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Haematology > Blood Transfusion > Flashcards

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
Q

What are apheresis donors?

A

Donors who will give off just a certain component of blood (e.g. platelets or clotting factors)

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26
Q

What are the three blood components and what comes from each?

A

Red cells

Buffy coat (platelets, leucocytes)

Plasma (albumin, clotting/coagulation factors, Abs)

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27
Q

FFP is imported now - true or false?

A

True due to CJD

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28
Q

What are indications for red cell transfusion?

A

Correct severe acute anaemia (which may otherwise –> organ failure)
Improve QoL in anaemia
Prepare for surgery/speed up recovery
Sickle cell dx etc.

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29
Q

Why might someone receive platelets?

A

Massive haemorrhage
Bone marrow failure (to prevent intracranial haemorrhage)
Prophylaxis for surgery
CP bypass

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30
Q

What is the problem with needing FFP rapidly?

A

Takes 30 minutes to thaw

31
Q

Why might you give FFP?

A

Massive haemorrhage
DIC with bleeding
Prophylaxis

32
Q

What FFP ABO type can you give to everyone?

A

AB+

33
Q

How do you get cryoprecipitate?

A

Allowing FFP to thaw and skimming off the precipitate that forms on top

34
Q

What is cryoprecipitate used for?

A

Source of fibrinogen and factor 8

35
Q

What is now implemented when giving blood samples to the blood bank?

A

Second sample

36
Q

What is the difference between group and save and cross match?

A

Group and save = full ABO, Rh and alloantibody testing

Crossmatching - mixing blood together from different samples (need straight away)

37
Q

How is cross matching done nowadays?

A

Automatically

38
Q

What is direct coombs test used for?

A

Autoimmune haemolytic anaemia
Passive Anti-D
Haemolytic transfusion reactions

39
Q

What is indirect coombs test used for?

A

Cross matching

40
Q

What is involved in a direct coombs test?

A

Mix patient’s erythrocyte with anti-human globulin and examine for agglutination

41
Q

What is involved in indirect coombs test?

A

Mix patient’s serum with donor erythrocytes and anti-human globulin
+ve –> evidence of pre-existing Ig in patients circulation

42
Q

How many blood group systems are there?

A

> 21

43
Q

What are some of the less relevant blood groups?

A 
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
Q

If you need red cells in minutes what blood do you take?

A

O-

NB may have alloantibodies but these won’t be lifethreatening reactions

45
Q

If you need red cells urgently what blood do you take?

A

Type specific ABO, RhD

46
Q

If you need red cells non-urgently what blood do you take?

A

Full cross match

47
Q

What is involved in massive haemorrhage protocol?

A

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
Q

What are the top risks with transfusion?

A

Fever

TACO

49
Q

What are the risks of viral transmission/fatal haemolysis with blood transfusion?

A

Very low

50
Q

What are most transfusion related deaths due to?

A

TACO - transfusion associated circulatory overload

51
Q

How can TACO be avoided?

A

Only write up units 1 at a time

Assess cardio risk factors

52
Q

What steps have been taken to reduce prion transmission?

A

Leucodepletion
UK plasma not used for fractionation
Imported FFP

53
Q

What is TRALI?

A

Transfusion related acute lung injury
Ab in the donor blood –> activation of granulocytes

Symptoms: dyspnoea, hypotonia, fever, chest infiltrates, hypotension etc.

54
Q

What has caused a decrease in rates of TRALI?

A

FFP all from males now

55
Q

If the patient is looking ill after transfusion what should you consider?

A

TACO, AHTR, bacterial infection, TRALI, FNHTR

56
Q

What is FNHTR?

A

Febrile non-haemolytic transfusion reaction - fever unknown

57
Q

How do you treat FNHTR?

A

Anti-pyretic

If mild - keep transfusing, if severe stop and send back to bank

58
Q

If patients have urticaria after transfusion what may this be indicative of?

A

Anaphylaxis or mild allergic reaction

59
Q

What should you give patients if they present with urticaria after transfusion?

A

antihistamine

If becomes more severe consider adrenaline, salbutamol, IV fluids

60
Q

What might dyspnoea indicate after a transfusion?

A

TACO or TRALI or anaphylaxis

61
Q

How should you manage TACO?

A

Oxygen, diuretic, ventilation, reduce transfusion rate, adrenaline

62
Q

How should you manage TRALI?

A

Stop and contact blood bank

63
Q

What are your differentials if a patient presents in shock after transfusion?

A

IBCT, anaphylaxis, TRALI, TAS

64
Q

How should you treat shock in patient after transfusion?

A 
Adrenaline, hydrocortisone, antihistamines
IV fluid/ITU admission 
Ventilation 
Antibiotics
FFP/Platelets if DIC
65
Q

What tends to cause haemolytic disease of the new born?

A

RhD tends to be the main one

Others like c, K may also do it

66
Q

What is the presentation of HDNB?

A

+DAT at birth, anaemia, jaundice

67
Q

How can you prevent HDNB?

A

Prophylactic anti-D at time of birth, 28 weeks and after any sensitising event (e.g. trauma)

68
Q

If HDNB develops how can you monitor it?

A

Ab titres

Doppler US of fetus carotid artery

69
Q

How can you manage HDNB?

A

IU infusions via cannulation of umbilical artery

Give babies phototherapy and transfusion when born

70
Q

How does neonatal alloimmune thrombocytopenia present?

A

Intracranial haemorrhage

71
Q

What is leucopheresis?

A

Bone marrow harvests/lymphocyte infusions

72
Q

What other banks exist?

A

Breast milk, bone, tendons, heart valves, faecal transplant

Islet cells, mesenchymal cells

73
Q

How can GvHDx be prevented?

A

Irradiation of blood

74
Q

What is acute haemolytic transfusion reaction?

A

ABO incompatibility –> severe destruction of donor RBCs by recipient Abs

Haematology (14 decks)

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