Transfusion

Question 1

What are the symptoms of an acute transfusion reaction?

Answer 1

Chills
Rigors
Rash
Flushing
Feeling of impeding doom
Loin pain
Collapse
Resp distress

Question 2

What are some of the signs of acute transfusion reaction?

Answer 2

Occurs early in transfusion
Fever 
Tachycardia
Tachypnoea
Hypotension

Question 3

What is the procedure when a patient suffers from a transfusion reaction?

Answer 3

STOP the transfusion
ABCDE assessment
Recheck comparability tag with patient details and inspect pack for contamination
Document everything in medical notes

Question 4

What is the immediate management for severe/life threatening transfusion reactions?

Answer 4

STOP TRANSFUSION
Seek senior assistance
Call lab
Resuscitate if necessary
Return component to transfusion lab

Question 5

What is acute haemolytic transfusion reaction?

Answer 5

ABO incompatible transfusion

Most severe reaction

Question 6

What is the pathophysiology of an AHTR?

Answer 6

Binding of IgM anti-A/anti-B antibodies to the corresponding antigens
Compliment activation
Haemolysis of transfused cells
Inflammatory cytokine release
Shock - increased vascular permeability, disseminated intravascular coagulation and renal failure
Often Fatal

Question 7

What is the clinical management of AHTR?

Answer 7

Stop transfusion
Inform Lab
Supportive measures - O2 and IV fluids
Repeat transfusion blood samples
Take bloods:
- FBC
- Coag screen
- renal function
- Measures of haemolysis
- Blood cultures

Question 8

What is the lab management of AHTR?

Answer 8

Repeat ABO and RhD group of pre and post transfusion samples
Direct antiglobulin test
Repeat cross-match
Send remains of unit for culture

Question 9

What are the differentials of a severe acute transfusion reaction?

Answer 9

Acute haemolytic transfusion reaction

Bacterial contamination

Question 10

What type of transfusion is a bacterial contamination more likely?

Answer 10

Platelet transfusions

Question 11

How do you manage a suspected bacterial contamination?

Answer 11

Treat supportively

Broad spectrum antimicrobial

Question 12

What does TACO stand for?

Answer 12

Transfusion Associated Circulatory Overload

Question 13

What are the clinical features of TACO?

Answer 13

Resp distress within first 6 hours
Raised BP
Raised JVP
Positive fluid balance

Question 14

What are some risk factors for a TACO?

Answer 14

Elderly
Cardiac failure
Low albumin
Renal impairment
Fluid overload

Question 15

What are the management steps for TACO?

Answer 15

O2
Diuretics
Consider slowing rate of transfusion next time or adding diuretics alongside

Question 16

What is the criteria of a mild transfusion reaction?

Answer 16

Temp rise of 1-2 degrees (38 degrees)
or
Rash

Question 17

What is the management of a mild transfusion reaction?

Answer 17

Continue transfusion
Possibly slow rate
Close monitoring for deterioration
Paracetamol/anti-histamine

Question 18

What are the 2 main causes of a mild transfusion reaction?

Answer 18

Febrile non-haemolytic transfusion reaction

Allergic reaction - commoner in plasma rich components

Question 19

What is a Delayed haemolytic transfusion reaction?

Answer 19

When the patient mounts a delayed immune response to the red cell antigen - usually IgG mediated
Causes extravascular haemolysis 5-10 days post transfusion

Question 20

What might be seen in Delayed haemolytic transfusion reactions and why?

Answer 20

Hb may drop
Raised Bilirubin
LDH
Transfused cells are destroyed

Question 21

What is a blood sample tested for before being fit for transfusion?

Answer 21

HIV
Hep B / C / E
HTLV
Syphillus

Question 22

How are red cells stored?

Answer 22

4 degrees

Up to 35 days

Question 23

How is FFP stored?

Answer 23

• 30 degrees

Up to 3 years

Question 24

How are platelets stored?

Answer 24

22 degrees
Up to 7 days
with agitation

Question 25

What blood components are available from a transfusion lab?

Answer 25

RBCs FFP Platelets Cryoprecipitate

Question 26

What blood products are available from a transfusion lab?

Answer 26

Anti-D immunoglobulin | Prothrombin complex concentrate

Question 27

What blood products are available from a transfusion lab pharmacy?

Answer 27

IV immunoglobulin Human albumin Specific Ig

Question 28

What chromosome is the gene for ABO on?

Answer 28

c9

Question 29

Which of ABO is dominant?

Answer 29

A and B are co-dominant | A and B both dominant over O

Question 30

What is Landsteiner's Law?

Answer 30

When an individual lacks A or B antigen, the individual produces the corresponding antibody in their plasma

Question 31

What will these naturally occurring A / B antibodies cause?

Answer 31

Haemolysis of red cells which express the antigen

Question 32

What bloods are compatible for transfusion in a patient with AB phenotype?

Answer 32

O A B AB

Question 33

What is the second most popular antigen after A & B?

Answer 33

RhD

Question 34

What can the anti-D antibody cause?

Answer 34

Transfusion reactions | Haemolytic disease of the newborn / foetus

Question 35

What is the reagent used to test ABO / D grouping? What is a positive test?

Answer 35

Antisera | If agglutination occurs

Question 36

What are some indications for a red cell transfusion?

Answer 36

Symptomatic anaemia with Hb <70g/L | Major bleeding

Question 37

What are some indications for a platelet transfusion?

Answer 37

Prophylaxis in pts with bone marrow failure & low platelet counts Treat bleeding in thrombocytopaenic pts Prophylaxis to surgery / procedure in thrombocytopaenic patients

Question 38

What are some indications for a FFP transfusion?

Answer 38

Treat bleeding pt with coagulopathy Surgery prophylaxis in pt with coagulopathy Management of massive hemorrhage Early transfusion in trauma