Transfusions - Other stuff Flashcards
1
Q
What is the minimum haemoglobin level for blood donation?
A
135 g/L for men, 125 g/L for women
2
Q
What is the minimum weight for blood donation?
A
50Kg
3
Q
How long can red cells, FFP (fresh frozen plasma) and platelets be stored?
A
(1) Red cells: 4℃ for 35 days.
(2) FFP: -30℃ for 3 years.
(3) Platelets: 22℃ for 7 days with agitation
4
Q
What blood group is the universal donor for red cells?
A
O- negative
5
Q
What blood group is the universal recipient of red cells?
A
AB-positive
6
Q
What chromosome is the ABO gene located on?
A
9
7
Q
Which ABO alleles are dominant?
A
A and B are dominant over O
8
Q
What percentage of the population is RhD-positive?
A
85%
9
Q
What antibody is associated with RhD sensitisation?
A
Anti-D antibody
10
Q
What is used to test for patient antibodies during pre-transfusion testing?
A
Reagent red cells and anti-human globulin (AHG)
11
Q
What is the Hb threshold for red cell transfusion in symptomatic anaemia?
A
Hb <70 g/L or <80 g/L if cardiac disease
12
Q
When is FFP transfusion indicated?
A
Bleeding or surgery in coagulopathy
(PT ratio >1.5)
+ management of massive hemorrhage
13
Q
When should observations be performed during a transfusion?
A
Before starting, at 15 minutes, and within 60 minutes of completion
14
Q
Donor
(1) A+
(2) A-
Can you donate to whom and receive blood from whom?
A
(1) Donate - A+, AB+
Receive - A+, A-, O+, O-
(2) Donate - A+, A-, AB+, AB-
Receive - A-, O-
15
Q
Donor
(1) B+
(2) B-
Can you donate to whom and receive blood from whom?
A
(1) Donate - B+, AB+
Receive - B+, B-, O+, O-
(2) Donate - B+, B-, AB+, AB-
Receive - B-, O-
16
Q
Donor
(1) AB+
(2) AB-
Can you donate to whom and receive blood from whom?
A
(1) Donate - AB+
Receive - All Blood types
(2) Donate - AB+, AB-
Receive - AB-, A-, B-, O-
17
Q
Donor
(1) O+
(2) O-
Can you donate to whom and receive blood from whom?
A
(1) Donate - A+, B+, AB+, O+
Receive - O+, O-
(2) Donate - All Blood Types
Receive - O-
18
Q
Define Landsteiner’s law
A
An antibody will specifically target and bind to an antigen that caused its production in the first place
19
Q
What causes acute hemolytic transfusion reactions?
A
IgM antibody binding, complement activation
→ lysis of transfused cells + cytokine release
20
Q
Name three complications of acute hemolytic transfusion reactions
A
(1) Shock,
(2) DIC (disseminated intravascular coagulation)
(3) Renal failure
21
Q
What type of antibody is involved in delayed hemolytic transfusion reactions?
A
IgG
22
Q
What causes minor allergic transfusion reactions?
A
Reaction to foreign plasma proteins
23
Q
What deficiency predisposes patients to anaphylaxis during transfusion?
A
IgA deficiency
24
Q
What are the clinical features of TACO? (Transfusion-Associated Circulatory Overload)
A
Hypertension, shortness of breath
25
Who is at higher risk for TACO?
Elderly patients and those with cardiac failure
26
How is TACO managed?
Slow the transfusion, give furosemide and supplementary oxygen as needed
manage fluid overload
27
What are the clinical features of TRALI? (Transfusion-Related Acute Lung Injury)
Pulmonary infiltrates on chest X-ray and hypotension, pulmonary oedema
28
Which transfusion products are most associated with TRALI?
Fresh frozen plasma and platelets
29
How fast should you transfuse patients with known heart failure?
Transfuse slowly (each unit over 4-6 hours)
30
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)
31
What are the features of a haemolytic transfusion reaction?
Patients present with a temperature > 40, signs of shock, chest/abdominal pain and agitation
32
What are the features of delayed haemolytic transfusion reactions?
The patient presents with jaundice, anaemia, and fever often on day 5 post-transfusion
33
What are the features of febrile non-haemolytic transfusion reactions?
Patients present with a temperature (typically <40'C), but are otherwise well.
34
Describe a mild-severity transfusion reaction
temperature <39 celsius and/or isolated rash
35
Describe a moderate-severity transfusion reaction
temperature >39 Celsius and symptoms other than isolated rash
36
Describe a severe severity transfusion reaction
(1) signs of haemodynamic compromise
(2) recognition that a patient has received the wrong blood product
37
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
38
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)
39
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
40
Management transfusion-related acute lung injury (TRALI)
Stop the transfusion, give saline, treat ARDS and give supplementary oxygen as needed
41
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
42
What is the normal lifespan of
(1) RBC
(2) platelets
(3) Neutrophils
RBCs, 90–120 days
platelets, 10 days
neutrophils, 4 days
43
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
44
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
45
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)
46
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
47
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
48
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
49
Acute haemolytic reaction symptoms
(1) fever
(2) chills
(3) hypotension
(4) tachycardia
(5) chest and/or back pain
(6) dyspnea
(7) haemoglobinuria
50
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
51
What are donor group A antibodies present in plasma?
Anti B
52
What are donor group B antibodies present in plasma?
Anti A
53
What are donor group AB antibodies present in plasma?
Neither
54
What are donor group O antibodies present in plasma?
Anti A + Anti B
55
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
55
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)
56
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
57
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)
58
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
59
Describe Anaphylaxis
Severe IgE-mediated reaction to transfusion
Symptoms
= difficulty breathing, swelling, hypotension. Requires emergency treatment
Occurs Immediately or within minutes of transfusion
60
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
61
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
62
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
63
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
64
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
65
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
66
What reactions do you slow the transfusion rather than just stopping it?
1. Transfusion-associated circulatory overload - fluid overload
2. Febrile nonhaemolytic transfusion reaction
67
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
68
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
69
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
70
Infusion with what blood product is most likely to result in an urticarial reaction?
FFP
71
What blood transfusion complication involves neutrophil proliferation
graft versus host disease
72
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
73
IgG mediated reactions are typically what?
delayed
74
What blood product can be administered to a non ABO-matched recipient?
platelets
75
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
76
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
77
'fine crackles are heard throughout her chest'
Immediately means what type of transfusion reaction?
TACO
78
A 54-year-old lady in the colorectal surgery ward has recently undergone an elective resection for colorectal cancer. Her haemoglobin has fallen to 57g/L and you decide she requires a blood transfusion. Within minutes of starting the transfusion, you notice a widespread red bumpy rash, wheezing, stridor and swelling of her lips and eyes. Her blood pressure has fallen from 120/80mmHg to 90/60mmHg and her temperature is 37ºC.
What is this patient experience and what is the most appropriate management option?
Anaphylactic reaction to blood transfusion should be immediately treated with IM adrenaline
79
A 52-year-old woman with acute myeloid leukaemia is receiving treatment with chemotherapy, which has significantly altered her blood cell counts. Due to her low blood counts, she requires a transfusion of blood components. Shortly after starting the transfusion, she develops symptoms including fever, chills, and rigours. The medical team suspects a transfusion-related infection and is considering the possibility of bacterial contamination.
What blood component is most likely associated with the above presentation?
Platelet concentrate
= Common contaminants include Staphylococcus epidermidis and Bacillus cereus
80
A 28-year-old woman is receiving a transfusion of fresh frozen plasma (FFP). After 2 hours into the transfusion, she develops shortness of breath. Observations are as follows: heart rate 120bpm, blood pressure 90/65 mmHg, SpO2 90% on air, respiratory rate 24 breaths per minute, and temperature 37.2ºC. On examination, you note bilateral coarse crepitations. The JVP is not raised and there is no evidence of peripheral oedema. There is no evidence of a rash.
What is the most likely cause?
Transfusion-related acute lung injury (TRALI)
81
A 25-year-old lady has developed disseminated intravascular coagulation due to an acute peripartum haemorrhage. After general resuscitation measures, what treatment should be administered first?
1. cryoprecipitate
2. FFP
82
A 55-year-old woman is receiving a blood transfusion following a road traffic accident. Approximately 20 minutes after the transfusion, she complains of severe breathlessness.
On examination, her pulse is 85 bpm, her blood pressure is 93/55 mmHg, and her temperature is 37.2ºC. You note that her lips are swollen and she is wheezing. It appears that she is suffering from a blood transfusion reaction.
A deficiency in which immunoglobulin increases the risk of such blood transfusion reaction?
IgA
= straight away so IgA
83
How can TRALI (Transfusion-Related Acute Lung Injury) be differentiated from TACO (Transfusion-Associated Circulatory Overload)?
TRALI is differentiated from TACO by the presence of hypotension in TRALI, while TACO is characterized by hypertension due to circulatory overload.
84
Transfusion-associated circulatory overload should be treated with what?
Stop the transfusion and administer IV loop diuretics
85
'Stop the transfusion and administer IV fluids' is for type of reaction?
acute haemolytic
86
What is the appropriate management for a transfusion-related acute lung injury (TRALI)?
Stop the transfusion and administer oxygen
87
A 32-year-old male is receiving a blood transfusion after being involved in a road traffic accident. A few minutes after the transfusion he complains of loin pain. His observations show a temperature of 39 C, HR 130bpm and blood pressure is 95/40mmHg. What is the best test to confirm his diagnosis?
Direct Coomb's test
88
'Fever, abdominal pain, hypotension during a blood transfusion' suggests what type of transfusion-based reaction has happened?
Acute haemolytic transfusion reaction
89
Symptoms of Anaphylaxis and treatment
Hypotension
Dyspnoea
Wheezing
Angioedema
= Stop the transfusion
IM adrenaline
ABC support
oxygen
fluids
90
John, a 35-year-old gentleman in the gastrointestinal ward has been suffering from melaena for a week. His haemoglobin level today is 60g/L and the consultant has requested that you transfuse John a unit of packed red blood cells
Within minutes of starting the transfusion, John complains of itching and stinging sensations on his trunk. On examination, you observe red raised welts over his abdomen and chest.
His blood pressure is unaltered from before the transfusion at 130/70mmHg, his temperature is 37ºC and there are no signs of dyspnoea, wheezing, stridor or angioedema.
What had the man developed and what is the appropriate management?
allergic reaction
= Temporary transfusion termination and an antihistamine
91
A 32-year-old male with leukaemia attends the day unit for a blood transfusion. Five days after the transfusion he attends A&E with a temperature of 38.5, erythroderma and desquamation
What is the above scenario describing?
Graft vs. Host disease
92
What blood product is most likely to cause an iatrogenic septicaemia with a Gram-positive organism?
Platelets
