blood transfusions

Question 1

RhD negative patient what blood do you not give?

Answer 1

do not give RhD +ve blood, delayed haemolytic transfusion reaction

generally if dont know blood group O-ve

Question 2

other RH antigens

Answer 2

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

Question 3

haemolytic disease of new born and management

Answer 3

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

Question 4

antibody screen on patient plasma method

Answer 4

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

Question 5

serological crossmatching

Answer 5

if patient has an antibody

Question 6

transfusion of red cells requirements

Answer 6

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

Question 7

platelet transfusion requirements

Answer 7

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

Question 8

plasma transfusion requirements FFP

Answer 8

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

Question 9

red cell transfusion indications

Answer 9

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

Question 10

special blood requirements (3)

Answer 10

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

Question 11

Platlet transfusion indications

Answer 11

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

Question 12

FFP indications

Answer 12

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)

Question 13

delayed transfusion reactions

Answer 13

DHTR

post transfusion purpura

transplant associated gvhd

none immune: viral infections

iron overload

Question 14

acute tranfusion reaction signs:

Answer 14

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

Question 15

soon after transfusion blood or platelets rise in temperatur 1degree

chills

rigors

Answer 15

febrile non-haemolytic transfusion reaction, common before blood was leucodepleted

white cell releases cytokines during storage

Question 16

typically plasma tranfusion mild urticarial rash itchy wheeze

history of atopy/allergy

Answer 16

allergic transfusion reaction. stop/slow transfusion

give |V antihistamines

allergy to donor plasma protein

Question 17

acute intravascular haemolysis IgM

vomiting chest loin pain fever collapse

shock decrease BP increase HR temp

later haemoglobulinurea

Answer 17

wrong blood, take samples repeat match and DAT test

can be severe or fatal

Question 18

after transfusion restlessness fever vomiting flushing collapse

shock bp hr temp

donor low grade GI

platelet transfusion

Answer 18

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

Question 19

post transfusion

shock bp hr breathless wheeze

laryngeal facial oedema

Answer 19

anaphylaxis

igE antibodies mast cell relases + vasocative substances

IgA defieincy anaphylactic reasion in 25%

wash platelets

Question 20

post transfusion

fluid overload cardiac failure renal impairment hypoalbuminaemia

SOB decrease O2

Answer 20

TACO transfusion associated ciruclatory overload

RF: wieght less than 50k , cardiac failure/ renal impairement

Question 21

TRALI

Answer 21

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

Question 22

dark urine jaundice haemoglobinuria over a few days

renal failure

Answer 22

delayed haemolytic transfusion reaction

repeat G+S look for new antibodies

Question 23

immunosupressed patients severe diarrhoea liver failure skin desquamation, bm failure

post transfusion 7 days ago

Answer 23

TA GVHD

99% fatal

donor lymphocytes

Question 24

Purpura 7 days after transfusion with platelets (1-4 weeks resolved)

anti HPA -1 a antibody positive

platelet count <20

purpura on skin

Answer 24

post transfusion pupura

give IVIG

Question 25

management of HDN

Answer 25

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