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Pathology Summaries > HAEM: Blood transfusion > Flashcards

HAEM: Blood transfusion Flashcards

1
Q

Which blood group antibodies decline with age? What are these associated with in terms of blood transfusion?

A

Anti-Duffy and Kidd = these can cause delayed transfusion reactions

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2
Q

In GROUP testing, what type of reaction indicates that the antibody/antigen is present in the patient’s blood?

A 
Present = agglutination at the top 
Absent = RBCs suspended at the bottom of vial
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3
Q

In SCREEN testing, what technique is used? What are the 3 components?

A

IAT = indirect antiglobulin technique at 37oC

Using patient serum + lab RBCs + anti-human globulin (AHG)

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4
Q

What type of antibodies does group vs screen testing test for ?

A 
Group = IgM - prevent immediate reaction
Screen = IgG - prevent delayed reaction
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5
Q

What is the result of a positive screen test?

A

Clumping

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6
Q

How is crossmatching done? What component of donor blood is used?

A

Plasma is used

Full crossmatch - ises IAT
Immediate spin - emergency only, detects ABO incompatibility only

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7
Q

Why does AGH have to be added in the screen test?

A

Because IgG would not cause clumping of the cells by itself like IgM does, so you wouldn’t see the positive result

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8
Q

Is Kell negative blood used?

A

Yes - for women of childbearing age

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9
Q

How is plasma stored?

A

Frozen - infused over 20-30min

Low risk of bacterial contamination as stored frozen SO if reaction occurs it’s more likely anaphylactic

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10
Q

Which compatibility needs to be checked for platelets and plasma transfusions?

A 
Platelets = D only 
Plasma = ABO only
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11
Q

Why are PLATLETS given over 20-30min?

A

Stored at room temp so high risk of bacterial contamination

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12
Q

How long can FFP vs cryoprecipitate be stored once thawed?

A 
FFP = keep 24hrs at 4oC
Cryo = keep 4hrs at RT
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13
Q

When is transfusion indicated in…

(a) major blood bloss
(b) peri-op/critical care
(c) post-chemo

A

a) if >30% lost
b) if Hb <70g/L and 80g/L respectively
c) if Hb <80g/L

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14
Q

Name 2 CI to platelet transfusion.

A

HiTT (heparin induced thrombocytopenia thrombosis)

TTP

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15
Q

How much does 1U platelets raise plt?

A

30-40x10^9/L

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16
Q

When should you consider FFP?

A 
Massive transfusion 
Liver disease
Single factor def
DIC bleeding 
TTP
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17
Q

What contains 2/7/9/10?

A

Prothrombin complex concentrate

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18
Q

Are FFP and plt cross-matched?

A

No, only group matched

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19
Q

What does blood irradiation do? What about washing?

A

Irradiation - prevents TA-GvHD

Washing - removes most plasma, platelets and WBC (useful for IgA deficient patients)

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20
Q

What is the RBC:FFP given in major bleeding?

A

1:1 usually x4 each
NB: add 50mg/kg fibrinogen if given more than 4 units

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21
Q

Name 2 respiratory related acute transfusion reactions.

A

TACO - circulatory overload

TRALI - acute lung injury

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22
Q

Other than TACO/TRALI, what are the acute transfusion reactions?

A

Acute haemolytic (ABO)
Allergic
Infective - bacterial
Febrile non-haemolytic

23
Q

What is a delayed transfusion reaction?

A

Occurs >24hrs post-transfusion

24
Q

Give 4 examples of delayed transfusion reactions.

A 
Delayed haemolytic (Duffy, Kidd) --> alloimmunisation 
TA-GvHD (>2w)
Infective - viral/prion/malaria 
Post transfusion purpura 
Iron overload
25
Q

What does SHOT and MSBOS stand for?

A 
SHOT = serious hazard of transfusion 
MSBOS = maximum surgical blood ordering schedule
26
Q

What are the first signs of acute reaction to transfusion?

A

Temp/HR rise
BP drop

Other symptoms:

  • flushing, urticaria, pain at site, itching
  • headache
  • collapse
  • vomiting
  • chest pain
27
Q

How often do you monitor for transfusion reactions in an unconscious patient?

A 
0min
15min
1hr 
2hrs
\+1hr etc
\+end of transfusion
28
Q

What is the cause of febrile NHTR? How is it managed?

A

Cytokine release from WBC during storage

Tx: stop/slow transfusion + paracetamol

29
Q

What type of haemolysis occurs in ABO incompatibility?

A

Acute intravascular

30
Q

What may be seen in urine in ABO incompatibility?

A

Haemoglobinuria (later sign)

31
Q

How severe are bacterial transfusion reactions?

A

severe/fatal - presents like ABO incompatibility with restlessness/vomiting/flushing/collapse

32
Q

What blood products are most and least associated with contamination?

A

plt»RBC>FFP

33
Q

How long can platelets be stored?

A

7 days at RT

34
Q

How long can RBCs be stored?

A

35 days at 4oC

35
Q

What is the mechanism of allergic transfusion reaction? Are these reactions severe?

A

IgE mediated

Usually not severe except IgA DEFICIENCY (common, IgA Abs form when exposed to donor)

36
Q

What is the cause of TACO and what are some signs/symptoms?

A

Caused by fluid overload or hypoalbuminaemia.

Sx: Fluid overload on CXR, SOB, low sats, high HR and high BP.

37
Q

What is the cause of TRALI?

A

No clinical fluid overload but lung injury like ARDS due to ANTI-WBC antibodies in donor blood. These aggregate and stick to capillaries which causes inflammation and lung injury.

Sx: SOB, low sats, high BP and high HR, fever, bilateral pulmonary infiltrated within 6hrs of transfusion on CXR

38
Q

What is the response to diuretics in TACO vs TRALI?

A

TACO - responds

TRALI - no

39
Q

What compatibility of platelets and RBC can a patient with… receive?

a) O blood
b) AB blood

A

O blood can receive..

  • only O RBCs
  • A, AB, B, O platelets

AB blood can receive…

  • only AB platelets
  • A, AB, B, O blood
40
Q

What platelets and RBCs can a patient with B blood receive?

A

Platelets: B, AB
RBC: B, O

41
Q

What donors should be used for plasma platelets and why?

A

Male for both - not likely to be sensitised so no HLA/HNA Abs

42
Q

What is the most common delayed TR and what is the consequence of this?

A

Delayed haemolytic = against Kell, Duffy

–> ALLOIMMUNISATION

43
Q

What is the management of alloimmunisation?

A

Repeat group and screen

44
Q

Who receives CMV negative blood?

A

Preg and neonates

45
Q

What is the pathophysiology of TA-GvHD? How do you prevent it?

A

Immunosuppressed patients cannot destroy donor lymphocytes which are able to divide and destroy tissue
Prevention: irradiate blood or HLA-match

46
Q

What are the signs/symptoms of TA-GvHD?

A

gut –> diarrhoea
liver –> failure
skin –> desquamation

and BM failure

47
Q

When does post-transfusion purpura occur?

A

7-10 days later

48
Q

Who is affected by post-transfusion purpura?

A

Human platelet antigen 1-ve patients
Previously immunised patients via blood or transfusion
Exact mechanism UNKNOWN

49
Q

What is the management of post-transfusion purpura?

A

IVIG - will resolve in 1-4 weeks

50
Q

How much iron in each unit of blood?

A

200-250mg

51
Q

When is a Kleinhauer test done?

A

Bleeding over 20 weeks and at delivery only

52
Q

What volume of fetal-maternal bleed do these anti-D doses cover for?

1) 500IU
2) 1250IU
3) 1500IU

A

1) 4ml
2) 10ml
3) 12ml

53
Q

Other than anti-D, name 2 Abs which can cause haemolysis in a newborn.

A

Anti-C

Anti-Kell

Pathology Summaries (23 decks)

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