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Clinical Pathology > Tranfusion > Flashcards

Tranfusion Flashcards

1
Q

how long does it take to transfuse 1 unit of RBC

A

1.3-3 hrs.

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2
Q

what is the time limit within which RBC for transfusion must be used once out of cold storage

A

4hrs

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3
Q

what conditions and for how many days is RBC for transfusion kept

A

4 degrees for 35 days.

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4
Q

what is plasma replaced with in a RBC transfusion

A

solution of electrolytes, glucose and adenine.

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5
Q

How we can determine the ideal Hb concentration for various groups or individual patients

A

Transfusion threshold- the lowest concentration of Hb that is not associated with symptoms of anaemia.

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6
Q

How does the body adapt to anaemia

A

increased cardiac output, increased artery blood flow, increased oxygen extraction, increased RBC DPG (diphosphoglycerate), increase production of EPO, increase erythropoeisis, high respiratory rate,

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7
Q

what affects the body’s ability to adapt to anaemia

A

underlying conditions

age- elderly can adapt less than younger.

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8
Q

how much RBC in transfused in anaemia.

A

≤70 g/L for patients with mild symptoms of anaemia,

≤80 g/L for patients with cardiovascular disease

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9
Q

alternative treatments for anaemia except RBC transfusion.

A

correcting the cause of anaemia- iron deficiency, B12 folate deficiency, EPO treatment for patients with renal disease

correction of coagulopathy
discontinuation of anti platelet agents. Administration of anti-fibrinolytic agents

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10
Q

what category of patients are on continuous RBC transfusion

A

those with myeloid failure syndromes

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11
Q

what are the aims of RBC transfusion of patients with acquired anaemia

A

Symptomatic relief of anaemia
Improvement of Quality of Life
Prevention of ischemic organ damage

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12
Q

why is the threshold Hb 80-100g/dl

A

Co-morbidities that affect cardiac, respiratory function
Iron overload
Adaptation to anaemia

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13
Q

what are the aims of RBC transfusion of patients with inherited anaemias (thalassemia)

A

Suppression of endogenous erythropoiesis- bacsue the RBC are abnormal.

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14
Q

In what conditions and for how many days are platelets stored for

A

22 degrees for 5 days

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15
Q

define adult therapeutic dose

A

is platelets from 4 pooled donations

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16
Q

why are patients transfused with platelets

A 
treat- bleeding disorders due to severe thrombocytopenia or platelet dysfunction.
Prevention of bleeding
Massive haemorrhage
bone marrow failure
prophylaxis for surgery.
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17
Q

what is the risk of platelet transfusion

A

infections

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18
Q

what are the contraindications of platelet transfusion

e.g. when should it not be used

A

Heparin induced thrombocytopenia and thrombosis

Thrombotic thrombocytopenic purpara.

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19
Q

why a patients transfused fresh, frozen plasma

A

coagulopathy with bleeding
massive haemorrhage
Thrombotic thrombocytopenic purpura.

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20
Q

what are the contraindications of fresh frozen plasma

A

Warfarin reversal.

Replacement of single factor deficiency

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21
Q

what conditions and for how long is fresh frozen plasma stored for.

A

30 degrees for up to 24 months

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22
Q

what is the typical dose of fresh frozen plasma

A

12-15 mL/kg (4-6 units for average adult

23
Q

what is the transfusion time for fresh frozen plasma

A

30 mins

24
Q

where is Prothrombin Complex Concentrate (PCC) derived from.

A

Plasma-derived

25
Q

what are the uses for prothrombin complex concentrate

A

life-threatening warfarin over-anticoagulation

Vit K dependent factors: II VII IX X

26
Q

what are the requirements of any prothrombin complex concentrate

A

CMV negative
Irradiated- To prevent transfusion associated graft versus host diseases (rare) in specific t cell immunodeficiency cases

27
Q

before transfusion what laboratory tests are conducted on the patient

A
  • Determination of ABO and Rh(D) group

* Patient’s plasma “screened” for antibodies against other clinically significant blood group antigens.

28
Q

what is crossmatching

A

Donor red cells of the correct ABO and Rh group are selected from blood bank.

Patients plasma is mixed with aliquots of donor red cells to see if a reaction (agglutination or haemolysis) occurs
o No reaction- RBC is compatible and no risk of acute haemolysis
o Reaction- RBC not compatible, risk of acute haemolysis.

29
Q

risk of transfusion

A

Acute transfusion reactions
o Immunological- acute haemolytic transfusion reaction, anaphylactic reaction, Transfusion related acute lung injury (TRALI).
o Non immunological- Bacterial contamination, TACO (transfusion associated circulatory overload), Febrile non-haemolytic transfusion reaction
Delayed transfusion reactions
o Immunological- Transfusion associated graft versus host disease (TA- GvHD)- abnormal T cell attack on host.
o Non- immunological- Transfusion Transmitted Infection (TTI) –viral/prion

30
Q

define acute reactions to transfusion.

A
31
Q

define delayed reactions to transfusion.

A

> 24 hours of transfusion

32
Q

pathogenesis of acute haemolytic reaction

A

Deposition of Hb in the distal renal tubule results in acute renal failure.
Stimulation of coagulation results in micro vascular thrombosis
Stimulation of cytokine storm

33
Q

what molecules causes vasoconstriction in acute haemolytic transfusion

A

NO

34
Q

what are the signs and symptoms of acute haemolytic reaction.

A

fever and chills, back pain, infusion pain, hypotension, haemoglobinuria, increased bleeding chest pain.

35
Q

what check must be made when administering a blood transfusion

A

Check patients details on the compatibility label against the patients wristband at the bedside.

36
Q

how many days after transfusion is a delayed haemolytic reaction

A

Onset 3-14 days following a transfusion of RBC

37
Q

what are the clinical features of delayed haemolytic reaction

A

fatigue, jaundice and fever.

38
Q

how is the haemoglobin affected in delayed haemolytic reaction

A

drop in Hb

39
Q

how is the LDH level affected in delayed haemolytic reaction

A

increased

40
Q

what does the direct coagulation test show show is a patient with delayed haemolytic reaction

A

positive

41
Q

what does the Coomb’s test show- The Anti-human globulin

A

used to detect IgG antibodies on red cells

42
Q

how is the anti human goblin test carried out

A
  1. Red cells coated with IgG antibody eg anti-Rh in a Rh Positive patient
  2. AHG added
  3. Visible aggulutination
43
Q

pathogenesis of acute lung injury

A

activated WBC lodge in pulmonary capillaries

release substances that cause endothelial damage and capillary leak.

44
Q

diagnosis of TRALI (acute lung injury)

A

Acute Lung Injury” occurring within 6 hours of a transfusion.
Hypoxemia- abnormally low oxygen.
New bilateral chest X-ray infiltrates
No evidence of volume overload

45
Q

Treatment of TRALI is supportive. (acute lung injury)

A

Mild form- oxygen therapy

severe form-mechanical ventilation and ICU support.

46
Q

within what time frame do patients suffering from TRALI recover within

A

72 to 96 hours

47
Q

symptoms of TACO (Transfusion-associated circulatory overload )

A

sudden dyspnea, orthopnoea (shortness of breath when lying flat), tachycardia, hypertension, hypoxaemia (low oxygen), raised BP and elevated JVP

48
Q

risk factors for TACO (Transfusion-associated circulatory overload )

A
  • elderly patients
  • small children
  • patients with compromised left ventricular function
  • increased volume of transfusion
  • increased rate of transfusion.
49
Q

common allergic reaction from transfusion results in what 2 symptoms

A

Urticarial Rash (hives- raised small bumps on skin) ± wheeze

50
Q

define anaphylaxis

A

Severe, life-threatening hypersensitivity reaction

51
Q

what are the symptoms os anaphylaxis

A

wheeze/asthma, raised pulse, decreased blood pressure, laryngeal and facial odema.

52
Q

what causes Febrile non-haemolytic transfusion reactions (FNHTR

A

cytokines or other biologically active molecules that accumulate during storage of blood components

53
Q

symptoms of Febrile non-haemolytic transfusion reactions (FNHTR

A
  • Fever - rise in temp > 1°C ± shakes/ rigors

* ± increased pulse

Clinical Pathology (45 decks)

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