Blood Transfusion Flashcards
What happens when foreign antigens discovered in blood
Antibodies made by your B cells
Cause agglutination
What are blood groups
Red cell antigens expressed on cell surface which can provoke antibody production if non-self
What is the most common blood group
ABO
What do ABO genes encode
Glycosyltransferase enzyme
What is the most common blood groups
A and O
What does A blood group have
A antigen on surface
Will develop antibodies against B if B given as foreign body
Can’t give B
What are A and B antigens
Co-dominant
O antigen is recessive
What does AB blood group have
A + B antigens on surface
No antibodies will form as no antigen will be detected as foreign
Can receive any blood group
What does O blood group have
No antigens
So if given A or B will develop antibodies
Can only receive O blood but can give O blood to anyone
What happens with fresh frozen plasma (FFP)
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
What is RhD antigen
Dominant so to be negative must inherit dd genotype
What happens if RhD negative
Body will make anti-RhD Ab if exposed to RhD positive blood either in transfusion or pregnancy
What happens after pregnancy if mother has become sensitised
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
What happens in a transfusion if RhD +ve blood transfused
Antibodies will attach and cause transfusion reaction
What is the treatment for haemolytic disease of new born
Prophylactic anti-D at time of delivery, 28 weeks if -ve and if any sensitisation events
What are sensitisation events
Trauma
Abruption
Invasive procedures
How do you monitor pregnancy or treat if Ab cross
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
What do you screen blood donors for
Sex Age Travel Tattoos / piercing ABO and Rh blood group Hep B, C, E, HIV, syphillis Tropical disease depending not travel
What blood products are available
Red cell Platelet rich plasma Platelet concentrate FFP Cyroprecipitate SAG-Mannitol blood
What are indications for red cell transfusion
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
What level of Hb should you think of transfusing
<70 if no ACS
<80 if ACS
Different if get regular transfusion / active haemorrhage
How do you transfuse RBC
2-4 hours
Longer if risk of overload
STAT in an emergency
What are indications for platelet transfusion
Massive haemorrhage Bone marrow failure = 90% Surgical prophylaxis Cardiopulmonary bypass if bleeding DIC Neonatal autoimmune thrombocytopenia
What do you want platelets to be if massive haemorrhage
75x10^9 so if less than this then transfuse
What level would you transfuse
Platelet <10-15x10^9
Platelet <20 if additional risk e.g. sepsis
Platelet <30 if active milder bleeding
When do you give platelet rich plasma vs platelet concentrate
Platelet rich plasma if bleeding / surgery
When would you not perform platelet transfusion
Chronic bone marrow failure
ITP / TTP / heparin induced
What must you do if think need FFP / cryoprecipitate
Call up as stored frozen
Must give fast to have affect
If don’t know blood group what do you give
AB
What does FFP contain
Clotting factor
Albumin
Ab
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
When do you not use
As 1st line in hypovolaemia - no role
What is cryprecipitate
Source of fibrinogen and factor VIII, XIII, VWF
Allow large concentrate to be delivered in small volume
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
What is prothrombin complex used for
Emergency reversal of anticoagulation e.g. brain haemorrhage / emergency surgery
What is SAG mannitol
All plasma removed from blood
Replaced with NaCL, adenine, mannitol
What is a cell saver device
Collect own patients blood lost in surgery and re-infuses
When is it CI
Malignancy
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
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
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
What is Coombs indirect
Add Ab of perspective donor + see if agglutination occurs
X-matching + allo’Ab’s
Usually used for Rhesus
What causes direct coombs
Autoimmune haemolytic anaemia
Passive anti-D
Haemolytic transfusion reaction
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
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
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
What are main hazards of blood transfusion
Immmune Infection TRALI TACO Electrolyte
What immune
Acute or delayed haemolytic - can be fatal Non-haemolytic reaction Allergic Thrombocytopenia GVHD Alloimmunisation ABO / Rh incompatibility PTP
What electrolyte
Hyperkalaemia = most common
Hypocalcaemia
Iron overload
Clotting
How does acute transfusion reaction present
Fever
Pruritus
Urticaria
What are more fatal signs
Dyspnoea
Pyrexia
LOC
Shock
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
How does allergic reaction present
Range
Fever
Urticaria
Anaphylaxis
When does it present
A few minutes after
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
How does it present
Pulmonary oedema
Hypertension
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
What is TRALI
Rare
Transfusion Associated Lung injury
Ab in donor reacting against antigen release granules transudates into lung causing inflammation
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
What infections
CJD / prion
HIV / HCV / HBV
CMV
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
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
How do you prevent
Leucopletion and irrraiation if immunocompromised
What is PTP
Ab after transfusion destroys platelets 7-10 days after
Treat with High dose Ig
How do you manage reaction
Stop transfusion
Check identify
Consider cause
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
What do you do for urticaria / mild allergy or anaphylaxis
Discontinue
Anti-histmaine IV
Consider restarting + observe
Treat anaphylaxis
What is most common cause of dyspnoea
TACO
TRALIA and anaphylaxis can cause
What do you do
Give O2
Diuretic IV
Ventilation
Adrenaline
What causes shock
Anaphylaxis
TRALI
How do you Rx
Adrenaline IV fluid Ventilation Ax FFP / platelet if DIC
How do you treat TRALI
O2 100%
Treat as ARDS
What must you always do for dyspnoea
Monitor blood gas
CXR
Measure CVP / PCP
If bacterial contamination
Blood cultures
Measure urine output
Broad spec Ax, fluid, O2
If ABO incompatibility
DAT to confirm haemolytic
IV saline
Treat any DIC - FFP / platelets
Inform lab
When is albumin 4% used
To restore and maintain blood volume
When is albumin 20% used
To restore and maintain blood volume and onctoc pressure
What is the universal donor of red cells
O Rhd -ve
What is universal recipient of red cells
AB Rhd +ve
What is universal donor of plasma
AB
What is universal recipient of plasma
O
What Ab does ABO activate and what heat does it like
IgM
Cold + complement activator
What Ab does Rh activate and what heat
IgG
Warm + not good at activating complement
What has highest risk of infection
Platelet as stored at room temp
Bacterial = most common
Other infections if in blood but usually screened
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
What do you do after sample taken
Complete label at bedside
Name, DOB, CHI, date and time taken and signature
If two samples are needed what should happen
Different person and time if possible to ensure +ve patient identification
What should you never do
Use pre-labelled tube
Label a sample from another member of staff
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
Written authorisation
Has correct component been authorised including rate, volume, special and signed
Check it matches ID
Visual linspection
Any damage or discolouration
Check component
Is it correct component against request Check compatible to blood group Do donation numbers match Check any specific Check expiration
Check identity
First and last name and DOB
Check against ID and matches lab label
Baseline obs
Temp, RR, HR, BP
When do you administer
As soon as check completed by 2nd checker
