Blood Transfusion

Question 1

What is donated blood screened for?

Answer 1

Hep B, C, E
HIV
HTLV
Syphilis

Question 2

How are red cells stored?

Answer 2

At 4 degrees Celsius for 35 days

Question 3

How is FFP stored?

Answer 3

-30 degrees for 3 years

Question 4

How are platelets stored?

Answer 4

At 22 degrees with agitation for 7 days

Question 5

Name three blood products

Answer 5

Anti-D
Prothrombin
IV Igs
Human albumin

Question 6

What are antigens made of?

Answer 6

Sugar and protein

Question 7

Where is the ABO gene expressed?

Answer 7

Chromosome 9

Question 8

What is substance H?

Answer 8

A transferase which is modified into A or B

Question 9

Which ABO antibodies are present with blood group A?

Answer 9

anti-B

Question 10

Which ABO antibodies are present with blood group B?

Answer 10

anti-A

Question 11

Which ABO antibodies are present with blood group O?

Answer 11

anti-A

anti-B

Question 12

Which blood groups can blood group A receive?

Answer 12

A and O

Question 13

Which blood groups can group B receive?

Answer 13

B and O

Question 14

Which blood groups can AB receive?

Answer 14

A, B, AB and O

Question 15

Which ABO antibodies are present in blood group AB?

Answer 15

None

Question 16

Which blood groups can O blood group receive?

Answer 16

O

Question 17

What is Landsteiner’s law?

Answer 17

If there is no A or B antigen expressed, antibodies will be made to A or B in the plasma

Question 18

What are anti-A and anti-B antibodies made in O blood groups?

Answer 18

Bacteria with a similar structure to A and B are present in the gut bacteria, so antibodies are made against these

Question 19

What is used to determine ABO blood group?

Answer 19

Anti-A and anti-B antisera

Question 20

How are D, K Jka and Fva antibodies tested for in blood?

Answer 20

Indirect anti-globulin test

Question 21

Why is anti-human globulin added to suspension in the indirect anti-globulin test?

Answer 21

IgG is used but as this only has two binding sites agglutination is not clear
Anti-human globulin binds to the IgG when bound to red cels to enhance the agglutination

Question 22

What are the indications for red cell transfusion?

Answer 22

Symptomatic anaemia Hb <70 (<80 in heart disease)
OR
Major bleed

Question 23

What are the indications for platelet infusion?

Answer 23

Prophylactically in marrow failure and very low platelet count or prior to surgery in thrombocytopenia
OR
In bleeding thrombocytopenic patient

Question 24

What are the indications for FFP transfusion?

Answer 24

Bleeding in coagulopathy with PT >1:5
Major haemorrhage
Early trauma
Prophylactically in coagulopathy before procedure

Question 25

What is the first thing to do in management of blood transfusion?

Answer 25

Stop the transfusion

Question 26

Why does fever occur in acute transfusion reactions?

Answer 26

Cytokine release

Question 27

How do acute transfusion reactions occur?

Answer 27

``` Chills, rigors, fever Flushing Collapse Loin pain Resp distress Tachycardia Hypotension ```

Question 28

When should senior help be requested with transfusion reactions?

Answer 28

Airway/breathing problems Shock Evidence of bacterial infection

Question 29

What checks should be performed in transfusion reaction?

Answer 29

Compatibility tag should be checked against patient details | Inspect pack for evidence of bacterial contamination

Question 30

Which antibody causes acute haemolytic transfusion reactions?

Answer 30

IgM

Question 31

What does IgM cause in acute haemolytic transfusion reactions?

Answer 31

Complement activation | Lysis of transfused cells and cytokine release

Question 32

What tests should be performed in acute haemolytic transfusion reactions?

Answer 32

Coag screen Blood cultures Renal function

Question 33

What life-threatening conditions does acute haemolytic transfusion reaction lead to?

Answer 33

DIC | Renal failure

Question 34

How does TACO present?

Answer 34

``` Resp distress within 6 hours Increased BP and JVP Positive fluid balance Oedema Bibasal crackles ```

Question 35

What risk factors are associated with TACO?

Answer 35

``` Elderly Cardiac failure Low albumin Renal impairment Pre-existing fluid overload ```

Question 36

How is TACO managed?

Answer 36

O2 and diuretics | Slow rate of future transfusions and give min volume req'd

Question 37

What are the criteria for a mild transfusion reaction?

Answer 37

Isolated temp rise >38 degrees and a rise of at least 1 degree OR rash only

Question 38

How are mild transfusion reactions managed?

Answer 38

Slow rate of transfusion | Paracetamol and anti-histamine

Question 39

What antibody is involved in delayed haemolytic transfusion reaction?

Answer 39

IgG

Question 40

When does delayed haemolytic transfusion reaction occur?

Answer 40

5-10 days post transfusion

Question 41

What investigation results confirm delayed haemolytic transfusion reaction?

Answer 41

Positive DAT scan | Alloantibody detection

Question 42

What type of reaction is an ABO incompatibility reaction?

Answer 42

Type II hypersensitivity

Question 43

Which antibody is involved in ABO incompatibility reactions?

Answer 43

IgM

Question 44

What does Hb appear in urine in ABO incompatibility reactions?

Answer 44

Membrane attack causes cell lysis and free Hb is excreted through the urine

Question 45

What occurs in transfusion associated lung injury?

Answer 45

Antibodies in donor blood directed against patients white cells

Question 46

What is the risk of viral transmission of Hep B through transfusion?

Answer 46

< 1 : 1.2mil

Question 47

What is the risk of viral transmission of HIV through transfusion?

Answer 47

<1: 7 mil

Question 48

What is the risk of Hep C transfusion through transfusion?

Answer 48

< 1: 28mil