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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
What level would you transfuse
Platelet <10-15x10^9 Platelet <20 if additional risk e.g. sepsis Platelet <30 if active milder bleeding
26
When do you give platelet rich plasma vs platelet concentrate
Platelet rich plasma if bleeding / surgery
27
When would you not perform platelet transfusion
Chronic bone marrow failure | ITP / TTP / heparin induced
28
What must you do if think need FFP / cryoprecipitate
Call up as stored frozen | Must give fast to have affect
29
If don't know blood group what do you give
AB
30
What does FFP contain
Clotting factor Albumin Ab
31
When do you use
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 ```
32
When do you not use
As 1st line in hypovolaemia - no role
33
What is cryprecipitate
Source of fibrinogen and factor VIII, XIII, VWF | Allow large concentrate to be delivered in small volume
34
When do you use
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
35
What is prothrombin complex used for
Emergency reversal of anticoagulation e.g. brain haemorrhage / emergency surgery
36
What is SAG mannitol
All plasma removed from blood | Replaced with NaCL, adenine, mannitol
37
What is a cell saver device
Collect own patients blood lost in surgery and re-infuses
38
When is it CI
Malignancy
39
What are options at blood bank
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
What must you send to bank and what is important when requesting
``` 2 samples Type of blood needed Urgency - routine or urgent Transfusion Hx Any special requirements e.g. irradiated ```
41
What does blood bank look at in blood if group and screen
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
What is Coombs indirect
Add Ab of perspective donor + see if agglutination occurs X-matching + allo'Ab's Usually used for Rhesus
43
What causes direct coombs
Autoimmune haemolytic anaemia Passive anti-D Haemolytic transfusion reaction
44
If need red cell immediately If need red cell urgently If non-urgent
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
What is massive haemorrhage and what do you get
2222 Say location in hospital 6 units RBC - O+ve, RhD -ve 4 FFP - AB 1 platelet
46
Who needs special requirements - irradiated, CMV -ve, HEV -ve
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
What are main hazards of blood transfusion
``` Immmune Infection TRALI TACO Electrolyte ```
48
What immune
``` Acute or delayed haemolytic - can be fatal Non-haemolytic reaction Allergic Thrombocytopenia GVHD Alloimmunisation ABO / Rh incompatibility PTP ```
49
What electrolyte
Hyperkalaemia = most common Hypocalcaemia Iron overload Clotting
50
How does acute transfusion reaction present
Fever Pruritus Urticaria
51
What are more fatal signs
Dyspnoea Pyrexia LOC Shock
52
What is never event
``` 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
How does allergic reaction present
Range Fever Urticaria Anaphylaxis
54
When does it present
A few minutes after
55
What is TACO
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
How does it present
Pulmonary oedema | Hypertension
57
What must you do
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
What is TRALI
Rare Transfusion Associated Lung injury Ab in donor reacting against antigen release granules transudates into lung causing inflammation
59
How does it present
``` 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
What infections
CJD / prion HIV / HCV / HBV CMV
61
How are infections prevented
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
What is graft versus host disease and how does it present
Rare but fatal Lymphocytes in donor transfused to immunocompromised host and mount a response Fever Erythoderma
63
How do you prevent
Leucopletion and irrraiation if immunocompromised
64
What is PTP
Ab after transfusion destroys platelets 7-10 days after | Treat with High dose Ig
65
How do you manage reaction
Stop transfusion Check identify Consider cause
66
If pyrexia what da you do
Anti-pyretic Stop transfusion to look for more concerning Sx - shock / DIC / sepsis Increase observation and give transfusion more slowly
67
What do you do for urticaria / mild allergy or anaphylaxis
Discontinue Anti-histmaine IV Consider restarting + observe Treat anaphylaxis
68
What is most common cause of dyspnoea
TACO | TRALIA and anaphylaxis can cause
69
What do you do
Give O2 Diuretic IV Ventilation Adrenaline
70
What causes shock
Anaphylaxis | TRALI
71
How do you Rx
``` Adrenaline IV fluid Ventilation Ax FFP / platelet if DIC ```
72
How do you treat TRALI
O2 100% | Treat as ARDS
73
What must you always do for dyspnoea
Monitor blood gas CXR Measure CVP / PCP
74
If bacterial contamination
Blood cultures Measure urine output Broad spec Ax, fluid, O2
75
If ABO incompatibility
DAT to confirm haemolytic IV saline Treat any DIC - FFP / platelets Inform lab
76
When is albumin 4% used
To restore and maintain blood volume
77
When is albumin 20% used
To restore and maintain blood volume and onctoc pressure
78
What is the universal donor of red cells
O Rhd -ve
79
What is universal recipient of red cells
AB Rhd +ve
80
What is universal donor of plasma
AB
81
What is universal recipient of plasma
O
82
What Ab does ABO activate and what heat does it like
IgM | Cold + complement activator
83
What Ab does Rh activate and what heat
IgG | Warm + not good at activating complement
84
What has highest risk of infection
Platelet as stored at room temp Bacterial = most common Other infections if in blood but usually screened
85
Before taking blood sample what must you do
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
What do you do after sample taken
Complete label at bedside | Name, DOB, CHI, date and time taken and signature
87
If two samples are needed what should happen
Different person and time if possible to ensure +ve patient identification
88
What should you never do
Use pre-labelled tube | Label a sample from another member of staff
89
What do you do before giving blood
``` Either single or double check depending on policy Check written authoritsatin Visual inspection Check component Check identify Baseline obs ```
90
Written authorisation
Has correct component been authorised including rate, volume, special and signed Check it matches ID
91
Visual linspection
Any damage or discolouration
92
Check component
``` Is it correct component against request Check compatible to blood group Do donation numbers match Check any specific Check expiration ```
93
Check identity
First and last name and DOB | Check against ID and matches lab label
94
Baseline obs
Temp, RR, HR, BP
95
When do you administer
As soon as check completed by 2nd checker

Haematology (13 decks)

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