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Pathology by week > W16 - Blood transfusion 1 > Flashcards

W16 - Blood transfusion 1 Flashcards

1
Q

There are 2 systems/groups we use for determining blood group - what are they?

A

ABO system
Rh system

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2
Q

Give ABO incompatible blood transfusion, what happens?

A

massive INTRAVASCULAR haemolysis (fatal)

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3
Q

ABO groups are determined by … (2)

A
  1. antigens (sugars) on RBCs
  2. naturally-occurring IgM abs in the plasma
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4
Q

What abs does each blood group have?
Group A
Group B
Group AB
Group O

A

Group A = anti-B
Group B = anti-A
Group AB = none
Group O = anti-A, anti-B

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5
Q

What antigens does each blood group have?
Group A
Group B
Group AB
Group O

A

Group A = A antigen
Group B = B antigen
Group AB = A antigen, B antigen
Group O = none

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6
Q

Rh D antigens - what % of population is Rh D + and -?

A

RhD + = 85%
RhD - = 15%

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7
Q

RhD + individual - what blood can they receive?

A

RhD + RBCs
AND
RhD - RBCs (waste of resource though)

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8
Q

RhD - individuals - what blood can they receive?

A

RhD - RBCs

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9
Q

What happens if RhD - individual is given RhD+ blood for the first time?

A

make immune anti-D IgG antibodies if exposed to RhD + blood

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10
Q

Immune antibody class are anti-D antibodies? can they cross the placenta?

A

IgG - yes!

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11
Q

What sort of reaction do anti-D antibodies cause?

A

relayed haemolytic transfusion reaction

(do not cause direct agglutination of RBCs)

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12
Q

Rh D negative women exposed to Rh D positive blood can produce _____, which can cause disorder 1 or disorder 2 in pregnancy. Name these 2.

A

anti-D

  1. haemolytic disease of the newborn
  2. severe foetal anaemia and heart failure (hydrops fetalis)
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13
Q

The blood group is done before every transfusion - T or F

A

True

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14
Q

Describe forward group in blood group testing?

A

Forward group is the use of known anti-A and anti-B and anti-D reagents against patient’s RBCs

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15
Q

Describe reverse group in blood group testing?

A

Reverse group is the use of known A and B group RBCs (antigens) against patient’s plasma, checking for IgM specific abs

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16
Q

After doing forward and reserve group testing in blood testing, what else is checked? What happens in such mismatch?

A

Antibody screen => check for immune antibodies which are IgG, that form following exposure to RBC antigens different to those expressed by patient. A mismatch could result in delayed haemolytic transfusion reaction

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17
Q

Group & Save Antibody Screen => how is it checked?

A

2 or 3 reagent Group O red cells that have all other important antigens => incubate using INDIRECT ANTIGLOBULIN TECHNIQUE => red cell coated with IgG will bridge when Antiglobulin reagent added= visible clumps!

18
Q

What happens if in blood group testing, the antibody screen comes back negative?

A

10-cell panel testing to identify specific RBC antibodies (essentially phenotyping)

19
Q

In terms of Kell blood group - what do we give to certain groups of people? why?

A

Kell negative (K - ) blood to women of childbearing potential because anti-K can cause haemolytic disease of the newborn (HDFN).

20
Q

For blood transfusion, a valid consent is required. What does this involve?

A

verbal AND written
* if transfused in surgery, must inform afterwards

21
Q

3 pillars of patient blood management - what’s pillar 1?

A

1st pillar = optimise haematopoiesis:
optimal iron, B12, folate, erythropoietin

22
Q

3 pillars of patient blood management - what’s pillar 2?

A

2nd pillar = minimise blood loss & bleeding:
stop anticoagulation + antiplatelet agents

23
Q

3 pillars of patient blood management - what’s pillar 3?

A

3rd pillar = harness & optimise physiological tolerance of anaemia = optimise cardiac output:
- restrictive threshold for transfusion (Hb 70g/L)

24
Q

What is the restrictive transfusion threshold?

A

Hb 70g/L

25
Q

Red cell transfusion:

  • compatibility check?
  • storage?
  • transfusion rules?
A

Red cell transfusion:

  • compatibility check => ABO/D + antibody screen
  • storage => 4 degrees Celsius for 35 days
  • transfusion rules => within 4 hours of leaving fridge, transfuse 1 unit RBC over 2-3 hours
26
Q

platelet transfusion:

  • compatibility check?
  • storage?
  • transfusion rules?
A

platelet transfusion:

  • compatibility check => D compatible
  • storage => 20 degrees Celsius for 7 days
  • transfusion rules => 1 unit of platelets over 20-30 mins
27
Q

Fresh Frozen Plasma (FFP) transfusion:

  • compatibility check?
  • storage?
  • transfusion rules?
A

Fresh Frozen Plasma (FFP) transfusion:

  • compatibility check => ABO compatible
  • storage => 30-40 mins to thaw, once thawed can be kept at 4 degrees Celsius for 24 hours
  • transfusion rules => 1 unit over 20-30 mins
28
Q

Cryoprecipitate transfusion:

  • compatibility check?
  • storage?
  • transfusion rules?
A

Cryoprecipitate transfusion:

  • compatibility check => ABO compatible
  • storage => 30-40 mins to thaw, once thawed must be kept at ROOM temp and used within 4 hours
  • transfusion rules => 1 unit over 20-30 mins
29
Q

difference between FFP and cryoprecipitate

A

FFP contains coagulation factors at the same concentration present in plasma. Cryoprecipitate is a highly concentrated source of fibrinogen

30
Q

What is serological crossmatch?

A

After G&S (ABO & Rh check), we do serological crossmatch where patient plasma and donor RBCs are incubated together for 30-40 mins => pick up antibody-antigen reaction

31
Q

Name 4 indications for blood transfusion?

A
  1. Major blood loss >30% blood volume
  2. Peri-op, critical care Hb <70g/L vs 80g/:
  3. Post chemo, Hb <80 g/L
  4. symptomatic anaemia - ischaemic heart disease, breathless, ECG changes
32
Q

1 unit RBC gives a Hb
increment of _____ in a 70
80 kg patient

A

10g/L

33
Q

Name 4 indications for platelet transfusion

A
  1. Massive transfusion (aim plt >75 x 10^9/L)
  2. Prevent bleeding (post chemo) => if 10 x 10^9/L **<20 if sepsis
  3. Prevent bleeding (surgery) => if <50 x10^9/L) **<100 if critical site i.e. eye, CNS
  4. platelet dysfunction or immune cause ONLY if active bleeding
34
Q

Platelet transfusion should always be discussed with a haematologist first, why?

A

B/c it is contraindicated in:

1) heparin-induced thrombocytopaenia thrombosis (HiTT)
2) thrombotic thrombocytopaenic purpura (TTP)

35
Q

Name 5 indications for FFP transfusion

A
  1. Massive transfusion (blood loss > 150ml/min)
  2. DIC with bleeding
  3. liver disease + risk (PT ratio >1.5x normal)
  4. TTP
  5. Replacement of single coagulation factor deficiency i.e. Factor V
36
Q

What is given to reverse warfarin?

A

PCC (prothrombin complex concentrate)

37
Q

What does PCC (prothrombin complex concentrate) contain?

A

Factors II, VII, IX, X

38
Q

What are the indications (4) for cryoprecipitate use?

A

When low in:

  • fibrinogen
  • Factor VIII
  • vWF
  • Factor XIII
39
Q

Can I use my own blood for transfusion:

  • Pre-op autologous deposit?
  • Intra-op cell salvage?
  • Post-op cell salvage?
A
  • Pre-op autologous deposit => NOT in the UK
  • Intra-op cell salvage => most UK surgical and obstetrics units can do this
  • Post-op cell salvage => Mainly orthopaedics (knee surgery)
40
Q

What is cell salvage in autologous blood transfusion?

A

Collect blood lost => centrifuge => filter out coagulation factors and platelets => wash => re-infuse!

41
Q

Special requirements for blood transfusion - what group receives each of the following:

1) CMV negative blood?
2) Irradiated blood?
3) Washed?

A

1) CMV negative blood:
- intra-uterine/neonatal transfusion
- pregnant women (b/c baby in-utero exposed to maternal transfusion)

2) Irradiated blood:
- highly immunosuppressed patients who cannot destroy incoming donor lymphocytes

3) Washed:
- patients who have severe allergic reactions to some donors’ plasma proteins

Pathology by week (70 decks)

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