Transfusion

Question 1

ABO antibodies

Answer 1

IgM

Question 2

Rhesus antibodies

RhD, Kell, Duffy, Kidd

Answer 2

IgG

Question 3

ABO vs. RhD mismatch

As a result…

Answer 3

ABO = Massive immediate intravascular haemolysis
RhD = Delayed haemolysis

Therefore can give anti-D if suspected exposure

Question 4

Antibodies naturally present in blood

Answer 4

ABO antibodies against antigens you do not have (e.g. if you are A you have anti-B)

Question 5

ABO matched only

Answer 5

Platelets + Plasma

only RBCs are ABO + RhD matched

Question 6

6 acute transfusion reactions (<24h)

Answer 6

Febrile non-haemolytic
Allergic (mild, anaphylaxis)
Acute haemolytic transfusion reaction (ABO incompatibility)
Bacterial contamination
TACO
TRALI

Question 7

5 delayed transfusion reactions (>24h)

Answer 7

Delayed haemolytic transfusion reaction (RhD incompatibility)
Infection
Graft vs. host disease
Post transfusion purpura
Iron overload

Question 8

Mild fever (<40) with chills + rigors just after transfusion
Tx: Slow or stop transfusion + give paracetamol

Answer 8

Febrile non-haemolytic transfusion reaction

Question 9

High fever (>40) + shock symptoms (hypotension, tachycardia) just after transfusion

Answer 9

Bacterial contamination

Question 10

Urticaria just after transfusion

Responds to anti-histamine

Answer 10

Mild allergic reaction

Question 11

Swelling, wheeze + shock symptoms (hypotension, tachycardia) just after transfusion
IgA deficiency

Answer 11

Severe allergic reaction (anaphylaxis)

IgA acts as antigen in IgA deficiency patients - common cause

Question 12

Breathlessness + fluid overload (raised JVP) just after transfusion
Diuretics help

Answer 12

TACO

(think of a filed TACO

Question 13

Breathlessness just after transfusion
No signs of fluid overload, diuretics don’t help
Anti-leucocyte antibodies in donor plasma

Answer 13

TRALI

Question 14

Prevention of TRALI

Answer 14

Use male donors only for plasma/platelet donation who have never been transfused (no HLA antibodies)

Question 15

Symptoms of haemolysis (bleeding, low Hb, dark urine, jaundice) + symptoms of shock (hypotension, tachycardia) just after transfusion

Answer 15

Immediate haemolytic transfusion reaction (ABO incompatibility)

Question 16

Symptoms of haemolysis (bleeding, low Hb, dark urine, jaundice) 1w after transfusion
Requires sensitisation

Answer 16

Delayed haemolytic transfusion reaction (RhD incompatibility)

Question 17

Bruising / pin prick reddish purple purpura 1w after transfusion
Platelets attacked by anti-HPA1alpha antibody
Give IVIG

Answer 17

Post-transfusion purpura

Question 18

Sickle cell disease
Fever, lethargy _ pallor 2m post-transfusion
Red cell aplasia in BM
Positive Paul-Bunnel antibody test

Answer 18

Parvovirus B19 infection

Question 19

Receives regular transfusions (B-thalassaemia, SCA)
Erectile dysfunction
Bronze-coloured skin
Short stature + poor cardiac function

Answer 19

Iron overload

Question 20

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

Answer 20

Graft vs. host disease

Question 21

Anti-D doses

Answer 21

<72h of sensitising event
250iu <20w
500iu >20w
Kleihauer test for larger bleeds - estimate amount of fetal Hb in mothers blood)

Question 22

Causative antibodies in HDFN

Answer 22

RhD, c and Kell (usually less severe - just causes reticulocytopenia)
anti-A and anti-B can cause mild haemolysis