Transfusion Reactions and Compatibility Testing

Question 1

Key components of ensuring correct transfusion

Answer 1

Patient identification
Paperwork
Labelling

Question 2

Management of major transfusion reactions

Answer 2

5 things!

Question 3

General Investigations and purposes

Answer 3

CBC
Blood film
RFT
Clotting
Haptoglobin, LDH, bilirubin 
Blood culture of donor and patient units
Blood group
Direct and Indirect coombe’s test

Question 4

Major transfusion reactions: pathogenesis, signs/symptoms, specific management

Answer 4

Acute haemolytic transfusion reaction (AHTR)
Septic reaction due to bacterial contamination
Anaphylaxis
Transfusion related Acute lung injury (TRALI)
Transfusion associated circulatory overload

Question 5

Minor transfusion reactions (more common): pathogenesis, signs/symptoms

Answer 5

Febrile non-haemolytic transfusion reaction (FNHTR)

Minor allergic reactions

Question 6

Delayed transfusion reactions: pathogenesis

Answer 6

Delayed haemolytic transfusion reaction (DHTR)
Transfusion associated graft versus host disease TA-GvHD)
Post transfusion purpura (PTP)
Transfusion transmitted infections (TTI)

Question 7

Common blood products: units per dose, effects on CBC, indication for use

Answer 7

Red cells/ Whole blood
Platelets
FFP (2-4 units for adults)
Cryoprecipitate (contains vWF, fibrinogen, VIII, XIII)

Question 8

Specific blood products and indications for use

Answer 8

Fresh whole blood
Leukocytes irradiated/ buffy coat
Leukocyte depleted red cells (also in haematological disease or paediatric oncology)
Irradiated cellular blood components

Question 9

Blood groups and blood group antibodies

Answer 9

ABO, RhD
Anti-A/B
Anti-D or others

Question 10

Haemolytic disease of newborn

Answer 10

Pathophysiology - RhD- mother with RhD+ foetus
Clinical presentations — hydrops fetalis, kernicterus
Treatment
Prevention

Question 11

Pre-transfusion compatibility testing process

Answer 11

Type and Screen

• forward grouping and reverse grouping x2
• detection of unexpected Ab using indirect coombe’s and identification of Ab

If clinically significant Ab detected, locate Ag negative compatible blood —> serologic crossmatch

If negative for Ab—>Computer crossmatch

Question 12

Blood products used for immediate transfusion without knowing ABO type

Answer 12

Whole blood –> must be the same! don’t use in emergency
Red cells –> O
Plasma –> AB
Platelet and Cryoprecipitate –> any ABO