Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - 4. Cancer Care > Blood transfusion > Flashcards

Blood transfusion Flashcards

1
Q

State benefits of blood transfusion

A
  • Relieve symptoms of anaemia (consider nutritional causes)
  • Improve delivery of oxygen to tissues
  • Replace blood loss
  • Help prevent further blood loss
  • May be needed for medical procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

State some risks of blood transfusion

A

Blood transfusions in the UK are usually very safe

However risks are:
- Acute haemolytic transfusion reactions OR delayed transfusion reaction
- Blood borne infections e.g. Hepatitis B
- Receiving unsuitable blood
- Fluid overload (TACO)
- Lung injury (TRALI)
- Iron overload (if repeated transfusions)
- Rare theoretical risk of CJD (Creutzfeldt-Jakob disease)

*In pregnant women, complications if given rhesus positive blood

Once received a blood transfusion - can no longer donate blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

State the different types of blood transfusion reaction

A
  • Acute haemolytic reaction (immune-mediated intravascular or extravascular haemolysis from incorrect blood given)
  • Delayed haemolytic reaction
  • Simple allergic reaction = hypersensitivity to a foreign protein
  • Anaphylactic reaction = can occur in a patient with IgA deficiency
  • TRALI (transfusion-related acute lung injury) = release of mediators leading to pulmonary oedema
  • TACO (transfusion-associated circulatory overload) = fluid overload
  • Sepsis = bacteria or bacterial byproducts
  • Transfusion-associated graft-versus-host disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

State some common symptoms of a transfusion reaction

A
  • Urticaria / itching
  • Respiratory distress / dyspnoea
  • Hypotension
  • Fever / chills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

State what is meant by a group and screen (G&S) and cross matching

A

Group and screen (G&S):
- Tests patient’s blood group (ABO and RhD)

Cross matching:
- Physically mixing the patient’s serum with the donor RBCs, in order to see if any immune reaction occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

State the meaning of electronic issue in blood transfusion

A

Allows blood to be issued after a group and screen (G&S), without the need for a physical cross-matching test to take place

Can only be used in the following circumstance:
- Never been pregnant in last 3 months
- No previous blood transfusions in last 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Outline what is an allo-antibody and why they are significant in blood transfusions and haemolytic disease of the newborn

A

Allo-antibodies are antibodies which are produced in response to exposure to incompatible blood groups antigens
Typically as a result of either
1) Blood transfusion
2) Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

State some alternatives to blood transfusion

A
  • Iron replacement therapy (oral or IV)
  • Cell salvage if surgery (autologous blood transfusion)
  • EPO injections
  • Doing nothing

Prophylactic methods to reduce blood loss (reduce risk of needing blood transfusion in first place)
- Iron supplementation (correct anaemia)
- Tranexamic acid (reduce blood loss during surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How long can blood last after being removed from storage

A

4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

State the main reason for transfusing red cells and state 3 main indications for red cell transfusion

A

Improve oxygenation to the tissues by increasing the circulating red cell mass

The main indications include:
1. Acute blood loss (acute blood loss 30-40% of circulating volume)
2. Anaemia (haemoglobin < 70g/L)
3. Haemoglobin disorders

Give 1 unit at a time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

State some ways to mitigate the risk of TACO (transfusion associated circulatory overload) in vulnerable patients

A
  • Prescribe one unit at a time and consider prescribing according to body weight
  • Transfuse at a slower rate
  • Consider use of a prophylactic diuretic
  • Monitor the observations closely, including oxygen saturations
  • Measure fluid balance
    .
    Review the patient following each unit = recheck Hb level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How much should 1 unit of packed red cells increase haemoglobin by?

A

10 g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How much should 1 unit of platelets increase platelets by?

A

20 x 10(9)/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the normal platelet range?

A

Between 150 and 400 x 10(9)/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

State the main reason for transfusing platelets and state 3 main indications for platelet transfusion

A

Mostly, platelets are given to prevent rather than to treat bleeding when platelet count is low
Given when platelets < 10 x 10(9)/L
Also given when platelets between 10 - 20 x 10(9)/L, if there are additional risk factors for bleeding

Prophylactic platelet transfusion:
1. Prevent bleeding prior to an invasive procedure
2. Treat acute/major bleeds
3. Reversible bone marrow failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

State the 2 transfusion fluids which help to replace coagulation factors (bleeding) and for plasma exchange

A
  1. Fresh frozen plasma (FFP)
  2. Cryoprecipitate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Briefly outline how fresh frozen plasma (FFP) is prepared and which blood type should it come from

A
  • White cells are removed
  • Prepared from anti-coagulated, whole blood
  • Rapidly frozen (maintain activity of labile coagulation factors)

FFP from a donor of an identical ABO Group should be used as the first choice

A patient’s rhesus antigen status is not relevant for FFP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

State some indications for fresh frozen plasma (FFP)

A
  • Major haemorrhage
  • Acute DIC (actively bleeding)
  • Inherited coagulation factor deficiency
  • Prolonged PT/INR (bleeding or prior to procedure)

Give 12-15ml/kg (usually 3-4 bags per adult)

Prophylaxis before surgery / invasive procedure if abnormal coagulation test results AND additional risk factors for bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Briefly outline how cryoprecipitate is prepared, which components it is rich in

A

Cryoprecipitate is produced by slowly thawing a single donation of fresh frozen plasma at 4-6°C
This brings out the following components:
- Factor VIII (8)
- Factor XIII (13)
- Von Willebrand factor
- Fibrinogen
- Fibronectin
These factors are resuspended in a small volume of plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

State the main reason for transfusing cryoprecipitate and state the main indications for cryoprecipitate transfusion

A

Cryoprecipitate is almost exclusively used to enhance fibrinogen level

Conditions with low fibrinogen!
- Prophylaxis before surgery / invasive procedure (fibrinogen < 1 g/l)
- DIC with bleeding (fibrinogen < 1 g/l)
- Major haemorrhage (fibrinogen < 1.5 g/l)
- Major obstetric haemorrhage (fibrinogen < 2 g/l)

Give approximately 2 pools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

State when patients might require irradiated blood products and what this means

A

Patients who are immunocompromised

Risk of transfusion associated graft vs host disease
Although blood products have had most of their white cells removed, there may be some residual white cells. In immunocompromised patients, their immune system is unable to protect against these, therefore irradiation is needed to remove these residual white cells

22
Q

State when patients might require CMV negative blood products and what this means

A

Neonatal blood transfusions
Intrauterine blood transfusions

Although patients are screened for CMV, need to ensure this is negative in blood transfusions associated with babies as it is one of the TORCH infectious diseases that can cause serious complications in neonates

23
Q

When is prothrombin complex concentrate used

A

Warfarin reversal and other vitamin K antagonist anti-coagulants, in the context of major or life-threatening bleeding

Also will need IV vitamin K in addition to prothrombin complex

24
Q

Outline the first steps in major haemorrhage protocol

A
  • Immediate senior involvement
  • IV access and warmed IV crystalloid bolus
  • Request red cells or use O negative blood if likely delay > 15 mins
  • Take necessary bloods
  • Attempt to control bleeding if possible

Dial 2222 - declare major haemorrhage protocol

25
Q

State some clinical scenarios for major haemorrhage protocol

A
  • Clinically obvious severe bleeding
  • Blood loss rate > 150ml/hr
  • Acute blood loss of >50% circulating volume in 30 mins
  • Circulatory shock e.g systolic BP < 70
26
Q

State what would happen if a patient is given the wrong unit of blood

A

Acute haemolytic transfusion reaction (via the complement part of immune system)

27
Q

How often should a patient be monitored whilst receiving blood transfusion and what should be monitored

A

Should have a full set of obs taken at the 3 following times:
1. Baseline obs - prior to transfusion
2. Transfusion obs - 15 mins after transfusion has started
3. Once transfusion has finished

28
Q

State some investigatory tests for a patient presenting with symptomatic anaemia

A

Bloods:
- FBC (haemoglobin and MCV)
- Check ferritin if low Hb or MCV
- WCC
- B12/folate
- Reticulocyte count
- Peripheral blood smear

29
Q

State what is an acute transfusion reaction and some signs / symptoms of acute transfusion reaction

A
  • Incompatible red cells react with the patient’s own antibodies (anti-A or anti-B antibodies), activating complement system
  • Causes intravascular haemolysis and DIC

Signs/symptoms:
- Pain at site of transfusion
- Pain (abdo / chest / muscle / bone)
- Fever / chills
- Tachycardia
- Hypotension / hypertension / collapse
- Nausea
- SOB
- Urticaria / rash
- Respiratory distress

30
Q

State what is a delayed transfusion reaction and some signs / symptoms of delayed transfusion reactions

A
  • When incompatible red cells are transfused a secondary response may be provoked
  • Can occur when titre of an antibody in a recipient’s plasma may be too low to be detected in pre-transfusion tests

Signs/symptoms:
- Fever (not always)
- Anaemia (drop in Hb)
- Jaundice (often not before day 5 post-transfusion and can be as late as day 10)
- Haemoglobinuria (a mean of 8 days post-transfusion)

31
Q

State how to manage a patient presenting with symptoms of a delayed transfusion reaction

A

Take following bloods:
- FBC
- LFT
- Direct Antiglobulin Test (Coombs test)
- Antibody screening

Discuss with senior haematology medical staff

32
Q

If you suspect an acute transfusion reaction, how should you manage the patient immediately

A

Immediately stop transfusion
Keep cannula patent with slow running drip of Sodium Chloride 0.9%
Involve medical staff responsible for the patient
Check blood product given against patient identifiers
Take basic obs again

33
Q

Describe how a direct agglutination test (direct Coombs test) works

A

Red blood cells with IgG bound to their membrane are incubated with antibodies to IgG

Agglutination (clump together) = positive result

34
Q

Describe the 2 main ways haemolysis can be categorised

A
  1. Hereditary
  2. Acquired
35
Q

State some causes of hereditary haemolysis

A

Abnormal haemoglobin:
- Sickle cell anaemia
- Thalassaemia

Red cell enzyme issues:
- G6PD deficiency
- Pyruvate kinase deficiency

36
Q

State some causes of acquired haemolysis

A

Non-immune:
- Malaria
- Sepsis / DIC
- Prosthetic heart valves
- Microangiopathic hemolytic anemia
- PNH (Paroxysmal nocturnal hemoglobinuria)

Autoimmune:
- Autoimmune hemolytic anemia (warm and cold)
- Cold haemmagglutinin disease (CHAD)

Alloimmune:
- Transfusion reaction
- Haemolytic disease of the fetus and newborn

37
Q

State first line management of autoimmune haemolytic anaemia (and what additional medication/supplement should be given?)

A

Steroids e.g. Prednisolone

PLUS folic acid (help make new blood cells)

38
Q

Which tests make up a haemolysis screen?

A

FBC (anaemia)
Reticulocytes (elevated)
LDH (elevated)
Bilirubin (elevated)
Haptoglobin (reduced)

Peripheral blood film (schistocytes, spherocytes, keratocytes or poikilocytosis)
Direct Coombs test (DAT)

39
Q

How is prophylactic anti-D helpful in preventing haemolytic disease of the newborn (in women who have received a blood transfusion)

A

Haemolytic disease of the newborn occurs when a rhesus -ve mother has been previously sensitised to rhesus antigen (e.g. during transfusion or if previous rhesus +ve baby)

When the next baby is rhesus +ve, the mother’s immune system may attack the baby causing haemolytic disease of the newborn

The prophylactic anti-D is helpful as it mops up any foetal RBCs in the maternal circulation BEFORE sensitisation can occur

40
Q

State what 2 parameters are tested in a coagulation screen

A
  1. Prothrombin time (PT)
  2. Activated partial thromboplastin time (APTT)
41
Q

State 2 medications which can be given to help coagulopathy

A
  1. Vitamin K
  2. Tranexamic acid
42
Q

For an acute transfusion reaction with mild fever - suggest how it should be managed

A
  • Give Paracetamol
  • Restart infusion at slower rate
  • More frequent observations
43
Q

For an acute transfusion reaction with an urticarial rash - suggest how it should be managed

A
  • Give antihistamine (Chlorphenamine i.e. Piriton)
  • Restart infusion at slower rate
  • More frequent observations
44
Q

For an acute transfusion reaction with a suspected ABO incompatibility - suggest how it should be managed

A
  • Take down blood and giving set
  • IV saline infusion
  • Monitor urine output
  • Return blood bag and giving set to blood bank
  • Seek advice from Haematology
45
Q

For an acute transfusion reaction with a suspected TACO (transfusion associated overload) - suggest how it should be managed

A
  • Stop transfusion
  • Oxygen
  • IV Furosemide
46
Q

For an acute transfusion reaction with a suspected TRALI (transfusion related acute lung injury) - suggest how it should be managed

A
  • Stop transfusion
  • Oxygen (100%)
  • Chest x-ray
  • Treat as ARDS (acute respiratory distress syndrome)
47
Q

State the name of the test used to estimate the quantity of foetal blood in maternal circulation

A

Kleihauer test

48
Q

State the range of platelets to keep value above in the following clinical scenarios
1) Reversible bone marrow failure, no bleeding
2) Reversible bone marrow failure, patient with sepsis/ other risk
factors for bleeding
3) Reversible bone marrow failure, minor mucosal bleeding e.g.
epistaxis
4) Reversible bone marrow failure, major bleeding or need surgery
5) Reversible bone marrow failure, neurosurgery or CNS bleed

A

1) Platelets >10
2) Platelets >20
3) Platelets > 30
4) Platelets > 40
5) Platelets > 80-100

49
Q

State the infusion rate for blood transfusion in the following scenarios
- Major haemorrhage
- Normal transfusion / chronic anaemia

A

Major haemorrhage:
- Transfuse over 5 minutes

Normal transfusion / chronic anaemia:
- Transfuse over 2-3 hours (blood must be used within 4 hours of leaving fridge)

50
Q

State some clinical conditions where a patient may need diuretics alongside blood transfusion

A

Any patient at risk of fluid overload

  • Heart failure
  • Cirrhosis
  • CKD

Year 4 - 4. Cancer Care (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions