Transfusion Flashcards
What are the two major blood groups?
ABO
Rhesus
Describe the ABO system
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
Describe the Rhesus system
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
What are the two major tests performed when trying to group blood for a transfusion?
Blood Grouping - determines ABO/Rh status
Antibody Screening - screened for atypical antibodies that would cause haemolysis
What are the two major tests performed when trying to crossmatch blood for a transfusion?
Indirect agglutination
Direct agglutination
Describe indirect agglutination
Donor RBCs added to pt serum w/ Coombs reagent
Agglutination = pts serum has antibodies for donor RBCs
PRE-TRANSFUSION
Describe direct agglutination
Pts ‘washed’ RBCs added to Coomb’s reagent
Agglutination = AI haemolytic process occurring
What blood products need to be cross-matched?
ALL OF THEM
Except platelets
What blood products does the massive transfusion protocol make available?
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
What blood products are available for transfusion?
Packed red cells Platelet concentrates FFP Cryoprecipitate Factor VIII & IX concentrates Albumin IVIG
What are packed red cells, and what are they used for?
Blood w/ all plasma removed & replaced by an additive
-given w/ crystalloids/colloids in acute blood loss
What are platelet concentrates used for?
Treat bleeding in severe thrombocytopenia OR
Prophylactically in pts w/ bone marrow failure
What is FFP, and what is it used for?
Frozen plasma containing all coag factors
-used to replaced coag factors in acquired deficiencies
What is cryoprecipitate, and what is it used for?
FFP w/o the supernatant
-used in when the fibrinogen is v. low e.g. DIC
What are Factor VIII & IX concentrates, and what are they used for?
Specific factor concentrates
-used in haemophilia/vWD
What is albumin used for?
In severe hypoalbuminaemia
-when pt overloaded & resistant to diuretics
What is IVIG used for?
To prevent infections in hypogammaglobulinaemia OR
Specific conditions e.g. ITP
How should pts be observed when being transfused?
Monitored closely
Obs ever 30mins
What are the six main potential complications of a transfusion?
Acute haemolytic reaction Allergy/anaphylaxis Bacterial contamination Transfusion related lung injury (TRALI) Non-haemolytic febrile transfusion reaction Fluid overload
What features suggest an acute haemolytic reaction?
Agitation Raised temperature Low BP Abdo/chest pain Signs of DIC
How should an acute haemolytic reaction be managed?
STOP transfusion
A-E resus
IV 0.9% NaCl
What features suggest allergy/anaphylaxis?
Urticaria
Itch
Swelling
Problems breathing
How should allergy/anaphylaxis be managed?
Allergy - slow/stop transfusion, give chloramphenamine
Anaphylaxis - STOP transfusion, treat appropriately
What features suggest bacterial contamination?
Rapid onset signs of sepsis and rigors
