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Clinical Pathology > Blood Transfusion > Flashcards

Blood Transfusion Flashcards

1
Q

What is the process by which whole blood is filtered and white blood cells removed?

A

Leucodepletion

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2
Q

What are the main constituents of whole blood?

A

RBC
Platelets
Plasma:
- Fresh frozen (

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3
Q

What is the process by which the main constituents of whole blood separated?

A

Centrifugation

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4
Q

How much in ml is one unit of RBC?

A

275ml

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5
Q

What are the storage conditions for RBC storage?

A

4 degrees for up to 35 days

Plasma is removed and replaced by solution of electrolytes, glucose and adenine - keeps RBC healthy

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6
Q

From removal from cold environment, what is the time limit for blood transfusion? How long does it take

A

within 4hrs

Between 1.5-3 hrs

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7
Q

Why do we transfuse patients?

A

To prevent symptoms of anaemia
Improve quality of life
Prevent ischaemic damage

NOT normalise Hb (Hb conc will remain the same, just number of RBCs will be lower)

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8
Q

What are the symptoms of anaemia the result of?

A

Tissue hypoxia

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9
Q

At what point should a blood transition be given (transfusion threshold)?

A

The lowest concentration of Hb where symptoms of anaemia are not observed

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10
Q

Name the mechanisms by which the body adapts to anaemia (i.e. maintain tissue oxygenation)?

A
  • Increased cardiac output
  • Increased 2,3 DPG
  • Increased cardiac artery flow
  • Increased EPO production
  • Increase erthroproiesis
  • Increased O2 extraction
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11
Q

what factors are used to determine the transfusion threshold of patients?

A

Acute vs chronic - less time for adaptation mechs to develop so termite anaemia less well

Underlying conditions - resp, CV, age - tolerate anaemia less well

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12
Q

Why are RBCs transfused?

A

To restore oxygen carrying capacity

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13
Q

What are the transfusion thresholds for patients and patients with CV disease who have mild symptoms of anaemia?

A
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14
Q

When are RBC transfusions to given?

A

Individuals with preventable causes of anaemia e.g. iron, B12, folate deficiency, renal disease (erythropoietin therapy is choice treatment)

Individual requiring correction of coagulopathy

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15
Q

Which blood loss, what is the amount of blood loss required to necessitate a transfusion?

A

> 2000 ml

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16
Q

What is the transfusion threshold level for individuals with chronic anaemia?

A

Hb 80-100 g/L

  • set individual threshold and set Hb concentration targets
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17
Q

What considerations should we have for individuals receiving blood transfusions?

A

Iron overload - avoid over transfusion

Causes cardiomyopathy and liver failure

18
Q

What is the transfusion threshold for individuals receiving regular transfusions due to inheritable conditions? What is the objective of this?

A

Hb 90-95 g/L

  • avoid iron overload
  • Suppression of endogenous erythropoiesis
19
Q

What are the optimum storage conditions for plasma?

A

22 degrees, 5 day shelf life

20
Q

How long does it take to transfuse plasma?

A

30 mins/unit

21
Q

Why are platelets transfused?

A

Thrombocytopenia/platelet dysfunction

-Prevention of bleeding

22
Q

What are the contraindications for platelet transfusion?

A

Heparin induced thrombocytopenia and thrombosis

Thrombotic thrombocytopenia purpura

23
Q

What are he storage conditions/shelf life for fresh frozen plasma?

A
  • 30 degrees
  • 24 months
  • Thawed for 20-30 mins immediately before use
  • takes 30 mins to transfuse
24
Q

How many units does an average adult require?

A

4-6 units (12-15mg/kg/unit)

25
Q

What are the main indications for use of fresh frozen plasma?

A

Coagulopathy with bleeding/surgery

Massive haemorrhage

Thrombotic thrombocytopenia purpura

26
Q

What patients is Fresh frozen plasma not used?

A

Individuals with warfarin overdose

Individual with single factor deficiency

27
Q

What are the some special requirements for transfusions?

A

CMV negative - protect at risk patients from CMV e.g. pregnant women,

28
Q

Pre trans lab testing. What comprises the group and screen process?

A

Test donors ABO/Rh(D) group

-Test patient plasma for antibodies against clinically significant blood group antigen

29
Q

What comprises the pre transfusion lab testing of ‘crossmatching?’

A

Correct donor ABO/Rh groups are selected for patient

Donor blood is mix ed with patient plasma to see if there is any reaction e.g. haemolysis/agglutination

Reaction = incompatible; risk of haemolysis

30
Q

What are the risks of transfusion? how are they classified?

A

Acute/chronic

Immunological/non-immunological

31
Q

Name so acute immunological conditions associated with blood transfusion

A

ABO incompatibility (acute haemolytic transfusion reaction)

Allergic/anaphalaxic reaction

32
Q

Name some acute non-immunological conditions associated with blood transfusion

A

bacterial contamination

33
Q

Name some chronic immunological reactions due to transfusion

A

Transfusion associated graft vs host disease

Post transfusion purpura

34
Q

Name some chronic non-immunological reactions due to blood transfusion

A

Transfusion transmitted infection

Virus e.g. HIV/prion disease

35
Q

What is the main cause of symptoms in acute haemolytic reaction with ABO incompatibility?

A

Free Hb in blood

36
Q

What are the symptoms of Acute haemolytic reaction - APO incompatibility

A 
Fever and chills
Back pain
Infusion pain
Hypotension/SHOCK
HAEMOGLOBURIA (Hb in urine) 
Increased bleeding (DIC)
37
Q

What type of error is acute haemolytic reaction (APO compatibility)? When does it most likely occur?

A

ALWAYS human error

Most likely with blood administration

38
Q

What are the clinical features of delayed haemolytic syndrome?

A

Fatigue
Jaundice
Fever

39
Q

What are the lab findings associated with delayed haemolytic syndrome?

A
  • Reduced Hb
  • Increase Lactate dehydrogenase
  • Increase inactive bilirubin (hence jaundice)
40
Q

What is delayed haemolytic syndrome caused by?

A

IgG antibodies that react to antigens other than those of ABO. Occurs 3-14 day post transfusion

41
Q

What is the Coombs test used for? How does it work?

A

Used to test for presence of antibodies on RBCs (delayed haemolytic syndrome)

Antihuman globulin added to blood - agglutination = positive for antibodies

42
Q

What is transfusional related acute lung injury? How is it treated?

A

Antibodies against recipients leukocytes/granulocytes are present in donor blood. Causes damage to lung endothelium and capillaries.

Supportive treatment O2/ventilation

Clinical Pathology (50 decks)

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