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Blood Transfusion Flashcards

1
Q

What does the ABO gene encode?

A

Glycotransferase (carb + transferase protein)

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2
Q

What is the A antigen?

A

N-acetyl-galactosamine

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3
Q

What is the B antigen?

A

Galactose

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4
Q

What is the O antigen?

A

No extra antigen upon the basic unit

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5
Q

Of the ABO groups what is dominant?

A

A and B co-dominant

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6
Q

What antibodies does each ABO group have?

A

Ab against the antigens it does not have

O - against A and B
A - against B
B - against A
AB - none

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7
Q

Define immune tolerance

A

Prevention of an immune response against a specific antigen

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8
Q

When do you develop IgM against A/B antigens?

A

As soon as exposed to bacteria of the gut, will form these antibodies

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9
Q

What kind of antibodies are the ones against A and B antigens?

A

IgM - stay like this

IgM can provoke the complement cascade

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10
Q

What is the reaction that occurs when Ab bind their antigen?

A

Agglutination

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11
Q

Who can A patients receive red cells from?

A

A, O

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12
Q

Who can B patients receive red cells from?

A

B, O

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13
Q

Who can AB patients receive red cells from?

A

All groups

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14
Q

Who can O receive red cells from?

A

O

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15
Q

Who are the universal recipients and donors of red cells?

A

Donor - O

Recipient - AB

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16
Q

Who can A patients receive FFP from?

A

A, AB

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17
Q

Who can B patients receive FFP from?

A

B, AB

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18
Q

Who can AB patients receive FFP from?

A

AB

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19
Q

Who can O patients receive FFP from?

A

A, B, AB, O

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20
Q

What is rhesus?

A

Transmembrane protein (ion channel for nitric oxide) that is very immunogenic

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21
Q

Being rhesus negative/positive is autosomal recessive

A

Negative (dd)

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22
Q

What do rhesus -ve individuals produce if they are exposed to rh +ve cells?

A

Anti-D

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23
Q

What can Anti-D cause?

A

Transfusion reactions or haemolytic disease of the newborn

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24
Q

What is involved in screening of blood donors?

A

Behaviour - age, sex, travel, tattoos etc.
ABO/Rh groups
Hep B/C/E/HIV/syphilis

Variably screened for HTLV1, malaria, west nile virus, zika virus

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25
What are apheresis donors?
Donors who will give off just a certain component of blood (e.g. platelets or clotting factors)
26
What are the three blood components and what comes from each?
Red cells Buffy coat (platelets, leucocytes) Plasma (albumin, clotting/coagulation factors, Abs)
27
FFP is imported now - true or false?
True due to CJD
28
What are indications for red cell transfusion?
Correct severe acute anaemia (which may otherwise --> organ failure) Improve QoL in anaemia Prepare for surgery/speed up recovery Sickle cell dx etc.
29
Why might someone receive platelets?
Massive haemorrhage Bone marrow failure (to prevent intracranial haemorrhage) Prophylaxis for surgery CP bypass
30
What is the problem with needing FFP rapidly?
Takes 30 minutes to thaw
31
Why might you give FFP?
Massive haemorrhage DIC with bleeding Prophylaxis
32
What FFP ABO type can you give to everyone?
AB+
33
How do you get cryoprecipitate?
Allowing FFP to thaw and skimming off the precipitate that forms on top
34
What is cryoprecipitate used for?
Source of fibrinogen and factor 8
35
What is now implemented when giving blood samples to the blood bank?
Second sample
36
What is the difference between group and save and cross match?
Group and save = full ABO, Rh and alloantibody testing | Crossmatching - mixing blood together from different samples (need straight away)
37
How is cross matching done nowadays?
Automatically
38
What is direct coombs test used for?
Autoimmune haemolytic anaemia Passive Anti-D Haemolytic transfusion reactions
39
What is indirect coombs test used for?
Cross matching
40
What is involved in a direct coombs test?
Mix patient's erythrocyte with anti-human globulin and examine for agglutination
41
What is involved in indirect coombs test?
Mix patient's serum with donor erythrocytes and anti-human globulin +ve --> evidence of pre-existing Ig in patients circulation
42
How many blood group systems are there?
>21
43
What are some of the less relevant blood groups?
``` Kell Duffy S, s, U P Kidd ``` Don't need to know these as such, just be aware that there is sometimes a funny Ab in the patient's system
44
If you need red cells in minutes what blood do you take?
O- | NB may have alloantibodies but these won't be lifethreatening reactions
45
If you need red cells urgently what blood do you take?
Type specific ABO, RhD
46
If you need red cells non-urgently what blood do you take?
Full cross match
47
What is involved in massive haemorrhage protocol?
Rapid control of bleeding (e.g. obstetric intervention, surgery, interventional radiology) Immediate supply of 6 units RCs, 4 units FFP 1 units platelets Phone up 22 22
48
What are the top risks with transfusion?
Fever | TACO
49
What are the risks of viral transmission/fatal haemolysis with blood transfusion?
Very low
50
What are most transfusion related deaths due to?
TACO - transfusion associated circulatory overload
51
How can TACO be avoided?
Only write up units 1 at a time | Assess cardio risk factors
52
What steps have been taken to reduce prion transmission?
Leucodepletion UK plasma not used for fractionation Imported FFP
53
What is TRALI?
Transfusion related acute lung injury Ab in the donor blood --> activation of granulocytes Symptoms: dyspnoea, hypotonia, fever, chest infiltrates, hypotension etc.
54
What has caused a decrease in rates of TRALI?
FFP all from males now
55
If the patient is looking ill after transfusion what should you consider?
TACO, AHTR, bacterial infection, TRALI, FNHTR
56
What is FNHTR?
Febrile non-haemolytic transfusion reaction - fever unknown
57
How do you treat FNHTR?
Anti-pyretic | If mild - keep transfusing, if severe stop and send back to bank
58
If patients have urticaria after transfusion what may this be indicative of?
Anaphylaxis or mild allergic reaction
59
What should you give patients if they present with urticaria after transfusion?
antihistamine | If becomes more severe consider adrenaline, salbutamol, IV fluids
60
What might dyspnoea indicate after a transfusion?
TACO or TRALI or anaphylaxis
61
How should you manage TACO?
Oxygen, diuretic, ventilation, reduce transfusion rate, adrenaline
62
How should you manage TRALI?
Stop and contact blood bank
63
What are your differentials if a patient presents in shock after transfusion?
IBCT, anaphylaxis, TRALI, TAS
64
How should you treat shock in patient after transfusion?
``` Adrenaline, hydrocortisone, antihistamines IV fluid/ITU admission Ventilation Antibiotics FFP/Platelets if DIC ```
65
What tends to cause haemolytic disease of the new born?
RhD tends to be the main one | Others like c, K may also do it
66
What is the presentation of HDNB?
+DAT at birth, anaemia, jaundice
67
How can you prevent HDNB?
Prophylactic anti-D at time of birth, 28 weeks and after any sensitising event (e.g. trauma)
68
If HDNB develops how can you monitor it?
Ab titres | Doppler US of fetus carotid artery
69
How can you manage HDNB?
IU infusions via cannulation of umbilical artery | Give babies phototherapy and transfusion when born
70
How does neonatal alloimmune thrombocytopenia present?
Intracranial haemorrhage
71
What is leucopheresis?
Bone marrow harvests/lymphocyte infusions
72
What other banks exist?
Breast milk, bone, tendons, heart valves, faecal transplant | Islet cells, mesenchymal cells
73
How can GvHDx be prevented?
Irradiation of blood
74
What is acute haemolytic transfusion reaction?
ABO incompatibility --> severe destruction of donor RBCs by recipient Abs

Haematology (14 decks)

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