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Haematology > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

What happens when foreign antigens discovered in blood

A

Antibodies made by your B cells

Cause agglutination

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2
Q

What are blood groups

A

Red cell antigens expressed on cell surface which can provoke antibody production if non-self

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3
Q

What is the most common blood group

A

ABO

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4
Q

What do ABO genes encode

A

Glycosyltransferase enzyme

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5
Q

What is the most common blood groups

A

A and O

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6
Q

What does A blood group have

A

A antigen on surface
Will develop antibodies against B if B given as foreign body
Can’t give B

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7
Q

What are A and B antigens

A

Co-dominant

O antigen is recessive

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8
Q

What does AB blood group have

A

A + B antigens on surface
No antibodies will form as no antigen will be detected as foreign
Can receive any blood group

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9
Q

What does O blood group have

A

No antigens
So if given A or B will develop antibodies
Can only receive O blood but can give O blood to anyone

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10
Q

What happens with fresh frozen plasma (FFP)

A

FFP contains the antibodies against blood groups
So if donor is A then will have anti-B Ab’s so can’t give to B or AB
O will have antibodies against A and B so can only give to O
AB will have no antibodies so give to anyone

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11
Q

What is RhD antigen

A

Dominant so to be negative must inherit dd genotype

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12
Q

What happens if RhD negative

A

Body will make anti-RhD Ab if exposed to RhD positive blood either in transfusion or pregnancy

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13
Q

What happens after pregnancy if mother has become sensitised

A

If next baby is Rh+Ve mothers Ab will cross placenta and attach to RhD antigen = haemolytic disease of the new born
Jaundice / anaemia / +ve DAT

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14
Q

What happens in a transfusion if RhD +ve blood transfused

A

Antibodies will attach and cause transfusion reaction

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15
Q

What is the treatment for haemolytic disease of new born

A

Prophylactic anti-D at time of delivery, 28 weeks if -ve and if any sensitisation events

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16
Q

What are sensitisation events

A

Trauma
Abruption
Invasive procedures

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17
Q

How do you monitor pregnancy or treat if Ab cross

A

Ab titre
Kliehaer test if >28 weeks - measure HbF in mother blood to see how much of fetes blood got into mother and see if extra-dose needed

Rx
Intra-uterine transfusion
Exchange transfusion
Phototherapy

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18
Q

What do you screen blood donors for

A 
Sex
Age
Travel
Tattoos / piercing 
ABO and Rh blood group
Hep B, C, E, HIV, syphillis
Tropical disease depending not travel
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19
Q

What blood products are available

A 
Red cell
Platelet rich plasma
Platelet concentrate
FFP
Cyroprecipitate
SAG-Mannitol blood
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20
Q

What are indications for red cell transfusion

A

Correct severe acute anaemia i.e. due to blood loss >20% which would cause organ damage
Correct anaemia but better to correct cause
Improve QOL with uncorrectable anaemia
Prepare surgery / speed up recovery
Revere damage by own cells e.g. sickle
Exchange transfusion - rare in adults

If infusion of large volume would compromise CVS

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21
Q

What level of Hb should you think of transfusing

A

<70 if no ACS
<80 if ACS
Different if get regular transfusion / active haemorrhage

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22
Q

How do you transfuse RBC

A

2-4 hours
Longer if risk of overload
STAT in an emergency

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23
Q

What are indications for platelet transfusion

A 
Massive haemorrhage
Bone marrow failure = 90%
Surgical prophylaxis
Cardiopulmonary bypass if bleeding
DIC
Neonatal autoimmune thrombocytopenia
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24
Q

What do you want platelets to be if massive haemorrhage

A

75x10^9 so if less than this then transfuse

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25
Q

What level would you transfuse

A

Platelet <10-15x10^9
Platelet <20 if additional risk e.g. sepsis
Platelet <30 if active milder bleeding

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26
Q

When do you give platelet rich plasma vs platelet concentrate

A

Platelet rich plasma if bleeding / surgery

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27
Q

When would you not perform platelet transfusion

A

Chronic bone marrow failure

ITP / TTP / heparin induced

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28
Q

What must you do if think need FFP / cryoprecipitate

A

Call up as stored frozen

Must give fast to have affect

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29
Q

If don’t know blood group what do you give

A

AB

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30
Q

What does FFP contain

A

Clotting factor
Albumin
Ab

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31
Q

When do you use

A

Clinically significant but no major haemorrhage with abnormalities in PT / APTT >1.5
Prophylactic if high risk bleeding in surgery

Massive haemorrhage
DIC with bleeding
Correct clotting hepatic failure
Reversal of anti-coagulant 
Correct congenital deficiency if no specific factor available - factor V
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32
Q

When do you not use

A

As 1st line in hypovolaemia - no role

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33
Q

What is cryprecipitate

A

Source of fibrinogen and factor VIII, XIII, VWF

Allow large concentrate to be delivered in small volume

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34
Q

When do you use

A

No vascular room
Clinically significant but not major haemorrhage with fibrinogen <1.5
- DIC
- Renal and liver failure
Also used in emergency for haemophiliac is specific factor not available and vWF
Prophylactic in surgery where risk of bleeding and low fibrinogen

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35
Q

What is prothrombin complex used for

A

Emergency reversal of anticoagulation e.g. brain haemorrhage / emergency surgery

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36
Q

What is SAG mannitol

A

All plasma removed from blood

Replaced with NaCL, adenine, mannitol

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37
Q

What is a cell saver device

A

Collect own patients blood lost in surgery and re-infuses

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38
Q

When is it CI

A

Malignancy

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39
Q

What are options at blood bank

A

Group and save if may require i.e. surgery
- If Ab -ve then blood can be provided if -ve
- If Ab +Ve then 2 unit blood is X-matched incase needed
Cross match if think will require blood - 45 minutes
Emergency cross match
X-match in MSBOS - max surgical blood order schedule which takes into account routine matching
Massive haemorrhage protocol

40
Q

What must you send to bank and what is important when requesting

A 
2 samples
Type of blood needed
Urgency - routine or urgent
Transfusion Hx 
Any special requirements e.g. irradiated
41
Q

What does blood bank look at in blood if group and screen

A

ABO / RhD / other Ab
Coombs test
If Ab -ve then blood is group and saved
If Ab +Ve then blood will be x-matched so available if needed

42
Q

What is Coombs indirect

A

Add Ab of perspective donor + see if agglutination occurs
X-matching + allo’Ab’s
Usually used for Rhesus

43
Q

What causes direct coombs

A

Autoimmune haemolytic anaemia
Passive anti-D
Haemolytic transfusion reaction

44
Q

If need red cell immediately
If need red cell urgently
If non-urgent

A

O Rhd -ve blood + AB FFP
Get specific group - ABO / Rhd
Must inform blood bank when you send sample if requiring immediate or urgent

Full X-match (1 hour) for specific type and allo-Ab’s

45
Q

What is massive haemorrhage and what do you get

A

2222
Say location in hospital

6 units RBC - O+ve, RhD -ve
4 FFP - AB
1 platelet

46
Q

Who needs special requirements - irradiated, CMV -ve, HEV -ve

A

Irradiated
- Immunocompromised as risk of T cells causing GVHD

CMV -ve

  • Malignancy
  • Neonate

HEV -ve

  • Solid 0organ transplant
  • Allogenic SCT
  • Neonates and infants up to 1
47
Q

What are main hazards of blood transfusion

A 
Immmune
Infection
TRALI
TACO 
Electrolyte
48
Q

What immune

A 
Acute or delayed haemolytic - can be fatal  
Non-haemolytic reaction 
Allergic 
Thrombocytopenia
GVHD
Alloimmunisation
ABO / Rh incompatibility 
PTP
49
Q

What electrolyte

A

Hyperkalaemia = most common
Hypocalcaemia
Iron overload
Clotting

50
Q

How does acute transfusion reaction present

A

Fever
Pruritus
Urticaria

51
Q

What are more fatal signs

A

Dyspnoea
Pyrexia
LOC
Shock

52
Q

What is never event

A 
Transfusion of ABO incompatible components no matter what the outcome 
Can be fatal
Leads to complement activation + haemolysis
Red cells are most dangerous 
Symptoms begin minutes after
- Fever
- Abdo / chest pain
- Hypotension 
- DIC 
- Renal failure
53
Q

How does allergic reaction present

A

Range
Fever
Urticaria
Anaphylaxis

54
Q

When does it present

A

A few minutes after

55
Q

What is TACO

A

Defined as fluid overload due to increased hydrostatic pressure
Most common cause of transfusion related complications
Transfusion associated circulatory overload
Blood given too quickly or too much
Leading cause of death
Occurs with 6 hours-12 hours but can occur up to 24 hours

At risk

  • Elderly
  • LBW
  • Low albumin
  • Renal failure
  • On IV fluid as well / +ve f fluid balance
56
Q

How does it present

A

Pulmonary oedema

Hypertension

57
Q

What must you do

A

TACO checklist prior to assess risk
Assess cardiac status before and after
Only write up 1 unit of blood at a time and reassess
Can give furosemide prior

58
Q

What is TRALI

A

Rare
Transfusion Associated Lung injury
Ab in donor reacting against antigen release granules transudates into lung causing inflammation

59
Q

How does it present

A 
Bilateral
Hypoxia 
Fever
Hypotension
ARDS within 6 hours

CXR cannot differentiate between TRALI and TACO
If don’t know then say TAD - transfusion associated dyspnoea
Can have both at same time

Rx

  • O2 and pause transfusion
  • Diuretic and ventilation may be needed
60
Q

What infections

A

CJD / prion
HIV / HCV / HBV
CMV

61
Q

How are infections prevented

A

Leucodepletion prior to remove any CJD / CMV etc
Can’t donate blood if had transfusion
Import all all FFP from patients born after 1996

62
Q

What is graft versus host disease and how does it present

A

Rare but fatal
Lymphocytes in donor transfused to immunocompromised host and mount a response
Fever
Erythoderma

63
Q

How do you prevent

A

Leucopletion and irrraiation if immunocompromised

64
Q

What is PTP

A

Ab after transfusion destroys platelets 7-10 days after

Treat with High dose Ig

65
Q

How do you manage reaction

A

Stop transfusion
Check identify
Consider cause

66
Q

If pyrexia what da you do

A

Anti-pyretic
Stop transfusion to look for more concerning Sx - shock / DIC / sepsis
Increase observation and give transfusion more slowly

67
Q

What do you do for urticaria / mild allergy or anaphylaxis

A

Discontinue
Anti-histmaine IV
Consider restarting + observe
Treat anaphylaxis

68
Q

What is most common cause of dyspnoea

A

TACO

TRALIA and anaphylaxis can cause

69
Q

What do you do

A

Give O2
Diuretic IV
Ventilation
Adrenaline

70
Q

What causes shock

A

Anaphylaxis

TRALI

71
Q

How do you Rx

A 
Adrenaline
IV fluid
Ventilation 
Ax
FFP / platelet if DIC
72
Q

How do you treat TRALI

A

O2 100%

Treat as ARDS

73
Q

What must you always do for dyspnoea

A

Monitor blood gas
CXR
Measure CVP / PCP

74
Q

If bacterial contamination

A

Blood cultures
Measure urine output
Broad spec Ax, fluid, O2

75
Q

If ABO incompatibility

A

DAT to confirm haemolytic
IV saline
Treat any DIC - FFP / platelets
Inform lab

76
Q

When is albumin 4% used

A

To restore and maintain blood volume

77
Q

When is albumin 20% used

A

To restore and maintain blood volume and onctoc pressure

78
Q

What is the universal donor of red cells

A

O Rhd -ve

79
Q

What is universal recipient of red cells

A

AB Rhd +ve

80
Q

What is universal donor of plasma

A

AB

81
Q

What is universal recipient of plasma

A

O

82
Q

What Ab does ABO activate and what heat does it like

A

IgM

Cold + complement activator

83
Q

What Ab does Rh activate and what heat

A

IgG

Warm + not good at activating complement

84
Q

What has highest risk of infection

A

Platelet as stored at room temp
Bacterial = most common
Other infections if in blood but usually screened

85
Q

Before taking blood sample what must you do

A

Check request form been completed and take to bedside - inc rate, volume, specials and signed
Confirm patients name and DOB against request form and identity badge
Confirm CHI against identity and request form
Confirm patients temporary emergency number and gender
Refer local policy if patient can’t identify themselves

86
Q

What do you do after sample taken

A

Complete label at bedside

Name, DOB, CHI, date and time taken and signature

87
Q

If two samples are needed what should happen

A

Different person and time if possible to ensure +ve patient identification

88
Q

What should you never do

A

Use pre-labelled tube

Label a sample from another member of staff

89
Q

What do you do before giving blood

A 
Either single or double check depending on policy
Check written authoritsatin
Visual inspection
Check component 
Check identify 
Baseline obs
90
Q

Written authorisation

A

Has correct component been authorised including rate, volume, special and signed
Check it matches ID

91
Q

Visual linspection

A

Any damage or discolouration

92
Q

Check component

A 
Is it correct component against request
Check compatible to blood group 
Do donation numbers match
Check any specific 
Check expiration
93
Q

Check identity

A

First and last name and DOB

Check against ID and matches lab label

94
Q

Baseline obs

A

Temp, RR, HR, BP

95
Q

When do you administer

A

As soon as check completed by 2nd checker

Haematology (13 decks)

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