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Heme > Blood Transfusions > Flashcards

Blood Transfusions Flashcards

1
Q

What does the donor screening involve?

A
  1. extensive questionnaire

2. multiple criteria for deferral

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2
Q

What are the 3 main serum tests for infectious agents when donating blood?

A

HIV, HCV, HBV

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3
Q

What are packed red blood cells (prbc)?

A

when one separates red cells from plasma and platelets

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4
Q

How much prbc are in each unit?

A

250ml, 1 unit will increase Hgb 1g/dL

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5
Q

How long can one store blood?

A

42 days

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6
Q

What is leukoreduced prbc?

A

when you remove leukocytes from rbcs

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7
Q

What kinds of Ags are on a RBC surface?

A
  1. proteins

2. complex carbs on lipids or proteins

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8
Q

What is the basic O antigen made up off?

A

Spingosine connected to 5 sugars (GalNac, Gal,GalNac, Glu, Fucose)

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9
Q

What is the role of ABO glycosyltransferase?

A

attach a 6th sugar to the O antigen

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10
Q

Which blood groups have the enzyme and what does it do for the blood group?

A
  1. A alleles - adds GalNac to O Ag
  2. B alleles - adds Gal to O Ag
  3. O alleles - enzymes is inactive
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11
Q

Type A blood makes what Abs?

A

Abs to B Ag

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12
Q

What subclass of Igs are the Abs against blood groups?

A

IgM

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13
Q

What can happen is a recipient is transfused with ABO-incompatible red cells?

A
  • lyse them all very quickly
  • acute hemolytic transfusion rxns
  • can be fatal
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14
Q

What blood groups can donate to O recipient?

A

O donors

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15
Q

Who can donate to A blood types?

A

O and A

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16
Q

Who can donate to B blood types?

A

O and B

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17
Q

Who can donate to AB blood types?

A

All blood types

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18
Q

What is antigenicity?

A

a measure of how likely it is that a potential Ab binding site wil actually induce an Ab response

19
Q

What are the RBC Ags encoded by?

A

genes that show substantial allelic variation

20
Q

What is the most antigenic protein on the red cell surface?

A

RhD – over 80% of D- individuals transfused with D+ red cells develop Abs

21
Q

What is the most common RhD?

A

a complete deletion of the coding sequence

22
Q

Why is RHD protein significant in obstetrics?

A
  • RhD (-) mother having a RhD (+) baby can cause complications for future pregnancies because mother makes Rh-Ab that can cross the placenta.
23
Q

How do you treat the problem with RhD-Abs in pregnancy?

A

give mother RhoGam – basically an immunization

24
Q

Who do you never give D+ red cells if they are D-?

A

girls and women of childbearing age

25
Q

What are minor red cell Ags?

A

currently over 350 known Ag-Ab combinations exist due to minor red cell Ags (i.e. RhCE)

26
Q

What should the blood bank do for minor red cell Ags?

A

screen recipients for ANY Abs to these Ags before any transfusion and identify

27
Q

What are the steps of compatibility testing?

A
  1. provide current blood speciment for a type and screen
  2. Crossmatch is performed - mix donor cells w/ patient plasma and look for agglutination
  3. if Ab screen is negative give blood
  4. in emergency use O negative blood
28
Q

When should one give blood speicmen to blood bank for surgery?

A

at least day before surgery but no more than 3 days before the surgery

29
Q

What is the objective of red cell transfusion?

A

to increase the patient’s O2 carrying capacit

30
Q

What is measured for the O2 carrying capacity?

A

Hgb mainly but sometimes can look at Hct

31
Q

When should you give a red cell transfusion?

A
  1. when patient is symptomatic and anemic (increased HR, RR, confusion, weakness, dizziness)
  2. Acute blood loss, rapid volume expansion
  3. During or following an MI
  4. Hgb trendline
32
Q

When shouldn’t you give a red cell transfusion?

A
  1. patient is old and frail
  2. asympotmatic coronary artery disease
  3. expand blood volume
  4. promote wound healing
33
Q

Is anemia a diagnosis?

A

no – need to determine why patient has anemia

34
Q

When will you need to give a rationale for transfusion at the VA?

A

if lab indications are questionable (such as Hgb > 8.0

35
Q

What is the average blood volume?

A

5 L

36
Q

How much are 2 units of prbc in terms of cc?

A

500, 10% of blood volume

37
Q

What are some risks associated w/ red cell transfusion?

A
  1. CMV seroconversion
  2. Fever w/out hemolysis
  3. Anti-RBC Ab development
  4. Urticaria
  5. circulatory overload
38
Q

How do hemolytic rxns present?

A

fever, chills, chest pain, hypotension
- overall nonspecific so if you see this after a transfusion, stop transfusion and ask blood bank to do work up for a transfusion rxn

39
Q

What does the blood bank do for a transfusion rxn?

A
  1. clerical check
  2. look at serum (pink = acute hemolysis, yellow= icteric, subabcute/chronic hemolysis)
  3. recheck ABO of patient and donor
  4. repeat crossmatch
  5. repeat Ab screen
  6. preform a DAT
40
Q

What is the most common cause of immediate hemolytic rxns?

A

clerical error

41
Q

What is the common cause of delayed hemolytic rxns? How to minimize risk for future?

A
  1. du to Ab to minor red cell ag

educate patient about Abti-RBC ab so it doesn’t happen in future

42
Q

Allergic rxns to plasma components?

A

urticaria (1-2%) and anaphylaxis rarely

43
Q

How to minimize allergic rxn?

A

-premedicate w/ antihistamines for subsequent transfusion, or request washed red cells for any subsequent transfusions

Heme (38 decks)

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