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Haematology > Blood Transplantation > Flashcards

Blood Transplantation Flashcards

1
Q

Where do the different blood groups arise from?

A
  • Arise from antigens

- These antigens are on the cell surface and can provoke antibodies

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2
Q

Which antigens are present on the surface of the red blood cells?

A
  • Type A: has A antigens
  • Type B: has B antigens
  • Type AB: has A and B antigens
  • Type O: has no antigens on the surface of the RBC
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3
Q

Which antibodies do each blood type have?

A
  • Group A: antibodies against B
  • Group B: antibodies agaisnt A
  • Group O: antibodies against A and B
  • Group AB: no antibodies against A and B
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4
Q

List the blood groups from most to least common

A
  • O (46%)
  • A (42%)
  • B (9%)
  • AB (3%)
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5
Q

Why is the Rhesus gene important with regard to blood groups?

A

If it is deleted then the patient is Rhesus negative. If they are then exposed to RhD positive blood it can cause haemolysis - very important for foetuses

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6
Q

What are blood donors screened for?

A
  • Behavioural screening (sex, age, travel, tattoos etc.)
  • Blood group and Rh blood group
  • HepB/C/E, HIV and syphilis
  • Variably screened for HTLV1, malaria, West Nile virus, Zika virus
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7
Q

What are the indications for red cell transfusion?

A
  • To correct severe anaemia
  • To improve quality of life in a patient who has otherwise uncorrectable anaemia
  • To prepare a patient for surgery or speed up recovery
  • To reverse damage caused by a patient’s own red cells e.g. Sickle cell disease
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8
Q

How are red blood cells transfused?

A
  • Stored at 4 degrees
  • Transfused over 2-4hrs
  • 1 unit increments (approx. 5g/L)
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9
Q

How are platelets transfused?

A
  • 1 dose of platelets
  • Stored at 22 degrees
  • Transfuse over 20-30 minutes
  • Try not to cross blood groups but can
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10
Q

What are the indications for platelet transfusion?

A
  • Massive haemorrhage
  • Bone marrow failure
  • Prophylaxis for surgery (CNS or eye surgery need higher platelet counts than the rest)
  • Cardiopulmonary bypass (if bleeding)
  • DIC if the patient is bleeding
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11
Q

What are the indications for fresh frozen plasma?

A
  • Massive haemorrhage (use in 1:1 with RBCs)
  • DIC in the presence of bleeding
  • Thrombotic thrombocytopenic purpura
  • Replacement of coagulation factor deficiencies where factor concentrate is unavailable
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12
Q

What is the indication for cryoprecipitate?

A
  • Fibrinogen <1.0g/dl
  • Hypofibrogenaemia secondary to massive transfusion
  • DIC with bleeding and fibrinogen
  • Bleeding with associated with thrombolytic therapy
  • Renal/liver failure with abnormal bleeding
  • Inherited hypofibrinogenaemia if fibrinogen concentrate is unavailable
  • Fibrinogen conc. on its way
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13
Q

What happens when blood is grouped and screened/saved?

A
  • ABO and RhD type
  • Checked against historical records
  • Screen for allo-antibodies in the serum
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14
Q

How does Coombs test work?

A

It tests for antibodies in the serum. If the Ab is present then the RBCs will clump together

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15
Q

What can a direct and indirect Coombs test show?

A
  • Direct: autoimmune haemolytic anaemia, passive anti-D and haemolytic transfusion reactions
  • Indirect: cross matching
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16
Q

What happens when a mother is RhD negative and the baby is RhD positive?

A

If nothing is done then the baby’s red blood cells can haemolysise, the baby can become anaemic, go into cardiac failure and die

17
Q

Which antigens can cause haemolytic disease of the newborn and how does it present?

A
  • RhD, c and k most immunogenic
  • Other Rh antigens, Jka and ABO less immunogenic
  • Positive DAT at birth, anaemia and jaundice
18
Q

How can haemolytic disease of the newborn be treated

A
  • Exchange transfusion when the baby is born
  • Anti-D prophylaxis
  • Careful monitoring: antibody titres, doppler USS and intrauterine transfusion
  • Neonatal alloimmune thrombocytopenia (NAIT) - similar process for platelets
19
Q

What cellular therapies are available?

A
  • Leucapheresis: bone marrow harvests and donor lymphocyte infusions
  • Other banks: bone, milk, tendons, heart valves, faecal, islet cells and mesenchymal stem cells
  • Gene therapies
20
Q

What is the threshold for red cell transfusion?

A

-A haemoglobin of 70 (90-100 in patients with cardiac impairment)

21
Q

What are the alternatives to transfusion for surgery?

A
  • Pre admission clinic: reversal of anaemia

- Intra-operative cell salvage

22
Q

Why are those born after 1996 given treated FFP?

A

Because there is a risk of new variant CJD

23
Q

Which patients need irraditated blood?

A

Immunosuppressed patients (to prevent graft versus host disease)

24
Q

What are the risks of a blood transfusion?

A
  • Transfusion of ABO incompatible components
  • TACO (transfusion associated circulatory overload)
  • TRALI (transfusion associated lung injury)
  • ATR (acute transfusion reactions)
  • Febrile
  • Allergic
  • Hypotensive
25
Q

What are the potential acute transfusion reactions and how are they treated?

A
  • Pyrexia: anti-pyretic
  • Urticaria: antihistamine
  • Dyspnoea: O2, diuretic, ventilation and adrenaline
  • Shock: adrenaline, hydrocortisone, antihistamine, IV fluids, ICU, ventilation, antibiotics and FFP/platelets if DIC

Haematology (11 decks)

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