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haematology > lecture 9- transfusion 2 > Flashcards

lecture 9- transfusion 2 Flashcards

1
Q

what is a transfusion

A

an organ transplant

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2
Q

what 2 factors are need to be considered in safe blood transfusion

A

protection of donor

protection of recipient

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3
Q

in terms of protecting the donor, which factors need to be considered

A 
age 17-70 years old
>8 stone, 51Kg
normal health
volunteer
medical history check
anaemia check
sign declaration
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4
Q

what may be checked of the donor, at the point of donation

A

blood pressure

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5
Q

what type of anaesthetic is used on the donor

A

local

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6
Q

what are the conditions for blood storage after blood has been taken from the donor

A

anticoagulated, sterile bag
CPD + adenine + glucose + mannitol
additional samples taken for testing
everything labelled with same bar code number
donor red cells stored between 2-6 degrees until use

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7
Q

what is donor blood shelf life

A

35-42 days

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8
Q

what is the blood tested for, for protection of the recipient

A 
ABO and Rhesus group
clinically important red cell antibodies
HIV I and II
HTLV
syphilis
hepatitis B and C
CMV- in some cases
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9
Q

what is the aim of blood transfusion

A

to get the right blood
to the right patient
at the right place
at the right time

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10
Q

what is meant by positive patient identification

A

identification of wrist band (with full name, DOB and hospital no.)

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11
Q

what type of wrist band should unconscious patients be given

A

typenex wristband

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12
Q

what happens if a patients wrist band is removed

A

must be replaced by the same person who removed it

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13
Q

what are the rules that must be followed when obtaining a blood sample from a patient

A

one patient at a time
ID by wristband and interrogation
mix sample and label by hand at bedside
label with full ID details and sign

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14
Q

what must NOT be done when obtaining a sample from a patient

A

dont pre-label tubes

dont use addressograph labels

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15
Q

what must be filled in on a blood request card

A 
full patient ID- 3 points minimum ID
obstetric and transfusion history
blood group and antibodies
number of units and type of blood component required
location at which blood is required
when blood component is required
reason for request
special requirements
prescribing and requesting (MSBOS)
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16
Q

what are requirements when collecting blood from a blood bank

A

bring patient detail evidence- not lab report
check card details match
check blood bag label matches
check blood unit number (bar code no. of unit)
check blood still in date
check blood looks ok

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17
Q

what are the requirements when administrating blood to a patient

A

prescribed by doctor/registered nurse
final bedside check
start transfusion within 30 mins of removing unit from blood bank (if not then return to blood bank)
only warm in blood warmer
dont add drugs
change giving set every 12 hours
flush cannula before using for anything else

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18
Q

how often must a transfusion patient be observed

A

base line 30 minutes before transfusion starts
during first 15 minutes
after 1 hour, then every hour
one hour after transfusion has finished

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19
Q

why do acute haemolytic transfusion reactions occur

A

usually due to ABO incompatibility

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20
Q

how fast do acute haemolytic transfusion reactions take place

A

usually within first 15 minutes

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21
Q

name all the acute haemolytic transfusion reactions

A 
agitation
pain at infusion site
pain in abdomen, flank or chest
flushing
feeling of apprehension/doom
intravascular haemolysis
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22
Q

what are the signs of a reaction to a transfusion

A 
fever
hypotension
oozing from wounds of puncture sites
haemoglobinaemia
hemoglobinuria 
raised temperature
nausea 
sweating
rashes
bruising
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23
Q

why do delayed transfusion reactions take place

A

due to non detectable blood group antibodies

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24
Q

how long after a transfusion does a delayed transfusion reaction take place

A

5-10 days post transfusion

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25
Q

what are the effects of a delayed transfusion reaction

A

rare, usually not life threatening

extravascular haemolysis

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26
Q

what are the 2 mechanisms of red cell destruction

A

extravascular

intravascular

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27
Q

what is the process of extravascular red cell destruction

A

normal red cell breakdown occurs in liver/spleen
cells aged/damaged

Hb broken down into haem and globin

molecules of haem are converted to bilirubin
degraded in liver

free Hb in circulating blood is avoided

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28
Q

what is the process of intravascular red cell destruction

A

red cells broken down within blood vessels

free haem removed by binding to haptoglobin

haptoglobin levels in circulation are reduced

haem-haptoglobin complex removed by reticuloendothelial system

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29
Q

what is the mechanism of acute intravascular haemolysis

A

Ab’s in patient plasma

Ab bind to Ag on donor red cell membrane

If Abs are complement fixing, complement proteins bind to red cell membrane

complement activation leads to membrane damage

rapid haemolysis of donor red cell

30
Q

what are the causes of acute intravascular haemolysis

A

disseminated intravascular coagulation (DIC)

acute renal failure

shock

death

31
Q

what does SHOT stand for

A

serious hazards of transfusion

32
Q

name the different SHOT

A

incorrect component being requested and issues to patient

failure of bedside check to pick up errors

wrong pack from blood bank

wrong blood in tube

transmission of disease

33
Q

what are the causes of the adverse affects of blood transfusion

A

infectious agents

transfused red cells

transfused white cells

transfused platelets

transfused plasma

transfused coagulation concentrates

other causes

34
Q

what are the 3 types of infectious agents that could cause the adverse effects of blood transfusion, give examples for each

A

viral- Hep B, C, HIV, CMV

bacterial- yersinia, treponema

protozoal- malaria, toxoplasma

35
Q

why would we transfuse red cells

A

correction of anaemia

active bleeding

36
Q

when would anaemia need to be corrected by transfusion

A

when Hb levels are 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

37
Q

when would we use a red cell transfusion due to active bleeding

A

trauma

perioperative bleeding

38
Q

what happens as a result of an acute haemolytic transfusion reaction

A

intra vascular haemolysis

destruction of red cells

39
Q

what is meant by allo-immunisation as an adverse affect of red cell transfusion

A

antibody production

40
Q

what meant by febrile reactions in adverse affects of red cell transfusion

A

reactions to donor white cell (uncommon as blood is now filtered to remove white cells)

41
Q

what meant by urticaria in adverse affects of red cell transfusion

A

reactions to donor plasma proteins

42
Q

name 3 other adverse effects of red cell transfusion

A

bacterial infections

iron overload

volume overload

43
Q

why is all donor blood now filtered to remove white blood cells

A

white blood cells were implicated in several different types of adverse reactions

44
Q

in which patients would we transfuse white blood cells

A

for desperately ill patients with:

bone marrow failure

severe neutropaenia (<0.5 x 10^(9)/L)

abnormal neutrophil function with persistent infection

genetic- chronic granulomatous disease

45
Q

how is the risk of transfusing variant CJD reduced

A

donor blood is filtered to remove white blood cells

46
Q

what does TRALI stand for

A

transfusion related acquired lung injury

47
Q

what is TRALI

A

serious syndrome characterised by sudden acute respiratory distress following transfusion

donor has granulocyte specific antibodies
enzymes released
increase permeability of capillaries
results in sudden pulmonary oedema within 6 hours of transfusion

48
Q

name 2 adverse effects of leucocyte transfusion

A

pulmonary infiltration- sequestration of WBC in lungs

adult respiratory distress syndrome (can cause death)

49
Q

what is TA-GvHD

A

transfusion associated graft versus host disease

rare complication of blood transfusion

immunologically competent donor T lymphocytes mount an immune response against the recipient’s lymphoid tissue

50
Q

what are the reasons for transfusing platelets

A

to prevent bleeding in patients with thrombocytopaenia (condition with low platelet count)- preventing and stopping haemorrhage

abnormalities of platelet function

dilutional thrombocytopaenia

vascular surgery

autoimmune thrombocytopaenia purpura

51
Q

what is dilutional thrombocytopaenia

A

when a patient recieves a massive blood transfusion (e.g. 15 units of blood) due to severe blood loss

this is a low platelet count

52
Q

what is autoimmune thrombocytopaenia purpura

A

clinical syndrome in which a decreased number of circulating platelets (thrombocytopenia)

manifests as a bleeding tendency, easy bruising (purpura)

53
Q

state the adverse effects of platelet transfusion

A

febrile reactions

allergic reactions

anaphalactic shock

bacterial infections

transmission of virus

alloimmunisation

54
Q

what is meant by a febrile reaction

A

type of transfusion reaction that is associated with fever but not directly with hemolysis

55
Q

what ratio of platelet transfusions show an allergic reaction

A

1 : 30

56
Q

what regulations are in place to prevent bacterial infections from platelet transfusions

A

platelets tored at room temperature 20-24˚C

shelf life 5 days

57
Q

give an example of a virus transmitted by transfusing platelets

A

CMV (cytomegalovirus)

58
Q

what is meant by alloimmunisation

A

red cells present in platelet concentrates

59
Q

what is FFP

A

fresh frozen plasma

blood product made from the liquid portion of whole blood

60
Q

why would FFP be transfused/used

A

multiple coagulation defects

DIC- disseminated intravascular coagulation

TTP- thrombotic thrombocytopaenia purpura

liver disease

massive transfusion (maintain PT and APTT)

61
Q

what are the adverse effects of plasma transfusion

A 
anaphylactic shock
allergic reactions
febrile reactions
transfusion-related lung injury
allo-immunisation
acute haemolysis
ABO antibodies in plasma
viral transmission
risk of vCJD
hypothermia
cardiac arrest
62
Q

why would you transfuse coagulation factor concentrates such as factor VIII and IX

A

haemophillia A and B

63
Q

why would you transfuse coagulation factor concentrates such as recombinant factor VIIa

A

massive haemorrhage

coagulation factor inhibitors

64
Q

why would you transfuse coagulation factor concentrates such as a prothrombin complex

A

severe over anticoagulation

treatment of rare bleeding disorders, factor X and factor II deficiency

sometimes liver disease

65
Q

what are the adverse effects of coagulation concentrates

A

viral infection

hepatitis B

HIV

inhibitors

66
Q

why would you transfuse human albumin solution (HAS)

A

burns patients

emergency treatment of shock

patients with low serum albumin levels

67
Q

why would a patient have low serum albumin levels

A

liver disease

renal disease

sepsis

surgery

68
Q

what are the adverse effects of transfusing human albumin solution (HAS)

A

allergic reactions

intra cranial haemorrhage

bleeding

circulatory overload

air embolism

thrombophlebitis at transfusion site

toxicity

hypothermia

cardiac arrest

hypersensitivity reactions

69
Q

what are the alternatives to allogenic blood transfusions

A

preoperative preparations

operative haemostasis

autologous blood transfusion

red cell salvage

recombinant factor VIIa

blood substitutes

70
Q

how would we improve hospital blood transfusion practice

A

hospital transfusion teams

specialist practitioner of transfusions

transfusion specialist nurses

promote good transfusion practice

train hospital staff

71
Q

how is transfusion practice regulated

A

medicines and healthcare products regulation agency (MHRA)

national patient safety agency

serious hazards of transfusion reporting scheme

hospital transfusion committees

haematology (3 decks)

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