Lecture 16 - blood Prudcts In The Treatment Of Disease

Question 1

3 parts of donor screening

Answer 1

• donor questionnaire form: identifies risk behavior, wording is covered by legislation, legal document
• Donor interview: confidential 1-1, auditory and visual privacy. Ensures that it is safe to donate and safe to receive
• donation undergoes mandatory testing

Question 2

Every donation is tested and negative for

Answer 2

• HBsAF and HBV
• HCV Ab and NAT
• HIV Ab and NAT
• HTLV1 AB
• syphillis
• ABO and RhD
• RBC antibody screen
• selected red cell phenotypes
• CMV ab
• malarial antibody testing

Question 3

Fresh components distributed by the blood service

Answer 3

• whole blood: no longer available
• RBC: leucodepleted. Thse may be washed, irradiated and or phenotyped
• platelets: Buffy coat poor pooled (leucodepleted), apheresis (leucodepleted), paediatric apheresis (leucodepleted)
• Plasma: FFP, Cryoprecipitate, cryo-depleted plasma
• Plasma products: coag factor, intragam P, immunoglobulins, albumex

Question 4

Red cells

Answer 4

• leucodepleted
• in additive
• store at 4 degrees
• 42 day shelf life

Question 5

Pre-transfusion testing of patient

Answer 5

• ABo and Rh blood group
• test for red cell antibodies
• cross match when requested

Question 6

ABO antigens and antibodies

Answer 6

• O: anti-a, anti-B
• A: anti-B
• B: Anti-A
• AB: Nil

Question 7

REd blood cell transfusion

Answer 7

• donor red cell and recipient plasma are ABo compatible
• contains a minimal amount of plasma (ABO alloantibodies) - can be used in situations of ABO non-identical compatibility
• group O RCC to Group A, B, AB
• group A or B to AB
• one unit should raise the haematocrit by 3% or the haemoglobin by 10g/L in an adult patient with an intact spleen

Question 8

Types of platelet products

Answer 8

• PRP platelets: historical
• BCP pooled LD platelets: whole blood derived, suspended in platelet additive solution, plasma-reduced
• apheresis platelets: non-matched and suspended in plasma, antigen-matched, crossmatch compatible. HLA type at diagnosis patients who may become refractory

Question 9

Pooled platelet LD

Answer 9

• made from 4 whole blood donations
• whole blood nto buddy coat, FFP, red cells
• leucodepleted
• store on platelet shaker at 20-24 degrees
• 5 day shelf life

Question 10

Apheresis platelets

Answer 10

• leucodepleted
• store on platelet shaker at 20-24 degrees
• 5 day shelf life

Question 11

Platelet transfusion

Answer 11

• to treat or prevent bleeding due to thrombocytopenia or functionally abnormal platelet
• chemotherapy, consumptive coagulopathy
• thrombocytopenia does not equal platelet transfusion
• rarely used in situations of rapid platelet destruction: ITP, TTP
• contraindicated in heparin induced thrombocytopenia

Question 12

Functionally abnormal platelets

Answer 12

• muelodysplastic disorders
• drugs which affect platelets: aspirin, clopidogrel, NSAIDS
• congenital platelet dysfunction
• platelet trasnfusion may be required even in the presence of a normal platelet count

Question 13

Crossing the ABO barrier in platelet tranfusion: plasma incompatibility

Answer 13

• platelets should be ABO compatible with the patient whenever possible
• crossing the ABO barrier may be considered whtn you rransfuse a special type of platelet or when the only platelet available is a different group to the patient

Question 14

Transfusing anti-A or anti-B into a patient who is A or B

Answer 14

• usually not clinically significant
• occasional positive DAT
• less plasma in pooled platelets than in apheresis platelets

Question 15

Transfusing Groups A or B platelets into a patient who has circulating Anti-A or anti-B

Answer 15

• recovery slightly reduced but not clinically significant

- ABO compatible platelets preferred

Question 16

Patients blood group vs preferred choice for paltelet

Answer 16

• O: O>A>B/AB
• A: A>O, low titre antiA/B> AB or B>O
• B: B>O, low titre anti A/B>AB or A>O
• AB: AB>O, low titre anti A/B>B or A>O

Question 17

Platelet storage

Answer 17

• 20-24 degrees
• with agitation, use within 5 days
• with no agitation, use ASAP
• platelets that are refrigerated quickly become irreversibly damaged

Question 18

Fresh frozen plasma

Answer 18

• store at 30 degrees C
• 12 months shelf-life
• plasma can be separated into cryoprecipitate (risch in f8 and fibrinogen) or cryodepleted plasma (cryosupernatant)

Question 19

Indications for fresh frozen plasma

Answer 19

control of bleeding due to deficiency of coag factor:

• liver disease
• warfarin overdose
• massive transfusion
• not indicated for volume replacement or specific factor deficiencies for which factor concentrates are available

Question 20

Indications for cryoprecipitate and cryo-depleted plasma

Answer 20

• cryoprecipitate: fibrinogen replacement: congenital hypofibrinogenemia, acquired hypofibrinogenemia (DIC)
• cryodepleted plasma: TTP (replacement fluid for plasma exchange), warfarin reversal

Question 21

Side effects of fresh blood components

Answer 21

• results of receiving allogeneic graft: infectious complication, alloimmunisation, allergic reaction, TRALI, transfusion - associated GvHD
• Results of storage
• result of adverse event
• result of massive transfusion: Acute (TACO) or chronic (iron overload)

Question 22

Infectious complications: clinical features of bacterial contamination

Answer 22

• symptoms and signs of a septic reaction: pain at IV site, fever or hypothermia, rigors, tachycardia, hypo/hypertension, haemolysis, shock or multiple organ failure
• at hospital level: consider bacterial contamination in all severe febrile reaction: stop transfusion immediately, manage the hemodynamic complication of sepsis

Question 23

Transfusion associated pulmonary sequelae

Answer 23

• lung injury: RARE
• circulatory overload: avoidable fluid assess
• resp manifestation to allergic foreign plasma protein
• DDx: bacterial contamination, intravascular hemolysis, acute respiratoryu distress syndrome, intercurrent illness

Question 24

Male predominant frozen plasma components from july 2007

Answer 24

• implicated components in TRALI cases were commonly associated with female donors
• donord who have had one or more pregnancies or donors who have been previously transfused
• females more likely to have HLA or granulocyte antibodies than males, due to exposure to fetal antigens during pregnancy

Question 25

TRALI: transplant related acute lung injurey

Answer 25

- during or within 6hour of transfusion, no competing aetiology - transfusion of a plasma or granulocyte containing component - onset between 1-6 hours - normal SVP if available - severe bilateral pulmonary oedema, severe hypoxemia, tachycardia, fever, hypotension, hypertension, cyanosis