Blood transfusion

Question 1

What A and B plasma antibodies will blood-antigen groups A,B,AB and O have?

Answer 1

antigen A = anti-B
antigen B = anti-A
antigen AB = none
antigen O = anti-A and anti-B

Question 2

What kind of immunoglobulin are anti-A and anti-B antibodies?

Answer 2

IgM (no placenta crossing)

Question 3

What do anti-A and anti-B antibodies cause in the blood?

Answer 3

Agglutination RBCs

Question 4

What are red cell antigen alloantibodies?

Answer 4

an IgG antibody against red cell antigens. These can develop when people recieve blood transfusions

Question 5

Issues formed when patients are transfused?

Answer 5

Pt cannot be a blood donor in the future

Question 6

When should a patient be transfused?

Answer 6

When other alternative treatments are not sufficient (treat underlying cause with anaemia/platelets for thrombocytopenia/use manufactured products for plasma)

Question 7

How many blood samples are needed to confirm a the correct blood group?

Answer 7

two

Question 8

What are possible complications of blood transfusions?

Answer 8

Haemolytic reactions
Allergic reactions
Anaphylaxis
Infection
Immune sensitization

Question 9

Type of hypersensitivity reaction when wrong ABO blood is given to a pt?

Answer 9

Type II hypersensitivity

Question 10

When do antibodies to RhD develop?

Answer 10

After someone has been exposed RhD antigens via transfusion, pregnancy, transplant

Question 11

Potential issues with RhD antibodies developing and pregnancy?

Answer 11

If mother is RhD neg and baby RhD pos, if mother exposed then she’ll develop anti-RhD antibodies
Big issue for second pregnancy as anti-RhD antibodies can cross placenta causing haemolytic disease of newborn

Question 12

What type of Ig is anti-RhD antibodies?

Answer 12

IgG

Question 13

What is ‘group and screen’?

Answer 13

technique to confirm blood donor / receiver compatibility
confirm ABO and Rh groups
screen serum for important antibodies in direct antiglobulin test

Question 14

What is crossmatching?

Answer 14

• Another form of patient / donor compatibility screening
• Donor cells are tested against the patient’s serum, mixed + incubated and any agglutination is detected visually or microscopically
• If agglutination is noted it means the donor + patient are not compatible

Question 15

What is electronic issue?

Answer 15

• If 2 separate group + screen tests have been carried out, with negative antibody screens, then ABO and Rh compatible blood can be given to the patient without further compatibility testing
  
  • NB: not valid if any blood has been transfused between the 2 separate group + save screening tests

Question 16

What is fresh frozen plasma and when is is used?

Answer 16

Plasma stored frozen

• Replacement of coagulation factors when specific concentrates are unavailable
• Massive transfusions
• Liver disease
• Disseminated intravascular coagulation (DIC)
• Cardiopulmonary bypass surgery
• Reversal of warfarin effects
• Thrombotic thrombocytopenic purpura

Question 17

What is cyroprecipitate?

Answer 17

Cryoprecipitate is a blood product that is obtained by thawing fresh frozen plasma (FFP) and then collecting the precipitate that forms.

Contains concentrated factor VIII and fibrinogen.

Question 18

When is cyroprecipitate used?

Answer 18

• Fibrinogen deficiency Replacement
• Massive Transfusion
  
  • Use after 4-10 for rbcs units
• Hepatic Failure

Question 19

What is prothrombin complex concentrate and when is it used?

Answer 19

Blood product - contains clotting factors II, VII, IX, X and protein C and S

• Reversal of anticoagulation with vitamin K antagonists (e.g., warfarin)
• Urgent reversal of life-threatening bleeding associated with vitamin K antagonists

Question 20

Describe transfusion-associated circulatory overload (TACO)?

Answer 20

Too much fluid being transfused too quickly

Pulmonary oedema and acute respiratory failure

Question 21

How to prevent TACO?

Answer 21

risk assessment pre transfusion
prescribe by volume
use diuretics
slow transfusion

Question 22

Investigation and Management of TACO?

Answer 22

Bloods – leukopenia, eosinophilia

• IV furosemide – diuretic
• High flow oxygen

Question 23

what is Transfusion Related Acute Lung Injury?

Answer 23

Donor plasma contains antibodies against patient’s leukocytes

Acute respiratory distress

Question 24

Presentation of Transfusion Related Acute Lung Injury?

Answer 24

Within 6 hours:

• Non-productive cough
• Dyspnoea
• Hypoxia
• Frothy sputum
• Fever
• Rigours

Question 25

Investigation and management of Transfusion Related Acute Lung Injury?

Answer 25

CXR: multiple perihilar nodules, infiltration in lower lung

• High flow oxygen
• IV fluids
• Inotropes
• ABGs
• Chest x-rays
• Consider ventilation and ICU

Question 26

What is acute (IgM) haemolytic reaction?

Answer 26

Incompatible red blood cells react with patient’s antibodies
activates pts complement system
acute reaction

Question 27

Diagnosis and management of an acute haemolytic reaction?

Answer 27

Presents with changes associated with haemolytic anaemia

Oxygen
- Fluids
- Diuretics
- Inotropes – increases vasoconstriction
- FFP (fresh frozen plasma)/platelet transfusion

Question 28

What is delayed (IgG) haemolytic reaction?

Answer 28

5-10 days post transfusion

Patient had previously had an immune response to a red blood cell antigen either from pregnancy or transfusion. After a second transfusion that contains that antigen, a secondary immune response occurs.

Question 29

Management of delayed (IgG) haemolytic reaction?

Answer 29

• IV immunoglobulin
• Erythropoietin

Question 30

What increases the risk of delayed (IgG) haemolytic reaction?

Answer 30

developing antibodies against non-AB and non-Rh D antigens from previous transfusions/ pregnancy