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Haematology > Transfusion > Flashcards

Transfusion Flashcards

1
Q

What are the symptoms of an acute transfusion reaction?

A 
Chills
Rigors
Rash
Flushing
Feeling of impeding doom
Loin pain
Collapse
Resp distress
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2
Q

What are some of the signs of acute transfusion reaction?

A 
Occurs early in transfusion
Fever 
Tachycardia
Tachypnoea
Hypotension
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3
Q

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

A

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

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4
Q

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

A 
STOP TRANSFUSION
Seek senior assistance
Call lab
Resuscitate if necessary
Return component to transfusion lab
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5
Q

What is acute haemolytic transfusion reaction?

A

ABO incompatible transfusion

Most severe reaction

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6
Q

What is the pathophysiology of an AHTR?

A

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

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7
Q

What is the clinical management of AHTR?

A 
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
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8
Q

What is the lab management of AHTR?

A

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

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9
Q

What are the differentials of a severe acute transfusion reaction?

A

Acute haemolytic transfusion reaction

Bacterial contamination

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10
Q

What type of transfusion is a bacterial contamination more likely?

A

Platelet transfusions

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11
Q

How do you manage a suspected bacterial contamination?

A

Treat supportively

Broad spectrum antimicrobial

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12
Q

What does TACO stand for?

A

Transfusion Associated Circulatory Overload

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13
Q

What are the clinical features of TACO?

A

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

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14
Q

What are some risk factors for a TACO?

A 
Elderly
Cardiac failure
Low albumin
Renal impairment
Fluid overload
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15
Q

What are the management steps for TACO?

A

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

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16
Q

What is the criteria of a mild transfusion reaction?

A

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

17
Q

What is the management of a mild transfusion reaction?

A

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

18
Q

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

A

Febrile non-haemolytic transfusion reaction

Allergic reaction - commoner in plasma rich components

19
Q

What is a Delayed haemolytic transfusion reaction?

A

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

20
Q

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

A

Hb may drop
Raised Bilirubin
LDH
Transfused cells are destroyed

21
Q

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

A

HIV
Hep B / C / E
HTLV
Syphillus

22
Q

How are red cells stored?

A

4 degrees

Up to 35 days

23
Q

How is FFP stored?

A
  • 30 degrees

Up to 3 years

24
Q

How are platelets stored?

A

22 degrees
Up to 7 days
with agitation

25
Q

What blood components are available from a transfusion lab?

A

RBCs
FFP
Platelets
Cryoprecipitate

26
Q

What blood products are available from a transfusion lab?

A

Anti-D immunoglobulin

Prothrombin complex concentrate

27
Q

What blood products are available from a transfusion lab pharmacy?

A

IV immunoglobulin
Human albumin
Specific Ig

28
Q

What chromosome is the gene for ABO on?

A

c9

29
Q

Which of ABO is dominant?

A

A and B are co-dominant

A and B both dominant over O

30
Q

What is Landsteiner’s Law?

A

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

31
Q

What will these naturally occurring A / B antibodies cause?

A

Haemolysis of red cells which express the antigen

32
Q

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

A

O
A
B
AB

33
Q

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

A

RhD

34
Q

What can the anti-D antibody cause?

A

Transfusion reactions

Haemolytic disease of the newborn / foetus

35
Q

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

A

Antisera

If agglutination occurs

36
Q

What are some indications for a red cell transfusion?

A

Symptomatic anaemia with Hb <70g/L

Major bleeding

37
Q

What are some indications for a platelet transfusion?

A

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

38
Q

What are some indications for a FFP transfusion?

A

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

Haematology (13 decks)

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