Transfusion medicine (Yr 3)

Question 1

how should you determine if a patient needs a blood transfusion?

Answer 1

clinical signs of reduced oxygen perfusion (tachycardia, tachypnoea, lethargy…)

Question 2

what should you ensure is normal before giving a blood transfusion?

Answer 2

normovolaemic

Question 3

what blood product should be used in cases of haemolysis?

Answer 3

packed red cells

Question 4

what blood product should be used in cases of coagulopathies?

Answer 4

fresh frozen plasma
regular plasma
cryoprecipitate
(depends on the cause)

Question 5

what is the difference between fresh frozen plasma and frozen/regular plasma?

Answer 5

frozen plasma doesn’t contain vWF or factor IIX as they breakdown over the time it is being stored for

Question 6

how long can whole blood be stored by a practice?

Answer 6

<21 days

Question 7

what blood type should be given to a dog if you haven’t specifically matched the type?

Answer 7

DEA negative

Question 8

do cats have to have type-matched blood?

Answer 8

yes (will kill it if it isn’t)

Question 9

what type of hypersensitivity is caused if the blood type doesn’t match?

Answer 9

type 2 (antigen/antibody)

Question 10

when will haemolysis of a transfusion occur?

Answer 10

if the donor has antibodies to the antigens found on the donor RBCs

Question 11

who can DEA negative dogs donate a receive blood from?

Answer 11

they can donate to any
they can receive from any (only for the first transfusion)

Question 12

what is the difference between a naive and sensitised DEA negative dog?

Answer 12

naive - first time receiving transfusion so will accept it
sensitised - after it has received DEA positive blood once it will create antibodies and haemolysis will occur if you give it again

Question 13

what is DEA?

Answer 13

dog erythrocyte antigen

Question 14

why are greyhounds very good blood donors?

Answer 14

they are always DEA negative

Question 15

what is cats blood typing based on?

Answer 15

A/B system (A is dominant to B)

Question 16

can you give type B cats type A blood?

Answer 16

no (this is BAd) it will cause severe acute haemolytic reaction

Question 17

can you give type A cats type B blood?

Answer 17

yes (not As Bad) as it will cause a milder more delayed reaction

Question 18

what can cause a cassette blood type test not to work?

Answer 18

auto-agglutination meaning the blood doesn’t move down the cassette (wash in saline)

Question 19

what is crossmatching?

Answer 19

used to detect more haematological incompatibilities than just doing blood typing

Question 20

what are the two types of crossmatching?

Answer 20

major
minor

Question 21

what is a major crossmatch?

Answer 21

recipient has antibodies to the donor RBCs so don’t give transfusion

Question 22

what is a minor crossmatch?

Answer 22

donor blood has antibodies against recipient RBCs (you can transfuse)

Question 23

when should a patient be crossmatched?

Answer 23

if they have had a previous transfusion more than 3 days ago

Question 24

what is a restrictive and liberal transfusion target?

Answer 24

restrictive - PCV 21-25%
liberal - PCV 35-45%

Question 25

what has be used to give blood products?

Answer 25

a transfusion set with an inline filter (drip-by-drip better)

Question 26

how fast should a blood transfusion be given?

Answer 26

1ml/kg/hr for first 30 minutes
5ml/kg/hr after 30 minutes

Question 27

should you warm blood products prior to transfusion?

Answer 27

no (only at room temperature) will damage RBCs and increase likelihood of sepsis

Question 28

how can transfusion reactions be categorised?

Answer 28

haemolytic
respiratory
non-haemolytic

Question 29

what are the features of an acute haemolytic transfusion reaction?

Answer 29

happens within minutes
severe clinical signs… tachycardia, tachypnoea, nausea, vomiting, haemoglobinuria, death

Question 30

what should be done if a patient is having a haemolytic transfusion reaction?

Answer 30

stop transfusion (it is due to an incompatible crossmatch)

Question 31

what are the two types of haemolytic transfusion reactions?

Answer 31

acute and delayed

Question 32

what are the features of a delayed haemolytic transfusion reaction?

Answer 32

milder slower haemolysis due to a mild antibody reaction
jaundice and bilirubinaemia with a slow reduction in PCV

Question 33

how do non-haemolytic anaphylactic transfusion reactions present?

Answer 33

vomiting, nausea, panting, tachycardia, pyrexia

Question 34

what should be done in cases of a non-haemolytic anaphylactic transfusion reaction?

Answer 34

pause transfusion (or slow rate)
can give maropitant

Question 35

what are the types of non-haemolytic transfusion reactions?

Answer 35

pyrexia/anaphylaxis
citrate toxicity
sepsis