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Heme/Onc > Transfusion Biology > Flashcards

Transfusion Biology Flashcards

1
Q

Define blood group antigen

A

carb/protein present on surface of an RBC

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2
Q

Define RBC phenotype

A

combo of antigens on RBC surface

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3
Q

Define RBC genotype

A

genetic sequences at the loci for blood group antigens

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4
Q

Who is a universal recipient of blood

A

AB+

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5
Q

Who is a universal donor of blood

A

O-

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6
Q

Describe the presence or absence of Rh D antigen

A
  • Rh+ if it is present (Can receive Rh+ OR Rh- blood)
  • Rh- if it is not present (Can ONLY receive Rh- blood)
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7
Q

When is an anti-D alloantibody produced

A

When an Rh- person is exposed to small amounts of Rh+ cells (transfusion, pregnancy)

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8
Q

Describe the Bombay blood group

A

Can’t receive blood from A, AB, B, or O and ONLY from Bombay group

(can still donate blood)

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9
Q

Describe pre-transfusion testing

A
  • ABO/Rh(D) typing: determines presence/absence of A, B, and Rh antigens on the patients RBCs
  • Antibody screen: screens antibodies in plasma, done on everyone
  • Compatibility testing/crossmatch: done when there is a high probability that the pt will need a transfusion & makes sure donor blood is compatible
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10
Q

Describe forward typing in ABO/Rh typing

A

test the patients RBCs for presence of A, B, and D antigens using antisera

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11
Q

Describe reverse typing in ABO/Rh typing

A

testing patients serum for presence of Anti-A, Anti-B, and Anti-D antibodies

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12
Q

Describe antibody screening by IAT (indirect antiglobulin test)

A

test for antibodies to common clinically significant RBC antigens

NOT a compatibility test, other Abs aside from ABO & Rh

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13
Q

What does a direct antiglobulin test screen for (DAT, Coombs)

A

used to detect Abs and/or complement on the surfaces of RBCs
- used in hemolytic anemia to detect auto/alloantibodies

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14
Q

What does an indirect antiglobulin test screen for (IAT, Coombs)

A

used to detect allo/autoantibodies in plasma or serum
- used in antibody screening for every pregnancy & compatibility testing before transfusion

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15
Q

If a crossmatch is negative, does that mean the blood product is compatible or incompatible with the patient?

A

compatible

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16
Q

Describe the 3 steps of pre-transfusion testing

A
  1. type (forward & reverse blood typing)
  2. screen (for antibodies)
  3. cross (identifying compatible blood product)
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17
Q

When is a type and screen done vs a type and cross

A

Type and screen
- just in case surgery is needed (minor surgery)
- doesn’t involve finding a compatible product

Type and cross
- transfusion likely needed or is needed (major surgery, trauma)
- does identify a compatible blood product

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18
Q

What special populations may be at greater risk when it comes to transfusion reactions

A
  • infants <4 mos
  • pregnancy
  • sickle cell disease (w/ frequent transfusion hx)
  • stem cell or organ transplant recipients
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19
Q

What non-antibody screening is done on blood products

A

Infectious agents
- HBV, HBC
- HIV
- Treponema pallidum
- Covid-19 Abs
- etc.

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20
Q

What are the major indications for packed RBCs (PRBCs)

A
  • symptomatic anemia including acute blood loss (Hgb <8)
  • asymptomatic w/ Hgb <7
  • exchange transfusion in sickle cell pain crisis or hemolytic disease of a newborn
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21
Q

What do PRBCs do for us

A
  • provide RBC mass and increase oxygen carrying capacity in the blood
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22
Q

What is the downside of transfusing whole blood

A
  • must be stored at 4C
  • platelet dysfunction over time
  • coag factors degrade over time
  • decreased capacity to deliver O2 over time
23
Q

Describe the indications for platelet transfusion

A
  • thrombocytopenia or plt dysfunction (<10k or <50k prior to procedure)
24
Q

What does a platelet transfusion do

A
  • reduces incidence of bleeding
  • provides functionally active platelets for pts with platelet dysfunction
  • 2 unites of Plts can increase the count by appx 10k
25
What is in fresh frozen plasma and what does it do when transfused
- contains all coag factors (except fV and fVIII) and all plasma proteins (except albumin, protein C & S) - helps control bleeding
26
What are the indications for fresh frozen plasma transfusion
- correction of coagulopathies (**rapid reversal of warfarin** in major bleeding) - treatment of TTP - massive transfusion protocol (Rh type not a consideration)
27
Who is the universal donor and universal recipient for **plasma**
Universal donor: AB Universal recipient: O
28
Who is the universal donor and universal recipient for **RBCs**
Universal donor: O Universal recipient: AB
29
What is in cryoprecipitate and what does it do
- contains plasma proteins, **fibrinogen**, Factor VIII, Factor XIII, vWF - raises fibrinogen level ~100mg to help aid hemostasis
30
What are the indications for cryoprecipitate infusion
- fibrinogen deficiency (Disseminated Intravascular Coagulation, liver disease, VWD) - massive transfusion protocol
31
When would cryoprecipitate be ineffective?
- thrombocytopenic bleeding (requires platelets) - reversal of anticoagulation (does not have vit-K dependent factors - requires FFP)
32
Describe leukoreduction of blood products
- removal of leukocytes via filtration/washing from PRBCs or platelets - prevents CMV infection, fever, alloimmunization (done to most blood products prior to storage)
33
Who requires leukoreduced blood products?
transplant patients & someone who requires multiple platelet transfusions
34
Describe irradiated RBCs
Prevents transfusion associated graft vs host disease (TAGVHD) - shortens half life of RBCs - used for immunosuppressed recipients
35
Describe washing of blood products
removes plasma/supernatant in PRBCs & platelets - red cells only live 24hrs, platelets 4hrs - indicated in IgA deficiency, neonatal thrombocytopenic purpura, hx severe allergy to transfusion, sensitive to K+
36
Describe volume reduction of blood products (platelets)
removes excess donor plasma - indicated in pts sensitive to volume overload or when ABO incompatible platelets transfused
37
Describe apheresis of a blood product
removal of a targeted cell type or substance in the blood while maintaining isovolemia - plasmapheresis - cytapheresis - photopheresis
38
What does plasmapheresis remove
plasma including autoantibodies, immune complexes, protein bound toxins
39
What does leukocytapheresis remove
malignant WBCs in pts with leukemia
40
What does erythrocytapheresis treat
severe sickle cell, malaria treatment, babiosis
41
What does photopheresis do
separates leukocytes from whole blood & exposes to light
42
What is the most common transfusion complication
HLA allosensitization Less common: infection Extremely rare: graft vs host disease
43
B
44
A
45
TACO & TRALI (if no fever: TACO)
46
What are 2 RBC breakdown products that can be detected int he setting of acute hemolytic transfusion reactions
LDH & bilirubin
47
which electrolyte leaks from blood during storage
potassium
48
Describe the etiology & presentation of urticarial transfusion reactions
49
Describe the etiology & presentation of febrile non-hemolytic transfusion reactions
50
Describe the etiology & presentation of transfusion associated circulatory overload
CXR with bilat infiltrates
51
Describe the etiology & presentation of transfusion related acute lung injury (TRALI)
52
Describe the etiology & presentation of acute hemolytic transfusion reaction
53
Describe the etiology & presentation of transfusion associated graft vs host disease

Heme/Onc (16 decks)

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