

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8
Q

what do A and B genes code for?

A

transferase enzyme

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9
Q

what is A antigen?

A

N-acetyl-galactosamine

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10
Q

what is B antigen?

A

galactose

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11
Q

what is O gene?

A

non functional allele

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12
Q

what antigens does everyone have?

A

2 x D-galactose
N-acetylgalactosamine
N-acetylglucosamine

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13
Q

what inheritance is A and B and O?

A

A and B codominant

O is recessive

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14
Q

group A antibodies

A

B

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15
Q

group B antibodies

A

A

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16
Q

group O antibodies

A

A and B

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17
Q

group AB antibodies

A

No antibodies

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18
Q

what type of immunoglobulin for anti-A/B is naturally occuring?

A

IgM

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19
Q

IgG vs IgM

A

IgG needs protein

IgM ability to fix complement

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20
Q

table red cells donor recipient compatibility

A

see notes

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21
Q

table showing FFP donor/recipient compatibility

A

see notes

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22
Q

why is FFP the reverse of RBC?

A

plasma contains antibodies not antigens

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23
Q

when do rhesus negative individuals make anti-D

A

when exposed to RhD+ cells

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24
Q

what kind of protein is RhD?

A

transmemebrane

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25
Q

why is RhD immunogenic?

A

hydrophobic

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26
Q

what can anti-D cause?

A

transfusion

haemolytic disease of the newborn

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27
Q

what does DD mean?

A

RhD +ve

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28
Q

what does Dd mean?

A

RhD +ve

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29
Q

what does dd mean?

A

RhD -ve

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30
Q

what are blood donors screened for?

A 
ABO, Rh
hep B/C/E
HIV 
syphilis
(HTLV1, malaria, West Nile virus, Zika virus)
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31
Q

what kind of antibody is RhD?

A

IgG

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32
Q

what are the indications for red cell transfusion?

A
  1. to correct severe acute anaemia, which might otherwise cause organ damage
  2. to improve QoL in patient with otherwise uncorrectable anaemia
  3. to prepare a patient for surgery or speed up recovery
  4. to reverse damage caused by patient’s own red cells - Sickle cell disease
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33
Q

other than freezing plasma what can you do?

A

extract clotting factors and albumin

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34
Q

what temp should RBCs be stored at?

A

4 C

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35
Q

how long should you transfuse RBCs over?

A

2-4hrs

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36
Q

RBC 1 unit increments is?

A

5g/l

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37
Q

what does 1 dose of platelets =?

A

4 pooled

1 apheresis donor

38
Q

platelets 1 dose increments?

A

20-40 10^9l

39
Q

what temp should platelets should be stored at?

A

22 c

40
Q

self life of platelets?

A

7 days

41
Q

how long to transfuse platelets over?

A

20-30 mins

42
Q

indications for platelets?

A

massive haemorrhage
bone marrow failure
prophylaxis for surgery
cardiopulmonary bypass

43
Q

what is the first clotting factor to run out?

A

fibrinogen

44
Q

in massive haemorrhage what do you want to keep platelet count above?

A

75 x 10^9/;

45
Q

what is bone marrow failure in terms of platelets?

A

platelet count < 10-15 x 10^9/l

or <20 x 10^9/l if additional risk

46
Q

platelets in prophylaxis for surgery

A

minor procedures 50x10^9/l
major 80x10^9/l
CNS or eye surgery 100x10^9/l

47
Q

when would you use platelets in cardiopulmonary bypass?

A

only if bleeding

48
Q

FFP is stored at what temp?

A

frozen

49
Q

how long do you thaw FFP for?

A

30 mins

50
Q

indications for FFP

A

massive haemorrhage
DIC with bleeding
prophylactic

51
Q

indications for cryoprecipitate

A

fibrinogen low

52
Q

how long to thaw cryroprecipitate for?

A

20 mins

53
Q

if fibrinogen < 1.0g/dl how much cryoprecipitate?

A

1-2 pools

54
Q

practical blood banking principles

A 
Blood sent to Blood Bank
‘Second sample’ now implemented
Group and Screen/Save
Cross match
Tariff defined by ’MSBOS’
Samples kept for 7 days
But only valid for 2 days if recent transfusion
55
Q

what type of near miss in blood banking is common?

A 
patient not identified
sample not labelled at bedside
sample not labelled by person taking blood
prelabelled bottle
same surname
56
Q

what is a group and save?

A

ABO and RhD type
checked against historical records
screen for allo-antibodies in serum

57
Q

direct Coombs test

A

antibody already there
autoimmune haemolytic anaemia
passive antiD
haemolytic transfusion reactions

58
Q

indirect Coombs test

A

Cross matching

59
Q

describe Coombs test

A

anti-human immunoglobulin if get clumping

60
Q

apart from ABO and Rh name some of the other most common

A 
Kell
Duffy
MN 
P 
Lewis
Lutheran
61
Q

how many people have allo-antibodies in blood?

A

1-10%

62
Q

what blood is available in minutes?

A

O -ve

63
Q

what is urgent blood?

A 
10-15 mins
type specific (ABO/RhD)
64
Q

what is non-urgent blood?

A

1 hr
full cross match
select correct ABO/RhD
if allo-antibodies choose antigen -ve blood

65
Q

when may you need rapid control of bleeding?

A

obstetric intervention
surgery
interventional radiology

66
Q

what does the massive haemorrhage protocol involve?

A

dedicated porter
6 units red cells
4 units FFP
1 unit platelets

67
Q

never events in blood transfusion

A

death

harm due to ABO incompatability

68
Q

other risks of blood transfuson

A 
TACO
TRALI
ATR
Febrile
allergic
vCJD risk
69
Q

what is a prion disease?

A

transmittable by blood transfusion from early disease in sheep

70
Q

steps taken to reduce risk of prion transmission in blood

A

leucodepletion
UK plasma not used for fractionation
imported FFP for all patients after 1996

71
Q

management of blood reactions

A

stop transfusion
check patient identify against component label
consider: anaphylaxis, TACO, AHTR, bacterial infection, lung injury

72
Q

acute transfusion reactions: pyrexia possible cause

A

FNHTR

73
Q

acute transfusion reactions: pyrexia treatment

A

anti-pyretic

other symptoms usually more concern - shock/DIC

74
Q

acute transfusion reactions: urticaria possible causes

A

mild allergic reaction

anaphylaxis

75
Q

acute transfusion reactions: urticaria reatment

A

antihistamine

other symptoms usually more concern - bronchospasm/shock

76
Q

acute transfusion reactions: dyspnoea causes

A

TACO
TRALI
anaphylaxis

77
Q

acute transfusion reactions: dyspnoea treatment

A

O2
diuretic
ventilation
adrenaline

78
Q

acute transfusion reactions: shock causes

A

IBCT
anaphylaxis
TRALI
TAS

79
Q

acute transfusion reactions: shock treatment

A 
adrenaline (IV) hydrocortisone/antihistamine
IV fluid/ITU admission
ventilation
antibiotics
FFP/platelets if DIC
80
Q

what is haemolytic disease of the newborn?

A

development of maternal anti-D antibodies (Sensitisation)

IgG crosses placenta

81
Q

most common antigens involved in haemolytic disease of the newborn

A

RhD - most immunogenic
also c, K
other Rh antigens, Jka, ABO less immunogenic
Positive DAT at birth, anaemia, jaundice

82
Q

how to prevent haemolytic disease of the newborn

A

prophylactic anti-D
sensitising events
routine 28/40

83
Q

treatment of haemolytic disease of the newborn

A

careful monitoring
antibody titres
doppler ultrasound
intrauterine transfusions

84
Q

what is leucapheresis?

A

bone marrow harvests

donor lymphocyte infusions

85
Q

other banks that are not blood

A 
bone
milk
tendons
heart valves
faecal
islet cells
mesenchymal stem cells
86
Q

name 3 cellular therapies

A

leucapheresis
other banks
gene therapies

87
Q

what does TRALI stand for?

A

transfusion related acute lung injury

88
Q

what is TRALI?

A

Tranfused anti-leucocyte Abs in donor plasma interact with patient’s WBC
Bilateral pulmonary infiltrate
Supportive management, ventilation

89
Q

what does PTP stand for?

A

post transfusion purpura

90
Q

what is PTP?

A

Tranfused anti-leucocyte Abs in donor plasma interact with patient’s WBC
Bilateral pulmonary infiltrate
Supportive management, ventilation

91
Q

what is transfusion associated graft versus host disease?

A 
Rare, but always fatal
Graft of lymphocytes in donor’s blood 
transfused to an immunocompromised host
Homozygosity of donor’s HLA type
Can be prevented by irradiation of blood

Year 3 (164 decks)

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