Job Interview Flashcards
A patient has a fever during a transfusion of 1C, from 37 baseline to 38C. What could this indicate?
Fever is the most common sign of acute haemolytic transfusion reaction. However, fever may be unrelated to the transfusion.
(If Tx Rx, = Febrile, non haemolytic transfusion reaction).
A patient has chills with or without rigors during a transfusion. What could this indicate?
Possible bacterial contamination. Suggest blood cultures on patient and suspected units.
(Transfusion Reaction)
A patient has tachycardia during a transfusion. What could this indicate?
Possible bacterial contamination. Suggest blood cultures on patient and suspected units.
(Transfusion Reaction)
A doctor suspects transfusion reaction on their patient, and orders Tx Rx Ix. Lab testing shows no evidence of red cell incompatibility. What could this mean?
Haemolytic transfusion reaction has been excluded, but still could be a Tx Rx; immunological or non-immunological.
A patient has shortness of breath during a transfusion. What could this indicate?
Possible bacterial contamination. Suggest blood cultures on patient and suspected units.
(Transfusion Reaction)
Following a transfusion of units, a patient develops hives/a rash. They have no other symptoms, what could be the cause?
A suspected allergic reaction to the unit, <2/3 would be a suspected minor reaction
>2/3 would be a suspected severe reaction
(Transfusion Reaction)
Following a transfusion of units, a patient develops hives/a rash AND has anxiety and chest pain, what could this indicate?
A suspected anaphylactic reaction to the unit, notify haematologist. Suggest testing for IgA levels and anti-IgA antibodies.
(Transfusion Reaction)
Following a transfusion of units, a patient develops hives/a rash AND has shortness of breath, low blood pressure and coughing, what could this indicate?
A suspected anaphylactic reaction to the unit, notify haematologist. Suggest testing for IgA levels and anti-IgA antibodies.
(Transfusion Reaction)
Within 15 minutes of receiving a transfusion of units, a patient develops shortness of breath, wheezing and coughing, what could this indicate?
A suspected anaphylactic reaction to the unit, notify haematologist. Suggest testing for IgA levels and anti-IgA antibodies.
(Transfusion Reaction)
60 minutes after receiving a transfusion of units, a patient develops shortness of breath, wheezing and coughing, what could this indicate?
Suspected transfusion associated circulatory overload; notify haematologist. Suggest BNP testing.
(Transfusion Reaction)
3 hours after receiving a transfusion of units, a patient develops shortness of breath, wheezing and coughing, what could this indicate?
Suspected transfusion related lung injury; notify haematologist. Suggest HLA testing on patient and donor.
(Transfusion Reaction)
5 hours after receiving a transfusion of units, a patient develops shortness of breath, wheezing and coughing, what could this indicate?
Suspected transfusion related lung injury; notify haematologist. Suggest HLA testing on patient and donor.
(Transfusion Reaction)
What are some signs which may indicate bacterial contamination of a unit that has been transfused?
High fever, rigors/chills, low blood pressure, tachycardia, nausea/vomiting, shortness of breath, circulatory collapse
What are some signs which may indicate that a patient may be reacting to a unit that has been transfused?
Fever
Rigors/chillsRespiratory distress (wheezing/coughing/SOB)
Change in blood pressure (high or low)
Pain in the abdomen/chest/back or infusion site
Uritcaria (skin rash)
Jaundice or blood in the urine
Nausea/vomiting
Abnormal bleeding
Small amounts of urine
Within 24 hours, a patient has symptoms of a transfusion reaction. What could be the cause?
It could be an acute immunological or acute non-immunological cause.
Acute immunological = acute haemolytic TR, febrile haemolytic TR, mild or severe allergic reaction, or TRALI
Acute non-immunological = complication of massive transfusion, non-immune mediated haemolysis, bacterial infection, TACO
24 hours after transfusion, a patient has symptoms of a transfusion reaction. What could be the cause?
Delayed HTR, post-transfusion purpura, TA-GvHD, alloimmuniation of RBC or HLA antigens, transfusion-related immune modulation
A patient has a history of a low incidence antibody (e.g. Kpa, Cw) and the screen cells are negative. Do we continue further testing to show the antibody is reactive?
Only if pregnant.
A patient has a complex antibody investigation, and some antibodies can’t be fully excluded. Explain how you would provide blood for that patient.
Serologically phenotype the unit to ensure it is NEGATIVE for the undetermined antigen.
During serological crossmatching, a unit is unexpectedly incompatible. Outline what you would do next?
Run a DAT on the unit; if it is positive try to obtain an alternative unit to crossmatch for the patient and inform ARCBS so they can update the donor file/discard the red cell.
A patient has a complex antibody investigation, and ARCBS can’t find phenotype matched units for the patient. Explain how you would provide blood for that patient.
Ideally, check millennium/private labs to see if they have phenotype matched blood they could send us.
Incompatible or least reactive red cells may need to be issued following senior scientist/haematologist approval.
A screen and panel are positive, but there are few, weak reactions. How would you continue your investigation?
Possible HLA reaction or a weak Ab
Consider changing the phase of the testing to enhance antibody reactivity; e.g. testing by enzyme/PEG technique or room temperature.
A screen and panel are positive, showing non-specific panagglutination. How would you continue your investigation?
Are the reactions strong or weak?
* Variable reactions could be warm auto, additive, or multiple or high frequency antibodies.
* Weak reactions could be rouleaux, warm auto (DAT +), HTLA.
- Enzyme and DTT screen excludes mAb, but a warm auto will be enhanced.
- TTH IAT saline phase will show rouleaux and, unless LISS additive, exclude additive.
A patient has a history of [RhK, Fy, Jk, Ss] antibody. Do you need to serologically crossmatch?
Yes, whether reactive or not. Also phenotype the unit as negative.
A patient has a history of M antibody. Do you need to serologically crossmatch?
Only if anti-M is currently reactive; if historic Rx M- is best practice but random units are fine.
A patient has a history of anti-[Cob, Kpa, Lua, Wra, Cw]. Do you need to serologically crossmatch?
Yes.
A patient has a history of N antibody. Do you need to serologically crossmatch?
Only if currently reactive.
A patient has a history of A1 antibody. Do you need to serologically crossmatch?
Only if currently reactive at 37*C.
A patient has a history of [HLA, RhD Ig, Rouleaux or Additive] antibody. Do you need to serologically crossmatch?
No.
A patient has a history of HTLA antibodies. Do you need to serologically crossmatch?
Yes, phenotype matched if currently reactive.
A patient has a history of anti-HI. Do you need to serologically crossmatch?
Only if currently reactive, technically only if A1 or A1B but I would probably err on the side of caution if it’s not urgent and serocrossmatch for A2 and anti-B patients anyways.
A patient has a history of anti-[Lea/Leb/P1] antibody. Do you need to serologically crossmatch?
Only if currently reactive.
A patient has anti-A1 antibodies that are currently reactive at 37*C. What group of blood do you give them?
Group O is good for everyone.
A2 can be given to A/AB patients, and B can be given for AB patients.
A patient has a weak reaction on a screening cell, and negative reactions on panel. What could this indicate?
Possible HLA antibody.
A patient has a positive antibody screen and panel, giving atypical MF type reactions. What could this indicate? What would you do next?
LISS TTH.
If 0/0, perform BioRad. If BR positive, resuspend screen cells in cellstab - additive to cells.
If 0/+, additive antibody excluded; consider auto/alloantibody.
If +/0, perform NISS. If NISS 0/0 it’s additive to LISS. If NISS +/0 it could be rouleaux. If NISS 0/+ it could be cold antibody.
Do you understand/could you explain the differences between a quality control and a quality assurance program
Quality control ensures techniques, equipment and reagents are in working order
Quality assurance ensures techniques, equipment and scientific knowledge are sufficient to ensure accurate patient results
Specimen reception/pretesting checks/how do you ensure attention to detail
Work one at a time
If interrupted, start again
Ensure QC is read first (e.g. phenotyping QC) ahead of patients
Do not trust your memory. Write it down each time a well/test tube is read.
Blood is required for a patient with antibodies
Do we have a current group and hold? Do we have a specimen - at what stage of processing? TTH group is quick to perform and enter if you want to give group specific products.
Ask for patient details, location of patient, doctor approving uncrossmatched units
Ask doc for urgency/quantity (e.g. 1 unit in 2 hours or an MTP now) ensure that the doctor is willing to accept the risk of uncrossmatched units
Check patient history for additional crossmatching requirements, e.g. irradiated, and try to choose units which meet the phenotype requirement of the historic antibodies via Rx typings if clinically significant. Keep unit segments for retrospective crossmatching/phenotyping
No current group, provide group O
In a critical bleed, it’s better to give a pheno incompatible unit (e.g. E+ to an anti-E patient) than to have a dead patient. Call/discuss with the critical bleed haematologist.
Can you issue group specific blood based off historic group
No
Even if you think you’re sure, you can’t trust that the patient has been correctly identified today and when the historic group was entered ; it might have been a transpositional error or file merge
TTH grouping only 2 takes minutes to perform and result if they can provide us with a sample, if not give O
Reverse group anomalies (up)
Cold reacting alloantibody e.g. M, Lea
- Prove the antibody is present
- If possible, repeat the reverse group with a cell negative for that antibody (e.g. alternate reverse group cell lot number or company, or use a donor unit)
Cold reacting autoantibody e.g. Anti I
- Strictly 37
ABO subgroup
- Prove the subgroup through phenotyping or referral to red cross
Rouleaux
- Saline replacement/dispersal
Anti CD47 (Magro) > IgG Class 1 TTH IAT
In Haematology, respect is one of our values. What does respect mean to you?
Treat everyone equally
Accept and embrace our differences
Open and fair in our decision making
Politeness, honour, care shown towards someone/something considered important
Avoid interrupting others, give others your full attention. Respond in a timely manner, this shows you value their time. Ensure information is communicated and shared openly
A screen and panel is all positive, but the A/C is negative. What are some possible reasons/what further testing?
Multiple antibodies
Additive to something in Red Cells
Rouleaux
Monoclonal therapy
What is the most important test in the blood bank?
You’re experiencing a blood shortage, how do you tackle the situation?
