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Y4: Perioperative care > Blood transfusions > Flashcards

Blood transfusions Flashcards

1
Q

Why should prescribing blood products be taken seriously?

A
  • Transfusion reactions are common even with cross-matched blood
  • Blood products are scarce so should be used only when necessary
  • Blood group incompatibility is life-threatening complication
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2
Q

What are the NICE guidelines recommendation for haemoglobin concentration for those who need RBC transfusion and the concentration target after tranfusion?

A
  • Restrictive Hb concentration for those who need RBC transfusion
    • 70g/L
  • Hb concentration target after transfusion
    • 70-90g/L
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3
Q

What are the important blood groups to consider when prescribing blood products and cross-matching?

A
  • ABO blood system
  • Group D of rhesus system
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4
Q

What are the Rhesus D (RhD) classifications in patients

A
  • RhD+ or RhD-
  • Depends on presence of rhesus D surface antigens
  • RhD+ (85%): RhD antigens present
  • RhD- (15%): RhD antigens absent
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5
Q

What happens if a RhD- patient is given RhD+ blood?

A
  • RhD- patient will begin to produce RhD antibodies
  • Will not matter for the patient
    • Cannot go onto attack their own RBCs because they do not have RhD present on the RBC membrane
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6
Q

What happens if a RhD- patient becomes pregnant with a RhD+ fetus (RhD+ partner)?

A
  • Causes Haemolytic Disease of the Newborn (HDN)
  • Feotal blood is RhD+ => mother creates RhD antibodies
  • Second pregnancy with RhD+ child
  • Anti-D antibodies cross placenta and enter foetal circulation and bind to RhD antigens on the feotal RBC surface membranes
  • Fotal immune system attacks its own RBCs leading to foetal anaemia
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7
Q

What type of RhD blood is given to men and women?

A
  • Women
    • Given RhD specific blood to avoid HDN
  • Men
    • Preferable to give cross-matched blood
    • Possible to give RhD+ blood to a RhD- male in emergency setting
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8
Q

Describe the ABO blood group?

A
  • Refers to the presence of A / B antigens on the surface of RBCs
  • People produce antibodies to bind to the surface antigen (A or B) that are NOT present on your own RBC membrane
  • Important consdieration for O- and AB+ blood
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9
Q

Describe the considerations for O- blood?

A
  • Universal donor
  • Blood can be given to anyone because there are no AB or Rhesus antigens on donor RBC surface membrane
  • They are unlikely to reject this blood as there are no ABO of Rh antigens to attack
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10
Q

Describe the considerations for AB+ blood?

A
  • Universal acceptor
  • They can receive any donor blood as they do not have any A, B or rhesus antibodies in their circulation so cannot mount an immune response to donor blood
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11
Q

Table of the different blood types and their antigens

A
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12
Q
  • Blood group A
    • What antibodies do they have in plasma?
    • What antigens do they have in RBCs?
    • What blood types are compatible in an emergency?
A
  • Anti-B
  • A antigen
  • Groups A and O
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13
Q
  • Blood group B
    • What antibodies do they have in plasma?
    • What antigens do they have in RBCs?
    • What blood types are compatible in an emergency?
A
  • Anti-A
  • B antigen
  • Groups B and O
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14
Q
  • Blood group AB
    • What antibodies do they have in plasma?
    • What antigens do they have in RBCs?
    • What blood types are compatible in an emergency?
A
  • None
  • A and B antigens
  • Universal recipient
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15
Q
  • Blood group O
    • What antibodies do they have in plasma?
    • What antigens do they have in RBCs?
    • What blood types are compatible in an emergency?
A
  • Anti-A and anti-B
  • No antigens
  • Can only receive group O
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16
Q

What are the two blood tests that should be preformed prior to blood transfusion?

A
  • Group and save (GC&S)
  • Crossmatch
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17
Q

Describe GC&S?

A
  • Determines patient’s blood group and screens for atypical antibodies
  • GC&S is recommended if blood loss is not anticipated but blood may be required if there is greater loss than expected
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18
Q

Describe the crossmatch blood test?

A
  • Involves mixing patient’s blood with donor blood to see if an immune reaction takes place
  • G&S should be done first
  • Recommended if blood loss is anticipated
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19
Q

Describe the process of requesting blood products?

A
  • 3 points of identification (name, DOB, CHI no)
  • Consent patient
  • Label bottles at the bedside
  • Complete transfusion request form at the bedside
20
Q

Describe CMV negative blood products?

A
  • CMV is common congenital infection
    • Can cause sensorineural deafness and cerebral palsy
  • => CMV negative blood should be given to women during pregnancy, intra-uterine transfusions and neonates
21
Q

Why are blood products irradiated?

A

To reduce graft-versus-host disease in at risk populations

22
Q

Name some patient groups who should receive irradiated blood products?

A
  • Receiving blood from first or second degree family members
  • Patients with Hodgkin’s lymphoma
  • Recent haematipoietic stem cell transplants
  • People receiving purine analogues as chemotherapy
23
Q

Describe the administration of blood products?

A
  • If receiving more than one unit, they should be prescribed individually
  • Important observational timings:
    • Before transfusion
    • 20 minutes
    • 1 hour
    • At completion
  • Admimnstered via green or grey cannula
24
Q

Why should blood be given via large cannulas?

A

Otherwise the cells will haemolyse due to sheering forces in a narrow tube

25
Q

What are the different parts that a donor’s blood is separated into?

A
  • Packed red cells
  • Platelets
  • Fresh frozen plasma (FFP)
  • Cryoprecipitate
26
Q

How are blood products administered?

A
  • Via blood giving set
    • Has a filter in the chamber which a normal fluid giving set lacks
27
Q

Major constituents of packed red cells?

A

Red blood cells

28
Q

Indications for packed red cells?

A
  • Acute blood loss
  • Chronic anaemia where Hb <70g/L or <100 in CVD
  • Symptomatic anaemia
29
Q

Duration of packed red cells administration?

A
  • 2-4 hours
  • Must be completed within 4 hours of removal from the store
30
Q

Considerations for giving packed red cells?

A
  • 1 unit of blood should increase Hb by 10g/L
  • Patient RBCs may produce autoantibodies to donor surface antigens
    • New G&S should be sent before starting another transfusion
31
Q

Indication for giving platelets?

A
  • Haemorrhagic shock in trauma patient
  • Profound thrombocytopenia (<20 x109/L)
    • Normal 150-400)
  • Bleeding with thrombocytopenia
32
Q

Duration for the administration of platelets?

A

30 minutes

33
Q

Describe an adult therpeutic dose of platelets?

A

Should increase platelet levels by 20-40 x109/L

34
Q

Constituents of FFP?

A

Clotting factors

35
Q

Indications for FFP?

A
  • Disseminated intravascular coagulation (DIC)
  • Haemorrhage secondary to liver disease
  • All massive haemorrhages
    • (given after 2nd unit of packed red cells)
36
Q

Duration of administration of FFP?

A

30 minutes

37
Q

Major constituents of cryoprecipitate?

A
  • Fibrinogen
  • Von-Willebrands factor (vWF)
  • Factor VII
  • Fibronectin
38
Q

Indications for cryoprecipitate?

A
  • DIC with fibrinogen <1g/L
  • Von willebrands disease
  • Massive haemorrhage
39
Q

Duration of administration of cryoprecipitate?

A

Stat

40
Q

General complications of red cell transfusions?

A
  • Clotting abnormalities
  • Electrolyte abnormalities
  • Hypothermia
41
Q

Describe the clotting abnormalities caused by packed red cell transfusions?

A
  • Due to a dilution effect
    • The packed red cells do not contamin platelets or clotting factors
  • To reduce the risk of impairment, FFP, platelets should be administered concurrently in patients receiving more than 4 units of RBCs
42
Q

Describe the electrolyte abnormalities caused by packed red cell transfusions?

A
  • Hypocalcaemia
    • chelation of calcium by calcium binding agent in preservative
    • results in reduced serum calcium level
  • Hyperkalaemia
    • due to partial haemolysis of RBCs and resultant intracellular potassium release
43
Q

Describe the hypothermia caused by packed red cell transfusions?

A
  • Blood products are thawed from frozen then kept and cool temperatures
  • They may not be at body temperature at the time of transfusion
44
Q

Name the ACUTE complications from transfusions?

A
  • Anaphylaxis
  • Acute haemolytic reaction
  • Transfusion associated circulatory overload
  • Transfusion related acute lung injury (TRALI)
    • Form of ARDs, non-cardiogenic pulmonary oedema
45
Q

Name the DELAYED complications from transfusions?

A
  • Infection
    • Risk of HBV, HCV, HIV, syphilis, malaria
    • Less concern now blood donors are screened
  • Graft vs Host Disease (GvHD)
    • Fever, skin involvement, diarrhoea, vomiting
  • Iron overload
    • Patients receiving multiple transfusions (thalassemia)

Y4: Perioperative care (8 decks)

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