blood transfusions Flashcards
RhD negative patient what blood do you not give?
do not give RhD +ve blood, delayed haemolytic transfusion reaction
generally if dont know blood group O-ve
other RH antigens
Kell (K)
Duffy (Fy)
Kidd(Jk)
antibody against wains with time so next hospital cant pick up, delayed haemolytic trasnfusion reaction day 7-10
sickle cell patients - ABO rhd kell duffy kid
haemolytic disease of new born and management
RH negative mother exposed to Rh positive blood
can cause haemolytic disaese of newborn
high risk of feto-maternal haemorrhage
and can cause fetal anaemia +jaundice hydrops fetalis
prophylatic inarmusuclar anti-D antibodies 28/34 weeks
antibody screen on patient plasma method
done before every transfusion
use 2 or 3 reagent red cells containing important red cell antigens called group and screen.
can see red cell clumping
serological crossmatching
if patient has an antibody
transfusion of red cells requirements
ABO/d compatiable
stored at 4degrees for 35 days
must be transfued within 4 hours of leaving fridge
transfuse 1 unit of RBC over 2-3h
platelet transfusion requirements
ABO/D antigens also matched, should be D compatiable, in an emergency can give anti-D treatment
group O to AB high titre negative (for antia/b antibodies)
as can get slight haemolysis
plasma transfusion requirements FFP
ABO compatiable only , D doesnt matter
children need methylene blue treated plasma (MB) as its sourced outside UK, dont want to expose them to variant CJD
group AB is universal doner but rarest. as no antiA/b plasma
red cell transfusion indications
major blood loss >30% blood volume
peri-op/cri care Hb <70g/L
post chemo Hb <80g/L (as decreased bone marow function
symptomatic anaemia -ischaemic heart disease breathelss EEG
special blood requirements (3)
CMV negative blood -intra uterine neonatal transfusion and pregnant women
Irradiated blood - immunosuppressed cannot destroy incoming donor lymphocytes can get transfusion TA-GvHD
washed products red cells and platelets are only given to patients who have severe allergic reactions to plasma proteins (takes 4h) , IgA deficient patients
Platlet transfusion indications
massive transfusion platlet >75
prevent bleeding <50 in surgery
<100 if critical sight eye cns
platelet dysfunction/immune cause only if bleeding
Herparin induced thrombocytopenai thrombosis HiTT worsened by platelets
and TTP is contraindicated
FFP indications
massive transfusions blood loss >150ml/min
DIC with bleeding
liver disease + risk Pt ratio >1.5x normal
reversing warfarin not FFC
give PCC prothrombin complex concentrate (factor 2 9 7 10)
delayed transfusion reactions
DHTR
post transfusion purpura
transplant associated gvhd
none immune: viral infections
iron overload
acute tranfusion reaction signs:
rise in temp pulse bp
fevers rigots flushing vomiting dyspnoea loin pain chest pain
uticaria itching headache collapse
monitor patient baseline obs and repeat after 15mins then hourly
soon after transfusion blood or platelets rise in temperatur 1degree
chills
rigors
febrile non-haemolytic transfusion reaction, common before blood was leucodepleted
white cell releases cytokines during storage
typically plasma tranfusion mild urticarial rash itchy wheeze
history of atopy/allergy
allergic transfusion reaction. stop/slow transfusion
give |V antihistamines
allergy to donor plasma protein
acute intravascular haemolysis IgM
vomiting chest loin pain fever collapse
shock decrease BP increase HR temp
later haemoglobulinurea
wrong blood, take samples repeat match and DAT test
can be severe or fatal
after transfusion restlessness fever vomiting flushing collapse
shock bp hr temp
donor low grade GI
platelet transfusion
bacterial contamination
caused by bacterial endotoxin
introduced during processing
platelets most likely cause room temeprature
presents similarly to ABO incompatiability
prevention divert first 20ml in pouch for testing
platelets stored at 22 now screened for bacteria
post transfusion
shock bp hr breathless wheeze
laryngeal facial oedema
anaphylaxis
igE antibodies mast cell relases + vasocative substances
IgA defieincy anaphylactic reasion in 25%
wash platelets
post transfusion
fluid overload cardiac failure renal impairment hypoalbuminaemia
SOB decrease O2
TACO transfusion associated ciruclatory overload
RF: wieght less than 50k , cardiac failure/ renal impairement
TRALI
transfusion related acute injury
similar to ARDS , bilateral pulmonary infilitrates within 6hr
anti-wbc antibodies in donor aggregates on white cells in hosts lung
(no raised JVP)
will not respond to diuretics
dark urine jaundice haemoglobinuria over a few days
renal failure
delayed haemolytic transfusion reaction
repeat G+S look for new antibodies
immunosupressed patients severe diarrhoea liver failure skin desquamation, bm failure
post transfusion 7 days ago
TA GVHD
99% fatal
donor lymphocytes
Purpura 7 days after transfusion with platelets (1-4 weeks resolved)
anti HPA -1 a antibody positive
platelet count <20
purpura on skin
post transfusion pupura
give IVIG
management of HDN
all pregnant women get G+S at 12 weeks booking bloods
and at 28 weeks to look for RBC
check if feather has antigen
check foetal FFDNA
monitor foetus for anaemia
deliver baby early as HDN gets worse
can give intra-uterine transfusion can be given to foetus
