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Haematology > hazards of blood transfusion > Flashcards

hazards of blood transfusion Flashcards

1
Q

what is needed to ensure a safe blood transfusion?

A
  • protection of donor

- protection of recipient

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2
Q

what is done to protect the donor?

A
  • 17 – 70 years old
  • > 8 stone. (51 Kg)
  • Normal health
  • Volunteer
  • Medical history check
  • Anaemia check
  • Sign declaration
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3
Q

what are all donations tested for to ensure the protection of the recipient?

A
  • ABO and Rhesus group
  • Clinically important red cell antibodies
  • HIV I and II
  • HTLV
  • Syphilis
  • Hepatitis B and C
  • Cytomegalovirus (CMV)-in some cases
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4
Q

what is done to ensure positive patient identification?

A
  • Identification wristband with full name, date of birth and hospital number
  • Unconscious patients should have Typenex wristband
  • If ID band is removed it must be replaced
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5
Q

what precautions should be taken when obtaining the sample?

A
  • One patient at a time
  • ID by wristband and interrogation
  • Mix sample and label by hand at the bedside
  • Label with full identification details and sign
  • DO NOT pre label tubes
  • DO NOT use addressograph labels
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6
Q

what must be included on the request card?

A
  • Full patient ID: minimum 3 points of ID
  • Obstetric and transfusion history
  • Blood group and antibodies (if known)
  • Number of units and type of blood component
  • Location at which blood is required
  • When blood component is required
  • Reason for request
  • Special requirements
  • Prescribing and requesting: MSBOS
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7
Q

what precautions must be taken when collecting blood from the blood bank?

A
  • Bring evidence of patient details: not a lab report
  • Check card details match
  • Check blood bag label matches
  • Check blood unit number (bar code number of unit)
  • Check blood still in date
  • Check blood looks OK
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8
Q

what must be done when administering blood?

A
  • Prescribed by doctor
  • Can be a registered nurse
  • Final bedside check by at least one person
  • Start transfusion within 30 minutes of removing unit from blood bank. If not return unit to blood bank
  • Only warm in a blood warmer
  • Do not add drugs
  • Change giving set every 12 hours
  • Flush cannula before using it for anything else
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9
Q

when must patient observations be done?

A
  • Base line 30 minutes before transfusion starts
  • During first 15 minutes
  • After about one hour then every hour
  • One hour after transfusion has finished
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10
Q

what are the features of acute haemolytic transfusion reactions?

A
  • Usually due to ABO incompatibility
  • Usually happens within first 15 minutes
  • Agitation
  • Pain at infusion site
  • Pain in abdomen, flank or chest
  • Flushing
  • Feeling of apprehension or doom
  • Intravascular haemolysis
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11
Q

what are the signs of a reaction?

A
  • Fever
  • Hypotension
  • Oozing from wounds of puncture sites
  • Haemoglobinaemia
  • Haemoglobinuria
  • Raised temperature
  • Nausea
  • Sweating
  • Rashes
  • Bruising
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12
Q

what are the properties of delayed transfusion reactions?

A
  • Non-detectable blood group antibodies
  • 5-10 days post transfusion
  • Rare
  • Usually not life threatening
  • Extravascular haemolyisis
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13
Q

what are the features of extravascular red cell destruction?

A
  • Normal red cell breakdown occurs in liver/spleen
  • Cells aged/damaged
  • Haemoglobin is broken down into haem and globin
  • Molecules of haem are converted to bilirubin
  • Degraded in liver
  • Free haemoglobin in circulating blood is avoided
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14
Q

what are the features of intravascular red cell destruction?

A
  • Red cells broken down within blood vessels
  • Free haem is removed by binding to haptoglobin
  • Haptoglobin levels in circulation are reduced
  • Haem-haptoglobin complex removed by reticuloendothelial system
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15
Q

what are the mechanisms of acute intravascular haemolysis?

A

• Antibodies in patient plasma
• Antibody binds to antigen on donor red cell membrane
• If antibodies are complement fixing complement proteins bind to red cell membrane
• Activation of complement leads to membrane damage
• Rapid haemolysis of donor red cell
• Causes:
- Disseminated intravascular coagulation (DIC)
- Acute renal failure
- Shock
- Death

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16
Q

what are serious hazards of transfusion (SHOT)?

A

• Incorrect component being requested and issued to patient
• Failure of bedside check to pick up errors
• Wrong pack from blood bank
• Wrong blood in tube.
- Blood in sample tube not from patient whose details appear on request card
• Transmission of disease

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17
Q

what can cause the adverse effects of blood transfusion?

A
  • Infectious agents
  • Transfused red cells
  • Transfused white cells
  • Transfused platelets
  • Transfused plasma
  • Transfused coagulation concentrates
  • Other causes
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18
Q

what are the infectious agents?

A 
•	Viral infections
-	Hep B, C
-	HIV
-	CMV
•	Bacterial infections
-	Yersinia
-	Treponema
•	Protozoal infections
-	Malaria
-	Toxoplasma
19
Q

why may red blood cells need to be transfused?

A

for the correction of anaemia

or if active bleeding is occurring

20
Q

when may anaemia need to be corrected by red blood cell transfusion?

A
  • Hb 70-80g/l post-op (NR 115-165g/l)
  • Patient symptomatic
  • Patient history
  • Hb 80-90g/l with cardiovascular disease
  • Not correctable by any other method
21
Q

what adverse effects might be caused by red blood cells?

A 
•	Acute haemolytic transfusion reactions
-	Intra vascular haemolysis
-	Destruction of red cells
•	Allo-immunization
-	Antibody production
•	Febrile reactions
-	Reactions to donor white cells-uncommon blood is now filtered to remove white blood cells
•	Urticaria
-	Reactions to donor plasma proteins
•	Bacterial infections
•	Iron overload
•	Volume overload
22
Q

what are some reasons that white blood cells are transfused?

A

White blood cell transfusions are only used for desperately ill patients
• Bone marrow failure
• Severe neutropaenia <0.5x109/l
• Abnormal neutrophil function with persistent infection
• Genetic- Chronic granulomatous disease

23
Q

what are some adverse effects of white blood cells?

A

• Donor blood is filtered to remove white blood cells
• Variant CJD
• Transfusion Related Acquired Lung Injury (TRALI)
• Pulmonary infiltration
- Sequestration of WBC in the lungs
• Adult respiratory distress syndrome
- Most severe form-can cause death
• TAGvHD- Transfusion Associated Graft versus Host Disease

24
Q

what are some reasons for why a platelet transfusion may be needed?

A 
•	To prevent bleeding in patients with thrombocytopaenia
-	Stop haemorrhage
-	Prevent haemorrhage
•	Abnormalities of platelet function
-	Bernard Soulier
-	Glanzmann’s thrombasthenia
•	Dilutional thromocytopaenia
•	Vascular surgery
•	Autoimmune thrombocytopaenia purpura
25
Q

what are some adverse effects of platelet transfusion?

A
  • Febrile reactions
  • Allergic reactions
  • 1:30 platelet transfusions
  • Anaphalactic shock
  • Bacterial infections
  • Platelets stored at room temperature 20-24oc
  • Shelf life 5 days
  • Transmission of virus’
  • CMV
  • Alloimmunisation
  • Red cells present in platelet concentrates
26
Q

why might human plasma transfusion be needed?

A
  • Multiple coagulation defects
  • DIC (disseminated intravascular coagulation)
  • TTP (Thrombotic thrombocytopaenia purpura)
  • Liver disease
  • Massive transfusion
  • Maintain PT and APTT
27
Q

what are some adverse effects of human plasma transfusion?

A 
•	Anaphylactic shock
•	Mild/serious allergic reactions
•	Febrile reactions
-	Some white cells in FFP preparations
•	Transfusion related lung injury
•	Allo-immunisation
-	A few red cells present in some FFP preparations
•	Acute haemolysis
•	ABO antibodies present in the plasma
•	Viral transmission
-	Plasma is virally inactivated
•	Risk of vCJD
•	Hypothermia
•	Cardiac arrest
28
Q

why might someone need a coagulation factor transfusion?

A 
•	Factor VIII and IX
-	Haemophilia A and B
•	Recombinant Factor VIIa
-	Massive haemorrhage
-	Coagulation factor inhibitors
•	Prothrombin complex
-	Severe over anticoagulation
-	Treatment of rare bleeding disorders Factor X and factor II deficiency
-	Sometimes liver disease
29
Q

what adverse reactions can coagulation transfusions cause?

A
  • Viral infection
  • Hepatitis B
  • HIV
  • Inhibitors
30
Q

why might a human albumin solution need to be transfused?

A 
•	Burns patients
•	Emergency treatment  of shock
•	Patients with low serum albumin levels
-	Liver disease
-	Renal disease
-	Sepsis
-	Surgery
31
Q

what adverse effects can be caused by human albumin solution?

A
  • Allergic reactions
  • Intra cranial haemorrhage
  • Bleeding
32
Q

what are some other adverse effects of transfusions?

A 
•	Circulatory overload
•	Air embolism
•	Thrombophlebitis at transfusion site
•	Toxicity
-	Iron
-	Additive solutions	
•	Hypothermia
•	Cardiac arrest
•	Hypersensitivity reactions
33
Q

what are alternatives to allogenic blood transfusion?

A
  • Preoperative preparation
  • Operative haemostasis
  • Autologous blood transfusion
  • Red cell salvage
  • Recombinant factor VIIa
  • Blood substitutes
34
Q

what can lead to better blood transfusions?

A
  • Specialist Practitioner of Transfusion
  • Transfusion specialist nurses
  • Promote good transfusion practice
  • Train hospital staff
35
Q

how are blood transfusions regulated?

A
  • Medicines and Healthcare Products Regulation Agency (MHRA)
  • National Patient Safety Agency
  • Serious Hazards of Transfusion reporting scheme
  • Hospital Transfusion Committees
36
Q

what temperature are donor red cells stored at?

A

4 degrees

37
Q

what is the shelf life of a unit of platelets?

A

5 days

38
Q

why might it be necessary to warm donor blood in a blood warmer prior to transfusion?

A

In the frail or patients with a weak heart cold blood could cause heart failure or shock

39
Q

Why are multi transfused patients susceptible to iron overload?

A

Donor blood contains iron which build up in the patient. The body can only get rid of iron by blood loss or utilisation

40
Q

What is alloimmunization?

A

Alloimmunistaion occurs when the body produces an antibody in response antigens derived from a genetically dissimilar animal of the same species.

41
Q

Why do transfusion laboratories issue recombinant factor VIII to its haemophillia A patients?

A

Recombinant factor concentrates are free from viral contamination (hepatitis B, HIV etc) They are produced using vectors. Recombinant factor VIII is obtained using recombinant DNA technology. With this technology, pure protein is synthesized in the laboratory instead of being extracted from blood

42
Q

Why is TRALI rarely seen following red cell transfusion?

A

Transfused blood is filtered to remove white cells which are implicated in TRALI

43
Q

What is TRGVHD?(Transfusion Related Graft versus Host Disease)

A

This type of GVHD is associated with transfusion of un-irradiated blood to immunocompromised recipients. Functional immune cells in the transplanted marrow recognize the recipient as “foreign” and mount an immunologic attack

Haematology (7 decks)

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