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Haematology > Blood Transfusions > Flashcards

Blood Transfusions Flashcards

1
Q

Why are there different blood groups?

A

Red cells express different antigens on their cell surface.
These can provoke antibodies.
There are 2 types of antigens A and B that are expressed in different combinations on certain cells.

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2
Q

What antigens/antibodies are present on Group A blood?

A

A antigen on its surface.

B antibodies in its plasma.

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3
Q

What antigens/antibodies are present on Group B blood?

A

B antigens

A antibodies in its plasma

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4
Q

What antigens/antibodies are present in group AB blood?

A

A and B antigens

But NO antibodies

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5
Q

What antigens/antibodies are present in Group O blood?

A

NO antigens

A and B antibodies

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6
Q

How can blood be transfused safely?

A

Group A - can get A and O
Group B - can get B and O
Group AB - can get A, B, AB & O.
Group O - can get O.

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7
Q

What is FFP?

A

Fresh Frozen Plasma.

Contains antibodies so is opposite to RBC transfusion.

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8
Q

How can FFP be transfused safely?

A

Group A - can get A and AB.
Group B - can get B and AB
Group AB - can get AB.
Group O can get A, B, AB and O.

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9
Q

What is Rh factor?

A

Protein that can be either positive (present) or negative (absent) on the surface of RBCs.

Rh + is most common type.

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10
Q

What is Anti D?

A

Antibody that RhD individuals make if they are exposed to RhD+ cells.
Can occur in transfusion or pregnancy.
Anti D can cause transfusion reactions or haemolytic disease of the newborn.

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11
Q

What is the blood tested for before it can be donated?

A

Behavioural screening - sex, travel, tattoos, age.
Tested for ABO and Rh blood groups.
Screened for Hep B/C/E, HIV, Syphilis.
Variably screened for HTLV1, malaria, West nile virus, Zika virus.

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12
Q

What are the products of Plasma?

A

Clotting factors
Albumin
Antibodies

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13
Q

What are the components of a Buffy coat?

A 
Platelets
White cells (leucocytes)
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14
Q

What are some indications for red cell transfusion?

A

To correct anaemia
Improve quality of life
Prepare patient for surgery to speed up recovery
Reverse damage caused by patients own RBCs e.g. sickle cell disease.

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15
Q

How do you store RBCs?

A

Stored at 4 degrees C
Transfuse over 2-4hours
1 unit increments = 5g/L

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16
Q

How do you store Platelets?

A 
22 degrees C
Shelf life of 7 days
Transfuse over 20-30mins
1 dose of platelets = 4 pooled donors or 1 aphaeresis donor. 
20-40.10 to the 9/L
17
Q

How much platelets should you give?

A

Massive haemorrhage - keep count about 75x10(9)/L

Bone marrow failure - <10-15 x10(9)

Minor procedures 50X10(9)
Major surgery 80x10(9)
CNS/eye surgery 100x10(9)

Only use if bleeding during cardiopulmonary bypass.

18
Q

How is FFP stored?

A

Stored frozen, allow 30mins to thaw.

1 unit from 1 unit of blood

19
Q

When is FFP indicated?

A

Massive haemorrhage
DIC with bleeding
Prophylactic

20
Q

How is Cryoprecipitate stored?

A

Source of fibrinogen
Stored frozen, 20mins to thaw.
1-2pools in fib <1.0g/dl

21
Q

What is a group and screen?

A

A blood group and an antibody screen of a sample of blood to see what type the patient needs and whether they have any atypical antibodies in their blood.

22
Q

What is a Coombs test?

A

Used to detect antibodies that attack the surface of your red blood cells.

Direct test - autoimmune haemolytic anaemia, passive anti D, haemolytic transfusion reactions.

Indirect - cross matching

23
Q

What happens when a Rh - mum is pregnant with a Rh+ baby?

A

When mum come sin contact with foetal blood she starts to produce Anti D antibodies. These are IgG which can cross the placenta.
They then go onto attack the antigens on the surface of the baby’s RBCs.
Can result in Haemolytic disease of the newborn (HDN).

24
Q

What are some signs of HDN at birth?

A

Positive DAT
Anaemia
Jaundice

25
Q

What is Haemolytic Disease of the Newborn?

A

When baby’s red blood cells breakdown at a fast rate. Due to Anti-D attacking Rh+ antigens on baby’s RBCs.

26
Q

What greatly reduces HDN?

A

Prescribing Anti-D early on in pregnancy. Usually happens in 2nd or 3rd pregnancy. So encourage sensitising events and get Anti-D prescribed at 28 weeks.

27
Q

How is HDN monitored?

A

Antibody titres
Doppler ultrasound
Intrauterine transfusions

28
Q

What is Neonatal alloimmune thrombocytopenia?

A

Similar disease to HDN except it is regarding platelets.

29
Q

What are the indications to give certain blood components?

A

Anaemia - red cells
Thrombocytopenia - platelets
Low coagulation factors - FFP
Low fibrinogen - cryoprecipitate.

30
Q

What is IOCS?

A

Intra-operative cell salvage.

Recovers blood loss during surgery and rein fuses it into patient.

31
Q

What are the indications for platelet transfusion?

A

Prophylactically or therapeutically to stop bleeding
Dilutional thrombocytopenia
Cardiopulmonary bypass surgery
DIC if bleeding
Abnormalities of platelet function e.g. Glanzmann’s disease, Bernard-Soulier syndrome, platelet storage deficiency.

32
Q

What are the indications for FFP use?

A

Replacement of coagulation factors due to major haemorrhage.
DIC in presence of bleeding
Thrombotic thrombocytopenia purpura (TTP)
Replacement of coagulation factor deficiencies where factor concentrate unavailable.

33
Q

What coagulation factors does cryoprecipitate contain?

A

Factor 8
von Willebrand factor
Fibrinogen
Factor 13

34
Q

What are the indications for cryoprecipitate use?

A

hypofibrinogenaemia secondary to a massive transfusion (>1.5g/L)
DIC with bleeding and fibrinogen <1g/L
Bleeding associated with thrombolytic therapy causing hypofibrinogenaemia
Renal/liver failure and abnormal bleeding
Inherited hypofibrinogenaemia if fibrinogen concentrate unavailable.

35
Q

What tests need to be done before blood is allowed to be transfused?

A 
Group and Screen/save
Cross match
group specific blood
2 sample policy
72 hr (10 day) validity
36
Q

What is the treatment for pyrexia as an acute transfusion reaction?

A

Anti-pyretic
Other symptoms are usually more of a concern.
FNHTR possible cause

37
Q

What is the treatment for urticaria as an acute transfusion reaction?

A

Antihistamine
Other symptoms usually more of a concern.
Mild allergy reaction or anaphylaxis may be possible cause.

38
Q

What is the treatment for dyspnoea as an acute transfusion reaction?

A

Oxygen
Diuretic
Ventilation
Adrenaline

TACO, TRALI< anaphylaxis are possible causes

39
Q

What is the treatment for shock as an acute transfusion reaction?

A 
Adrenaline IV
IV fluid
ITU admission
Ventilation
Antibiotics
FFP/platelets if DIC

IBCT, anaphylaxis, TRALI and TAS are all possible causes.

Haematology (6 decks)

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