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MCD Haematology > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

what is the extra sugar residue of A?

A

N-acetyl galactosamine

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2
Q

what is the extra sugar residue of B?

A

galactose

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3
Q

what is the extra sugar residue of group O?

A

no extra sugar, just fructose stem

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4
Q

what is inheritance pattern of A and B?

A

co-dominant genes

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5
Q

what is the inheritance of O?

A

recessive

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6
Q

which blood group is the universal donor?

A

O-

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7
Q

which blood group is the universal receiver?

A

AB+

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8
Q

which antibodies are present for a certain blood group?

A

the antibodies against antigens NOT present on the red cell in the person’s blood

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9
Q

which antibody type reacts to mismatched blood

what effect does this antibody have in incompatible transfusion?

A

IgM:
reactive at 37 degrees C causing a full complement cascade and haemolysis of red cells

can cause a fatal haemolysis

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10
Q

how is blood group determined as a test

A

a known anti-A and anti-B reagent is given

donor of same group is selected and cross-matched (check for agglutination)

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11
Q

how is the RhD gene inherited?

A

D is dominant
d is recessive

dd- no D antigen
DD/Dd- D antigen present

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12
Q

which two factors are used to name blood groups?

A

antigen present e.g. A, B, AB, O

RhD status (±)

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13
Q

when do RhD- make antibodies?

A

after exposure to RhD+ antigen

e.g. by transfusion or when pregnant with RhD+ child

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14
Q

which antibody type is made against the RhD antigen

A

IgG (not as potent as IgM)

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15
Q

what needs to be done if RhD+ blood (as its the more common blood type) to a RhD- person?

A

they have to to receive RhD- blood after the first transfusion otherwise the newly formed anti-D antibodies will react
[delayed haemolytic transfusion reaction]

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16
Q

what is HDN? what happens in HDN?

A

Haemolytic Disease of the New Born

  • RhD- mother creates anti-D antibodies post-transfusion or in reaction to her RhD+ foetus in a prior pregnancy
  • so if she is pregnant with a RhD+ child, the antibodies will cross the placenta to attack the unborn child’s RBCs
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17
Q

examples of other RBC antigens

A

RhC c, E, e
Kell
Duffy
Kidd

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18
Q

what is the issue created by the additional antigens present on RBCs

A

patient will create antibodies against these antigens, therefore need blood without the antigens present

they will need an antibody screen pre-transfusion

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19
Q

why are only components of blood given to patients?

A
  • to avoid wasting blood
  • certain components degenerate if stored as whole blood
  • avoid fluid overloading
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20
Q

layering of blood sample after centrifugation

A

plasma top
platelets middle
RBC bottom

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21
Q

how are red cells stored

A

5 weeks at 4 degrees C

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22
Q

why are red cells usually not frozen?

A

they recover poorly after thawing

freezing is only done for rare groups

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23
Q

how is Fresh Frozen Plasma (FFP) stored

A

2 years at -30 degrees C

thawed 20-30 minutes before use

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24
Q

when would FFP be given

A
  • bleeding with abnormal coagulation test results

- reversal of warfarin for urgent surgery

25
Q

what does cyroprecipitiate contain?

therefore what uses does it have?

A

fibrinogen and F8

for massive bleeding and hypofibrinogenaemia

26
Q

how are platelets stored

A

5 days at 22 degrees C

27
Q

why is it necessary to know the blood group of the PLATELET donation?

A

platelets have a low level of ABO antigen so wrong ones are destroyed quickly

28
Q

indication for the use of platelets

A

1) bone marrow failure (thrombocytopenia)
2) massive bleeding
3) surgery
4) cardiac bypass (patient is using anti-p drugs to prevent clotting)

29
Q

Fractioned products examples

A
  • F8 and F9: for use in haemophilia A and B, F8 for VWD
  • Ig molecules for specific illnesses
  • albumin for burns, plasma exchanges, severe liver and kidney conditions
30
Q

what are the particular uses of certain fractionated Ig molecules?

A
  • IM-Ig – Specific – tetanus, anti-D and rabies.
  • IM-Ig – Normal globulin – broad mix in population (e.g. HAV).
  • IV-Ig – Pre-op patients with ITP or AIHA (Autoimmune haemolytic anaemia).
31
Q

how is blood transfusion kept safe

A
  • testing for infections

- exclusion of donors by questionnaire (e.g. investigate risky behaviour)

32
Q

what must donated blood be tested for?

A 
o	Hepatitis B and C.
o	HIV.
o	HTLV – Human T-Lymphotropic Virus.
o	Syphilis.
o	CMV or HEV.
33
Q

what is the issue in detecting infections at a certain time point when looking for blood donors?

A

window periods of certain infections mean that the antibodies against the infection are too low to be detected in the system

people who are at high risk of contracting blood borne diseases are not accepted as donors as they may be in early stage of infection and have not yet developed antibodies in the window period

these antibodies can react

34
Q

Prion disease example that can be transmitted by transfusion

A

vCJD

variant Creutzfeld-Jakob Disease

35
Q

how are fractionated products made safer despite pooling from multiple donors?

A

Leucodepletion: white cells filtered out (prevent the uptake of vCJD prion into brain)

normally obtained from the USA:

36
Q

what are the antigens and antibodies of O?

Can they received blood? if so, from who?

A

no antigens
antibodies for A and B

can not receive blood from anyone else but O

37
Q

what are the antigens and antibodies of A?

A

A antigens
antibodies for B

can’t receive B but can receive O, A, AB

38
Q

what are the antigens and antibodies of B?

A

B antigen
antibodies for A

can’t receive A but can receive O, A, AB

39
Q

what are the antigens and antibodies of AB?

A

A and B antigens
no antibodies

can receive any blood (A,B,O)

40
Q

can you give RhD- people RhD+ blood?

A

yes but…
if D- person receives D+ blood, they form anti-D antibodies, they should switch back to RhD- transfusions to avoid a delayed haemolytic transfusion reaction

nb in an emergency when the blood group of the patient is not known, O RhD- blood is given (will not have antigens, in case the patient does have anti-D antibodies)

41
Q

RhD positive antigens and antibodies

A

D antigen

no antibodies

42
Q

RhD negative antigens and antibodies

A

no antigen

antibodies formed after exposure to RhD+ blood in tranfusion or foetus

43
Q

how is compatible blood identified?

A

grouping of the blood

antibody screening

44
Q

how does hydrops foetalis (haemolytic disease of the new-born) arise during pregnancy?

A
  • A woman who is RhD- may be exposed to RhD+ antigen from the foetus (as the father maybe be RhD+)
  • if she produced anti-D antibodies, the IgG antibodies will cross the placenta in the next pregnancy and destroy the foetal red blood cells (if the foetus is RhD+)
45
Q

how is the hydrops foetalis risk reduced?

A

RhD-ve girls and women of child bearing age are avoided sensitisation to RhD positive blood

46
Q

how are red cells grouped using biochemical method?

A

the red cells are incubated with antibodies of known specificity

observe for agglutination indicating that the patient has the corresponding antigen

47
Q

What is antibody screening?

A

recipient of transfusion has their PLASMA compared for compatibility to the donor’s red cells

this identifies any antibodies the patient may have that will react with the donor’s blood

“cross match”

remember that antibodies are found in the plasma
remember that serum excludes clotting factors

48
Q

who are high risk groups in the donor exclusion criteria?

A
  • infected with HIV, Hep B or C
  • injected illegal or non-prescribed drugs including anabolic steroids
  • given money or drugs for sex
  • sex with any of the above; in HIV prevalent areas; men who have had unprotected oral/anal sex with another man or woman with such man
49
Q

what are some other Rh blood groups determined in donations?

A

C, c, E, e and the K blood group

50
Q

how is the risk of vCJD been reduced through transfusion in the UK?

A
  • plasma from the UK is no longer used for fractionation

- all blood products are leucodepleted i.e. remove white blood cells

51
Q

storage temperature and shelf life of red cells

A

2-6 degrees

35 day shelf life

52
Q

storage temperature and shelf life of platelets

A 
22 degrees (agitated)
5 days
53
Q

storage temperature and shelf life of fresh frozen plasma

A

frozen

2 years

54
Q

storage temperature and shelf life of cryoprecipitate

A

frozen

2 years

55
Q

what are the uses of platelet transfusion?

A
  • prophylaxis against thrombocytopenia
  • thrombocytopenia

NOT for autoimmune thrombocytopenia as the antibodies will destroy the platelets

56
Q

Fresh Frozen Plasma use

A

Once thawed (at 30-37ºC) – deterioration of clotting factors – use as soon as possible

57
Q

what does cyroprecipitate contain?

A

factor VIII
fibrinogen
(therefore use for deficiencies )

58
Q

what products can be made from blood fractionation?

A
  • albumin
  • factor VIII
  • factor IX
  • Ig (normal or specific)

MCD Haematology (11 decks)

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