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TXN243 > Compatibility > Flashcards

Compatibility Flashcards

1
Q

_______ __________

-to increase oxygen-carrying capacity
-not just to raise RBC count or Hgb
-Patient should show symptoms of decreased oxygen-carrying capacity

A

Blood transfusion

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2
Q

Transfusion Candidates:

-_________ production of RBC’s (leukaemia, BM failure, chronic anemia)
-_________ destruction of RBC’s (Hemolytic Anemia)
-___ of RBC’s (Traumatic bleed or Surgical blood loss)

A

Decreased
Increased
Loss

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3
Q

_________ _________
-Physician will obtain this from the patient
-patient will be given a pamphlet “Blood transfusions- Information for Patients and their Families”
-Current alternatives, benefits and risks associated with transfusion will be discussed
-Patient has an opportunity to ask questions
-Placed in hospital chart

A

Informed Consent

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4
Q

_______ _______
-Jehova’s witnesses forbid blood transfusion based on their interpretation of the Biblical scripture
-the use of recombinant human erythropoietin (r-huEPO) and one plasma fractionated products may be acceptable for some people
-Refusal documentation should reflect the decision of recepient

A

Informed Refusal

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5
Q

___________
-may be defined as the ability if donor cells and proteins to survive in the recipient’s circulation for the expected length of time without evoking an immune response
-the __-_________ tests involved in the crossmatch procedure provide some information about the “in-vivo” effect on the donor cells but does not guarantee their survival

A

Compatibility
pre-transfusion

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5
Q

___________
-may be defined as the ability if donor cells and proteins to survive in the recipient’s circulation for the expected length of time without evoking an immune response
-the __-_________ tests involved in the crossmatch procedure provide some information about the “in-vivo” effect on the donor cells but does not guarantee their survival

A

Compatibility
pre-transfusion

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6
Q

_________ ________
-purpose is to provide compatible blood for patients who require or may require a transfusion
-transfused blood will survive in the recipient
-Transfusion will be tolerated by the recipient
-transfusion won’t have adverse events on the recipient’s health or future treatments (beneficial)

LIMITATIONS
-the word “Compatible” means __ _______ incompatibility
-we must assume the transfusion will be successful and tolerated by the patient and be beneficial

A

Compatibility Testing

No Obvious

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7
Q

A Compatibility Test cannot prevent:
-_________ due to antibodies below detectable levels
-_________ of recipient to donor antigens during TXN
-it can only detect _______ reactions due to antibodies present

A

Reactions
Sensitization
Obvious

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8
Q

Compatibility Testing:
-test the patient for a ____ and _____
-Select ____ and ____ Compatible donor units
-test the ______ and the specific ___ cell compatibility

A

Type and Screen
ABO and Rh
Patient; donor

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9
Q

______ ________
-determine ABO and Rh status
-aids in the selection of compatible blood products

A

ABO/Rh Blood Type

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10
Q

__________ screen
-determine if the patient has antibodies

A

Antibody

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11
Q

_________
-final test of compatibility between donor and patient
-3 methods (Immediate spin crossmatch, Full Crossmatch which includes Tube and MTS, and Electronic Crossmatch)

A

Crossmatch

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12
Q

Crossmatch Methods
1. ________ - patient ABO and Rh must have been typed at least twice, by 2 different technologists
-patient has no antibodies and no record of previous antibodies
-donor information must be bar-coded into computer inventory for accuracy
-computer does not allow use of donor unit until ABO and Rh is verified
-computer does not allow issue of ABO and Rh incompatible blood

A

Electronic

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13
Q

Crossmatch interpretation
- ________- means no agglutination and no hemolysis
-___________- means there is agglutination or hemolysis

A

Compatible
Incompatible

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14
Q

DONOR UNIT SELECTION
-Select ABO and Rh compatible units for transfusion
—-each unit of blood has connected tuning that contains sealed segments of aliquots of the donor blood
—-make a 3-5% or 0.8% suspension for testing

A

IS Crossmatch
Electronic Crossmatch

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15
Q

DONOR UNIT SELECTION
-Select ABO and Rh compatible units for transfusion
—-each unit of blood has connected tuning that contains sealed segments of aliquots of the donor blood
—-make a 3-5% or 0.8% suspension for testing

A

Immediate Crossmatch
Full Crossmatch

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16
Q

________ _______ _____
-Patient history is relevant
-determine if patient has been transfused or pregnant previously
-history of Antibody (Red Cell or Non-Red Cell Immune)
-Identification of antibody is required (regardless of significance even if it is a cold antibody)
-phenotype the patient
-use the antigen frequency calculation to determine how many units are required for testing before finding the compatible units
-Select ABO and Rh compatible units
-Phenotype Donor Units (must lack the antigen)
-Crossmatch donor units with patient plasma (IS, and IAT tube or by MTS method)

A

Positive Antibody Screen

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17
Q

_______ ________ ______
-current antibody screen is negative but there is a history an antibody
——-use the antigen frequency calculation to determine how many units are required for testing before finding compatible units
——-select ABO/Rh compatible units
-Phenotype donor units (must lack the antigen)
-Crossmatch donor units with patient plasma
-reports indicate that the patient “PREVIOUSLY IDENTIFIED ANTIBODY IS NOT DETECTABLE”
-do not report negative screen

A

Negative Antibody Screen

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18
Q

Negative Antibody Screen
-current antibody screen is negative
——-select ABO/Rh Compatible units
——-crossmatch donor units with patient plasma
——-Immediate spin technique

A
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19
Q

RULES TO REMEMBER
-always repeat the RA/RB on the sale when crossmatching if the sample was retrieved from storage
-if you are currently typing the patient then you do not have to repeat the RA/RB

A
20
Q

Memorize the formula:

A
21
Q

fill out what’s missing in the formula:

A

of units required

Frequency of Ag Neg

22
Q

Example of calculation:

A
23
Q

Example 2 of calculation:

A
24
Q

TRANSFUSION REQUEST

If the patient has an Antibody or a history of an Antibody, we MUST have a minimum of __ units crossmatch compatible & phenotyped negative available for the entire hospital admittance.

A

2

25
Q

NEONATAL TRANSFUSION

-Neonatal period is generally considered to extend from birth to __ months for the purposes of transfusion.

-Due to the immunogenic system of the newborn during the first 4 months of life, standards for compatibility testing for neonates are different than adults.

-Routine Transfusion of a neonate should be irradiated and < __ days old

-Depending on Hospital protocol, __ Rh ____ units will be selected.

-In an emergency situation if irradiated blood is not available use one unit that is __ days old (WBC contained in packed cells are nearly non-viable)

-Pre-transfusion specimen is tested for unexpected antibodies using the ________ plasma

-Use a _______ or ________ (heel prick) and NOT a Cord specimen for testing

-Test for ABO and RH typing (No Reverse Grouping)

-Crossmatch the donor unit with maternal plasma if required

A

4

7

O;Negative

14

maternal

venous or capillary

26
Q

Memorize the table:

A
27
Q

Fill out what’s missing on the table:

A

NO Crossmatch is required
Crossmatch using Maternal Plasma
Crossmatch using Infant’s plasma

28
Q

ROUTINE TRANSFUSION

-Blood Bank Receives the requisition and sample (EDTA)

-Sample must contain the Patient Identification (__ unique identifiers)

-Phlebotomist’s signature, date and time on the sample drawn

-Ask for recollection if the sample is _________ (Can be mistaken for a reaction during testing)

-Perform the Type and Screen

-Determine the history or Transfusion/ pregnancy

-Diagnosis: CLL, Subgroup of A, weak reactions in RA/RB, IgA deficient

-__________ if blood products are required (IS, Full, or Electronic)

-Newly adapted procedure: must have __ _____ collected at different times to crossmatch units (CABO)

-Label the Unit of blood product with a crossmatch card / Donor unit tag (Indicates information about the unit and the patient)

-Notify floor with broadcasting or calling

-Issue request form is faxed from the floor

-Check the patient ID, unique identifier, Unit Number, Group of unit, Expiry dates, and visually examine the unit of blood product

-Sign the crossmatch issue slip and send the copy to the floor

-Issue blood to the porter (EFRS, PSR) or through pneumatic tube

-RN/physician transfuses patient after checking the 2 unique pieces of identification

-Check vitals (heart rate/blood pressure) at start and at regular intervals

A

2

HEMOLYZED

Crossmatch

2 T/S

29
Q

ROUTINE TRANSFUSION

Most of the “Transfusion accidents” occur as a result of _______ __________ ____________. All information from the patient ID bracelet, transfusion records and blood/blood products from transfusion must match exactly. All labels must remain attached to the blood and blood product bag until the transfusion is complete.

A

incorrect patient identification

30
Q

EXPIRY DATES ON THE SAMPLE

-Expiry date of the sample refers to how long it can be used for ____________

  • Once the T/S is complete you can still XM more units as needed
  • Sample does not actually expire, we are bearing in mind the
    antibody status of the patient

-Sample expires in __ days if: Patient has not been transfused or pregnant in the last 3 months (some hospitals allow usage of the sample up to 28 days)

-Sample expires in __ hours or __ days if Patient has been transfused or pregnant in the last 3 months (chance of immunization is ongoing, new sample required to check for newly formed antibodies)

-There might be some variations depending on your hospital protocol

A

Crossmatching
14
96 hrs or 4 days

31
Q

SAMPLE STORAGE

Sample must be kept for a minimum of __ days after a transfusion.
• May require investigation if a delayed transfusion occurs.
• Storage of the sample is 4-6 ̊C
• If hospital has enough storage
area, they are kept for __ weeks.

A

7
5

32
Q

PRE-ADMISSION TESTING:

• Booked elective surgery (Patients usually comes in 2 weeks prior to surgery to complete the blood work for surgery. Includes CBC, Chemistry and T/S. Depending on type of surgery, physician may or may not order units.).

• Allows for enough time to identify antibodies, and phenotype units for the patient.

• Some patients have autologous units that will be delivered from CBS a couple of
days before surgery.

• Usually pull the Pre-Admit samples day before surgery to make sure investigation is complete and units are ready if required.

• MUST BE CAREFUL WITH THE EXPIRY DATES OF THE SAMPLES

A
33
Q

PRE-ADMISSION TESTING ADVANTAGES

• Schedule blood work appropriately
• Discover abnormalities in advance before surgery
• Blood Bank inventory utilization is optimized
• Time to identify Antibodies present
• Time to order Blood from Canadian Blood Services

A
34
Q

STANDARD SURGICAL BLOOD ORDER SCHEDULE

• Agreement between Lab medical Director and Surgery Department
• Standard # of units of blood to be cross-matched for a type of surgery
• Type and Screen sometimes is sufficient
• No units crossmatched because there is only a low risk of transfusion and IS XM is quick and can be done as required during surgery or post-op.
• To ensure that the blood inventory is used more efficiently

A
35
Q

Memorize:

A
36
Q

STANDARD SURGICAL BLOOD ORDER SCHEDULE

• If Blood is required during surgery or post-op, the current sample is used for crossmatching.

• Retrieve sample

• If no Antibodies are present, Select ABO compatible blood, Repeat the ABO reverse group on the patient (using plasma) and perform the IS XM on the patient plasma and the donor cells (packed cells from the fridge).

• Platelets, can give any group but Rh must be compatible (to be discussed further in platelet lecture).

• Plasma must be ABO compatible; no compatibility or reverse grouping is performed.

A
37
Q

EMERGENCY REQUESTS

• Blood is needed urgently
• Immediate administration is required
• Crossmatching time carries an increased risk
• The responsibility for the order rests with the physician who submits the request

A
38
Q

EMERGENCY REQUESTS

Never withhold issuing blood to a patient when it is urgent as long as there is a request/order for un-crossmatched blood by the doctor. The responsibility for the order of un-crossmatched blood rests solely with the physician who submits the request. The “Doctor’s Authorization for Urgent Blood” form may be issued to the physician with the first unit.

A
39
Q

EMERGENCY REQUESTS

  • Physician must specify that they want UNCROSSMATCHED
    BLOOD
  • MUST GIVE ABO COMPATIBLE BLOOD PRODUCTS
  • NEVER GIVE BLOOD PRODUCTS BASED ON HISTORICAL BLOOD GROUP
  • Obtain sample when possible and determine patient group and continue with the screen and compatibility testing.
  • Inform physician if any issues occur (antibodies present)
A
40
Q

EMERGENCY REQUESTS

All blood products, regardless of how they were issued, must be traceable to the patient who received them. Thus, all patients receiving un-crossmatched blood must have 2 unique identifiers at time of product issue.
e.g. ER can verbally request units over phone, patient will have be called Trauma, A with DOB.

A
41
Q

Emergency Requests

__ __ _______ units are given to women of child-bearing age (depending on your hospital setting, the age is usually under 50) and Children Under 18 Years of age.

_ ___ Negative _____ Negative given to women of child-bearing age.

O Rh _______ units are given to everyone else.

A

O Rh Negative

O Rh; Kell

Positive

42
Q

Risks for Uncrossmatched Blood

-Significant Risk of acute hemolysis if RBC’s are issued without AHG/MTS XM and without completing an antibody identification.

-Significant Risk of severe delayed hemolytic transfusion reactions occur if patient has a history of Kidd antibodies or have Sickle Cell Disease (usually has antibodies present).

A
43
Q

ABO Selection for Transfusion

A
44
Q

Rh Compatibility

Rh Positive is labelled on the unit even if CBS has tested it to be Weak D positive.

Patients who are genotyped and found to be weak D are treated as Rh positive, except if they are Mosaic D because they can produce Anti-D.

A
45
Q

Switching Patient Back to Group Specific Blood

If a patient is not Group O but has received a large amount of Group O red cells, they may develop a positive direct antiglobulin test due to the Anti-A and Anti-B.

In some hospital protocols, after a patient has received 8 units of group O red cells within 24 hours, they do NOT switch back to group specific blood until:

____ is performed on new sample and results are negative

A

DAT

46
Q

Donor Unit Testing

  • Canadian Blood Services collects and tests all donor blood
  • Blood that is shipped to hospitals are re-checked or confirmed
  • We test the _______ (________) and _____ testing only
  • No weak D or reverse grouping are completed on the units from CBS
A

ABO (Forward)
Rh

47
Q

______ ___________ ____________

This technique is used for patients that have demonstrated Cold Agglutinin in their plasma. All other clinically significant antibodies must be excluded before use of this technique.

Patient plasma and red cell suspension is prewarmed to 37 ̊C before testing.

A

Prewarm Crossmatching Technique

48
Q

A/An ____________ crossmatch maybe used for patients who have received a massive transfusion. A massive transfusion is defined as the transfusion of a volume of packed cells approximately a whole body blood volume (10 units PC) within a 24 hour time frame. The crossmatch itself is no longer necessary, units are issued as emergency issue and not tested.

A

Abbreviated

TXN243 (4 decks)

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