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Transfusion Yr 2 Sem 2 > Compatibility > Flashcards

Compatibility Flashcards

1
Q

What is blood transfusion used for

A
  • to increase O2 carrying capacity
    -raise RBC count or Hbg
    -pts need to show symptoms of decreased O2 carrying capacity
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2
Q

Transfusion candidates have

A

-decreased RBC production - Leukemia, Marrow failure, Anemia and non nutritional anemia

-increased rbc destruction - Hemolytic anemia

-RBC loss - traumatic bleed or blood loss via surgery

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3
Q

What is informed refusal

A

Jehovahs witnesses
-can used R-HuEPO and plasma fractionated products like albumin, clottin factors, globulins
-each person decides what they are comfortable with and their refusal needs to be documented

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4
Q

What is compatibility

A

-when donor cells and proteins can survive in the recipient
-testing helps to give information but in vivo reactions cant be predicted

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5
Q

What are the limitations of compatibility testing

A

Compatibile means NO OBVIOUS incompatibility
-assume the transfusion will be successful

compatibility testing cannot prevent
-AB reactions below detectable levels
-sensitization of recipient to donor AG during transfusion
-orresponding antigen is absent from screening cells (failed to detect alloantibodies)

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6
Q

What is part of compatibility testing

A

-test pt for type and screen
-select ABO and Rh compatible donor units
-test pt and specific donor cell compatibility

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7
Q

What does a ABO / Rh
Blood Type (T&S) determine?

A

Determines ABO and Rh status
-Helps in selecting compatible blood products

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8
Q

What does Antibody Screen (T&S) determine

A

-if pt has AB
-type of crossmatch procedure

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9
Q

What is crossmatch

A

Final test of compatibility between donor and patient

  • Three methods (Immediate Spin Crossmatch, Full Crossmatch, which includes Tube and MTS, and Electronic Crossmatch)
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10
Q

how is Immediate spin done

A

2 drops of Patient Serum
1 drop 3-5% Donor Cells

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11
Q

how is a full crossmatch done

A

Patient Serum and Donor Cells
Tube IAT or MTS

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12
Q

What is Crossmatch Methods (Electronic)

A

-pt ABO and Rh needs to be typed by two techs
-pt has no ABs now or previously
-donor info has to be barcoded into computer inventory for accuracy so you cant use the donor unit until ABO and RH are verified
-Computer wont issue what is incompatible

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13
Q

What does a negative result look like for crossmatching

A

No agglutination or hemolysis = NO AG/AB reaction
therefore COMPATIBLE

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14
Q

How do you complete a donor unit selection

A

-Select ABO/RH compatible units for transfusion
-make 3-5% or 0.8% suspension for testing

if there is no evidence of significant AB in sample or history = IM XM

no evidence of significant AB in sample, history, after two ABO determinations and validated comp system = Computer XM

evidence of significant AB in current sample and history = Antiglobulin XM

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15
Q

What occurs when you have a positive AB screen

A

-get pt history
-determine if pt has been transfused or pregnant
-AB history (Red cell immune or non red cell immune)
-AB ID is required even if it is insignificant like cold AB
-pt must be phenotyped
-find out how many units are needed for testing with AG frequency calculation BEFORE getting compatible units
-Get the compatible units
-Phenotype (must LACK the ag)
-Crossmatch donor units with patient plasma via IS AND` IAT OR MTS)

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16
Q

What do you do when you have a negative AB screen with a history of AB

A

-use AG frequency calculation to see how many units are needed for testing before you look for compatible units
-select the ABO/Rh compatible units
-phenotype donor units (LACK THE AG)
-XM donor with patient plasma (IS AND IAT or IS AND MTS)
-note :“Previously identified Anti- ____ is not
detectable”
-DO NOT REPORT THE NEGATIVE SCREEN

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17
Q

What do you do when the AB screen is negative

A

-select compatible units ABO/Rh
-XM donor with patient plasma
-IM

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18
Q

if the sample is retrieved from storage what must be done

A
  • repeat the RA/RB on the sample when crossmatching
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19
Q

what type of samples are unacceptable

A

-hemolyzed
-contaminated with IV fluid (Ringers Lactate). Can cause a weak AB to be missed or cause false positives . Samples need to be collected from below the IV site, different vein or better yet another arm

20
Q

Calculating the Percentage of Antigen Negative Donors

A

of units to test = # of units required/Frequency of Ag Neg

21
Q

If a patient has AB or history of AB what is the minimum amount of units that should be avaialble

A

2 units XM compatible and phenotyped negative available for the entire hospital admittance

22
Q

How are neonatal transfusions done

A

-neonatal period is from birth to 4 months for transfusion
-transfusion of a neonate should be irradiated and <7 days old
-O Rh negative units are selected
-in emergency if irradiated blood is not available use ONE unit that is 14 days old - WBC are non viable
-only use venous or capillary NOT cord
-test only ABO/Rh NO REVERSE GROUPING
-XM donor unit to maternal plasma if needed

23
Q

when in neonatal transfusion is cross match not required

A

-MATERNAL AB SCREEN IS NEG
-INFANT’S DAT IS NEGATIVE OR POSITIVE DUE TO ABO
INCOMPATIBILITY

24
Q

When in neonatal transfusion is XM done with maternal plasma

A

-CLINICALLY SIG AB IN MATERNAL PLASMA
-SELECT BLOOD LACKING
CORRESPONDING ANTIGEN TO AB PRESENT

25
When in neonatal transfusion is XM done with infants plasma
if A MATERNAL SPECIMEN IS NOT AVAILABLE
26
how is blood for transfusion order in hospital received
-req and EDTA sample with 2 pt 2 identifiers -phlebs signature, date and time -recollection if hemolyzed ( can be mistaken for reaction) -Type and screen is performed -history of transfusion or pregnancy is determined Diagnosis: CLL (irradiated units to be given), Subgroup of A, weak reactions in RA/RB, IgA deficient
27
What is the procedure if blood products are required in a hospital
-XM with IS, Full or Electronic -2 T/S samples must be collected at different times to XM (CABO) -unit of blood product is labelled with XM card and Donor unit tag -Notify the floor -issue request form faxed from floor -ensure you check pt ID, MRN, Unit #, Group of unit, expiry date and preform a visual inspection of sample -sign XM slip and send copy to the floor -blood is issued to porter -PT is transfused after RN checks the 2 different pieces of ID -check vitals at start and regular intervals
28
most common cause of transfusion accidents
-incorrect pt ID -all ID info from bracelet, charts, records needs to match exactly -all labels need to stay on the blood bag until the transfusion is complete. PT and sample ID are the most important part of the transfusion procedure
29
What happens if there is a discrepancy between Current and Historical samples and how is it solved
- investigation -causes include : Mislabeled sample, wrong patient collection, use of incorrect health card, admission under the wrong hospital account number, and weak reactions or extra reactions in antigen or antibody reactions are misinterpreted tools used to solve : Patient History from other hospital visits, patient consultation, phlebotomist clarification, work up ABO discrepancy with enhancing, optimal incubation, saline replacement techniques, and determining current visit diagnosis
30
What does the expiry date of sample refer to?
-how long it can be used for XM -even after T/S more units can be XM -sample doesnt expire because it refers to pt AB status
31
important expiry dates
-Sample expires in 14 days if: Pt hasnt been transfused or pregnant in the last 3 months (some hospitals allow usage of the sample up to 28 days) * Sample expires in 96 hours or 4 days if Pt has been transfused or pregnant in the last 3 months (chance of immunization is ongoing, new sample required to check for newly formed antibodies)
32
how are samples stored
-keep sample for a minimum of 7 days after a transfusion in case of investigation for delayed reactions -4-6 degrees -some hospitals can keep up to 5 weeks
33
What is pre admission testing
-when pts come in 2 weeks before their surgery to do a full work up with T/S -blood bank can identify what units the pt will need or autologous units can be delivered from CBS -samples will be pulled a few days prior and checked for completion -be careful with expiry dates of the samples
34
What are the advantages of pre admission testing
-blood work is scheduled -abnormalities are found before the surgery -optimize bloodbank inventory -you have time to ID ABs present or order blood from CBS the schedule of bloodwork is agreed upon by Lab Med Director and Surgery -there is a standard unit of blood required for specific surgeries -if no units are XM then its due to low transfusion risk - IS XM is quick if needed -so blood is used efficiently
35
what is the procedure if blood is required during surgery or post op
-retrieve current sample and use for XM -if no AB then use ABO compatible blood - REPEAT ABO REVERSE on pt with plasma -do IS XM on patient plasma and donor cells (packed cells) -any group can be given PLT but Rh needs to be compatible -plasma needs to be ABO compatible ; no reverse grouping is done
36
Emergency requests
-greater time to XM has greater risk -never withhold blood as long as there is a request for un XM blood by Dr - they bare the responsibility "Dr authorization form" -Dr MUST specify they want UNCROSSMATCHED BLOOD * MUST GIVE ABO COMPATIBLE BLOOD PRODUCTS * NEVER GIVE BLOOD PRODUCTS BASED ON HISTORICAL BLOOD GROUP -obtain samples when you can and determine group and do testing -inform physician if AB are found -all blood products must have traceability to pt who got them so all pt that get un XM blood need to have 2 unique identifiers at the time product was issued -ER can request over the phone for traumas
37
During Emergency Issue, if the Group is UNKNOWN:
-O Rh Negative units are given to women of childbearing age (depending on your hospital setting, the age is usually under 50) and Children Under 18 Years of age. -O Rh Negative Kell Negative (BIG K) given to women of child-bearing age. -O Rh Positive units are given to everyone else
38
What are the Risks for Uncrossmatched Blood
-Significant Risk of acute hemolysis if RBCs are issued without AHG/MTS XM or without AB identification -* Significant Risk of severe delayed hemolytic transfusion reactions occur if the patient has a history of Kidd antibodies or has Sickle Cell Disease (usually has antibodies present).
39
Donor RBC unit must lack
antigen corresponding to antibodies of the recipient
40
Donor Plasma unit must lack
antibodies corresponding to the antigens Rh grouping is not included on plasma bag because it doesnt have any RBC
41
How are weak D labelled on the bag
Rh positive on the bag (wont know if weak D ) -unless you are Mosaic D because you can produce Anti D
42
how does Switching Patient Back to Group Specific Blood work
-if pt is not group O but got group O red cells they can have a positive direct antiglobulin because of the Anti A and Anti B -sometimes if pt has gotten 8 units of group O blood in 24hrs they will NOT switch back to specific blood group until DAT is done on new sample and results are negative
43
Donor Unit Testing
-CBS collects and tests all donor blood -blood sent to hospitals is rechecked -ABO (FORWARD) and Rh only for confirming -no weak D or reverse grouping done on units from CBS
44
What is the rewarm Crossmatching Technique
-used for patients with Cold Agglutinin in plasma -before this is used all clinically significant AB need to be excluded -pt plasma and red cell suspensions are prewarmed to 37 before testing
45
What is an abbreviated XM
-for pts who have gotten a massive transfusion (whole body blood volume) in 24 hours -XM not needed -units issued as emergency
46
What happens if there is blood shortage
-transfusion requests are reviewed by medical director -only those in life threatening conditions will get blood -youll only get RH neg blood if youre dying, RH neg with anti D or woman of childbearing years -OR surgeries are postponed unless its an emergency * Green, Amber, Red, and Recovery Phases

Transfusion Yr 2 Sem 2 (10 decks)

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