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Clinical Haematology > Transfusion Science > Flashcards

Transfusion Science Flashcards

1
Q

What does SAE stand for?

A

Serious Adverse Event

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2
Q

What does SAR stand for?

A

Serious Adverse reaction

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3
Q

What is an SAR?

A

an unintended response in a donor/patient that is associated with the collection or transfusion of blood or blood components that is fatal, life threatening, disabling or incapacitating or which results in or prolongs hospitalisation or morbidity (SAE is a serious untoward occurrence)

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4
Q

What are the safety of a blood donor requirements?

A

must not:

weigh

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5
Q

What are the requirements of a donor for the safety of the recipient?

A 
High risk behaviours
chronic infections
risk of CJD(creutzfeldt Jakob Disease)
Blood transfusion
Disease of unknown or viral aetiology
Piercing/tatto/accupuncture
Travel - e.g malaria
infectious diseases come to close contact with
Vaccinations
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6
Q

Upon blood donation how much blood is taken?

A

450ml into 1L bags

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7
Q

List the passage of blood from donor to patient

A 
election of donor
blood taken
blood tested
platelet pheresis
process into blood components
Storage
Patient
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8
Q

What are the storage conditions of red cells?

A

4 degrees c for 35 days

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9
Q

What are the storage conditions of pooled platelets?

A

22 degrees C 5 days

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10
Q

What are the storage conditions of FFP?

A

minus thirty degrees C for 24 months

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11
Q

Why are red cells given in transfusion?

A

to increase O2 delivery capacity of blood when acute/chronic anaemia contributes to inadequate O2 delivery

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12
Q

Why are platelet transfusions given?

A

indicated for prevention and treatment of haemorrhage in its with thrombocytopenia or platelet function defects (chemo/radiotherapy)

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13
Q

Why is fresh frozen plasma given?

A

for requirement of replacement of coagulation factors in a few specific situation and for treatment of thrombotic thrombocytopenia

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14
Q

What is a blood group?

A

series of red cell Ags determined by a single genetic locus, or by two or more very closely linked loci, with little or no observable recombination between them.

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15
Q

Common blood groups are:

A 
ABO: A, B, (O)
RhD: D, E, e, C, c
Kell: K, k  (Kpa/kpb, Jja/Jjb)
MNS: S, s, M, N
Fy (duffy): Frya, Fyb
Jk (Kidd): Jka, Jkb
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16
Q

The ABO blood system..

A

A&B antigens are indirect gene products, the direct products are transferable enzymes.
ABO locus is on chromosome 9, expression also requires H (FUT1) gene on chromosome 19

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17
Q

What are the A sub groups?

A 
A1  800-900 thousand
A2  160-440 thousand
A3  35-100 thousand
A4 1400-10,300
Am- least antigens 200-900
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18
Q

Acquired B antigen

A

Occurs in:
rectal & bowel carcinomas
Perforation/ulceration
infection/septicaemia

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19
Q

What causes B antigen acquired?

A

Causes by deacetylation of A antigen

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20
Q

The Rh blood group system, where is the Rh locus found?

A

found on chromosome 1

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21
Q

what does the Rh antigen comprise of?

A

RHD and RHCE

22
Q

What is Rh Null?

A

Rare individuals fail to produce RHD and RHCe:
Two types:
AMORPH- homozygous for a silent allele at the RH locus
REGULATOR - homozygous for an autosomal suppressor gene X^0r

23
Q

What are Rh proteins?

A

structural and are involved in ion transport

24
Q

What Rh protein is morphologically and functionally abnormal

A

Rh null

25
Q

what do individuals with the Rhnull protein result with?

A

mild haemolytic anaemia

26
Q

Describe how the Kell system works

A

Ag encoded by alleles at KELL locus on chromosome 7. Antethical alleles K/k co-dominant typically high and low frequency

27
Q

What is the Kell protein?

A

kell protein a single pass glycoprotein and has structural homology with a family of enzyme ZINC NEUTRAL ENDOPEPTIDASES

28
Q

What does the expression of the Kell protein depend upon?

A

depends on the production of Kx protein by genes at XK locus on chromosome X. Kell protein is complexed by a disulphides bridge to KX.

29
Q

What is X-linked Mcleod syndrome?

A

Lack Kx, all kell Ags decreased. acanthocytic, compensated HA

30
Q

What is the Fy system?

A

Fy locus on chromosome 1
Alleles are Fya and Fyb.
Cya and Fyb Ags are co-dominant, they differ by 1 residue at position 44 glycine in Fya, asparganin in Fyb

31
Q

Where is Fy glycoprotein expressed?

A

On vascular endothelial cells and prukinje cells in the cerebellum. it is a receptor for 2 classes of proinfalmmatory chemokine, so may have a role as a scavenger for excess chemokine. it is also a receptor for plasmodium vivax and P kmowelsi.

32
Q

The Fy (a-b) phenotype is?

A

occurs in populations where malaria is endemic. an alternative gene at the Fy locus, Fy occurs. The Fy gene is identical to Fyb gene in its structural region but has a mutation in the promoter region. glycoprotein is not produced on red cells when an individual is homozygous for this gene

33
Q

Explain the JK system

A 
JK locus (now called HUT11) on chromosome 18 
multipass protein which carries human erythroid protein which carries human erythroid urea transporter as well as JK antigens
Codominant alleles Jka and Jkb, differ by single amino acid substitution
Aka-b phenotype, very rare,caused by inheritance of 'silent' allele JK or dominant inhibitor gene ln(JK) which is not linked to the JK locus - individual have defective urea transport
34
Q

MNS blood system, GYPA & GYPB are closely linked on which chromosome?

A

Chromosome 4, coding for glycophorin A and B respectively

M and N are alleles of GYPA and encode N and M Ags on GPA

35
Q

What are the alleles of GYPB?

A

S and s

36
Q

Red cell antibodies are of which class?

A

IgG or IgM

37
Q

What is the universal donor?

A

O

38
Q

What is the universal recipient?

A

AB

39
Q

What are the symptoms of haemolytic transfusion reaction?

A 
Fever
Chills
Rigours
Tight chest pin
Joint pain
Lower back pain
Haemoglobinurea
Renal failure
disseminate intravascular coagulation
high mortality rate
40
Q

Haemolytic transfusion reaction, IgG

A

Binds to the red cell.
macrophages bind via Fc receptor sites
Cell phagocytksed or lysed

41
Q

what type of reaction is the IgG haemolytic transfusion reaction

A

Delayed reaction 5-10 days

42
Q

What are the symptoms of IgG haemolytic transfusion reaction

A 
fever and chills
Jaundice
haemoglobin urea
haemoglobin drops
low mortality rate
43
Q

What is haemolytic disease of the newborn?

A

condition in which the lifespan of infants red cells is shortened by the action of specific Ab derived from mother by placental transfer; disease begins in INTRAUTERINE life and may result in significant mortality and morbidity

44
Q

What are the clinical effects of HDN?

A 
anaemia
hydrops foetalis
Hyperbilirubinaemia
neurological defects
Kernicterus
hepatosplenomegaly
45
Q

Red cell matching for transfusion

A

ABO and RhD matched
K -ve for women of childbearing age
K-ve and full Rd phenotype for transfusion dependant pts

46
Q

What is the cause of Delayed Haemolytic TransfusionReactions (DHTR)?

A

Anti-Jia is Ig3 complement binding and are labile in vivo and in vitro often falling to levels below detection

47
Q

How to prevent HDN?

A

identify foetus at risk
ABO,RhD type and Ab screen
Repeat at 28 weeks gestation if no Ab detected originally
Anti-D immunoglobin given if Ab detected, given at 30 weeks gestation
post delivery further anti D immunoglobulin given

48
Q

Causes of HDN in order of severity

A 
Anti D
Anti C
Anti K
ABO Ab
Anti E 
Anti Fya
49
Q

What causes bacterial contamination of blood transfusion?

A

donor bacteriamia, pack contaminant (often platelets)

symptoms appear immediately

50
Q

what are the symptoms of bacterial contamination in a transfusion?

A 
fever and chills
riggers
hypertension
collapse
shock
nausea
vomittiing
DIC
intravascular haemolysis
Renal failure
51
Q

Transfusion related acute lung injury

A

acute resp distress within 6 hrs of transfusion
severe bilateral pulmonary oedema
severe hypoxia
fever
nodular shadowing on X ray
90% caused by prevalence of HLA/Granulocyte specific Ab in donor plasma

Clinical Haematology (10 decks)

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