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Essential Haematology > Pretransfusion Testing > Flashcards

Pretransfusion Testing Flashcards

1
Q

What are the aims of Pre-transfusion Testing

A

To select blood components that will not harm the recipient

To select blood components that will have acceptable survival when transfused

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2
Q

What are the seven steps in Pre transfusion testing

A

1) the request for transfusion
2) positive identification of recipient and recipient’s blood sample
3) Blood grouping- determination of the ABO and Rhesus types of both recipient and blood components
4) Screening of components of ABO and Rh types appropriate for recipient
5) selection of components of ABO and Rh types appropriate for the recipient
6) Performance of a crossmatch (for RBC recipient only) between the recipient’s plasma and the donor cells (done to determine whether the donor cells are compatible with the recipient’s plasma)
7) Label blood component

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3
Q

In Pre transfusion testing what is done after the request for transfusion

A

2)positive identification of recipient and recipient’s blood sample

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4
Q

In Pre transfusion testing what is done after 2) positive identification of recipient and recipient’s blood sample

A

3) Blood grouping- determination of the ABO and Rhesus types of both recipient and blood components

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5
Q

In Pre-transfusion testing, what is done after

3) Blood grouping- determination of the ABO and Rhesus types of both recipient and blood components

A

4) Screening of components of ABO and Rh types appropriate for recipient

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6
Q

In pre-transfusion testing what is done after

4) Screening of components of ABO and Rh types appropriate for recipient

A

5) selection of components of ABO and Rh types appropriate for the recipient

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7
Q

In pre-transfusion testing, what is done after

5) selection of components of ABO and Rh types appropriate for the recipient

A

6) Performance of a crossmatch (for RBC recipient only) between the recipient’s plasma and the donor cells (done to determine whether the donor cells are compatible with the recipient’s plasma)

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8
Q

In pre transfusion testing what is done after
6) Performance of a crossmatch (for RBC recipient only) between the recipient’s plasma and the donor cells (done to determine whether the donor cells are compatible with the recipient’s plasma)

A

7) Label blood component

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9
Q

What are the two main requirements for Pre-transfusion testing

A

One anticoagulated (EDTA) sample (plasma)

Request form

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10
Q

1 requirement of Pre-transfusion testing is anti-coagulated (EDTA) sample (plasma), which other sample may be used

A

Serum from clotted sample
(Plasma is preferred)

NB// Serum and plasma both come from the liquid portion of the blood that remains once the cells are removed, but that’s where the similarities and. Serum is the liquid that remains after the blood has clotted. Plasma is the liquid that remains when clotted is prevened with the addition of an anticoagulant.

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11
Q

In pretransfusion testing what should be done if a patient was pregnant or recieved a blood transfusion within the past 3months

A

A fresh plasma sample should be collected 3 days (or less) before the intended transfusion

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12
Q

In pretransfusion testing if a patient was pregnant or recieved a blood transfusion within the past 3months A fresh plasma sample should be collected 3 days (or less) before the intended transfusion.

Why

A

To allow time for antibody production and detection

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13
Q

Are verbal requests for pre-transfusion testing accepted?

A

Yes in urgent situations but should be documented according to local policies

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14
Q

What are the pre-transfusion request requirements

A

a) Detailed identification of the patient
b) Details of the diagnosis as well as indication for transfusion
c) Blood Group, if known
d) Details of potentially sensitizing episodes (for example pregnancy, previous transfusion or transplantation
e) identification of component needed
f) the degree of urgency/ expected date of transfusion
g) location of the patient
h) name and or signature of the clinician responsible for pt

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15
Q

Accurate Recipient identification is required for Pretransfusion Request Form.

This includes

A

First and last names
Hospital registration /ID number
Date of birth

(If pt is unconscious then the minimum information required is the hospital registration/ID number and gender)

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16
Q

Identification of component needed is required for Pretransfusion request form .

This includes

A

Type
Quantity
Special request (leukocyte reduction,irradiation)

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17
Q

What should be done with Pre-transfusion requests that lack the required information or have inaccurate or illegible information?

A

Should be rejected as it is extremely risky for anyone to correct identifying information on an incorrectly labelled form

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18
Q

What are the four steps to Sample Collection and Processing

A

1) There should be no doubt about the identity of the specimen and the recipient
2) The specimen tubes appropriately labelled, after blood collection and preferably at the pts bedside
3) There should be no discrepancy between the information on the request form and that on the specimen tubes
4) Pretransfusion blood specimens are retained for a minimum of 7 days post-transfusion in the Blood Bank

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19
Q

Blood submitted for compatibility testing must be tested for what blood types

A

ABO and Rh in order to transfuse ABO and Rh compatible components.

Also for unexpected antibodies to red cell antigen using the Indirect Coombs test

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20
Q

What is the Compatibility test process for pts with previous blood bank records

A

They should have ABO and Rh type checked against the current information

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21
Q

Describe the selection of Blood and Plasma for transfusion

For whole blood

A

ABO identical to recipient

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22
Q

Describe the selection of Blood and Plasma for transfusion in

For red cells

A

Group O packed red cells (lack A and B antigens)

Red cells compatible with the recipients plasma

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23
Q

Describe the selection of Blood and Plasma for transfusion in

For plasma

A

Group AB plasma (contains no anti-A or Anti-B)

Plasma compatible with recipient’s RBC

24
Q

Describe the selection of Blood and Plasma for transfusion in

For platelets

A

All ABO groups acceptable

Components compatible with recipient RBC preferred

25
Q

Describe the selection of Blood and Plasma for transfusion in

For cryoprecipitate

A

ABO compatibility preferred

26
Q

When in doubt of Rh D type, which Rh D type should be used

A

Rh D-negative blood

27
Q

What Rh-D type blood component should be selected for D-positive recipients?

A

Rh-D positive

28
Q

Should you reserve Rh D- negative components for D-negative recipients?

A

Nope

29
Q

Why is a crossmatch done in the Compatibility Process of Pre-transfusion testing

A

This is performed to detect ABO incompatibility and clinically significant immune antibodies in the plasma of the recipient that will react with donor red cell antigens

30
Q

Which blood group is administered if the ABO/Rhesus D status is unknown

A

Group O Rh D negative

And the physician must provide a signed statement that the clinical situation required the urgent release of blood

31
Q

Crossmatchibg is not routinely done for which three types of transfusion

A

Platelet
Plasma
Cryoprecipitate

Blood group compatibility is still done

32
Q

The method for crossmatching involves mixing donor red cells with recipient plasma. What are the steps in this method

A

1) Select a unit of donor blood (whole or packed RBC) that has the same ABO and rhesus blood group as the recipient
2) Centrifuge A mixture of recipients serum or plasma and doing a red cells at room temperature. Examined for agglutination. If present, this indicates ABO incompatibility. Absence of agglutination indicates a compatible immediate spin crossmatch
3) The sample is been incubated at 37°C, washed, followed by the Addition of the cools reagent and examined for agglutination. Agglutination indicates incompatibility and the blood should not be transfused.

33
Q

In the cross matching test during centrifugation, if agglutination between the plasma of the recipient and the donors red blood cells is present what does this indicate

A

Incompatiblility

34
Q

What are the two steps in Issuing of Blood for Transfusion

A

Blood Transfusion Compatibility label

Final inspection of blood component for any abnormal colour or appearance and expiration date should be performed before issue

35
Q

What information is included in the Blood Transfusion Compatibility label

A

Recipient’s name, hospital registration/ID number, ABO and Rh type

Donor unit number, ABO and Rh type

Identification of person who performed the compatibility test

Type and amount of blood component contained in the unit

Special transfusion requirements e.g leukoreduction

36
Q

What are the four phases of Administration of Blood Components

A

Consent
Pre-transfusion
During Transfusion
Post Transfusion

37
Q

What is done in the CONSENT phase of administration of transfusion

A
  • obtain the consent
  • consent form includes: risks of transfusion, indications and benefits as well as alternative treatment discussed
  • consent form where available signed by recipient

The patient has the right to refuse or accept the transfusion

38
Q

List the 7 steps in the Pre-transfusion phase of Administration of transfusion

A
  • Treatment chart reviewed
  • Patient identity checked
  • Blood and components stored correctly prior to transfusion
  • The unit to be given should be checked for compatibility-and infectious screen labels
  • inspect the unit for leaks, haemolysis, large clots, clumping
  • expiry date of the unit of blood
  • The transfusionist must determine the catheter size required to access the vein
39
Q

Catheter size in transfusion depends on what factors

A

On how quickly the blood needs to be administered

40
Q

How should Blood components be warmed?

A

Certified blood warmers (For s with Cold AIHA)

NOT by putting in warm water or under the hot water pipe or in a microwave!!!

41
Q

Can drugs be added to blood during transfusion??

A

Nope, never, not under any circumstance

42
Q

Which intravenous fluids may be added to blood during transfusion ?

Normal Saline
Dextrose
Ringer lactate

A

Normal Saline to packed RBC

43
Q

Why isn’t Dextrose allowed to be added to blood during transfusion

A

May cause red cells to agglutinate or haemolyze

44
Q

Why isn’t Ringer lactate or other solutions containing calcium allowed to be added to blood during transfusion

A

The calcium present will lead to coagulation

45
Q

How are the vital signs monitored during blood transfusion

A

Temperature, Pulse, Respiration - documented before, then 15mins after starting each unit and after the transfusion

Unconscious pt( pulse, temperature and urine)

46
Q

What is the rate of transfusion of Red cells

A

One unit of Red cells is given within 2-3hrs

infusion longer than 4hrs is not recommended

47
Q

Why isn’t administration of blood transfusion longer that 4hrs recommended

A

Bacterial Proliferation because the opened unit is at room temperature

48
Q

Can platelets be stored in the freezer

A

Never

Stored at room temperature

49
Q

What is the dosage of platelet for transfusion

A

1 unit /10kg

50
Q

What is the rate of infusion of platelets in nin emergency settings

A

200-300 ml/hr

51
Q

What is the infusion rate of plasma and cryoprecipitate

A

200-300 ml/hr

52
Q

What is the plasma dose in transfusion

A

10-15ml/kg

53
Q

What is the cryoprecipitate dose in transfusion

A

1-2 units /10kg

54
Q

What is done Post blood transfusion

A

Documentation of the transfusion event should be made in the patient’s medical record

55
Q

Documentation of the transfusion event should be made in the patient’s medical record, these details include:

A 
The medical request for the transfusion 
Recipient’s signed consent form
The transfusion tag/compatibility label
Date and time of transfusion 
Pre- and post-Transfusion vital signs
Any adverse events related to the blood transfusion 
The clinical response to the transfusion

Essential Haematology (14 decks)

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