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CP3 @ UoN - Medicine & Surgery > Transfusion > Flashcards

Transfusion Flashcards

1
Q

What are the two major blood groups?

A

ABO

Rhesus

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2
Q

Describe the ABO system

A

RBCs can be A, B, AB or O (depends on surface antigens)
Carry IgM against antibodies they do not carry –> HAEMOLYSIS
-O carries both anti-A/anti-B
-AB carries no antibodies

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3
Q

Describe the Rhesus system

A

RBCs can carry Rh D antigen or not (+ve/-ve)
If a Rh-ve pt receives Rh+ve blood they will produce IgG antibodies against Rh D
Second exposure –> HAEMOLYSIS

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4
Q

What are the two major tests performed when trying to group blood for a transfusion?

A

Blood Grouping - determines ABO/Rh status

Antibody Screening - screened for atypical antibodies that would cause haemolysis

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5
Q

What are the two major tests performed when trying to crossmatch blood for a transfusion?

A

Indirect agglutination

Direct agglutination

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6
Q

Describe indirect agglutination

A

Donor RBCs added to pt serum w/ Coombs reagent
Agglutination = pts serum has antibodies for donor RBCs
PRE-TRANSFUSION

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7
Q

Describe direct agglutination

A

Pts ‘washed’ RBCs added to Coomb’s reagent

Agglutination = AI haemolytic process occurring

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8
Q

What blood products need to be cross-matched?

A

ALL OF THEM

Except platelets

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9
Q

What blood products does the massive transfusion protocol make available?

A

2 units of O- blood available IMMEDIATELY
Blood of same ABO/Rh group available in 10-15 MINS
Cross-matched blood available w/i 45 MINS

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10
Q

What blood products are available for transfusion?

A 
Packed red cells
Platelet concentrates
FFP
Cryoprecipitate
Factor VIII & IX concentrates
Albumin
IVIG
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11
Q

What are packed red cells, and what are they used for?

A

Blood w/ all plasma removed & replaced by an additive

-given w/ crystalloids/colloids in acute blood loss

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12
Q

What are platelet concentrates used for?

A

Treat bleeding in severe thrombocytopenia OR

Prophylactically in pts w/ bone marrow failure

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13
Q

What is FFP, and what is it used for?

A

Frozen plasma containing all coag factors

-used to replaced coag factors in acquired deficiencies

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14
Q

What is cryoprecipitate, and what is it used for?

A

FFP w/o the supernatant

-used in when the fibrinogen is v. low e.g. DIC

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15
Q

What are Factor VIII & IX concentrates, and what are they used for?

A

Specific factor concentrates

-used in haemophilia/vWD

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16
Q

What is albumin used for?

A

In severe hypoalbuminaemia

-when pt overloaded & resistant to diuretics

17
Q

What is IVIG used for?

A

To prevent infections in hypogammaglobulinaemia OR

Specific conditions e.g. ITP

18
Q

How should pts be observed when being transfused?

A

Monitored closely

Obs ever 30mins

19
Q

What are the six main potential complications of a transfusion?

A 
Acute haemolytic reaction
Allergy/anaphylaxis
Bacterial contamination
Transfusion related lung injury (TRALI)
Non-haemolytic febrile transfusion reaction
Fluid overload
20
Q

What features suggest an acute haemolytic reaction?

A 
Agitation
Raised temperature
Low BP
Abdo/chest pain
Signs of DIC
21
Q

How should an acute haemolytic reaction be managed?

A

STOP transfusion
A-E resus
IV 0.9% NaCl

22
Q

What features suggest allergy/anaphylaxis?

A

Urticaria
Itch
Swelling
Problems breathing

23
Q

How should allergy/anaphylaxis be managed?

A

Allergy - slow/stop transfusion, give chloramphenamine

Anaphylaxis - STOP transfusion, treat appropriately

24
Q

What features suggest bacterial contamination?

A

Rapid onset signs of sepsis and rigors

25
Q

How should bacterial contamination be managed?

A

STOP transfusion
START sepsis protocol
Send blood unit to lab AND cultures from pt

26
Q

What is Transfusion Related Acute Lung Injury (TRALI)?

A

Acute respiratory distress syndrome due to antibodies in the donor plasma

27
Q

What features suggest TRALI?

A

Dyspnoea

CXR white out

28
Q

How should TRALI be managed?

A

STOP transfusion

Treat as ARDS

29
Q

What features suggest a non-haemolytic febrile transfusion reaction?

A

Shivering & fever 30mins-1hr after starting transfusion

30
Q

How should a non-haemolytic febrile transfusion reaction be managed?

A

Slow transfusion

Administer antipyretic

31
Q

How should fluid overload be managed?

A

Slow/stop transfusion
Give O2 & a diuretic
-if pt not hypovolaemic often co-prescribe Furosemide w/ transfusion
Consider exchange transfusion

32
Q

What procedures should be followed when taking a sample of blood?

A

Ensure pt details are correct
Use pink bottle for cross match
Label immediately

33
Q

What should be done when requesting blood products?

A

Ensure sample has been taken
Counsel pt
-benefits/indications
-risks of infection (HIV 3/million, HBV 2/100,000)
-non-infectious risks (transfusion reactions)
-right to refuse (e.g. Jehovah’s)

CP3 @ UoN - Medicine & Surgery (135 decks)

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