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CR3 > Blood Transfusion Reactions > Flashcards

Blood Transfusion Reactions Flashcards

1
Q

Components of blood

A

RBCs
Platelets
Plasma

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2
Q

Types of Plasma

A

Fresh Frozen Plasma

Cryoprecipitate

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3
Q

Units of plasma

A

Fresh Frozen Plasma = 3-4U per dose

Cryoprecipitate = 10U per dose

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4
Q

Non UK Plasma

A

Methylene Blue FFP = for children = single donor = US sourced
Solvent Detergent plasma = octapharma = needs 500-1000 pooling = plasma exchange TTP

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5
Q

Immune adverse effects of transfusion

A
  • wrong blood compatibility
  • Urticarial rash
  • anaphylaxis
  • immunomodulation
  • DHTR (other RBC AB = Rh)
  • FNHTR
  • PTP
  • TRALI
  • TA-GVHD
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6
Q

Non immune non-infectious adverse effects of transfusion

A
  • iron overload

- fluid overload (TACO)

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7
Q

Infectious adverse effects of transfusion

A
  • viral = HBV, HCV, HIV, HTLV, CMV, EBV, parovirus, rarely HAV
  • bactericidal
  • syphilis
  • parasites (malaria, trypanosomiasis)
  • prions
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8
Q

Commonest blood group

A

O then A then AB then B

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9
Q

Acute Haemolytic reaction cause and presentation

A
  • soon after starting transfusion
  • ABO incompatible
  • immediately complement mediated lysis
  • shock, high fever, kidney failure, death
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10
Q

What are acute haemolytic reactions often due to? Which is most common?

A
  • human errors
  • wrong patient details on sample
  • muddle up 2 patients samples/results in lab (least common)
  • bedside wrong unit of blood collected and given (commonest)
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11
Q

Management of acute haemolytic reaction?

A
  • STOP transfusion
  • IV fluids to maintain BP
  • FBC, coag screen, chemistry
  • Repeat blood group pre and post samples
  • return blood unit to blood bank
  • culture blood
  • intensive care, manage DIC, dialysis
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12
Q

Delayed haemolytic transfusion reaction cause and presentation

A
  • due to IgG in RBCs
  • 7-10 days post transfusion
  • jaundice
  • failure of Hb to rise
  • higher rates in patients with Sickle cell as have more ABs
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13
Q

Diagnosis of delayed haemolytic transfusion reaction

A
  • Direct Antiglobulin test positive
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14
Q

FNHTR presentation

A

Febrile non-haemolytic transfusion reactions

  • during or soon after
  • fever, shakes/rigors, high pulse
  • unpleasant but not life threatening
  • need to exclude wrong blood or bacteria infection
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15
Q

Urticarial rash Presentation

A

Can be accompanied by wheeze
Not severe
Hypersensitivity to random plasma protein

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16
Q

Anaphylaxis Presentation

A

Severe, life threatening
Soon after transfusion started
With wheeze, asthma, high pulse, low bp = shock
laryngeal and facial oedema
May be related to IgA deficiency but uncommon

17
Q

What are the pulmonary complications?

A
  • TACO = transfusion associated circulatory overload

- TRALI = transfusion associated acute lung injury

18
Q

TACO RF

A

Transfusion associated circulatory overload

  • elderly
  • pre-existing heart disease
  • low body weight given large volume transfusion
19
Q

TACO Management

A

Assess patients at risk at pre-transfusion

20
Q

TRALI cause

A
  • transfused anti-leucocyte ABs in donor plasma interact with patients WBCs
21
Q

TRALI presentation

A

Bilateral pulmonary infiltrates

22
Q

TRALI management

A
  • supportive

- ventilation

23
Q

Rare complication

A 
PTP = post transfusion purpura
Ta-GVHD = Transfusion Associated Graft vs. Host Disease
24
Q

PTP

A
  • 7-10 days after
  • destruction of own platelets eventually
  • HPA1 negative patients form ABs
  • after transfusion or pregnancy
25
Q

Ta-GVD

A
  • always fatal
  • lymphocytes in donor blood transfused to immunocompromised host
  • prevent by giving irradiated blood and platelets
26
Q

Organisms transmitted by blood transfusion

A
  • persist in circulation for a long time
  • donor has infection for a while = exclude unwell donors
  • HBV, HCV, HEV, HAV
  • HIV, HTLV, Herpees, CMV, EBV, HHV8
  • Parovirus B19
27
Q

Commonest infective organism in blood tranfusion

A

Hep B
Then HIV
Then Hep C

28
Q

Effects of bacterial contamination

A
  • rare but fatal
  • bacterial sepsis = especially if endotoxin produced (E coli)
  • shock, kidney failure, death
29
Q

Prevention of bacterial contamination

A
  • stringent cleansing

- BACT Alert = bacterial screening of platelets

30
Q

Prion Disease

A
  • transmitted by blood in sheep and humans

- no blood test available only biopsy

31
Q

Prion Disease Transmission RIsk Reduction Strategies

A
  • leucodepletion in 1998
  • UK plasma not used for fractionation
  • barr patients who receieved blood after 1980 for donation
  • import FFP for all patient born after 1996
32
Q

Surgery Pre-Op Blood Management

A
  • correct iron deficiency anaemia

- review warfarin, antiplatelet drugs

33
Q

Cell Salvage

A
  • collect patients own blood during major surgery
34
Q

Antifibrinolytics

A

Tranexamic acid to reduce blood loss

35
Q

Restrictive transfusion triggers

A

Hb<70g/l

Hb<80g/l if ACS

36
Q

Blood Management in Surgery

A 
Pre-Op Assess
Cell Salvage
Antifibrinolytics
Near patient testing to guide component usage
Restrictive transfusion triggers
37
Q

Consent

A
  • valid consent required before planned transfusion and documented in patient record
  • give info on risks, benefit, alternatives then ask consent
  • does not need to include signature from patient

CR3 (30 decks)

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