Transfusion Flashcards
ABO antibodies
IgM
Rhesus antibodies
RhD, Kell, Duffy, Kidd
IgG
ABO vs. RhD mismatch
As a result…
ABO = Massive immediate intravascular haemolysis RhD = Delayed haemolysis
Therefore can give anti-D if suspected exposure
Antibodies naturally present in blood
ABO antibodies against antigens you do not have (e.g. if you are A you have anti-B)
ABO matched only
Platelets + Plasma
only RBCs are ABO + RhD matched
6 acute transfusion reactions (<24h)
Febrile non-haemolytic Allergic (mild, anaphylaxis) Acute haemolytic transfusion reaction (ABO incompatibility) Bacterial contamination TACO TRALI
5 delayed transfusion reactions (>24h)
Delayed haemolytic transfusion reaction (RhD incompatibility) Infection Graft vs. host disease Post transfusion purpura Iron overload
Mild fever (<40) with chills + rigors just after transfusion Tx: Slow or stop transfusion + give paracetamol
Febrile non-haemolytic transfusion reaction
High fever (>40) + shock symptoms (hypotension, tachycardia) just after transfusion
Bacterial contamination
Urticaria just after transfusion
Responds to anti-histamine
Mild allergic reaction
Swelling, wheeze + shock symptoms (hypotension, tachycardia) just after transfusion
IgA deficiency
Severe allergic reaction (anaphylaxis)
IgA acts as antigen in IgA deficiency patients - common cause
Breathlessness + fluid overload (raised JVP) just after transfusion
Diuretics help
TACO
(think of a filed TACO
Breathlessness just after transfusion
No signs of fluid overload, diuretics don’t help
Anti-leucocyte antibodies in donor plasma
TRALI
Prevention of TRALI
Use male donors only for plasma/platelet donation who have never been transfused (no HLA antibodies)
Symptoms of haemolysis (bleeding, low Hb, dark urine, jaundice) + symptoms of shock (hypotension, tachycardia) just after transfusion
Immediate haemolytic transfusion reaction (ABO incompatibility)
Symptoms of haemolysis (bleeding, low Hb, dark urine, jaundice) 1w after transfusion
Requires sensitisation
Delayed haemolytic transfusion reaction (RhD incompatibility)
Bruising / pin prick reddish purple purpura 1w after transfusion
Platelets attacked by anti-HPA1alpha antibody
Give IVIG
Post-transfusion purpura
Sickle cell disease
Fever, lethargy _ pallor 2m post-transfusion
Red cell aplasia in BM
Positive Paul-Bunnel antibody test
Parvovirus B19 infection
Receives regular transfusions (B-thalassaemia, SCA)
Erectile dysfunction
Bronze-coloured skin
Short stature + poor cardiac function
Iron overload
Rare but fatal Cannot treat - prevent by screening Donor lymphocytes recognised as foreign Severe diarrhoea, liver failure, BM failure as pt tissues attacked Death weeks-months post-transfusion
Graft vs. host disease
Anti-D doses
<72h of sensitising event
250iu <20w
500iu >20w
Kleihauer test for larger bleeds - estimate amount of fetal Hb in mothers blood)
Causative antibodies in HDFN
RhD, c and Kell (usually less severe - just causes reticulocytopenia)
anti-A and anti-B can cause mild haemolysis
