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Haematology > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

what needs to be check to ensure blood donor safety

A

minimum criteria:
weight 50kg
Hb 135 for men, 125 for women

make sure not anaemic
donor selection questionnaire
contact details if become wells post donation

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2
Q

what is FFP

A

fresh frozen plasma

stored for 3 years

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3
Q

how long are rbcs stored for

A

35 days

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4
Q

how long can platelets be stored for

A

7 days (agitated to stop them sticking together)

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5
Q

what microbiological tests are done on the blood

A

HIV, Hep B, Hep C, Hep E, HTLV, syphilis

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6
Q

what is available from the transfusion lab

A

blood components: red cells, FFP, platelets, cryoprecipitate

blood products: anti D immunoglobulin, prothrombin complex concentrate (used in warfarin overdose)

blood products from pharmacy: IV immunoglobulin, human albumin, specific Ig (e.g. varicella immunoglobulin to be given to pregnant women)

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7
Q

which blood group is most important for transfusion, why

A

ABO- as red cell all have antigens on cell surface depending on ABO genes, those antigens not present will have corresponding antibody in circulation which causes haemolysis of red cells with them

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8
Q

what determines ABO blood group

A

gene on chromosome 9
A and B genes code for transferases which modify precursor called H substance on red cell membrane

depending whether you are A B or O alters the structure of substance H

A and B are dominant over 0 and are co dominant with each other
O is silent

O adds no sugar
A and B add different sugars

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9
Q

what is the most common ABO type

A 
O (47%)
then 
A (42%)
B (8%)
AB (3%)
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10
Q

what antigens are present on group A red cells

A

A

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11
Q

what antigens are present on group B red cells

A

B

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12
Q

what antigens are present on group AB red cells

A

A and B

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13
Q

what antigens are present on group O red cells

A

neither

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14
Q

what is the genotype and phenotype of the ABO groups

A

phenotype- which antigens are detected (=which ABO group you are)

genotype- which genes are present

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15
Q

what are the genotypes for each ABO group

A

group O- OO
group A- AA or AO
group B- BB or BO
group AB- AB

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16
Q

how many ABO genes do you get from each parent

A

one

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17
Q

what antiBODY will you have if you are group A

A

B

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18
Q

what antiBODY will you have if you are group O

A

A and B

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19
Q

what antiBODY will you have if you are group AB

A

neither A nor B

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20
Q

what antiBODY will you have if you are group B

A

A

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21
Q

who can donor O blood be given to

A

everyone (no sugar, no antigens)

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22
Q

who can donor A blood be given to

A

A and AB

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23
Q

who can donor B blood be given to

A

B and AB

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24
Q

who can donor AB blood be given to

A

AB

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25
Q

what blood can O group people receive

A

only O blood as they have no A or B antiGENS

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26
Q

is it more common to RhD positive or negative

A

85% positive

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27
Q

what is the genetics of RhD blood groups

A

2 alleles D and d
inherit one from each parent
d is silent (will NOT have a D antiGEN, will have anti D antibody)

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28
Q

what genotypes are the RhD blood groups

A 
RhD+ = DD or Dd 
RhD- = dd
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29
Q

what diseases are RhD groups responsible for

A

transfusion reactions haemolytic disease of the newborn (very immunogenic, small amount of blood creates lots of antibodies)

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30
Q

who should avoid D antigen (RhD+ blood) in transfusion

A

RhD -ve patients

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31
Q

what blood should you give RhD-ve patients

A

RhD-ve blood

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32
Q

what is the onset of transfusion reactions

A

ABO incompatibility= immediate reaction (IgM)

RhD incompatibility= delayed reaction (IgG)

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33
Q

how common are transfusion reactions

A

1% will have reaction

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34
Q

what are the aims of pre transfusion testing

A

identify ABO and RhD group
identify presence of clinically significant red cell antibodies (previous blood exposure that has resulted in antibody formation)
allow selection of blood

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35
Q

how is ABO grouping done

A

anti A, anti B and anti D Antisera (IgM reagent) (identifies antigens on red cells, causes agglutination)

reagent red cells of group
A and B (with known antigen specificity- if person has antibodies will get agglutination- clot) (addition of anti-human globulin facilitates agglutination)

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36
Q

what is the indirect antiglobulin test

A

uses reagent red cells, patient plasma and antihuman globulin (coombs reagent)
agglutination indicates antibodies to the reagent red cells

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37
Q

what in general does agglutination mean

A

blood is incompatible for transfer

38
Q

what are the indications for red cell transfusion

A 
symptomatic anaemia (Hb <70) 
major bleeding
39
Q

what procedure should you follow for transfusions

A

transfuse a single unit and then reassess patient

always think of alternatives

40
Q

what are the indications for platelet transfusion

A

prophylaxis in patients with bone marrow failure and very low platelets
treatment of bleeding in thrombocytopenic patient
prophylaxis prior to surgery/ procedure in thrombocytopenic patient

41
Q

what are the indications fr FFP transfusion

A

bleeding in patient with coagulopathy (PT ratio >1.5)
prophylaxis prior to surgery in patient with coagulopathy (PT>1.5)
management of massive haemorrhage
transfuse early in trauma

give 50ml/kg

(used mostly to replace clotting factors, contains factors 1-12), correct PT and APTT ratio)

42
Q

who is CMV -ve blood used in

A

pregnancy and neonates

43
Q

how long is the sample for transfusion valid for if you have never been transfused or have not been transfused within the last 3 months

A

7 days

44
Q

how long is the sample for transfusion valid for if you have been transfused or pregnant in the last 3 months

A

3 days

45
Q

how should you lable blood samples

A

NEVER PRE LABLE
name, ward, gender
DOB, date and time of sampling, CHI number
signature

46
Q

how should a patient be monitored during transfusion

A

within 60 mins before blood is commenced
obs at 15 mins
obs within 60 mins of completion

47
Q

what should you watch out for during transfusion

A

pyrexia, rash, hypoxia
any adverse reactions stop transfusion and contact haematology reg
assess patient (can restart transfusion if mild reaction, may need to slow rate)

48
Q

what are the signs and symptoms of acute transfusion reactions

A

often happen in early transfusion
sy- chills, rigors, rash, flushing, feeling of impending doom, collapse, loin pain, resp distress
si- fever, tachycardia, hypotension, tachypnoeia

49
Q

what management for all transfusion reactions

A 
stop transfusion 
abcde
re check compatibility tag against patient details and inspect for evidence of contamination 
document event in notes
contact transfusion lab
50
Q

what should you do in severe/ life threatening reactions

A

(evidence of life threatening airway/ circulatory problem/ wrong component transfused/ bacterial contamination)

seek senior help
resus
return component blood to transfusion lab for analysis

51
Q

which type of acute haemolytic transfusion reaction (AHTR) is most dangerous

A

ABO incompatible

causes INTRAvascular haemolysis of transfused cells

52
Q

what causes an AHTR

A

binding of IgM anti A or B antibodies to antigens on donor blood = complement activation and lysis of transfused cells

  • inflammatory cytokines (complement, kinin, coagulation systems) released
  • shock, increased vascular permeability, DIC, renal failure
  • often fatal
53
Q

what is the clinical management of AHTR

A 
stop transfusion 
return unit to lab 
oxygen, fluids 
repeat transfusion samples 
bloods for FBC, coag screen, renal function, haemolysis measures, blood cultures
54
Q

what does the lab do after an AHTR

A

repeat ABO and RhD of pre and post transfusion samples
direct antiglobulin test (antibody bound to donor cells- shows recipient imune system fighting it)
repeat cross match
send remains of unit for culture

55
Q

what are the ddx for an severe ATR

A

AHTR

bacterial contamination of blood component

56
Q

what are the clinical features of a transfusion associated circulatory overload (TACO)

A

resp distress within 6 hours of transfusion (pulmonary oedema due to increased blood volume, pulmonary infiltrates)
raised BP
raised JVP
+ve fluid balance

57
Q

what are the risk factors of TACO

A 
elderly 
cardiac failure 
low albumin 
renal impairement 
fluid overload
58
Q

what is the management for TACO

A 
oxygen + supportive care
diuretics 
consider slowing rate of transfusions 
consider diuretic with further transfusion 
only transfuse minimum volume required
59
Q

what is a mild ATR like

A

Isolated temp rise >38 and rise of 1-2 degrees or rash only

60
Q

what is the management for a mild TR

A

continue transfusion, consider slowing rate
close monitoring
consider paracetamol/ antihistamine

61
Q

what can cause a mild TR

A

febrile non haemolytic transfusion reaction (Tx paracetamol)
mild allergic reaction (rash/ itch, commoner with plasma rich compenents, Tx= antihistamines)

62
Q

what is a delayed haemolytic transfusion reaction

A 
delayed immune response to red cell antigen- usually IgG
Positive DAT (direct agglutination test) 
Extravascular haemolysis 5-10 days post transfusion

Transfused cells destroyed
Hb may drop, raised bili, LDH
Positive DAT and detection of alloantibody

63
Q

is viral transmission common

A

no

64
Q

what are the signs of a severe transfusion reaction

A

oedema
circulatory collapse
difficulty breathing

65
Q

who needs irradiated blood products

A 
previous hodgkins lymphoma 
previous purine analogue chemo 
anyone receiving HLA selected platelets (more closely matched to patient, more likely to cause GVHD)
intrauterine transfusions 
stem cell transplant patients
66
Q

who needs CMV negative blood

A

foetal transfusions
babies up to 4 months
pregnant women (not needed in delivery)

67
Q

do you need to give HIV positive patients on retroviral Tx irradiated/ CMV negative blood

A

no, will likely also be CMV positive

68
Q

do transplant patients need special blood

A

no, most immunosuppressants don’t carry special transfusion risks

69
Q

what are the alternatives to transplant

A 
IV/oral iron if IDA 
tranexamic acid (can also be use for surgery) or coil if menorrhagia
B12/folate if megaloblastic anaemia 
cell salvage if surgery 
pre op anaemia check and treat
70
Q

who could you maybe give RhD +ve blood to if they were RhD-

A

men or people past child bearing age

71
Q

how must you identify patient for transfusion

A

positive identification: ask them to ask name and DOB

check with other HCP that it matches wristband and blood products

72
Q

how many blood samples from patient do you need before transfuse

A

2 separate ones (can be historical or from different venepuncture sites)

73
Q

how long is the transfusion window for one pack of blood

A

4 hours

74
Q

what can you give for a mild transfusion reaction

A

paracetamol
piritin
slow infusion rate

75
Q

if a large transfusion is anticipated to be required what could be prepared for this

A

blood warmers
cell salvage
prior group and save if possible

76
Q

what groups are the universal donor and acceptor

A

O universal donor

AB universal acceptor

77
Q

what can cause delayed transfusion reactions

A

infections (bact, fungal, crion - CJD), iron overload, GVHD, purpura

78
Q

what does oozing at venepuncture site suggest

A

acute transfusion reaction

79
Q

what does a febrile non haemolytic reaction look like

A

fever, shivering 1/2 - 1 hour after transfusion

80
Q

what x-ray sign in TRALI

A

white out

81
Q

what signs in fluid overload

A

dyspnoea, hypoxia, tachycardia, raised JVP, basal creps

82
Q

what antibodies are tested for

A

any that cause clinically significant reactions e.g. anti k

83
Q

when is a blood transfusion indicated

A

Hb <70g/L
other comorbs e.g. bone marrow prob, COPD
symptomatic anaemia

84
Q

what extra precautions for transfusion in HF patient

A

transfuse slowly with diuretics and assess repeatedly for fluid overload

85
Q

what does irradiated blood not have

A

donor lymphocytes (why it prevents GVDH as these establish immune system in recipient marrow)

86
Q

when would you transfuse platelets

A

<20 or <100 for surgery

87
Q

when would you transfuse FFP

A

clotting defects, warfarin OD, liver disease, TTP

88
Q

when would you transfuse albumin

A

hypoproteinaemic patient (liver disease, nephrosis) with fluid overload

89
Q

what type of rash can occur in ATR

A

urticarial

90
Q

what can cause a mild TR

A

febrile non haemolytic

mild allergic

91
Q

what can cause a severe TR

A

ABO incompatibility- acute haemolysis
bacterial contamination (more common in platelets)
IgA deficiency (anaphylaxis to IgA in red cells)
TACO and TRALI (both present with resp distress)

Haematology (27 decks)

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