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Year 2 clinical pathology > week 10 transfusion medicine > Flashcards

week 10 transfusion medicine Flashcards

1
Q

What are the different blood components?

A

RBC
platelets
Plasma

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2
Q

What is leucodepletion?

A

Whole blood is filtered before further processing to remove white cells

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3
Q

What are the 3 procedures can occur to the plasma after blood components?

A

Fresh frozen plasma
cryoprecipitate
Fractionation

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4
Q

What is the plasma fractionated to?

A

Factor concentrates (FVIII, FIX, prothrombin complex)
Albumin
immunoglobulin

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5
Q

How is RBC stored?

A

Stored at 4oC for up to 35 days from collection.

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6
Q

What is the name of red cells when the plasma is removed?

A

concentrated red cells

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7
Q

What replaces plasma cells in concentrated red cells?

A

Replaced by a solution of electrolytes, glycose and adenine to keep the red cells healthy during storage

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8
Q

What is the trasfusion policy of red blood cell transfusion

A

Usual transfusion time: 1.30 -3hrs

4 hr limit from removal from cold storage to end of transfusion

Use blood warmer for rapid transfusion

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9
Q

Why do we transfuse patients?

A

To normalize the Hb in anaemic patients
To prevent symptoms of anaemia
To improve quality of life of anaemic patients
To prevent ischemic damage of end organs in anaemic patients.

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10
Q

Does transfusion stop anemia?

A

No it is just used to improve the quality of life by removing symptoms

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11
Q

What is the mains ymptom of anaemia?

A

Tissue hypoxia

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12
Q

What is Transfusion threshold (trigger)?

A

is the lowest concentration of Hb that is not associated with symptoms of anaemia.

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13
Q

What are the mechanisms of adaption to anaemia?

A 
Increased cardiac output
Increased cardiac artery blood flow
Increased oxygen extraction 
Increase of red blood cell 2,3 DPG (diphosphoglycerate)
Increase production of EPO
Increase erythropoiesis
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14
Q

Does transfusion threshold differ betwen subgroups?

A

Transfusion thresholds differ in various subgroups of patients depending on the balance between mechanisms of adaptation to anaemia and O2 requirements.

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15
Q

What is the affect on respiration in acute anaemia?

A

In acute anaemia the respiration rate is more markedly increased than in chronic anaemia

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16
Q

Why is oxgen extraction increased in chronic anaemia?

A

In chronic anaemia the O2 extraction is increased due to the rise of the levels of 2,3 DPG.

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17
Q

What is the response of kidney to chronic anaemia?

A

In chronic anaemia kidneys respond to hypoxia by increasing the production of erythropoietin and this in turn results in increased erythropoiesis.

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18
Q

What are the parameters that affect the adaptation mechanisms to anaemia?

A

Acute/chronic anaemia
Underlying conditions
Transfusion of RBC

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19
Q

For a patient with mild symptoms of anaemia how much red blood cell would you transfuse?

A

Transfusion of ≤70 g/L for patients with mild symptoms of anaemia

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20
Q

For a patient with cardiovascular disease how much red blood cell would you transfuse?

A

Transfusion of ≤80 g/L for patients with cardiovascular disease

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21
Q

What is anaemia?

A

Is a condition in which there is a deficiency of red cells or of haemoglobin in the blood, resulting in pallor and weariness.
Origin

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22
Q

What caues of anaemia is treated rather than doing RBC transufsion?

A

Iron deficiency

B12 and folate deficiency

Erythropoietin treatment for patients with renal disease

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23
Q

How can you correct coagulopathy without the use of transfusion?

A

Discontinuation of antiplatelet agents

Administration of anti-fibrinolytic agaents

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24
Q

What is cell salvage?

A

Is a medical procedure involving recovering blood lost during surgery and re-infusing it into the patient.

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25
Q

At what calss of haemorrhage is indication for transfuon neccessary?

A

Class 3 and definetly at class 4

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26
Q

What is the objectives forPatients on regular transfusions due to myeloid failure syndromes

A

Symptomatic relief of anaemia
Improvement of Quality of Life
Prevention of ischemic organ damage

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27
Q

What do you have to take into consideration when treating chronic anaemia?

A

co-morbidities that affect cardiac, respiratory function
iron overload
adaptation to anaemia

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28
Q

What is the aim of Hb for patients who have chronic anaemia?

A

Threshold Hb 80-100g/dl

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29
Q

What is the objective for a patient on regular transfusions due to inherited anaemia?

A

suppression of endogenous erythropoiesis to avoid complications due to expansion of the endogenous erythropoiesis

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30
Q

What is the threshold that needs to be aimed at for a patient that has thalassaemia?

A

Threshold 90-95, target 100-120g/L

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31
Q

What do you take into consideration of thalassaemia?

A

iron overload

32
Q

How is platelets stored and what is the transfusion time?

A

Stored at “room temperature” (22oC)
Shelf-life 5 days from collection

Transfusion time: 30 mins/unit

33
Q

What is adult therapeutic dose?

A

Adult therapeutic dose” is platelets from 4 pooled donations

34
Q

Why transfuse platelets?

A

Treatment of bleeding due to severe thrombocytopenia (low platelets) or platelet dysfunction

35
Q

What are you trying to prevent when doing transfuse plateletes?

A

Prevention of bleeding :

Massive haemorrhage

Bone marrow failure
Prophylaxis for surgery

36
Q

What are the contraindications of transufe platelets?

A

Heparin induced thrombocytopenia & thrombosis

thrombotic thrombocytopenic purpura

37
Q

What is thrombocytopenia?

A

deficiency of platelets in the blood.

38
Q

How is fresh frozen plasma stored, the usual dose and trasfusion time?

A

Stored at –300C for up to 24 months
Thawed immediately before use (takes 20-30 min)
Usual dose 12-15 mL/kg (4-6 units for average adult)

Usual transfusion time: 30 mins/unit

39
Q

What is the main indication of fresh frozen plasma?

A

coagulopathy with bleeding/surgery,
massive haemorrhage
thrombotic thrombocytopenic purpura

40
Q

When do you not transfuse fresh frozen plasma?

A

Warfarin reversal

Don’t treat bleeding causes by single factor deficiency such as haemophilia

41
Q

What is the aim of the group and screen testing?

A

Determination of ABO and Rh(D) group

Patient’s plasma “screened” for antibodies against other clinically significant blood group antigens

42
Q

If the patient plasma screen is positive what is the next action?

A

Antibody identification: testing the patient’s plasma against a panel of red cells containing all the clinically significant blood groups, using the Antiglobulin Test

43
Q

What is the cross matching test?

A

Patients plasma is mixed with aliquots of donor red cells to see if a reaction (agglutination or haemolysis) occurs

44
Q

What are the two outcomes of cross matching testing

A

No reaction
RBC units compatible
No risk of acute haemolysis

Reaction
RBC units incompatible
Risk of acute haemolysis

45
Q

What are the two groups for the complications of transfusion?

A

Acute reactions present 24 hours of transfusion

46
Q

What is the immunological complciations that occurs in acute transfusion reaction?

A

Acute haemolytic transfusion reaction
ABO incompatibility
Allergic /anaphylactic reaction
TRALI (Transfusion-related acute lung injury)

47
Q

What is the non immunological complciations that occurs in acute transfusion reaction?

A

Bacterial contamination

TACO (transfusion associated circulatory overload)

Febrile non-haemolytic transfusion reaction

48
Q

What is the non immunological complciations that occurs in delayed transfusion reaction?

A

Transfusion Transmitted Infection (TTI) –viral/prion

49
Q

What is the immunological complciations that occurs in delayed transfusion?

A

Transfusion-associated graft-versus-host disease (TA-GvHD)

Post transfusion purpura

50
Q

What is purpa?

A

A rash of purple spots on the skin caused by internal bleeding from small blood vessels.

51
Q

What is the outcome of Acute haemolytic reaction-ABO incompatibility?

A

Release of free Hb due to:

Deposition of Hb in the distal renal tubule results in acute renal failure.
Stimulation of coagulation results in microvascular thrombosis
Stimulation of cytokine storm
Scavenges NO resulting in generalized vasoconstriction

52
Q

What is the onsent of Acute haemolytic reaction-ABO incompatibility?

A

Severe reactions may occur early in the transfusion, within the first 15 min

Milder reactions may occur later but usually before the end of transfusion

53
Q

What is the signs and symptoms of Acute haemolytic reaction-ABO incompatibility?

A 
Fever and chills 
Back pain 
Infusion pain
Hypotension /shock
Hemoglobinuria (may be the first sign in anesthetized patients)
Increased bleeding (DIC)
Chest pain
Sense of “impending death”
54
Q

What percentage of Acute haemolytic reaction-ABO incompatibility is fatal?

A

20-30%

55
Q

What is the cause of Acute haemolytic reaction -ABO incompatibility ?

A

Always a human error either due to mistake in patient identification or the correct product use

56
Q

What is the cause of delayed haemolytic reaction?

A

Delayed haemolytic reaction is due to immune IgG antibodies against RBC antigens other than ABO

The antibodies are formed after the transfusion

57
Q

What is the onset time of delayed haemolytic reaction?

A

Onset 3-14 days following a transfusion of RBC

58
Q

What is the clinical features of delayed haemolytic reaction?

A

fatigue,
jaundice,
and/or fever

59
Q

What is the libaoratory findings of delayed haemolytic reaction?

A

Drop in Hb
Increased LDH
Increased indirect bilirubin

Direct antiglobulin test is Positive

60
Q

What is a serious complication of transfusion?

A

Transfusion related acute lung injury

61
Q

What is the cause of transfusion related acute lung injury?

A

Donor has antibodies to recipient’s leucocytes

62
Q

What is the effect of transfusion related acute lung injury on the lung pathology?

A

Activated WBC lodge in pulmonary capillaries

Release substances that cause endothelial damage and capillary leak

63
Q

What type of transfusion is complicated by transfusion related acute lung injury?

A

Almost always complicates transfusion of plasma rich components

64
Q

What is the onset of transfusion related acute lung injury?

A

Sudden onset of “Acute Lung Injury” occurring within 6 hours of a transfusion

65
Q

What are the clinical signs of transfusion related acute lung injury?

A

Hypoxemia
New bilateral chest X-ray infiltrates
No evidence of volume overload

66
Q

What is the treatment for TRALI?

A

Mild forms of TRALI may respond to supplemental oxygen therapy.
Severe forms may require mechanical ventilation and ICU support.

67
Q

Is diuretics or corticosteroids used in TRALI?

A

There is no role for diuretics or corticosteroids

68
Q

What are the laboratory investigations of TRALI?

A

Donor is tested for HLA and granulocyte antibodies.

The recipient is tested for expression of neutrophil antigens

69
Q

How do you confirm the diagnosis of TRALI?

A

Donor has antibodies against antigens that are expressed on recipient’s granulocytes.

70
Q

What is the presentation of Transfusion-associated circulatory overload?

A 
Symptoms:
sudden dyspnea
orthopnoea
tachycardia 
hypertension 
hypoxemia.

Signs
Raised BP
elevated jugular venous pul

71
Q

What are the risk factors of TACO?

A 
elderly patients 
small children
Patients with compromised left ventricular function
increased volume of transfusion
increased rate of transfusion
72
Q

What is the cause of urticarial Rash?

A

Hypersensitivity to a ‘random’ plasma protein

73
Q

What is anaphylaxis?

A

Severe, life-threatening reaction soon after transfusion started

74
Q

What is the consequence of anaphylaxis?

A

Wheeze/ asthma, increase in pulse and decrease in BP (shock)

Laryngeal oedema/ facial oedema

75
Q

What are the laboratory investigations for anaphylaxis?

A

Quantification of IgA, testing for anti-IgA antibodies.

Year 2 clinical pathology (21 decks)

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