Transfusion Flashcards
IUT specification
ABO compatible mother and infant
K neg
Negative to maternal allo-ab
IAT x-match compatible maternal serum
Repeat donor
Mandatory micro neg, leukodepleted
PANTS tested
CMV negative
HbS negative
HT negative
<5 days old
Irradiated <24 hours ago
In CPD
HCT 0.7-0.85
Neonatal RCEX specification
ABO compatible mother and infant
K neg
Negative to maternal allo-ab
IAT x-match compatible maternal serum
Repeat donor, neg all micro tests
PANTS tested
CMV negative
HbS negative
HT negative
<5 days old
Irradiated <24 hours ago
In CPD
HCT 0.5-0.6
Paeds blood specification categories
NHSBT release
Unit processing
Local blood bank release
NHSBT characteristics paeds specification
Repeat/new
Mandatory screen, leucodeplete
PANTS
CMV
HbS
HT
Processing characteristics paeds specification
Irradiated/Time since irradiation
Shelf life
Diluent
HCT
Blood bank release characteristics paeds specification
ABO/D
K
Allo-abs
X-match
Non-immune causes platelet refractoriness
Fever
Sepsis
Splenomegaly
DIC
Antibiotics (vanc, ambisome)
Bleeding
VOD
GvHD
Definition platelet refractoriness
Failed increment with at least 2 ABO matched platelet units
Important HPA in UK
HPA-1
HPA-5
HPA-2
HPA-15
Strategies to reduce blood usage
Cell salvage
PBM
This needs sorting / dividing up
NAIT
When to investigate
Fetal/neonatal thrombocytopenia
Fetal anemia (hydrops)
Fetal ICH
Neonatal bleeding
FHx NAIT
NAIT
Investigations
Detect anti-HPA antibodies with PIFT and MAIPA (both use panel platelets)
Genotype parents and infants at HPA loci 1-6, 9, 15
Can calculate risk depending on paternal genotype
NHSBT Filton will test for serum reactivity against paternal, maternal and neonatal platelets
NAIT
Antenatal management
If personal or sister hx of NAIT refer to specialist MDT
Fetal HPA typing to assess risk
Inform blood centre and obs/haem/paeds
Arrange for HPA compatible platelets to be available
Commence IVIg 1g/kg/week from 12 weeks for women with previous NAIT-ICH. If no history start from 20 weeks.
Consider fetal platelet count from 28 weeks
If platelets remain low then 2x IVIg dose, add pred, consider IUT platelets (2x conc platelets)
Planned delivery, consider C-section, if VD then avoid scalp sampling
Woman needs HPA negative red cells (if not risk PTP)
NAIT
Neonatal management
Cord blood count, if plt <100 send venous blood
Inspect for bleeding/bruising, if clinical suspicion don’t delay for FBC results
Use HPA-1a/5b double neg patelets for caucasian
Transfuse platelets to aim plt >100 for ICH or GI bleed
Aim plt >30 if asymptomatic
Cranial USS within 24 hours
IVIg not first line but consider if protracted low plt
DAT - frequent Q
Irradiation specification
99% have <1M leukocytes
90% have <5M leukocytes
Response to NEQAS
Redo sample
Ask for new samples
Review IQC
Review pre-, post- and analytical variables
Review SOP and training
Ask neighbouring labs for asistance
Post transfusion purpura NHSBT 2011
Mechanism
Happens with any blood product that contains platelets
Less post leukodepletion (cuts down platelets as well)
Patient pre-sensitised to HPA antigens (e.g. parous women)
Creates bystander destruction of transfused and own platelets
Post transfusion purpura NHSBT 2011
Investigation
Detection of anti-HPA antibodies in serum with antigen capture ELISA
Post transfusion purpura NHSBT 2011
Management
IVIg 1g/kg consecutive days, total dose 2g/kg
Platelet transfusions not normally effective but give ABO matched if bleeding
PLEX if IVIg doesn’t work
Report to SHOT
