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Pathology > Ha - Blood Transfusion > Flashcards

Ha - Blood Transfusion Flashcards

1
Q

What proteins determine blood group

A

ABs and Ags - ABO and RhD

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2
Q

What happens if ABO is incompatible

A

Intravascular haemolysis - can be fatal

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3
Q

What % of people are RhD+

A

85

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4
Q

What happens if RhD- gets RhD+ blood

A

Make immune anti D

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5
Q

What do immune anti D ABs cause

A

Delayed haemolytic transfusion reaction

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6
Q

Immune anti D ABs do not cause what to RBCs?

A

NOT direct agglutination of RBCs - therefore no immediate reaction, but a delayed one

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7
Q

Do anti D cross placenta? Why/why not?

A

YES - IgG so they do

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8
Q

What 2 tests do they do for ABO group testing

A

Forward group - anti A/B/D reagents against pt’s RBC
Reverse group - known A/B groups RBCs against pt plasma

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9
Q

Who gets other RBC Ags auto reactions

A

Frequent transfusers eg sickle / pregnancy

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10
Q

What is IAT

A

Indirect anti globulin technique
Bridges RBC coated by IgG, which can’t themselves bridge 2 RBCs
Forms clumps - visible after 30 mins

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11
Q

When can you do electronic issue of blood, and what is the benefit

A

Negative AB screen
Faster, fewer staffs remote work

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12
Q

How do you do a serological cross match

A

IAT - put pt plasma incubated with donors for 30 mins to observe any reaction

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13
Q

What is the donor blood labelled with

A

ABO and RhD type
Kell
Other are Ag

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14
Q

What is the legal requirement for all blood products

A

They should be 100% traceable to donor

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15
Q

3 pillars of patient blood management

A

Optimise haemopoeisis
Minimise blood loss and bleeding
Harness and optimise physiological tolerance of anaemia

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16
Q

How is blood loss minimised pre transfusion

A

Tranexamic acid
Stop anticoagulant
Cell salvage

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17
Q

Why should blood be given

A

Bleeding
Anaemic
Sx
Transfusion will solve the problem
Benefits vs risk
Alternative Tx not appropriate

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18
Q

Tx alternatives to blood products

A

Iron
B12
EPO
Folate
Cell salvage

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19
Q

Emergency blood

A

O-

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20
Q

How are red cells stored & given

A

4 degrees for 35 days
Transfuse within 4 hours of leaving fridge, IV over 2-3 hours

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21
Q

How are platelets stored / used

A

20 degrees (room temp) for 7 days
Transfuse IV over 20 to 30 mins

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22
Q

Do platelets have ABO/RhD

A

Yes - weakly expressed but not massively

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23
Q

What is the risk with platelet transfusion and why

A

Bacterial infection - stored at room temp

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24
Q

Do FFP/cryoprecipitate have ABO/RhD

A

ABO but not RhD

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25
Q

How is FFP/cryo stored / given

A

30 to 40 mins to thaw
FFP - keep at 4 degrees for 24 hours
Cryo - keep at RT and use within 4hrs
Transfuse IV over 20 to 30 mins

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26
Q

What type is the universal plasma donor

A

AB - neither ABs in

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27
Q

What is the maximum surgucal blood ordering schedule for / how does it work

A

Predicted blood loss for planned surgery to allow them to decide what is normal
Then do G&S then can do electronic issue within 10 mins when requested
Do cross match if Hx of ABs reactivity

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28
Q

Indicators for RBC

A

Haemorrhage - >30% volume lost
Peri op /crit care - hb <70
Post chemo - <80

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29
Q

Indications for platelets

A

Big transfusion aim >75
Post chemo <10
Surg <50
Plt dysfunction, only if active bleeding

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30
Q

When are platelets CI

A

HiTT or TTP

31
Q

Indications for FFP

A

TTP
Deficiency of coagulation factors when active bleeding

32
Q

How is cryoprecipitate different to FFP

A

More fibrinogen in cryo vs FFP

33
Q

How much does cryo raise the fibrinogen by

A

1g/L

34
Q

What is the closest used alternative to autologous blood transfusions

A

Cell salvage during operations

35
Q

When is CMV- blood needed

A

Pregnant / neonates / IU

36
Q

When is irrigated blood needed

A

Highly immune suppressed

37
Q

When is washed blood needed

A

Severe allergic reaction to donor blood previously

38
Q

% of UK that are O vs A vs B vs AB

A

47% O
42% A
8% B
3% AB

39
Q

Acute reactions to transfusion (<24hrs)

A

ABO incompatible
Allergy
TACO - transfusion associated circulatory overload
Incorrect component transferred

40
Q

Delayed reaction to transfusions (>24hrs)

A

Iron overload
GVHD
Malaria and other infections

41
Q

Sx of acute transfusion reaction

A

Fever, rigors, chest/loin pain, collapse

42
Q

Monitoring done for acute transfusion reactions

A

Baseline temp / pulse / RR / BP
Repeat after 15 mins
Repeat hourly
Repeat after transfusion finished

43
Q

What is febrile non haem transfusion reaction inc when it occurs

A

During / soon after
Rise of temp by 1 degree, chills, rigors

44
Q

Mx febrile non haem transfusion reaction

A

Slow / stop transfusion

45
Q

Mx of allergy to transfusion product

A

Slow / stop transfusion
Antihistamines if needed

46
Q

Sx of wrong blood given

A

Low BP
High HR, temp
Restless
Chest / loin pain
Collapse

47
Q

Mx of wrong blood given

A

Send cross match
Call haem

48
Q

Sx of bacterial contamination of blood

A

Restless, fever, vomiting, flushing, collapse
Low BP, high HR, high temp

49
Q

In which blood product is bacterial contamination the most common and why

A

Platelets - kept at room temp

50
Q

What is the protocol if RBCs have been out of fridge for up to 30 mins and aren’t needed anymore

A

Return to fridge for min 6 hours
Transfuse over max 4 hours

51
Q

Cause of anaphylaxis to blood product

A

IgE ABs in pt cause mast cell release of granules and vasoactive substances

52
Q

Most common resp complication of transfusion

A

TACO

53
Q

What is TACO

A

Transfusion associated circulatory overload - fluid overload

54
Q

What does TACO look like on CXR

A

Pulmonary oedema

55
Q

When does TACO present

A

Within 6hours of transfusion

56
Q

RFs for TACO

A

Cardio / resp disease
<50kg
IV fluids / fluid balance
Diuretics
CKD

57
Q

Prevention of TACO

A

Single unit transfusion and reassess

58
Q

What is TRALI

A

transfusion related acute lung injury

59
Q

What is TRALI similar to

A

ARDS

60
Q

Mechanism of TRALI

A

anti HLA ABs

61
Q

Why are transfusions still only given sparingly

A

Still a potential risk of infection

62
Q

What causes delayed haemolytic transfusion reaction (inc % of people)

A

1-3% of people develop immune AB to RBC Ag

63
Q

Ix and results for delayed haemolytic transfusion reaction

A

Haemolysis screen - high BR, high LDH, low Hb
U&Es
G&S - any new ABs formed

64
Q

Mechanism of TA-GvHD

A

Donor blood contains lymphocytes that can divide
Recipient is imm supp so can’t destroy the foreign lymphocytes
Donor lymphocytes destroy host tissues

65
Q

How do you prevent TA-GvHD

A

Leucodepletion
Irradiation of blood products for imm supp

66
Q

Prognosis of post transfusion purpura

A

Clears in a few weeks
Can increase bleeding

67
Q

How many transfusions cause iron overload

A

> 50

68
Q

Tx and Tx threshold for iron overload

A

Iron chelation (exjade tablet) once ferritin >1000

69
Q

Mechanism of haemolytic disease of newborn

A

Foetal RBCs enter mothers circulation causing RhD anti D production if mum is RhD- and foetus RhD+
2nd preg —> anti D from mother crosses placenta and enters foetal circulation, attacking foetal RBCs if RhD+
Causes foetal anaemia and hydrous fetalis

70
Q

Tx of haemolytic disease of newborn

A

G&S at booking and 28 weeks
If AB present - check fathers RhD status to see if baby could be RhD and monitor anti D levels in preg
MCA Doppler to monitor foetus for anaemia
Deliver early
IU transfusion to baby if needed

71
Q

How to prevent sensitisation events for RhD

A

Always given RhD neg blood if unknown blood group / RhD- mother
Give anti D within 72hrs of sensitisation event

72
Q

What are the doses for anti D

A

250IU if event before 20 weeks
500IU if event after 20 weeks, inc at delivery

73
Q

What test is done to determine how much anti D to give

A

Kleihaur

Pathology (87 decks)

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