W2: ALS4 blood transfusion Flashcards
Group A plasma antibodies
Anti B
Group A RBC antigens
antigen A
Group B plasma antibodies
Anti A
Group B RBC antigens
Antigen B
Group AB plasma antibodies
none
Group AB antigens
Antigen A and B
Group O plasma antibodies
Anti-A and Anti-B
Group O antigens
none
antigen A
GalNac + H antigen
antigen B
Gal + H antigen
antigen O
h antigen only (glycoprotein+ fucose)
Group A genes
AA or OA
Group B
BB or OB
which blood group to give in emergency and why
Group O since no surface ABO antigen
incompatibility test for IgM
agglutination as clump when antigen and antibody interact
The RhD system
Ig antibodies with antigen D centred
RhD positive
antigen D present with genes coding for DD or Dd
RhD negative
antigen D absent with genes coding for dd
production of anti-D antibodies when exposed to antigen D during blood transfusion or pregnancy
Implications of RhD antibodies
Delayed haemolytic transfusion reaction haemolytic disease of the newborn(HDN)
hepatitis B
HBs antigens and PCR
Hepatitis
PCR
other test
search for anti-(infection name) antibodies
syphillis
TPHA antibodies test
hepatitis C
anti-HCV antibodies and PCR
Pion disease
Creutzfeldt–Jakob disease (CJD)
results in brain damage and memory impairment
clumping of proteins in the brain
red cells
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.
fresh frozen plasma(FFP)
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).
cryoprecipitate
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)
platelet concentrate
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.
Factor VIII and IX
For haemophilia A and B respectively.
- Heat treated - viral inactivation.
- Recombinant factor VIII or IX alternatives mostly now used instead.
Immunoglobulins
- 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
Albumin (2 strengths)
- 5% - Useful in burns, plasma exchanges, etc. Probably overused (not indicated in malnutrition).
- 20% (salt poor)- For certain severe liver and kidney conditions only.
when to use red blood cells
to increase the haemoglobin level
when to use FFP
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
when to use cryoprecipitate
massive bleeding or low fribrinogen
cases of inherited hypofribrinogenaemia
when to use platelets
bone marrow failure
massive bleeding/disseminated intravascular coagulation
low platelet count
cardiac bypass and patients on anti platelet drugs
