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Clinical Pathology > Core Haematology - Blood Transfusion (35) > Flashcards

Core Haematology - Blood Transfusion (35) Flashcards

1
Q

Leucodepletion

A

Whole blood filtered, then WBC removed

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2
Q

Leucodepletion

A

Whole blood filtered, then WBC removed

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3
Q

How long does it take to transfused 1 unit of RBC?

A

1.5-3 hours

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4
Q

What is limit on unit of RBC after removal from cold storage > end of transfusion?

A

4 hour limit

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5
Q

Does warmer or colder blood transfuse faster?

A

Warmer

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6
Q

What temperature is it stored at and for how many days?

A

4 degrees for up to 35 days from collection

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7
Q

Most of plasma removed to leave conc RBC and replaced by a solution of

A

Electrolytes, glucose and adenine to keep RBC healthy

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8
Q

Why do we transfuse patients?

A

Prevent symptoms, prevent end organ damage and improve QoL of anaemic patients

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9
Q

Symptoms of anaemia are due to

A

Tissue hypoxia

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10
Q

Transfusion threshold (trigger)

A

Lowest concentration of Hb that is not associated with symptoms of anaemia

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11
Q

Mechanism of adaption to anaemia

A

Increased:

  • CO
  • Cardiac artery blood flow
  • Oxygen extraction
  • RBC 2,3 DPG (diphosphoglycerate)
  • Production of EPO
  • Erythropoiesis
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12
Q

Things that affect adaption to anaemia

A
  • Acute/Chronic
  • Underlying (CVD, drugs, resp disease)
  • Elderly
  • Transfusion
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13
Q

When transfuse RBC?

A

-

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14
Q

When not transfuse? (treatable causes)

A

Iron deficiency, B12 and folate deficiency, erythropoietin treatment renal disease (correct tablets)

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15
Q

When not to transfuse? (coagulopathy)

A

Discontinuation of anti-platelet agents, administration of anti-fibrinolytic agents

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16
Q

BSCH guideline for transfusion in acute anaemia due to blood loss

A

Lose >30% of volume (>1,500ml)

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17
Q

Alternative to transfusion

A

Cell salvage

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18
Q

Chronic anaemia

A

Regular transfusions due to myeloid failure syndromes

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19
Q

Reason for regular transfusion for chronic anaemia

A
  • Symptomatic relief of anaemia
  • Improvement of QoL
  • Prevention of ischaemic organ damage
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20
Q

Threshold (target) for chronic anaemia transfusion

A

Hb 80-100g/dl

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21
Q

What do you need to take into account with patients with thalassaemia?

A

Iron overload (can be fatal - cardiomyopathy/liver failure)

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22
Q

Objectives in thalassaemia

A

Suppress endogenous erythropoiesis (balance between bone marrow suppression and Fe overload)

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23
Q

Threshold for Thalassaemia

A

90-95g/dl (target 100-120)

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24
Q

What temperature at platelets stored at?

A

22 degrees

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25
Q

How many days from collection are platelets stored?

A

5 days

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26
Q

Adult therapeutic dose

A

Platelets from 4 pooled donations/1 apheresis donation

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27
Q

Apheresis donation

A

Just platelets

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28
Q

What is usual transfusion time for platelets?

A

1 unit in 30 mins

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29
Q

Why transfuse platelets?

A
  • Treatment of bleeding due to severe thrombocytopenia/platelet dysfunction
  • Prevention of bleeding
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30
Q

When would you transfuse platelets?

A

Massive haemorrhage, bone marrow failure, prophylaxis for surgery

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31
Q

Contraindications for transfusing platelets

A
  • Heparin induced thrombocytopenia/thrombosis

- Thrombotic thrombocytopenic purpura

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32
Q

Fresh frozen plasma stored at what temp

A

Minus 30, for 24 months (20-30 mins to thaw)

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33
Q

Dose of fresh frozen plasma

A

12-15ml/kg (4-6 units as adult)

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34
Q

Transfusion time of FFP

A

30 mins/unit

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35
Q

Indications for FFP

A

Coagulopathy with bleeding/surgery, massive haemorrhage, thrombotic thrombocytopenic purpura

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36
Q

Contraindications for FFP

A

Warfarin reversal or replacement of single factor deficiency

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37
Q

Special transfusions

A
  1. CMV negative blood

2. Irradiated blood

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38
Q

CMV negative blood use for

A
  • Children
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39
Q

Irradiated blood used for

A

(Avoiding graft verus host disease T-cell deficiency)

  • Congenital immunodeficiency
  • Hodgkins lymphoma
  • Stem cell/transplant patients
  • After purine analogue chemo
  • Intrauterine transfusion
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40
Q

Group and screen tests

A
  • ABO and Rh (D) group

- Antibodies against significant groups

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41
Q

If positive for antibodies

A

Test plasma against panel of RBC containing significant blood groups, using Antiglobulin test

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42
Q

Crossmatching

A

Patients plasma is mixed with aliquots of donor red cells to see if reaction (agglutination/haemolysis)

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43
Q

If crossmatching reaction

A

RBC incompatible, risk of acute haemolysis

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44
Q

Acute immunological effects of transfusion

A
  • ABO incompatibility
  • Acute haemolytic transfusion reaction
  • Allergic/anaphylactic reaction
  • Transfusion-related acute lung injury (TRALI)
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45
Q

Acute non-immunological effects of transfusion

A
  • Bacterial contamination
  • Transfusion associated circulatory overload (TACO)
  • Febrile non-haemolytic transfusion reaction
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46
Q

When do acute adverse reactions to transfusion occur?

A
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47
Q

When do delayed adverse reactions to transfusion occur?

A

> 24 hours after

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48
Q

Delayed immunological effects of transfusion

A
  • Transfusion-associated graft-verus-host disease (TA-GvHD)

- Post transfusion purpura

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49
Q

Delayed non-immunological effects of transfusion

A

Transfusion transmitted infection (TTI) - viral/prion

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50
Q

Prion disease reduce risk of transmission

A
  • Leucodepletion
  • UK plasma not used for fractionation
  • Imported FFP for patients after 1996
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51
Q

Acute haemolytic reaction-ABO incompatibility

A
  • Release of free Hb
  • Deposition of Hb in distal renal tubule > acute renal failure
  • Stimulation of coagulation > microvascular thrombosis
  • Stimulation of cytokines
  • Scavenges NO > generalised vasoconstriction
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52
Q

Onset of Acute haemolytic reaction-ABO incompatibility

A

Within first 15 mins

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53
Q

Acute haemolytic reaction-ABO incompatibility prognosis

A

Fatal 20-30%

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54
Q

Acute haemolytic reaction-ABO incompatibility signs and symptoms

A

Fever and chills, back pain, infusion pain, hypotension/shock, haemoglobinuria, increased bleeding, chest pain, sense of impending death

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55
Q

Cause of ABO incompatibility

A

HUMAR ERROR

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56
Q

Delayed haemolytic reaction onset

A

3-14 days following transfusion

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57
Q

Delayed haemolytic reaction clinical features

A

Fatigue, jaundice, fever

58
Q

Delayed haemolytic reaction lab findings

A

Decreased Hb, increased LDH, increased indirect bilirubin

59
Q

Delayed haemolytic reaction direct antiglobulin test is

A

Positive

60
Q

What is a Delayed haemolytic reaction?

A

Immune IgG antibodies against RBC antigens other than ABO (formed after transfusion)

61
Q

Coomb’s test

A

Anti-human globulin to detect incomplete IgG antibodies

62
Q

Positive Coomb’s test

A
  1. Red cells coated with IgG antibody (anti-Rh in Rh +ve)
  2. Anti-human globulin added
  3. Visible agglutination
63
Q

Transfusion related lung injury

A

5-10% fatal, donor has antibodies to recipient’s leucocytes, activated WBC lodge in pulmonary capillaries and release substances > endothelial damage and capillary leak

64
Q

Diagnosis of TRALI

A

Sudden onset, within 6 hours, acute lung injury (hypoxemia, bilateral chest x-ray infiltrates, no vol overload)

65
Q

TRALI recovery

A

Within 72-96 hours

66
Q

Transfusion-associated circulatory overload (TACO) presentation

A

Sudden dyspnea, orthopnoea, tachycardia, hypertension, hypoxemia, raised BP, elevated JVP

67
Q

TACO risk factors

A

Elderly, children, compromised LV function, increased vol of transfusion/rate of transfusion

68
Q

Minor allergic reactions

A

Urticarial/hives rash, wheeze, hypersensitivity to ‘random’ plasma protein

69
Q

Severe allergic reactions

A

Anaphylaxis - severe, wheeze/asthma, increased pulse, low BP, laryngeal/facial oedema

70
Q

Allergic reactions laboratory investigations

A

IgA and anti-IgA antibodies

71
Q

Febrile non-haemolytic transfusion reactions (FNHTR)

A

Due to cytokines accumulating, self-limited, fever, shakes, rigors, increase pulse

72
Q

How long does it take to transfused 1 unit of RBC?

A

1.5-3 hours

73
Q

What is limit on unit of RBC after removal from cold storage > end of transfusion?

A

4 hour limit

74
Q

Does warmer or colder blood transfuse faster?

A

Warmer

75
Q

What temperature is it stored at and for how many days?

A

4 degrees for up to 35 days from collection

76
Q

Most of plasma removed to leave conc RBC and replaced by a solution of

A

Electrolytes, glucose and adenine to keep RBC healthy

77
Q

Why do we transfuse patients?

A

Prevent symptoms, prevent end organ damage and improve QoL of anaemic patients

78
Q

Symptoms of anaemia are due to

A

Tissue hypoxia

79
Q

Transfusion threshold (trigger)

A

Lowest concentration of Hb that is not associated with symptoms of anaemia

80
Q

Mechanism of adaption to anaemia

A

Increased:

  • CO
  • Cardiac artery blood flow
  • Oxygen extraction
  • RBC 2,3 DPG (diphosphoglycerate)
  • Production of EPO
  • Erythropoiesis
81
Q

Things that affect adaption to anaemia

A
  • Acute/Chronic
  • Underlying (CVD, drugs, resp disease)
  • Elderly
  • Transfusion
82
Q

When transfuse RBC?

A

-

83
Q

When not transfuse? (treatable causes)

A

Iron deficiency, B12 and folate deficiency, erythropoietin treatment renal disease (correct tablets)

84
Q

When not to transfuse? (coagulopathy)

A

Discontinuation of anti-platelet agents, administration of anti-fibrinolytic agents

85
Q

BSCH guideline for transfusion in acute anaemia due to blood loss

A

Lose >30% of volume (>1,500ml)

86
Q

Alternative to transfusion

A

Cell salvage

87
Q

Chronic anaemia

A

Regular transfusions due to myeloid failure syndromes

88
Q

Reason for regular transfusion for chronic anaemia

A
  • Symptomatic relief of anaemia
  • Improvement of QoL
  • Prevention of ischaemic organ damage
89
Q

Threshold (target) for chronic anaemia transfusion

A

Hb 80-100g/dl

90
Q

What do you need to take into account with patients with thalassaemia?

A

Iron overload (can be fatal - cardiomyopathy/liver failure)

91
Q

Objectives in thalassaemia

A

Suppress endogenous erythropoiesis (balance between bone marrow suppression and Fe overload)

92
Q

Threshold for Thalassaemia

A

90-95g/dl (target 100-120)

93
Q

What temperature at platelets stored at?

A

22 degrees

94
Q

How many days from collection are platelets stored?

A

5 days

95
Q

Adult therapeutic dose

A

Platelets from 4 pooled donations/1 apheresis donation

96
Q

Apheresis donation

A

Just platelets

97
Q

What is usual transfusion time for platelets?

A

1 unit in 30 mins

98
Q

Why transfuse platelets?

A
  • Treatment of bleeding due to severe thrombocytopenia/platelet dysfunction
  • Prevention of bleeding
99
Q

When would you transfuse platelets?

A

Massive haemorrhage, bone marrow failure, prophylaxis for surgery

100
Q

Contraindications for transfusing platelets

A
  • Heparin induced thrombocytopenia/thrombosis

- Thrombotic thrombocytopenic purpura

101
Q

Fresh frozen plasma stored at what temp

A

Minus 30, for 24 months (20-30 mins to thaw)

102
Q

Dose of fresh frozen plasma

A

12-15ml/kg (4-6 units as adult)

103
Q

Transfusion time of FFP

A

30 mins/unit

104
Q

Indications for FFP

A

Coagulopathy with bleeding/surgery, massive haemorrhage, thrombotic thrombocytopenic purpura

105
Q

Contraindications for FFP

A

Warfarin reversal or replacement of single factor deficiency

106
Q

Special transfusions

A
  1. CMV negative blood

2. Irradiated blood

107
Q

CMV negative blood use for

A
  • Children
108
Q

Irradiated blood used for

A

(Avoiding graft verus host disease T-cell deficiency)

  • Congenital immunodeficiency
  • Hodgkins lymphoma
  • Stem cell/transplant patients
  • After purine analogue chemo
  • Intrauterine transfusion
109
Q

Group and screen tests

A
  • ABO and Rh (D) group

- Antibodies against significant groups

110
Q

If positive for antibodies

A

Test plasma against panel of RBC containing significant blood groups, using Antiglobulin test

111
Q

Crossmatching

A

Patients plasma is mixed with aliquots of donor red cells to see if reaction (agglutination/haemolysis)

112
Q

If crossmatching reaction

A

RBC incompatible, risk of acute haemolysis

113
Q

Acute immunological effects of transfusion

A
  • ABO incompatibility
  • Acute haemolytic transfusion reaction
  • Allergic/anaphylactic reaction
  • Transfusion-related acute lung injury (TRALI)
114
Q

Acute non-immunological effects of transfusion

A
  • Bacterial contamination
  • Transfusion associated circulatory overload (TACO)
  • Febrile non-haemolytic transfusion reaction
115
Q

When do acute adverse reactions to transfusion occur?

A
116
Q

When do delayed adverse reactions to transfusion occur?

A

> 24 hours after

117
Q

Delayed immunological effects of transfusion

A
  • Transfusion-associated graft-verus-host disease (TA-GvHD)

- Post transfusion purpura

118
Q

Delayed non-immunological effects of transfusion

A

Transfusion transmitted infection (TTI) - viral/prion

119
Q

Prion disease reduce risk of transmission

A
  • Leucodepletion
  • UK plasma not used for fractionation
  • Imported FFP for patients after 1996
120
Q

Acute haemolytic reaction-ABO incompatibility

A
  • Release of free Hb
  • Deposition of Hb in distal renal tubule > acute renal failure
  • Stimulation of coagulation > microvascular thrombosis
  • Stimulation of cytokines
  • Scavenges NO > generalised vasoconstriction
121
Q

Onset of Acute haemolytic reaction-ABO incompatibility

A

Within first 15 mins

122
Q

Acute haemolytic reaction-ABO incompatibility prognosis

A

Fatal 20-30%

123
Q

Acute haemolytic reaction-ABO incompatibility signs and symptoms

A

Fever and chills, back pain, infusion pain, hypotension/shock, haemoglobinuria, increased bleeding, chest pain, sense of impending death

124
Q

Cause of ABO incompatibility

A

HUMAR ERROR

125
Q

Delayed haemolytic reaction onset

A

3-14 days following transfusion

126
Q

Delayed haemolytic reaction clinical features

A

Fatigue, jaundice, fever

127
Q

Delayed haemolytic reaction lab findings

A

Decreased Hb, increased LDH, increased indirect bilirubin

128
Q

Delayed haemolytic reaction direct antiglobulin test is

A

Positive

129
Q

What is a Delayed haemolytic reaction?

A

Immune IgG antibodies against RBC antigens other than ABO (formed after transfusion)

130
Q

Coomb’s test

A

Anti-human globulin to detect incomplete IgG antibodies

131
Q

Positive Coomb’s test

A
  1. Red cells coated with IgG antibody (anti-Rh in Rh +ve)
  2. Anti-human globulin added
  3. Visible agglutination
132
Q

Transfusion related lung injury

A

5-10% fatal, donor has antibodies to recipient’s leucocytes, activated WBC lodge in pulmonary capillaries and release substances > endothelial damage and capillary leak

133
Q

Diagnosis of TRALI

A

Sudden onset, within 6 hours, acute lung injury (hypoxemia, bilateral chest x-ray infiltrates, no vol overload)

134
Q

TRALI recovery

A

Within 72-96 hours

135
Q

Transfusion-associated circulatory overload (TACO) presentation

A

Sudden dyspnea, orthopnoea, tachycardia, hypertension, hypoxemia, raised BP, elevated JVP

136
Q

TACO risk factors

A

Elderly, children, compromised LV function, increased vol of transfusion/rate of transfusion

137
Q

Minor allergic reactions

A

Urticarial/hives rash, wheeze, hypersensitivity to ‘random’ plasma protein

138
Q

Severe allergic reactions

A

Anaphylaxis - severe, wheeze/asthma, increased pulse, low BP, laryngeal/facial oedema

139
Q

Allergic reactions laboratory investigations

A

IgA and anti-IgA antibodies

140
Q

Febrile non-haemolytic transfusion reactions (FNHTR)

A

Due to cytokines accumulating, self-limited, fever, shakes, rigors, increase pulse

Clinical Pathology (60 decks)

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