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METABOLIC > HAEMATOLOGY - BLOOD TRANSFUSIONS > Flashcards

HAEMATOLOGY - BLOOD TRANSFUSIONS Flashcards

1
Q

What are the 4 blood transfusion services in the UK?

A

NHS blood and transplant for England

• The Scottish national blood transfusion service
• The welsh blood service
• The Northern Ireland blood transfusion service

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2
Q

What are warm and cold antibodies?

A

Some antibodies react with red cells around normal body temperature (warm antibodies). Others are only active at lower temperatures (cold antibodies) and do not usually cause clinical problems although they may be picked up on laboratory testing.

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3
Q

What class of immunoglobulins are anti-A and anti-B antibodies?

A

Mainly IgM -

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4
Q

What class of immunoglobulins are Rh antigens?

A

IgG

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5
Q

What is a direct anti globulin test also known as?

A

Coombs test

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6
Q

What are the 2 different types of Coombs tests and what are the differences?

A

Direct Coombs test - detects antibodies or complement on the surface of RBCs
Indirect Coombs test - detects antibodies in the serum.

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7
Q

What are the uses for direct Coombs test?

A

Autoimmune haemolysis
Drug induce haemolysis
Alloimmune haemolysis (haemolytic disease of the newborn or alloimmune haemolytic transfusion reaction)

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8
Q

What are the uses for indirect Coombs test?

A

Pre transfusion testing e.g. blood types and cross matching
Prenatal antibody screen

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9
Q

Whats a positive Coombs test?

A

Visible agglutination

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10
Q

which immunoglobulin crosses the placenta

A

IgG

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11
Q

Whats the rarest blood type?

A

AB-

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12
Q

Whats the most common blood type?

A

O+ (37% of population)

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13
Q

Whats the difference between homologous and autologous transfusions?

A

Autologous blood transfusion is the collection and re-infusion of the patient’s own blood or blood components. Homologous, or more correctly allogenic, blood transfusions involves someone collecting and infusing the blood of a compatible donor into him/herself.

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14
Q

Whats the universal donor blood type?

A

O negative

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15
Q

Whats blood mixed with once collected to prevent it from coagulating?

A

Sodium citrate

Citrate reduces the ionized calcium levels in the blood, which prevents the blood from clotting.

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16
Q

Whats the universal recipient?

A

AB

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17
Q

Which blood can people with Rh+ blood have?

A

Rh+ or Rh- blood as they don’t have antibodies against the Rh glycoprotein

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18
Q

What happens if a Rh- person receives Rh+ blood?

A

They could develop a haemolytic transfusion reaction as they have anti-Rh antibodies so can only recieve Rh- blood

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19
Q

How is blood typing tested?

A

A blood sample is mixed with anti-A/antiB antibodies
If an agglutination reaction occurs when mixing with anti-A antibodies but not when mixing with anti-B antibodies then they have type A blood (as they have A antigens on RBC surface)

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20
Q

What is cross matching?

A

When the recipients serum gets mixed with the donors blood to check for agglutination
If it des then it means the recipients blood contains antibodies against donors RBCs so cannot recieve it - this is important in case there are additional glycoproteins causing a reaction not identified by blood typing

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21
Q

Outline the epidemiology of rhesus positive and negative blood?

A

85% of the population have rhesus positive blood so can recieve any type of blood
15% are RhD negative so can only recieve RhD negative blood

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22
Q

What is ‘group and save’?

A

A quick check for blood group compatibility just looking at ABO - takes about 15 minutes

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23
Q

Whats the minimum age and weight for donating blood?

A

17
50kg

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24
Q

How often can you donate blood?

A

The normal interval between whole blood donations is 16 weeks but no more than 3 donations a year are collected from female donors because of a more precarious iron status

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25
Q

What infectious agents are screened for when donating blood?

A

hepatitis B
hepatitis C
hepatitis E
HIV
treponemal infections (like syphilis)
Donations from new donors and those used for non-leucodepleted components are tested for human T cell lymphotropic virus (HTLV).

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26
Q

What volume is a whole blood donation?

A

470ml

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27
Q

Why are most WBC removed from blood donations?

A

To reduce the incidence of febrile transfusion reactions, alloimmunisation to white cells and to reduce the risk of vCJD

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28
Q

What is irradiated blood?

A

Cellular blood components which have been exposed to irradiation via x-ray or gamma rays to inactivate lymphocytes

This prevents transfusion- Associated Graft-versus-Host Disease (TA-GvHD)

29
Q

Who needs to recieve irradiated blood components?

A

Patients recieving transfusions from a first or second degree relative
Patients receiving a granulocyte transfusion
Recieving HLA selected components
Recieving purine analogues
All intrauterine transfusions
Neonates
Those with Hodgkin lymphoma
Those recieving allogenic or autologous HSC grafts
Those with aplastic anaemia recieving immunosuppressive therapy with anti-thymocyte globulin or alemtuzumab
Those with T cell immunodeficiency

30
Q

What is transfusion- Associated Graft-versus-Host Disease (TA-GvHD)?

A

a rare complication of blood transfusion, in which the immunologically competent donor T lymphocytes mount an immune response against the recipient’s lymphoid tissue. In situations where the recipient is severely immunocompromised, or when the donor and recipient HLA type is similar (as can occur in directed donations from first-degree relatives), the recipient’s immune system is not able to destroy the donor lymphocytes.

31
Q

What are symptoms and signs of transfusion-associated-graft-versus-host disease?

A

2 days-6 weeks after transfusion

fever
erythematous maculopapular rash, which can progress to generalised erythroderma
toxic epidermal necrolysis in extreme cases
hepatomegaly
diarrhea

32
Q

How are red cells stored and used?

A

Shelf life 35 days
Stored 4 degrees
Transfusion should be completed within 4 hours of removal from storage

33
Q

How are platelets stored and used?

A

Shelf life 5 days
Stored at 20-24 degrees on agitation rack
Must be used within 4 hours of collection from stoage

34
Q

How are FFP and cryoprecipitate stored and used?

A

Shelf life 1 years
Stored -30 degrees
Thaw at 37 degrees and use within 4 hours

35
Q

What should you do if you have unused red cells that have not been transfused within 4 hours of removal from storage?

A

They must be returned to the Hospital Transfusion laboratory with clear documentation confirming the length of time out of refrigeration

36
Q

What is cryoprecipitate?

A

The precipitate of thawed FFP
Has high levels of factor 8 and fibrinogen

37
Q

What are the 3 steps to a safe transfusion?

A

Positive patient identification
Good documentation
Excellent communication

38
Q

What is haemovigillance?

A

the systemic surveillance of adverse reactions and adverse events related to transfusion

39
Q

What are acute transfusion reactions?

A

adverse signs or symptoms during or within 24 hours of a blood transfusion.

40
Q

What are some different transfusion reactions?

A

Acute hemolytic
Delayed hemolytic
Febrile non-hemolytic
Anaphylactic
Simple allergic
Septic
Transfusion-related acute lung injury (TRALI)
Transfusion-associated circulatory overload (TACO

41
Q

Whats the difference between TACO and TRALI?

A

TACO is characterized by pulmonary hydrostatic (cardiogenic) edema, whereas TRALI presents as pulmonary permeability edema (noncardiogenic)

42
Q

What is variant Creutzfeldt-Jakob disease (cVJD)?

A

a fatal type of brain disease within the transmissible spongiform encephalopathy family; known as mad cow disease because it’s caused by eating beef from infected cows. Initial symptoms include psychiatric problems, behavioral changes, and painful sensations

43
Q

What is SHOT?

A

the UK’s independent, professionally-led haemovigilance scheme. Since 1996 SHOT has been collecting and analysing anonymised information on adverse events and reactions in blood transfusion from all healthcare organisations that are involved in the transfusion of blood and blood components in the United Kingdom

44
Q

What are the most common delayed haemolytic transfusion reactions?

A

Graft versus host disease
Iron overload
Post transfusion purpura

45
Q

What is graft versus host disease?

A

when the donor’s T cells view the patient’s healthy cells as foreign, and attack and damage them. Graft-versus-host disease can be mild, moderate or severe. In some cases, it can be life-threatening. - alloimmunity

46
Q

What are some alternative or adjuncts to blood transfusions?

A

Tranexamic acid
EPO stimulating agents
TPO mimetics
Parenteral iron
Haemodilution
Cell salvage

47
Q

Outline Jehova’s witnesses views on blood transfusions?

A

their refusal of transfusions of whole blood or its four primary components—red cells, white cells, platelets and plasma—is a non-negotiable religious stand and that those who respect life as a gift from God do not try to sustain life by taking in blood, even in an emergency. Witnesses are taught that the use of fractions such as albumin, tranexamic acid, EPO stimulants, immunoglobulins and hemophiliac preparations are not absolutely prohibited and are instead a matter of personal choice

48
Q

What should you do where the parents or legal gausrdians of a child under 16 refuses blood transfusions that, in the opinion of the treating clinician, is life saving?

A

a Specific Issue Order (or national equivalent) can be rapidly obtained from a court. All hospitals should have policies that describe how to do this, without delay, 24 hours a day.

49
Q

How should you treat a patient who needs a blood transfusion but you do not know their wishes e.g. unconscious?

A

clinicians must give life-saving treatment, including blood transfusion, unless there is clear evidence of prior refusal such as an Advance Decision Document. The patient record should document the indication for transfusion and the patient should be informed of the transfusion when mental capacity is regained (and their future wishes should be respected).

50
Q

Who is anaphylaxis from blood transfusion most likely in?

A

IgA deficiency

51
Q

What is the presentation of anaphylaxis?

A

Hypotension
Dyspnoea
Wheeze
Angiooedema

52
Q

How should you manage anaphylaxis secondary to blood transfusions?

A

Stop transfusion
Adrenaline
Antihistamine
Corticosteroids
A-E assessment

53
Q

How does acute haemolytic blood transfusion reaction present?

A

Fever >40
Abdo pain
Hypotension
Shock
Within hours of transfusion

54
Q

What causes acute haemolytic transfusion reaction?

A

It’s a never event - RBC destruction by IgM type antibiotics - incomparable ABO

55
Q

How can you confirm a diagnosis of acute haemolytic transfusion reaction?

A

Direct Coombs test will be positive

56
Q

How do you manage acute haemolytic transfusion reactions?

A

Stop transfusion
Check identity
Supportive treatment with fluids

57
Q

How does febrile non-haemolytic transfusions reaction present?

A

Within 4 hours…
Low grade fever

58
Q

What causes a febrile non-haemolytic transfusions reaction ?

A

Antibodies reacting to WBC fragments and cytokines that leaked from blood cells during storage

59
Q

How do you manage febrile non-haemolytic transfusion reaction?

A

Stop transfusion
Paracetemol

60
Q

What causes TRALI?

A

Caused by increased vascular permeability - host neutrophils activated by substances in donated blood causing non-cardio genie pulmonary oedema

61
Q

How does TRALI present?

A

6-72 hours after transfusion
Hypoxia, pulmonary infiltrates on X-ray, fever, HYPOTENSION

62
Q

How do you manage TRALI?

A

Stop
Give oxygen
May need to escalate!

63
Q

How does TACO present?

A

Within 6 hours - pulmonary oedema and HYPERtENSION

64
Q

Who is TACO common in?

A

Elderly, pre-existing HF, excessive rate of transfusion

65
Q

How do we manage TACO?

A

Slow/stop transfusion
IV loop diuretics

66
Q

What causes delayed haemolytic transfusion reaction?

A

Exaggerated response to a foreign antigen the pt has been exposed to before?

67
Q

How does delayed haemolytic transfusion reaction present?

A

About 5 days after transfusion… anaemia, Jaundice and fever

68
Q

What is a mild, moderate and severe transfusion reaction?

A

Mild - temp <39 and/or isolated rash
Moderate - temp >40 and symptoms other than just ash
Severe - haemodynamic compromise

69
Q

What causes transfusion related sepsis?

A

Bacterial contamination of blood

METABOLIC (43 decks)

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