Blood Transfusions 2

Question 1

What are adverse reactions to transfusions split into, timing wise?

Answer 1

Acute (<24h)

Delayed (>24h)

Question 2

What are causes of ACUTE adv reactions to transfusion?

Answer 2

• Acute haemolysis (ABO incompatible)
• Allergy/anaphylaxis
• Infection
• Febrile non-haemolytic
• Respiratory (TACO, TRALI)

Question 3

What are causes of DELAYED adv reaction to transfusion?

Answer 3

• delayed haemolytic transfusion reaction
• infection
• TA-GvHD
• Iron overload

Question 4

What happens to OBS at the start of an acute reaction?

Answer 4

HIGH temp, HIGH HR, low BP

Question 5

What monitoring needs to be done for adverse reaction?

Answer 5

BASELINE temp, HR, RR, BP
Repeat after 15 mins
Repeat hourly and at end of transfusion

Question 6

How do you treat FNHTR?

Answer 6

STOP transfusion

give paracetamol

Question 7

How do you treat allergic TR?

Answer 7

Stop/slow transfusion

give IV antihistamine

Question 8

What are the most common causes of giving wrong blood for a transfusion?

Answer 8

FAILURE of bedside check
Wrongly labelled blood
lab error

Question 9

What all giving the wrong blood cause?

Answer 9

Acute IgM intravascular haemolysis

Question 10

What component is likely to cause bacterial infection following transfusion?

Answer 10

PLATELET - as stored at room temp

Question 11

What condition is an allergic reaction to transfusion severe to?

Answer 11

IgA deficiency

Question 12

What is TACO?

Answer 12

Transfusion Associated circulatory Overload

Question 13

What does TACO cause?

Answer 13

pulmonary oedema/fluid overload

Due to lack of attention to fluid balance

Question 14

What is TRALI?

Answer 14

Transfusion Related Acute Lung injury

Question 15

What does a TRALI CXR look like?

Answer 15

bilateral pulmonary infiltrates

Question 16

How is TRALI distinguishable from TACO?

Answer 16

Will NOT respond to furosemide

No elevated JVP

Question 17

What is a delayed haemolytic transfusion reaction caused by?

Answer 17

Development of an antibody against RBC antigen that patient lacks

Question 18

What are symptoms of GvHD?

Answer 18

Diarrhoea 
LF 
skin desquamation 
BM failure
DEATH

Question 19

How do u prevent GvHD?

Answer 19

Irradiate blood components to very immunocompromised patients (get rid of donor WBC)

Question 20

How do you prevent iron overload?

Answer 20

With Iron Chelators e.g exjade

Question 21

What causes haemolytic disease of the newborn?

Answer 21

Prior maternal sensitisation to RhD+ when she is RhD-

Question 22

What does haemolytic disease of the newborn present as after birth?

Answer 22

Anaemia

High bilirubin

Question 23

When are G&S scheduled for pregnant women?

Answer 23

12, 28 wks

Question 24

How do you treat extreme anaemia in the foetus from this?

Answer 24

Intrauterine Blood transfusion

Question 25

How do you prevent haemolytic disease of the newborn

Answer 25

IM injection of Anti D Ig to mother at times of high risk sensitisation events

Question 26

How does Anti D Ig work?

Answer 26

RhD positive cells of foetus are coated by exogenous Anti D Ig These cells are then removed by the mothers spleen without sensitisation of the mother

Question 27

What time frame must Anti D be given to be successful?

Answer 27

max 72 h from sensitisation event

Question 28

When is anti-D given as RAPPD?^

Answer 28

28 week gestation

Question 29

What is the immediate cause of adverse reeaction to transfusion

Answer 29

Anaphylaxis

Question 30

What are symptoms of anaphylaxis as adverse reaction to transfusion

Answer 30

Breathlessness, wheeze, aangioedema, laryngeeal oedema

Question 31

What is the next ATR likely to occur after anaphylxis

Answer 31

Acute haemolytic due to ABO incompativility

Question 32

What symptoms occur with Acute haemolytic ( ABO incompativility) reaction

Answer 32

ABDO PAIN | Chills, rigors

Question 33

What antibodies mediate Acute haemolytic (ABO incompatibility)

Answer 33

IgM

Question 34

What is bacterial contamination commonest with

Answer 34

Platelet transfusion

Question 35

What is the presentation of a FNHTR

Answer 35

Rise in temperature by less than 1 degree | Patient stable, no circulatory collapse

Question 36

What is FNHTR caused by

Answer 36

Caused by release of cytokines by leukocytes

Question 37

How can you prevent FNHTR

Answer 37

Leukodepletion

Question 38

What antibodies are responsible for delayed haemolytic reaction

Answer 38

Kell | Duffy

Question 39

Who is CMV in a blood transfusion fatal in

Answer 39

Immunodeficient patient

Question 40

How can you avoid giving CMV to an immunodeficient blood transfusion patient

Answer 40

LEUKOCEPLETION | It removes CMV from WBC

Question 41

What is the presentation of an acute haemolytic reaction

Answer 41

Abdo pain, chills, rigors | within mins - 2h

Question 42

What mediates acute haemolytic reaction

Answer 42

IgM antibodies > cause IV haemolysis

Question 43

how does anaphylaxis reaction present

Answer 43

breathlessenss with wheeze laryngeal and facial oedema symptoms within minutes

Question 44

What IgE is anaphylaxis due to

Answer 44

IgE

Question 45

what igE def makes anaphylaxis worse

Answer 45

IgA

Question 46

What are symptoms of FNHTR

Answer 46

rise in temp less than 1 degree | no circulatory collapse

Question 47

WHat causes FNHTR and how do you prevent it

Answer 47

release of cytokines by leukocytes | prevented by leukodepletion

Question 48

What are symptoms of TACO

Answer 48

fluid overload > dyspnoea, raised JVP, pink frothy sputum

Question 49

What are symptoms of trali

Answer 49

dry cough dyspnoea fever

Question 50

what are symptoms of delayed haemolytic transfusion reaction

Answer 50

same as acute, but milder | within 1 week