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Systems: Haematology + Immunology > Blood Transfusions > Flashcards

Blood Transfusions Flashcards

1
Q

Why do we transfuse blood?

A
  • Major bleeds

- Failure of production

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2
Q

How are blood groups established?

A
  • Arise from antigens= something that provokes an immune response
  • Red cell antigens are expressed on cell surface (proteins, sugars, lipids)
  • Can provoke antibodies
  • Glycans added to proteins or lipids on RBC
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3
Q

What does the ABO gene encode?

A

Glycosyltransferase

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4
Q

What do the A and B genes encode for?

A

Transferase enzymes

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5
Q

What is the A antigen?

A

N-acetyl-galactosamine

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6
Q

What is the B antigen?

A

Galactose

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7
Q

What is the O gene?

A

A non-functional allele

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8
Q

Describe the inheritance of blood groups.

A

A and B are co-dominant whilst O is recessive

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9
Q

What does blood group B have antibodies against?

A

A

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10
Q

What does blood group A have antibodies against?

A

B

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11
Q

What does blood group O have antibodies against?

A

A and B

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12
Q

What does blood group AB have antibodies against?

A

No antibodies

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13
Q

Who is universal red cell donor?

A

Blood group O

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14
Q

Who is the universal red cell recipient?

A

Blood group AB

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15
Q

Who is the universal FFP donor?

A

Blood group AB

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16
Q

Who is the universal FFP recipient?

A

Blood group O

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17
Q

What can RhD negative individuals do during pregnancy or transfusion?

A
  • They can make anti-D if exposed to RhD cells

- This can lead to transfusion reactions or haemolytic disease of the new-born

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18
Q

What screening do blood donors undergo?

A
  • Extensive ‘behavioural’ screening
  • Sex, age, travel, tattoo
  • Tested for ABO and Rh blood groups
  • Screened for HepB/C/E, HIV, syphilis
  • Variably screened for: HTLV1, malaria, West Nile virus, Zika virus…
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19
Q

What are the components and products of blood?

A

Plasma

  • Clotting or coagulation factors
  • Albumin
  • Antibodies

Buffy Coat

  • Platelets
  • White cells

Red Blood Cells

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20
Q

What are some indications fro RBC transfusion?

A
  • Severe acute anaemia
  • Uncorrectable anaemia
  • Surgery
  • Sickle cell disease
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21
Q

How are RBCs transfused?

A
  • Stored at 4oC
  • Transfuse over 2-4 hours
  • 1 unit increments ~5 g/L
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22
Q

How are platelets transfused?

A
  • 1 dose platelets (=4 pooled or 1 apheresis donor)
  • Increments 20-40 10^9/L
  • Stored at ~22oC, shelf life 7 days
  • Transfuse over 20-30 minutes
23
Q

When may platelets be transfused?

A
  • Massive haemorrhage
  • Bone marrow failure
  • Prophylaxis for surgery
  • Cardiopulmonary bypass
24
Q

What are the components of plasma?

A
  • Fresh frozen plasma

- Cryoprecipitate

25
Q

What are the indications for FFP?

A
  • Massive haemorrhage
  • DIC with bleeding
  • Prophylactic
26
Q

How is FFP used?

A
  • 1 unit from 1 unit of blood

- Stored frozen, allow 30 minutes to thaw

27
Q

What are the lab tests for FFP?

A

PT and APTT

28
Q

What is the lab test for cryoprecipitate?

A

Fibrinogen

29
Q

How is cryoprecipitate stored?

A

Frozen, allow 20 minutes to thaw

30
Q

How are patients grouped and screened?

A
  • ABO and RhD type
  • Checked against historical records
  • Screen for allo-antibodies in serum
31
Q

What is the direct Coombs test used for?

A
  • Autoimmune haemolytic anaemia
  • Passive anti-D
  • Haemolytic transfusion reactions
32
Q

What is the indirect Coombs test used for?

A

Cross matching

33
Q

At what temperature do the ABO and Rh blood group systems usually react?

A

37C

34
Q

What blood is usually available within minutes?

A

O- red cells (AB plasma)

35
Q

What bloods are usually available uregently?

A

Type specific (ABO/RhD)

36
Q

What bloods take time and are non-urgent?

A
  • Full cross match to select the correct ABO/RhD type

- If allo-antibodies choose antigen negative blood

37
Q

What is the definitive management for massive haemorrhage?

A

Rapid control of bleeding via intervention or surgery

38
Q

Once a massive haemorrhage protocol has been activated what is there an immediate supply of?

A
  • 6 units red cells
  • 4 units FFP
  • 1 unit platelets
39
Q

What should decision to transfuse be based on?

A

The decision to transfuse should be based on a careful assessment of patient’s clinical state and must be justified as essential to prevent major morbidity or mortality

40
Q

How is prion disease transmittable?

A

By blood transfusion from early in the disease

41
Q

How should transfusion reactions be managed?

A
  • Stop transfusion
  • Check patient identity against component label
  • Consider: anaphylaxis, circulatory overload (TACO), acute haemolytic transfusion reaction (AHTR), bacterial infection, lung injury (TRALI) (other…)
42
Q

Acute transfusion reaction: possible cause of pyrexia

A

FNHTR

43
Q

Acute transfusion reaction: possible cause of urticaria

A
  • Mild allergic reaction

- Anaphalaxis

44
Q

Acute transfusion reaction: possible cause of dyspnoea

A
  • TACO
  • TRALI
  • Anaphylaxis
45
Q

Acute transfusion reaction: possible cause of shock

A
  • IBCT
  • Anaphylaxis
  • TRALI
  • TAS
46
Q

Acute transfusion reaction: treatment for pyrexia

A
  • Antihistamine

- Other symptoms usually more concern (bronchospasm/shock)

47
Q

Acute transfusion reaction: treatment of dyspnoea

A
  • O2
  • Diuretic
  • Ventilation
  • Adrenaline
48
Q

Acute transfusion reaction: treatment of shock

A
  • Adrenaline(IV)/Hydrocortisone/Antihistamine
  • IV fluid / ITU admission
  • Ventilation
  • Antibiotics,
  • FFP/platelets if DIC
49
Q

What is sensitisation in rhesus disease?

A

Development of maternal anti D antibodies

50
Q

Does IgG cross the placenta?

A

Yes

51
Q

How does haemolytic disease of the new-born present at birth?

A
  • Positive direct antiglobulin test
  • Jaundice
  • Anaemia
52
Q

How is HDN prevented?

A

Using prophylactic anti-D at 28/40 weeks or during sensitising events

53
Q

What is the treatment for HDN?

A

Careful monitoring

  • Antibody titres
  • Doppler ultrasound
  • Intrauterine transfusions
54
Q

What is TRALI?

A

Transfusion related acute lung injury

  • Transfused anti-leucocyte Abs in donor plasma interact with patient’s WBC
  • Bilateral pulmonary infiltrate
  • Supportive management, ventilation

Systems: Haematology + Immunology (19 decks)

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