Blood Transfusion

Question 1

What is the A antigen in blood

Answer 1

N-acetyl-galactosamine

Question 2

What is the B antigen in blood

Answer 2

Galactose

Question 3

What happens if a RhD -ve individual is exposed to RhD +ve blood

Answer 3

• They make anti-D

- Causes transfusion reactions or haemolytic disease of newborn

Question 4

Indications for RBC transfusion

Answer 4

• Severe bleeding (trauma/surgery)
• Anaemia (thalassaemia, sickle cell)
• Bone marrow failure
• Chemotherapy

Question 5

Indications for platelet transfusion

Answer 5

• Massive haemorrhage
• Bone marrow failure
• Prophylaxis for surgery
• Cardiopulmonary bypass (use only if bleeding)

Question 6

Indications for fresh frozen plasma

Answer 6

• Massive haemorrhage

- DIC with bleeding

Question 7

What is DIC

Answer 7

• Disseminated intravascular coagulation
• Small blood clots develop throughout the bloodstream
• The increased clotting depletes platelets + clotting factors causing excessive bleeding.

Question 8

Minor reactions to blood transfusion

Answer 8

-Fever (usually <38C)
-Urticarial rash
(consider paracetamol, antihistamine)

Question 9

Major reactions to blood transfusion

Answer 9

• Fever
• Urticaria
• Resp. distress
• Hypotension
• Tachycardia
• Oliguria
• Bleeding
• Collapse

Question 10

Possible causes of a transfusion reaction

Answer 10

• Anaphylaxis
• Circulatory overload (TACO)
• Lung injury (TRALI)
• Acute haemolytic transfusion reaction (AHTR)
• Bacterial infection

Question 11

Management of transfusion reactions

Answer 11

• Stop transfusion
• Check patient ID against component label
• Consider anaphylaxis, Circulatory overload (TACO), acute haemolytic transfusion reaction (AHTR), lung injury (TRALI), bacterial infection, etc

Question 12

Rx of transfusion associated circulatory overload (TACO)

Answer 12

Slow rate, IV diuretic + O2

Question 13

Symptoms of immediate haemolytic reactions

Answer 13

• Shock
• High fever
• Renal failure

Question 14

Management of immediate haemolytic reactions

Answer 14

• Notify blood services to investigate
• O2
• IV fluids
• Diuretics
• Ionotropes
• Dialysis

Question 15

Management of Transfusion Related Acute Lung Injury (TRALI)

Answer 15

• O2
• Resp. support
• IV fluids
• Notify blood services to investigate/intiate recalls

Question 16

Management of bacterial infection related to transfusions

Answer 16

• IV antibiotics
• O2
• IV fluids
• Notify blood services to investigat/initiate recalls

Question 17

What stepes are taken to reduce the risk of transmissioni via blood transfusion of Prion Disease

Answer 17

• UK plasma not used for fractionation
• Imported FFP for all patients born after 1996
• Leucodepletion 1998

Question 18

What is leucodepletion

Answer 18

Removal of WBC from blood

Question 19

Example of prion disease

Answer 19

Creutzfeldt-Jakob Disease (CJD)

Question 20

1 immunoglobulin that corsses the placenta and 1 that doesn’t

Answer 20

• IgG crosses

- IgM doesn’t (M = macro, it’s too big)

Question 21

When could Haemolytic Disease of the Newborn (HDN) occur

Answer 21

• When mother is RhD -ve but foetus is RhD +ve
• Mother produces Anti-D antibodies (sensitisation)(IgG)
• Causes glutination + haemolysis to foetal blood

Question 22

How to prevent HDN

Answer 22

• Prophylactic Anti-D (~28wk)
• Binds to any Rh+ in mother’s blood from the foetus, preventing the mother from developing her own antibodies/immunity to RhD
• Binding to RhD “hides” it from the mother’s immune system

Question 23

RX of HDN

Answer 23

By careful monitoring

• Antibody titres
• Doppler US
• Intrauterine transfusions