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Module 103: The Heart, Lungs and Blood > Theme 2: Lecture 8 - Principles of blood transfusion > Flashcards

Theme 2: Lecture 8 - Principles of blood transfusion Flashcards

1
Q

What is the fundamental problem with blood transfusion

A
  • Red cells have antigens on their surface
  • Human plasma may contain antibodies to these antigens
  • These can cause reactions - sometimes fatal
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2
Q

Agglutinins

A

Naturally occurring pentameric IgM antibodies in the plasma

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3
Q

What does transfusion of ABO incompatible blood cause

A

intravascular lysis (red blood cells rupture)

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4
Q

What can intravascular lysis due to transfusion of incompatible blood cause

A
  • shock, hypotension, tachycardia
  • renal failure, loin pain, haemoglobinuria
  • disseminated intravascular coagulation
  • death
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5
Q

haemoglobinuria

A

presence of excess haemoglobin in the blood

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6
Q

Blood group A

A

If you belong to the blood group A, you have A antigens on the surface of your red blood cells and B antibodies in your blood plasma.

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7
Q

Blood group B

A

If you belong to the blood group B, you have B antigens on the surface of your red blood cells and A antibodies in your blood plasma

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8
Q

Blood group AB

A

If you belong to the blood group AB, you have both A and B antigens on the surface of your red blood cells and no A or B antibodies at all in your blood plasma.

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9
Q

Blood group O

A

If you belong to the blood group 0 (null), you have neither A or B antigens on the surface of your red blood cells but you have both A and B antibodies in your blood plasma.

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10
Q

What is cross matching by forward grouping

A

Determining what antigens are present on the RBCs by mixing a patient’s RBCs with known anti serum

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11
Q

What is cross matching by reverse grouping

A

Determines what antibodies are present by mixing patient’s plasma with known RBCs

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12
Q

Who can blood group AB give blood to

A

Blood group AB

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13
Q

Who can blood group AB receive blood from

A

AB, A, B, O

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14
Q

Who can blood group A give blood to

A

A and AB

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15
Q

Who can blood group A receive blood from

A

A and O

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16
Q

Who can blood group B give blood to

A

B and AB

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17
Q

Who can blood group B receive blood from

A

B and O

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18
Q

Who can blood group O give blood to

A

AB, A, B, O

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19
Q

Who can blood group O receive blood from

A

O

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20
Q

% of people with blood group O in the UK

A

46%

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21
Q

% of people with blood group A in the UK

A

42%

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22
Q

% of people with blood group B in the UK

A

9%

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23
Q

% of people with blood group AB in the UK

A

3%

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24
Q

What does the lad do when you send a blood sample

A
  • Test the ABO group of red cells

- Screen for atypical antibodies

25
Q

What are atypical antibodies

A
  • These arise due to sensitisation with foreign red cell antigens
  • Atypical antibodies can cause blood transfusion reactions if the patient is transfused with incompatible blood in the future
26
Q

What causes atypical antibodies

A
  • previous blood transfusion

- pregnancy

27
Q

Anti-globulin or Coombs test

A

It uses anti-immunoglobulin antibody to agglutinate red cells

28
Q

What are the two types of anti globulin or Coombs test

A
  • Direct antiglobulin test (DAT)

- Indirect antiglobulin test (IAT)

29
Q

What does the DAT tell us

A

The DAT tells us if red cells are coated with antibody

30
Q

When is the DAT positive

A
  • It is positive after a transfusion reaction and in HDN

- It is also positive in autoimmune haemolytic anaemia

31
Q

IAT

A
  • The IAT is used in the lab for testing blood group antigens
  • It can tell us if a patient is positive for Rhesus and other blood groups
32
Q

Can Rhesus positive people develop antibodies

A

No

33
Q

When can Rhesus negative people develop antibodies

A
  • they are transfused with Rh pos blood

- pregnant with a Rh pos baby

34
Q

What antibody is generated in Rhesus sensitisation

A

IgG type antibodies

35
Q

What is Rhesus sensitisation

A

When Rhesus negative people develop antibodies

36
Q

Haemolytic disease of the newborn (HDN)

A

If a mother, who is Rh neg is pregnant with an Rh pos fetus, she may produce antibodies that can cross the placenta and harm the baby

37
Q

Can a Rh negative person who develops Rh antibodies be given Rh positive blood

A

No

38
Q

Which antigens does the Rhesus system comprise of

A

C, D and E (only need to know D)

39
Q

What can HDN cause in the baby

A
  • Anaemia
  • Jaundice
  • Kernicterus
40
Q

Kernicterus

A

brain damage due to high levels of bilirubin in the blood

41
Q

How is HDN prevented

A
  • Rh-ve women (15%) receive anti-D antibody i.m. injection at 28 and 34 weeks to prevent sensitisation
  • Baby tested at birth and if Rh+ve, mother receives further anti-D until Kleihauer test (foetal cells) becomes negative
  • If already sensitised, then the foetus requires monitoring via trans-cranial Doppler scan and may require intra-uterine transfusions if signs of anaemia
42
Q

What is in a bag of donated blood

A
  • Red cells
  • Buffy coat (white cells, platelets)
  • Plasma (albumin, gamma globulins, coagulation factors)
  • Water, electrolytes, additives
43
Q

What is the process that blood goes through to be separated into its different parts

A

Fractionation

44
Q

Apheresis

A

A medical procedure that involves removing whole blood from a donor or patient and separating the blood into individual components so that one particular component can be removed. The remaining blood components then are re-introduced back into the bloodstream of the patient or donor.

45
Q

When do you give a blood transfusion

A
  • Severe acute blood loss
  • Elective surgery associated with significant blood loss
  • Medical transfusions (cancer, chemotherapy, renal failure)
  • Anaemia
46
Q

When do you give a blood transfusion in anaemia

A
  • Only for symptomatic anaemia or if refractory to haematinic replacement
  • Bone marrow failure e.g., myelodysplasia or aplastic anaemia
  • Haemoglobinopathy - thalassaemia major and sickle cell disease
47
Q

Cryoprecipitate

A

plasma but enriched with fibrinogen

48
Q

What type of transfusion is cell salvage

A

blood lost during operation is reinfused into the patient (rarely done)

49
Q

What is an autologous transfusion

A

store blood from somebody to be given back to them at a later date (very rarely done)

50
Q

What other transfusion reactions are there (excluding transfusion of ABO incompatible blood)

A
  • Febrile non-haemolytic reactions
  • Fluid overload
  • Anaphylaxis and severe allergic reactions
  • Minor allergic reactions
  • Delayed transfusion reactions
  • TRALI (transfusion related acute lung injury
51
Q

What are the broad transfusion transmitted infections that you could get

A
  • Bacterial infections
  • Viral infections
  • Malaria
  • vCJD
52
Q

What are the bacterial infections you could get from blood transfusions

A
  • syphilis
  • pyogenic infections
  • contamination infections (pseudomonas)
53
Q

What are the viral infections you could get from blood transfusions

A
  • hepatitis (B,C)
  • HIV
  • Others - HTLV (Human T-lymphotropic virus), CMV
  • Emerging - West Nile virus
54
Q

Haemosiderosis

A

iron overload

55
Q

How is iron overload treated

A

by iron chelation

56
Q

What can happen if you transfuse too quickly

A

fluid overload

57
Q

What can fluid overload cause

A

acute pulmonary oedema

58
Q

Frusemide

A

A diuretic drug

59
Q

How is fluid overload treated

A

with diuretics to remove fluid

Module 103: The Heart, Lungs and Blood (51 decks)

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