Blood transfusion

Question 1

What are the requirements of a blood donor?

Answer 1

Generally healthy
>50kg
Hb levels: Hb 135g/L men, Hb 125g/L women
17-65

Question 2

What is all blood screened for?

Answer 2

HIV
Hep B/C/E
Human T-Lymphotropic Virus
Syphilis.

Question 3

What components can blood be split into?

Answer 3

Red Blood Cells
Fresh Frozen Plasma
Platelets
Cryoprecipitate
Factor VIII and IX concentrates
Albumin

Question 4

How are RBC stored?

Answer 4

Stored at 4 degrees for 35 days.

Question 5

How is FFP stored?

Answer 5

Stored at -30 degrees for 3 years.

Question 6

What important product does FFP contain?

Answer 6

Contains coag factors.

Used to replace coag factors.

Question 7

How are platelets stored?

Answer 7

Stored at room temp for 7 days with constant agitation.

Question 8

How is cryoprecipitate created and stored?

Answer 8

Freeze thaw plasma and take off supernatant.

Store at 30 degrees.

Question 9

What does cryoprecipitate contain and what is it used for?

Answer 9

Contains VIII, vWF, fibrinogen.

Use for DIC and other low fibrinogen conditions.

Question 10

How are Factor VIII and IX concentrates stored and what are they used for?

Answer 10

Freeze dried.

Use for haemophilia and vW disease.

Question 11

What is albumin used for?

Answer 11

Use for severe hypoalbuminemia and plasma exchange.

Question 12

When should albumin not be used?

Answer 12

Do not use in malnutrition or severe renal impairment.

Question 13

What products can be created from blood?

Answer 13

Anti-D immunoglobulin

Prothrombin complex concentrate

Question 14

What is Anti-D immunoglobulin used for?

Answer 14

Important for treating RhesusD isoimmunisation.

Question 15

What is prothrombin complex concentrate used for?

Answer 15

Used to treat warfarin OD

Question 16

What are the two main blood type categories?

Answer 16

ABO

Rh

Question 17

Which chromasome is ABO coded on?

Answer 17

Cromasome 9

Question 18

What is the most common and rarest ABO blood types?

Answer 18

Most common- O

Rarest- AB

Question 19

What is the genotype of A blood type?

Answer 19

AA or AO

Question 20

What is the genotype of B blood type?

Answer 20

BB or BO

Question 21

What is the genotype of AB blood type?

Answer 21

AB

Question 22

WHat is the genotype of O blood type?

Answer 22

OO

Question 23

What are the two blood types in Rh blood group?

Answer 23

RhD+

RhD-

Question 24

Is RhD+ and RhD- more common?

Answer 24

RhD+ (85%)

Question 25

What do RhD- patients produce?

Answer 25

Produces IgG antibodies against D+

Question 26

What are some complications of RhD mismatching?

Answer 26

Transfusion reaction | Haemolytic disease of the fetus and newborn

Question 27

What is haemolytic disease of the foetus and newborn?

Answer 27

RhD baby and Rhd mother. Mother produced Ab against baby and kills it.

Question 28

What are the indications for transfusing RBC?

Answer 28

Symptomatic anaemia Hb<70g/L (80g/L if cardiac disease) | Major bleed

Question 29

How should RBC be transfused?

Answer 29

Transfuse single unit and reassess.

Question 30

What are some indications for transfusing platelets?

Answer 30

- Prophylaxis in patients with bone marrow failure and very low platelet counts - Treatment of bleeding in thrombocytopenic patient - Prophylaxis prior to surgery/ procedure in thrombocytopenic patient

Question 31

What are some indications for transfusing FFP?

Answer 31

- Treatment of bleeding in patient with coagulopathy (PT ratio >1.5) - Prophylaxis prior to surgery or procedure in patient with coagulopathy (PT ratio >1.5) - Management of massive haemorrhage - Transfuse early in trauma

Question 32

What needs tested before transfusing?

Answer 32

Blood group | Presence of clinically significant RBC antibodies

Question 33

How are RBC tested before transfusion?

Answer 33

Antisera- Reagents with known Ab to RBC antigens (AntiA/B/D) Reagent RBC- Patient plasma and RBC with known antigens. Indirect anti-globulin test- Add anti-human globulin (AHG) to plasma/red cells and see of agglutinate.

Question 34

What is the final test before transfusing a patient?

Answer 34

ITA crossmatch- Mix known donor cells with patient plasma and AHG.

Question 35

When should observations be taken when transfusing?

Answer 35

Observations before blood is commenced Observations at 15 minutes while transfusing Observations within 60 minutes of completion

Question 36

What is a common transfusion reaction?

Answer 36

Mild fever: Isolated temp rise >38 Rise 1-2 degrees Rash only

Question 37

How do you treat a mild transfusion reaction?

Answer 37

Reduce rate and give paracetamol but don't stop.

Question 38

What are some severe transfusion reactions?

Answer 38

Acute transfusion reactions (ATR) Acute haemolytic transfusion reactions (AHTR) Bacterial contamination Transfusion associated circulatory overload (TACO)

Question 39

What are acute transfusion reactions?

Answer 39

``` Fever Tachycardia Hypotension Chills Rigor Rash Flushing Feeling of impending doom Collapse ```

Question 40

What causes Acute haemolytic transfusion reactions (AHTR)?

Answer 40

Wrong blood type given

Question 41

Give some main points of a bacterial contamination

Answer 41

More common with platelets Culture patient and remaining product Broad spectrum antibiotics

Question 42

What are some symptoms of Transfusion associated circulatory overload (TACO)?

Answer 42

Respiratory distress within 6 hours of transfusion Raised blood pressure Raised JVP Positive fluid balance

Question 43

What are some risk factors for Transfusion associated circulatory overload (TACO)?

Answer 43

``` Old Cardiac failure Low albumin Renal impairment Fluid overload ```

Question 44

How do you treat TACO?

Answer 44

O2 Support Diuretics Transfuse minimum volume required

Question 45

What are some symptoms of Delayed haemolytic transfusion reactions?

Answer 45

Hb may drop | Raised bili

Question 46

What causes Delayed haemolytic transfusion reactions?

Answer 46

IgG reaction 5-10 days after transfusion

Question 47

What viruses can be passed in a transfusion?

Answer 47

Hep B HIV Hep C

Question 48

What king of Ig are AntiA/B?

Answer 48

IgM

Question 49

What kind of antibodies are seen in alloimmunity?

Answer 49

IgG