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Y4 Cancer care > Transfusion workbook > Flashcards

Transfusion workbook Flashcards

1
Q

What are some complications of prolonged anaemia?

A
  • Renal failure
  • Heart failure
  • Irregular heart beats (arrhythmias)
  • Fatigue and weakness
  • Cognitive impairment (memory issues)
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2
Q

What are some alternatives to transfusions?

A

EPO

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3
Q

List and discuss potential risks of blood transfusion?

A

Transfusion reactions
- TACO
- Graft vs host

Blood borne infections

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4
Q

Why would someone with myelodysplastic syndrome not respond as well to EPO?

A
  • Inflammatory response cause cell destruction
  • Cannot overcome ineffective blood cell production
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5
Q

What blood borne infections would you be worried about with transfusions?

A
  • Hep B
  • HIV
  • Syphyllis
  • CMV
  • Malaria
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6
Q

How long does a group and screen take?

A

40 minutes

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7
Q

What is the difference between an auto-antibody and allo-antibody?

A

Allo= made against a donor
Auto= made against yourself

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8
Q

What antigens do you screen for in pregnant women?

A
  • ABO
  • Rh-D
  • K antigen
  • Duffy antigen

These two because they are the most antigenic (most likely to have a reaction with these) but with pregnant women you need to screen for more! There are about 27 antigens on the surface of RBCs.

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9
Q

How is irradiated blood organised at a hospital?

A
  • Fill out a specific blood bank request form with appropriate clinical details
  • Get a senior to sign it
  • Tick CMV box
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10
Q

What could happen if you don’t irradiate the blood you give to a patient with Hodgkin’s disease?

A

Transfusion graft vs host disease

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11
Q

What steps are taken to prevent transfusion associated reactions?

A
  • Labelling done at the patient bedside
  • Patient’s cannot receive transfusion without ID badges
  • Double checking with a colleague
  • Checking the blood bag to make sure there is no sludge
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12
Q

How will a patient be monitored during a blood transfusion?

A

Obs done before
20 minutes into transfusion
Then every 30 minutes for the 2nd hour
Then every hour

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13
Q

Do you get B symptoms with low grade lymphoma?

A

No not really

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14
Q

Main three reasons to give irradiated blood?

A
  • Hodgkin’s lymphoma
  • Bone marrow transplant
  • Fludarabine (chemo)
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15
Q

4 causes of anaemia in a patient with Chronic Lymphocytic Leukaemia

A
  • Bone marrow infiltration
  • Autoimmune hemolytic anaemia
  • Hemorrhage
  • B12/folate deficiency
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16
Q

Difference between B12 and folate

A

Vitamin B12 (Cobalamin):

Helps keep nerve cells healthy and plays a key role in making DNA and red blood cells.
Found in animal products like meat, fish, eggs, and dairy.
A deficiency can cause nerve damage, memory problems, and anaemia.
Folate (Vitamin B9):

Also important for making DNA and red blood cells.
Found in leafy green vegetables, fruits, and fortified foods.
A deficiency can lead to anaemia, and during pregnancy, it can cause birth defects in the baby (like spina bifida).

17
Q

What should be determined from a history in an anaemic patient with CLL?

A

AIHA- might have other immune related disorders like RA, type 1 diabetes
Bleeding- anaemic, DRE, liver cirrhosis stigmata
Coeliac- B12 deficiency, diet

18
Q

What should you look for on examination of an anaemic patient with CLL?

A

Haemotinic deficiencies
- Macroglossia
- Pallor of the conjunctiva

Lymphoreticular examinatino

19
Q

What blood tests should be arranged for an anaemic patient with CLL? (suspecting AIHA)

A
  • FBC (anaemia)
  • Haptoglobin (binds to free heme so you measure the unbound heme) Low in AIHA
  • LFTs Increase in billirubin
  • Haematinincs- ferritin, B12/folate
  • LDH (if raised indicates increased cell turnover)
20
Q

Most likely cause of a dramatic anaemia?

A

Bleeding/hemolysis

21
Q

What would be seen on a blood film of a patient with CLL?

A
  • Smudge cells
  • Small dense lymphocytes
  • Spherocytes (non-uniform RBCs)
22
Q

What test would confirm AIHA?

A

DAT
Direct antiglobulin test
Not called COOMBs anymore

23
Q

How does a DAT test work? (Direct agglutination test)

A

You will have lots of your own RBCs with IgG bound to the membrane
The blood is incubated with antibodies to human IgG
Agglutination test= positive

Patient’s RBCs: A sample of the patient’s RBCs is taken. If the patient has a condition where their own IgG antibodies or complement have attached to their RBCs, these will already be present on the cell surface.

Addition of Antihuman Globulin (AHG): The patient’s RBCs are incubated with antihuman antibodies, which are special antibodies that bind to human IgG or complement proteins. These antibodies are often called Coombs reagent or AHG.

Agglutination: If the patient’s RBCs have IgG or complement attached to them, the added antihuman antibodies will bind to these. This causes the RBCs to clump together, or agglutinate.

Positive Test: Agglutination indicates a positive DAT result, meaning that IgG antibodies or complement are present on the RBC surface. This can occur in conditions like autoimmune haemolytic anaemia, haemolytic disease of the newborn, or transfusion reactions.

24
Q

How can haemolysis be categorised?

A

Hereditary

Red cell enzymopathies
- G6PD deficiency
- Pyruvate kinase deficiency

Abnormal Hb
- Sickle cell disease
- Thalassaemia
- Unstable haemoglobins

Acquired

Alloimmune
- HDFN (hemolytic disease of fetus and neonate)
- Incompatible transfusion

Autoimmune
- AIHA (warm and cold)

Non-immune
- MAHA
- Sepsis
- Malaria

25
Q

What are the two diff

A
26
Q

What are the initial treatments of AIHA?

A
  • Corticosteroids (1mg/kg of Prednisolone)
  • Immunosuppressive therapy (Azathioprine, cyclophosphamide)
  • Intravenous immunoglobulin
  • Rituximab
27
Q

What are the special requirements for transfusing a patient with AIHA?

A

Extended cross matching (takes several hours compared to G&screen which takes 40 minutes)

Washed RBCs and Leukocyte reduced blood

Irradiation if the patient is on Fludarabine

28
Q

How is hemolysis monitored in the acute and out-patient settings?

A

Acute
- Monitor daily billirubin and reticulocytes should be coming down
You can let a patient go home when their hemoglobin is stable

29
Q

What is the first thing you do with a patient if you suspect a major hemorrhage

A

Put the bed down- patient should be flat

30
Q

How should you attempt to control the bleeding with major haemorrhage?

A
  • Direct pressure on wounds
  • Pelvic binder
  • Limb torniquet
31
Q

How do you activate the major hemorrhage protocol?

A

Senior makes the decision to declare massive haemorrhage
Nominate a blood bank coordinator for the duration of the incident
Coordinator to dial 2222 and say “Major Haemorrhage in (state exact location)
Switchboard will fast bleed blood transfusion laboratory
When blood bank staff call back, coordinator should say “Massive haemorrhage DECLARED”

32
Q

In a major hemorrhage protocol when the patient is NOT obstetric, how many RBC/FFP is given if the patient is over 50kg

A

4 units of RBCs
3 units of FFP

33
Q

What investigations do you immediately want

A

Coagulation profile (APTT/PT)
+ Fibrinogen (has to be ordered as a separate test and you need to know when to give cryoprecipitate
FBC- hemoglobin and platelet count
Us&Es/LFTs- don’t say baseline, instead say to check perfusion to the organs and before you prescribe a drug

34
Q

What is important to do once you once bleeding has settled after you activate MHP?

A

You should step down!! Blood bank will keep defrosting plasma/wasting valuable products etc.

35
Q

What should you administer to a lady once she has given birth who is Rh-D negative?

A

Anti-D immunoglobulin

36
Q

In disseminated intravascular coagulation, which haematological parameter would suggest that the transfusion of cryoprecipitate is indicated?

A

Fibrinogen <1.0g/l

37
Q

How long do you give vitamin K for?

A

5 days

38
Q

Do you need to give someone blood products with liver cirrhosis about to have paracentesis?

A

No
Not at a major bleeding risk- mindful of DIC and prescribing platelets! Weight up bleeding vs clotting risk

Y4 Cancer care (15 decks)

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