W2: ALS4 blood transfusion

Question 1

Group A plasma antibodies

Answer 1

Anti B

Question 2

Group A RBC antigens

Answer 2

antigen A

Question 3

Group B plasma antibodies

Answer 3

Anti A

Question 4

Group B RBC antigens

Answer 4

Antigen B

Question 5

Group AB plasma antibodies

Answer 5

none

Question 6

Group AB antigens

Answer 6

Antigen A and B

Question 7

Group O plasma antibodies

Answer 7

Anti-A and Anti-B

Question 8

Group O antigens

Answer 8

none

Question 9

antigen A

Answer 9

GalNac + H antigen

Question 10

antigen B

Answer 10

Gal + H antigen

Question 11

antigen O

Answer 11

h antigen only (glycoprotein+ fucose)

Question 12

Group A genes

Answer 12

AA or OA

Question 13

Group B

Answer 13

BB or OB

Question 14

which blood group to give in emergency and why

Answer 14

Group O since no surface ABO antigen

Question 15

incompatibility test for IgM

Answer 15

agglutination as clump when antigen and antibody interact

Question 16

The RhD system

Answer 16

Ig antibodies with antigen D centred

Question 17

RhD positive

Answer 17

antigen D present with genes coding for DD or Dd

Question 18

RhD negative

Answer 18

antigen D absent with genes coding for dd

production of anti-D antibodies when exposed to antigen D during blood transfusion or pregnancy

Question 19

Implications of RhD antibodies

Answer 19

Delayed haemolytic transfusion reaction 
haemolytic disease of the newborn(HDN)

Question 20

hepatitis B

Answer 20

HBs antigens and PCR

Question 21

Hepatitis

Answer 21

PCR

Question 22

other test

Answer 22

search for anti-(infection name) antibodies

Question 23

syphillis

Answer 23

TPHA antibodies test

Question 24

hepatitis C

Answer 24

anti-HCV antibodies and PCR

Question 25

Pion disease

Answer 25

Creutzfeldt–Jakob disease (CJD)
results in brain damage and memory impairment
clumping of proteins in the brain

Question 26

red cells

Answer 26

1 unit from 1 donor - ‘packed cells in SAGM nutrients’ (fluid plasma removed).
Shelf life 5 weeks.
Stored at 4 degrees Celsius (fridge).
Given through a ‘blood giving set’- has filter to remove clumps/debris.
Rarely need frozen red cells (National Frozen Bank) - for rare groups/ antibodies - poor recovery on thawing.

Question 27

fresh frozen plasma(FFP)

Answer 27

One unit from 1 donor (300ml) can get small packs for children.
Stored at -30 degrees Celsius (frozen within 6h of donation to preserve coagulation factors).
Shelf life 3 years.
Must thaw approx 20-30 mins before use (if too hot, proteins denature).
Give ASAP – ideally within 1h or else coagulation factors degenerate at room temperature.
Dose 12-15ml/kg = usually 3 units.
Need to know blood group - no cross-match, just choose same group (as contains ABO antibodies, which could cause a little bit of haemolysis).

Question 28

cryoprecipitate

Answer 28

From frozen plasma thawed at 4-8 degrees Celsius overnight residue remains.
Contains fibrinogen and factor VIII.
Storage is same as FFP - store at -30 degrees Celsius for 3 years.
Standard dose = from 10 donors (5 in a pack)

Question 29

platelet concentrate

Answer 29

Store at 22 degrees Celsius (Room temp).
​Constantly agitated.
Shelf life 7 days only - (risk of bacterial infection).
Need to know blood group: no cross-match, just choose same group (as platelets have low levels of ABO antigens on, so wrong group platelets would be destroyed quickly) - and can cause RhD sensitisation, as some red cell contamination.

Question 30

Factor VIII and IX

Answer 30

For haemophilia A and B respectively.

​- Heat treated - viral inactivation.

​- Recombinant factor VIII or IX alternatives mostly now used instead.

Question 31

Immunoglobulins

Answer 31

• ​Intramuscular - Specific – fractionated from plasma from selected donors who have a high titre of a specific antibody (from hyperimmune donors) e.g. anti-D, hepatitis B, varicella zoster, rabies, tetanus, CMV.
• Intramuscular: Normal globulin - broad mix in population (eg: to protect against hepatitis A)

​- Intravenous Immunoglobulin (ivIg) – can be used in some autoimmune disorders e.g. immune thrombocytopenia

Question 32

Albumin (2 strengths)

Answer 32

4. 5% - Useful in burns, plasma exchanges, etc. Probably overused (not indicated in malnutrition).
   - ​ 20% (salt poor)- For certain severe liver and kidney conditions only.

Question 33

when to use red blood cells

Answer 33

to increase the haemoglobin level

Question 34

when to use FFP

Answer 34

1:when bleeding or abnormal coagulation results(shown clinically and by coagulation tests)
2: To reverse the effects of warfarin( anticoagulant used in surgery)
note : this does not just replace the guild volume

Question 35

when to use cryoprecipitate

Answer 35

massive bleeding or low fribrinogen

cases of inherited hypofribrinogenaemia

Question 36

when to use platelets

Answer 36

bone marrow failure
massive bleeding/disseminated intravascular coagulation
low platelet count
cardiac bypass and patients on anti platelet drugs