Practical Aspects of Transfusion

Question 1

Pre Transfusion testing

Answer 1

Determine ABO and Rh(D) type of recipient
Antibody screen (AHG test)
Selection of blood component

Question 2

Compatibility testing (3)

Answer 2

Full cross match with AHG test
Immediate spin cross match to exclude ABO incompatibility
Computer cross match as another ABO test

Question 3

Immediate haemolytic transfusion reactions

Note if a reaction occurs, stop transfusion, infuse saline and seek advice

Answer 3

Intravascular and extravascular

Question 4

Intravascular haemolysis causes and signs and symptoms

____ incompatibilty, related to human error
______ cascade causes rbc haemolysis causing haemoglobinurea and DIC
____ and renal failure

Symp: ____, restlessness, retrosternal pain
Signs: Increased temp, _____, _____ bleeding

Answer 4

ABO incompatibilty, related to human error
Complement cascade causes rbc haemolysis causing haemoglobinurea and DIC
Hypotension and renal failure

Symp: fever, restlessness, retrosternal pain
Signs: Increased temp, hypotension, uncontrolled bleeding

Question 5

Extravascular haemolytic reactions

____ antibodies in plasma, Rh(D), Kell, Kidd, Duffy
No _____ activation, early phase to C3.
Clinically _______ to intravascular

Answer 5

IgG antibodies in plasma, Rh(D), Kell, Kidd, Duffy
No complement activation, early phase to C3.
Clinically indistinguishable to intravascular

Question 6

Delayed haemolytic transfusion reactions

Occur _-__ days post transfusion
Due to _____ not _____ in pretransfusion testing
Falling ____ and jaundice

Answer 6

Occur 7-10 days post transfusion
Due to antibody not detectable in pretransfusion testing
Falling Hb and jaundice

Question 7

Febrile non haemolytic transfusion reaction

__ often with ___.
May be _____ from haemolytic reactions

Due to presence of ____ cells in transfusion ____ and presence of _____ antibodies in ____

Answer 7

Fever often with rigors.
May be indistinguishable from haemolytic reactions

Due to presence of white cells in transfusion product and presence of ant-HLA antibodies in recipient

Question 8

TRALI

Onset of acute ____ injury 6-7 hours post ____
____ plasma with white cell ____ (___ antibodies), ____ etc of neutrophils in _____ vasculature
Radiographic diagnosis

Answer 8

Transfusion related acute lung injury

Onset of acute lung injury 6-7 hours post transfusion
Donor plasma with white cell antibodies (HLA antibodies), agglutination etc of neutrophils in pulmonary vasculature
Radiographic diagnosis

Question 9

Reactions to plasma proteins

Answer 9

• Anaphylaxis: rare, immediate. hypotension, dyspnoea, abdominal cramps. IgA deficient recipients with anti-IgA antibodies
• Urticarial- common, with anti-histamines