Transfusions - Other stuff Flashcards
What is the minimum haemoglobin level for blood donation?
135 g/L for men, 125 g/L for women
What is the minimum weight for blood donation?
50Kg
How long can red cells, FFP (fresh frozen plasma) and platelets be stored?
(1) Red cells: 4℃ for 35 days.
(2) FFP: -30℃ for 3 years.
(3) Platelets: 22℃ for 7 days with agitation
What blood group is the universal donor for red cells?
O- negative
What blood group is the universal recipient of red cells?
AB-positive
What chromosome is the ABO gene located on?
9
Which ABO alleles are dominant?
A and B are dominant over O
What percentage of the population is RhD-positive?
85%
What antibody is associated with RhD sensitisation?
Anti-D antibody
What is used to test for patient antibodies during pre-transfusion testing?
Reagent red cells and anti-human globulin (AHG)
What is the Hb threshold for red cell transfusion in symptomatic anaemia?
Hb <70 g/L or <80 g/L if cardiac disease
When is FFP transfusion indicated?
Bleeding or surgery in coagulopathy
(PT ratio >1.5)
+ management of massive hemorrhage
When should observations be performed during a transfusion?
Before starting, at 15 minutes, and within 60 minutes of completion
Donor
(1) A+
(2) A-
Can you donate to whom and receive blood from whom?
(1) Donate - A+, AB+
Receive - A+, A-, O+, O-
(2) Donate - A+, A-, AB+, AB-
Receive - A-, O-
Donor
(1) B+
(2) B-
Can you donate to whom and receive blood from whom?
(1) Donate - B+, AB+
Receive - B+, B-, O+, O-
(2) Donate - B+, B-, AB+, AB-
Receive - B-, O-
Donor
(1) AB+
(2) AB-
Can you donate to whom and receive blood from whom?
(1) Donate - AB+
Receive - All Blood types
(2) Donate - AB+, AB-
Receive - AB-, A-, B-, O-
Donor
(1) O+
(2) O-
Can you donate to whom and receive blood from whom?
(1) Donate - A+, B+, AB+, O+
Receive - O+, O-
(2) Donate - All Blood Types
Receive - O-
Define Landsteiner’s law
An antibody will specifically target and bind to an antigen that caused its production in the first place
What causes acute hemolytic transfusion reactions?
IgM antibody binding, complement activation
→ lysis of transfused cells + cytokine release
Name three complications of acute hemolytic transfusion reactions
(1) Shock,
(2) DIC (disseminated intravascular coagulation)
(3) Renal failure
What type of antibody is involved in delayed hemolytic transfusion reactions?
IgG
What causes minor allergic transfusion reactions?
Reaction to foreign plasma proteins
What deficiency predisposes patients to anaphylaxis during transfusion?
IgA deficiency
What are the clinical features of TACO? (Transfusion-Associated Circulatory Overload)
Hypertension, shortness of breath
Who is at higher risk for TACO?
Elderly patients and those with cardiac failure
How is TACO managed?
Slow the transfusion, give furosemide and supplementary oxygen as needed
manage fluid overload
What are the clinical features of TRALI? (Transfusion-Related Acute Lung Injury)
Pulmonary infiltrates on chest X-ray and hypotension, pulmonary oedema
Which transfusion products are most associated with TRALI?
Fresh frozen plasma and platelets
How fast should you transfuse patients with known heart failure?
Transfuse slowly (each unit over 4-6 hours)
What should you do if a patient develops fluid overload during a blood transfusion?
Stop the transfusion, and administer furosemide 40 mg IV (repeat as necessary)
What are the features of a haemolytic transfusion reaction?
Patients present with a temperature > 40, signs of shock, chest/abdominal pain and agitation
What are the features of delayed haemolytic transfusion reactions?
The patient presents with jaundice, anaemia, and fever often on day 5 post-transfusion
What are the features of febrile non-haemolytic transfusion reactions?
Patients present with a temperature (typically <40’C), but are otherwise well.
Describe a mild-severity transfusion reaction
temperature <39 celsius and/or isolated rash
Describe a moderate-severity transfusion reaction
temperature >39 Celsius and symptoms other than isolated rash
Describe a severe severity transfusion reaction
(1) signs of haemodynamic compromise
(2) recognition that a patient has received the wrong blood product
What plasma blood group can be universally donated? and why?
Group AB plasma
= can be universally donated due to a lack of anti-A or anti-B antibodies. The lack of antibodies in the plasma prevents an immune reaction from occurring
Describe what is and what to do in a febrile non-haemolytic transfusion reaction - mild reaction
(1) A temperature rise of 1 - 2°C leading to pyrexia ≥38°C, but <39°C
(2) And/or pruritus or a rash
WITHOUT other features
(3) The transfusion can be continued with appropriate treatment (oral paracetamol 500 - 1000mg) and direct observation.
(4) If a rash/pruritis is also present, slow the transfusion)
Describe what is and what to do in a febrile non-haemolytic transfusion reaction - moderate reaction
(1) Temperature ≥39°C OR a rise of ≥2°C from baseline
(2) AND/OR systemic symptoms such as chills, rigours, myalgia, nausea or vomiting)
(3) Symptomatic treatment should be considered. If symptoms settle, the transfusion can be resumed. If symptoms are sustained, bacterial contamination or a haemolytic reaction should be considered
Management transfusion-related acute lung injury (TRALI)
Stop the transfusion, give saline, treat ARDS and give supplementary oxygen as needed
An 85-year-old male presents to the transfusion unit for a blood transfusion. He has been prescribed packed red cells. The nurse administering the transfusion sites two cannulas and sets up the unit. On returning to the patient she notes his temperature has risen from 37.0 to 38.5 Celsius and he is feeling very anxious. She stops the transfusion and ensures patient details match the blood product compatibility label.
What is the best next step in managing this patient?
Administer 500mg paracetamol and continue the transfusion
= mild severity
What is the normal lifespan of
(1) RBC
(2) platelets
(3) Neutrophils
RBCs, 90–120 days
platelets, 10 days
neutrophils, 4 days
A patient with blood group B presents to the Emergency Department with large amounts of blood loss and requires an urgent blood transfusion.
Why would group AB red cells be unsuitable?
The presence of anti-A antibodies in the patient’s plasma
Slow the transfusion and administer 10 mg intravenous chlorphenamine
When would this be right?
This is the appropriate management for an allergic reaction to a transfusion. This typically presents with urticaria and itching within minutes of starting the transfusion
A 70-year-old man is receiving a blood transfusion for chronic anaemia. Around 5 hours after the transfusion, he develops dyspnoea and a cough. A chest x-ray is ordered which shows evidence of a ‘white out’ on his chest x-ray. There is limited response to IV diuretics.
What blood transfusion reaction is most likely to be occurring in this patient?
Transfusion-related acute lung injury (TRALI)
A 70-year-old female is receiving a blood transfusion in hospital for chronic anaemia. A few minutes into the transfusion, she becomes agitated and reports chest pain. She has a rapid increase in temperature up to 38.5°C, and her blood pressure drops to 94/64mmHg, but her oxygen saturation remains stable at 98%.
She can maintain a conversation. On auscultation, her chest is clear.
What blood transfusion reaction is most likely occurring in this patient? and why?
Acute haemolytic reaction
= Occurs within 15mins
When would starting broad-spectrum antibiotics be appropriate?
The patient had signs of infection due to bacterial contamination of blood products. This is very uncommon and the patient would likely appear much more unwell, for example, have a fever, tachycardia, hypotension and rigours
A 78-year-old man with known alcoholic liver disease presents to the emergency department with haematemesis. He is found to be severely anaemic and is quickly started on a RBC transfusion. When his observations are rechecked later, his temperature is found to have risen from 36.7˚C to 37.9˚C. His other observations are stable and the patient has no new symptoms
What is the above reaction describing?
non-haemolytic febrile reaction
Acute haemolytic reaction symptoms
(1) fever
(2) chills
(3) hypotension
(4) tachycardia
(5) chest and/or back pain
(6) dyspnea
(7) haemoglobinuria
A 62-year-old man presents to the emergency department after collapsing earlier that day. He is found to be severely anaemic and is started on a RBC transfusion. Three minutes after the transfusion starts, he develops pain in his abdomen and back. He appears flushed, and restless and has noticeable rigours. His observations are repeated and show a new fever along with worsening hypotension and tachycardia.
What would be the underlying cause for the above presentation
ABO incompatibility
What are donor group A antibodies present in plasma?
Anti B
What are donor group B antibodies present in plasma?
Anti A
What are donor group AB antibodies present in plasma?
Neither
What are donor group O antibodies present in plasma?
Anti A + Anti B
Describe Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
Immune response to white blood cells in the transfusion
Symptoms
= fever, chills, mild hypotension. No hemolysis
Occurs within 1–2 hours after transfusion
Describe Acute Hemolytic Transfusion Reaction (AHTR)
Rapid hemolysis due to ABO incompatibility
Symptoms
= fever, chest pain, hypotension, and hemoglobinemia. Immediate and severe
Occurs within minutes (usually within 15 minutes of starting the transfusion)
Describe Allergic Reaction
Immune response to plasma proteins. IgE
Symptoms
= rash, itching, hives. No hemolysis or severe systemic symptoms
Occurs within minutes to 1 hour after transfusion, depending on the severity
Describe Transfusion-Related Acute Lung Injury (TRALI)
Pulmonary edema from donor antibodies reacting with recipient’s white blood cells
Symptoms
= respiratory distress, hypoxia
Occurs within 6 hours of transfusion, often sooner (1-2 hours)
Describe Delayed Hemolytic Transfusion Reaction (DHTR)
Occurs days later, usually from minor blood group incompatibilities.
Symptoms
= fever, anaemia, jaundice. No immediate danger
Occurs 3–10 days after transfusion
Describe Anaphylaxis
Severe IgE-mediated reaction to transfusion
Symptoms
= difficulty breathing, swelling, hypotension. Requires emergency treatment
Occurs Immediately or within minutes of transfusion
Describe TACO - Transfusion Associated Circulatory Overload
Happens within 6 hours of transfusion due to fluid overload
Symptoms
= dyspnea, hypoxia, jugular venous distension, pulmonary crackles, hypertension, and edema
Risk factors
= heart failure, renal issues, rapid transfusion
Treatment
= stop transfusion, diuretics, and oxygen
A 36-year-old man is receiving a red blood cell transfusion in the emergency department. He had a motorcycle accident and has a suspected pelvic fracture. Within ten minutes of starting the transfusion, the patient develops a rash across his torso.
On examination, he is alert and responsive, with no signs of airway compromise. His chest is clear, and his heart sounds are normal. A urticarial rash is seen across his chest. Repeat observations show his blood pressure at 112/57, heart rate at 94, oxygen saturations at 96% on air, respiratory rate at 17, and temperature at 36.5C.
What is the single most appropriate initial action? and why?
Slow the rate of transfusion, give oral chlorphenamine 10mg (antihistamine)
= Currently, the patient appears to be having a mild allergic transfusion reaction, demonstrated by development of an urticarial rash soon after starting the transfusion, in the absence of any signs of anaphylaxis/haemodynamic compromise. The most appropriate action would be to initially slow the transfusion, and give oral (not IV) antihistamine
A 38-year-old female patient is receiving a blood transfusion on the acute medical unit for symptomatic anaemia secondary to uterine fibroids.
50 minutes after starting the transfusion, her vital signs were as follows: temperature 38.9 °C, blood pressure 125/85 mmHg, heart rate 70 bpm, respiratory rate 16/minute, and oxygen saturation 99% on room air.
The patient does not report any symptoms.
What is this type of reaction nd what would you do in this situation to mange it?
febrile non-haemolytic transfusion reaction as no symptoms and below 40 degrees.
Slow the transfusion and administer paracetamol
A 45-year-old man requires a group and save for an elective total hip replacement of his right hip due to osteoarthritis. He has a past medical history of Hodgkin’s lymphoma for which he has been successfully treated with chemotherapy. He has been in remission for 5 years.
Why does he require irradiated blood products?
To reduce the risk of transfusion-associated graft versus host disease
A 60-year-old female with Non-Hodgkin’s Lymphoma presents with fatigue, and her hemoglobin is found to be 65 g/L. A blood group test shows a nil response to Anti-D. What does this indicate about her blood type?
This indicates that the patient is Rh negative
A 60-year-old female undergoing chemotherapy requires a blood transfusion. Why is irradiated blood necessary for this patient?
Irradiated blood is needed because chemotherapy can weaken the immune system, increasing the risk of transfusion-associated graft-versus-host disease (GVHD). Irradiation inactivates lymphocytes in the transfused blood, preventing this complication
What reactions do you slow the transfusion rather than just stopping it?
- Transfusion-associated circulatory overload - fluid overload
- Febrile nonhaemolytic transfusion reaction
A 45-year-old female presents with confusion and haematemesis. She has a known history of alcohol excess. Initial blood tests reveal a haemoglobin of 60 g/L, and the decision is made to transfuse her with packed red cells. A group and save sample is sent for cross-matching.
The patient’s blood demonstrates
agglutination with anti-A antibodies. There is no agglutination to anti-D antibodies
A-negative
A 68-year-old man with aplastic anaemia is scheduled to have a transfusion. The red cell unit you see in the fridge is past its use-by date.
What is a complication of transfusing out-of-date red cell units?
hyperkalaemia
You are a medical student attached to a surgical team. Before a patient’s operation, the FY1 doctor asks you to take a group and save blood test in case they need a transfusion, the patient is identified as blood group A, this means they have anti-B antibodies.
What type of antibodies will they have?
IGM
Infusion with what blood product is most likely to result in an urticarial reaction?
FFP
What blood transfusion complication involves neutrophil proliferation
graft versus host disease
A 26-year-old woman has been started on a transfusion of two units of packed red cells to treat a case of severe menorrhagia. Within minutes of starting the transfusion, the patient develops intense flank pain and starts to feel cold and lightheaded.
The nurse takes a basic set of observations showing a blood pressure of 89/50mmHg, respiratory rate of 20 breaths per minute, peripheral oxygen saturation of 94%, a heart rate of 130 beats per minute and a temperature of 38°C.
Given the likely diagnosis, what is the underlying mechanism for the patient’s symptoms?
IgM mediated haemolytic transfusion reaction
IgG mediated reactions are typically what?
delayed
What blood product can be administered to a non ABO-matched recipient?
platelets
Max, a 23-year-old man, is attending the haematology appointment for treatment of Hodgkin’s lymphoma. He has been tolerating the chemotherapy well but it has suppressed his bone marrow. Due to the bone marrow suppression he requires regular blood transfusions. The haematologist decides to prescribe irradiated red cells to reduce his risk of developing graft versus host disease (GVHD).
How does such blood products help?
They have fewer active T lymphocytes
A 6-year-old girl has undergone a high-dose chemotherapy followed by a bone marrow transplant for acute leukaemia. Three weeks later she develops an itchy rash on her palms and soles. She also develops anorexia, nausea and vomiting.
Which cells are the most important mediators of graft versus host disease?
Donor T cells
