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Clinical Pathology > Core Haematology - Blood Transfusion (35) > Flashcards

Core Haematology - Blood Transfusion (35) Flashcards

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1
Q

Leucodepletion

A

Whole blood filtered, then WBC removed

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2
Q

Leucodepletion

A

Whole blood filtered, then WBC removed

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3
Q

How long does it take to transfused 1 unit of RBC?

A

1.5-3 hours

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4
Q

What is limit on unit of RBC after removal from cold storage > end of transfusion?

A

4 hour limit

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5
Q

Does warmer or colder blood transfuse faster?

A

Warmer

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6
Q

What temperature is it stored at and for how many days?

A

4 degrees for up to 35 days from collection

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7
Q

Most of plasma removed to leave conc RBC and replaced by a solution of

A

Electrolytes, glucose and adenine to keep RBC healthy

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8
Q

Why do we transfuse patients?

A

Prevent symptoms, prevent end organ damage and improve QoL of anaemic patients

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9
Q

Symptoms of anaemia are due to

A

Tissue hypoxia

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10
Q

Transfusion threshold (trigger)

A

Lowest concentration of Hb that is not associated with symptoms of anaemia

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11
Q

Mechanism of adaption to anaemia

A

Increased:

  • CO
  • Cardiac artery blood flow
  • Oxygen extraction
  • RBC 2,3 DPG (diphosphoglycerate)
  • Production of EPO
  • Erythropoiesis
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12
Q

Things that affect adaption to anaemia

A
  • Acute/Chronic
  • Underlying (CVD, drugs, resp disease)
  • Elderly
  • Transfusion
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13
Q

When transfuse RBC?

A

-

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14
Q

When not transfuse? (treatable causes)

A

Iron deficiency, B12 and folate deficiency, erythropoietin treatment renal disease (correct tablets)

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15
Q

When not to transfuse? (coagulopathy)

A

Discontinuation of anti-platelet agents, administration of anti-fibrinolytic agents

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16
Q

BSCH guideline for transfusion in acute anaemia due to blood loss

A

Lose >30% of volume (>1,500ml)

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17
Q

Alternative to transfusion

A

Cell salvage

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18
Q

Chronic anaemia

A

Regular transfusions due to myeloid failure syndromes

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19
Q

Reason for regular transfusion for chronic anaemia

A
  • Symptomatic relief of anaemia
  • Improvement of QoL
  • Prevention of ischaemic organ damage
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20
Q

Threshold (target) for chronic anaemia transfusion

A

Hb 80-100g/dl

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21
Q

What do you need to take into account with patients with thalassaemia?

A

Iron overload (can be fatal - cardiomyopathy/liver failure)

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22
Q

Objectives in thalassaemia

A

Suppress endogenous erythropoiesis (balance between bone marrow suppression and Fe overload)

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23
Q

Threshold for Thalassaemia

A

90-95g/dl (target 100-120)

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24
Q

What temperature at platelets stored at?

A

22 degrees

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25
How many days from collection are platelets stored?
5 days
26
Adult therapeutic dose
Platelets from 4 pooled donations/1 apheresis donation
27
Apheresis donation
Just platelets
28
What is usual transfusion time for platelets?
1 unit in 30 mins
29
Why transfuse platelets?
- Treatment of bleeding due to severe thrombocytopenia/platelet dysfunction - Prevention of bleeding
30
When would you transfuse platelets?
Massive haemorrhage, bone marrow failure, prophylaxis for surgery
31
Contraindications for transfusing platelets
- Heparin induced thrombocytopenia/thrombosis | - Thrombotic thrombocytopenic purpura
32
Fresh frozen plasma stored at what temp
Minus 30, for 24 months (20-30 mins to thaw)
33
Dose of fresh frozen plasma
12-15ml/kg (4-6 units as adult)
34
Transfusion time of FFP
30 mins/unit
35
Indications for FFP
Coagulopathy with bleeding/surgery, massive haemorrhage, thrombotic thrombocytopenic purpura
36
Contraindications for FFP
Warfarin reversal or replacement of single factor deficiency
37
Special transfusions
1. CMV negative blood | 2. Irradiated blood
38
CMV negative blood use for
- Children
39
Irradiated blood used for
(Avoiding graft verus host disease T-cell deficiency) - Congenital immunodeficiency - Hodgkins lymphoma - Stem cell/transplant patients - After purine analogue chemo - Intrauterine transfusion
40
Group and screen tests
- ABO and Rh (D) group | - Antibodies against significant groups
41
If positive for antibodies
Test plasma against panel of RBC containing significant blood groups, using Antiglobulin test
42
Crossmatching
Patients plasma is mixed with aliquots of donor red cells to see if reaction (agglutination/haemolysis)
43
If crossmatching reaction
RBC incompatible, risk of acute haemolysis
44
Acute immunological effects of transfusion
- ABO incompatibility - Acute haemolytic transfusion reaction - Allergic/anaphylactic reaction - Transfusion-related acute lung injury (TRALI)
45
Acute non-immunological effects of transfusion
- Bacterial contamination - Transfusion associated circulatory overload (TACO) - Febrile non-haemolytic transfusion reaction
46
When do acute adverse reactions to transfusion occur?
47
When do delayed adverse reactions to transfusion occur?
>24 hours after
48
Delayed immunological effects of transfusion
- Transfusion-associated graft-verus-host disease (TA-GvHD) | - Post transfusion purpura
49
Delayed non-immunological effects of transfusion
Transfusion transmitted infection (TTI) - viral/prion
50
Prion disease reduce risk of transmission
- Leucodepletion - UK plasma not used for fractionation - Imported FFP for patients after 1996
51
Acute haemolytic reaction-ABO incompatibility
- Release of free Hb - Deposition of Hb in distal renal tubule > acute renal failure - Stimulation of coagulation > microvascular thrombosis - Stimulation of cytokines - Scavenges NO > generalised vasoconstriction
52
Onset of Acute haemolytic reaction-ABO incompatibility
Within first 15 mins
53
Acute haemolytic reaction-ABO incompatibility prognosis
Fatal 20-30%
54
Acute haemolytic reaction-ABO incompatibility signs and symptoms
Fever and chills, back pain, infusion pain, hypotension/shock, haemoglobinuria, increased bleeding, chest pain, sense of impending death
55
Cause of ABO incompatibility
HUMAR ERROR
56
Delayed haemolytic reaction onset
3-14 days following transfusion
57
Delayed haemolytic reaction clinical features
Fatigue, jaundice, fever
58
Delayed haemolytic reaction lab findings
Decreased Hb, increased LDH, increased indirect bilirubin
59
Delayed haemolytic reaction direct antiglobulin test is
Positive
60
What is a Delayed haemolytic reaction?
Immune IgG antibodies against RBC antigens other than ABO (formed after transfusion)
61
Coomb's test
Anti-human globulin to detect incomplete IgG antibodies
62
Positive Coomb's test
1. Red cells coated with IgG antibody (anti-Rh in Rh +ve) 2. Anti-human globulin added 3. Visible agglutination
63
Transfusion related lung injury
5-10% fatal, donor has antibodies to recipient's leucocytes, activated WBC lodge in pulmonary capillaries and release substances > endothelial damage and capillary leak
64
Diagnosis of TRALI
Sudden onset, within 6 hours, acute lung injury (hypoxemia, bilateral chest x-ray infiltrates, no vol overload)
65
TRALI recovery
Within 72-96 hours
66
Transfusion-associated circulatory overload (TACO) presentation
Sudden dyspnea, orthopnoea, tachycardia, hypertension, hypoxemia, raised BP, elevated JVP
67
TACO risk factors
Elderly, children, compromised LV function, increased vol of transfusion/rate of transfusion
68
Minor allergic reactions
Urticarial/hives rash, wheeze, hypersensitivity to 'random' plasma protein
69
Severe allergic reactions
Anaphylaxis - severe, wheeze/asthma, increased pulse, low BP, laryngeal/facial oedema
70
Allergic reactions laboratory investigations
IgA and anti-IgA antibodies
71
Febrile non-haemolytic transfusion reactions (FNHTR)
Due to cytokines accumulating, self-limited, fever, shakes, rigors, increase pulse
72
How long does it take to transfused 1 unit of RBC?
1.5-3 hours
73
What is limit on unit of RBC after removal from cold storage > end of transfusion?
4 hour limit
74
Does warmer or colder blood transfuse faster?
Warmer
75
What temperature is it stored at and for how many days?
4 degrees for up to 35 days from collection
76
Most of plasma removed to leave conc RBC and replaced by a solution of
Electrolytes, glucose and adenine to keep RBC healthy
77
Why do we transfuse patients?
Prevent symptoms, prevent end organ damage and improve QoL of anaemic patients
78
Symptoms of anaemia are due to
Tissue hypoxia
79
Transfusion threshold (trigger)
Lowest concentration of Hb that is not associated with symptoms of anaemia
80
Mechanism of adaption to anaemia
Increased: - CO - Cardiac artery blood flow - Oxygen extraction - RBC 2,3 DPG (diphosphoglycerate) - Production of EPO - Erythropoiesis
81
Things that affect adaption to anaemia
- Acute/Chronic - Underlying (CVD, drugs, resp disease) - Elderly - Transfusion
82
When transfuse RBC?
-
83
When not transfuse? (treatable causes)
Iron deficiency, B12 and folate deficiency, erythropoietin treatment renal disease (correct tablets)
84
When not to transfuse? (coagulopathy)
Discontinuation of anti-platelet agents, administration of anti-fibrinolytic agents
85
BSCH guideline for transfusion in acute anaemia due to blood loss
Lose >30% of volume (>1,500ml)
86
Alternative to transfusion
Cell salvage
87
Chronic anaemia
Regular transfusions due to myeloid failure syndromes
88
Reason for regular transfusion for chronic anaemia
- Symptomatic relief of anaemia - Improvement of QoL - Prevention of ischaemic organ damage
89
Threshold (target) for chronic anaemia transfusion
Hb 80-100g/dl
90
What do you need to take into account with patients with thalassaemia?
Iron overload (can be fatal - cardiomyopathy/liver failure)
91
Objectives in thalassaemia
Suppress endogenous erythropoiesis (balance between bone marrow suppression and Fe overload)
92
Threshold for Thalassaemia
90-95g/dl (target 100-120)
93
What temperature at platelets stored at?
22 degrees
94
How many days from collection are platelets stored?
5 days
95
Adult therapeutic dose
Platelets from 4 pooled donations/1 apheresis donation
96
Apheresis donation
Just platelets
97
What is usual transfusion time for platelets?
1 unit in 30 mins
98
Why transfuse platelets?
- Treatment of bleeding due to severe thrombocytopenia/platelet dysfunction - Prevention of bleeding
99
When would you transfuse platelets?
Massive haemorrhage, bone marrow failure, prophylaxis for surgery
100
Contraindications for transfusing platelets
- Heparin induced thrombocytopenia/thrombosis | - Thrombotic thrombocytopenic purpura
101
Fresh frozen plasma stored at what temp
Minus 30, for 24 months (20-30 mins to thaw)
102
Dose of fresh frozen plasma
12-15ml/kg (4-6 units as adult)
103
Transfusion time of FFP
30 mins/unit
104
Indications for FFP
Coagulopathy with bleeding/surgery, massive haemorrhage, thrombotic thrombocytopenic purpura
105
Contraindications for FFP
Warfarin reversal or replacement of single factor deficiency
106
Special transfusions
1. CMV negative blood | 2. Irradiated blood
107
CMV negative blood use for
- Children
108
Irradiated blood used for
(Avoiding graft verus host disease T-cell deficiency) - Congenital immunodeficiency - Hodgkins lymphoma - Stem cell/transplant patients - After purine analogue chemo - Intrauterine transfusion
109
Group and screen tests
- ABO and Rh (D) group | - Antibodies against significant groups
110
If positive for antibodies
Test plasma against panel of RBC containing significant blood groups, using Antiglobulin test
111
Crossmatching
Patients plasma is mixed with aliquots of donor red cells to see if reaction (agglutination/haemolysis)
112
If crossmatching reaction
RBC incompatible, risk of acute haemolysis
113
Acute immunological effects of transfusion
- ABO incompatibility - Acute haemolytic transfusion reaction - Allergic/anaphylactic reaction - Transfusion-related acute lung injury (TRALI)
114
Acute non-immunological effects of transfusion
- Bacterial contamination - Transfusion associated circulatory overload (TACO) - Febrile non-haemolytic transfusion reaction
115
When do acute adverse reactions to transfusion occur?
116
When do delayed adverse reactions to transfusion occur?
>24 hours after
117
Delayed immunological effects of transfusion
- Transfusion-associated graft-verus-host disease (TA-GvHD) | - Post transfusion purpura
118
Delayed non-immunological effects of transfusion
Transfusion transmitted infection (TTI) - viral/prion
119
Prion disease reduce risk of transmission
- Leucodepletion - UK plasma not used for fractionation - Imported FFP for patients after 1996
120
Acute haemolytic reaction-ABO incompatibility
- Release of free Hb - Deposition of Hb in distal renal tubule > acute renal failure - Stimulation of coagulation > microvascular thrombosis - Stimulation of cytokines - Scavenges NO > generalised vasoconstriction
121
Onset of Acute haemolytic reaction-ABO incompatibility
Within first 15 mins
122
Acute haemolytic reaction-ABO incompatibility prognosis
Fatal 20-30%
123
Acute haemolytic reaction-ABO incompatibility signs and symptoms
Fever and chills, back pain, infusion pain, hypotension/shock, haemoglobinuria, increased bleeding, chest pain, sense of impending death
124
Cause of ABO incompatibility
HUMAR ERROR
125
Delayed haemolytic reaction onset
3-14 days following transfusion
126
Delayed haemolytic reaction clinical features
Fatigue, jaundice, fever
127
Delayed haemolytic reaction lab findings
Decreased Hb, increased LDH, increased indirect bilirubin
128
Delayed haemolytic reaction direct antiglobulin test is
Positive
129
What is a Delayed haemolytic reaction?
Immune IgG antibodies against RBC antigens other than ABO (formed after transfusion)
130
Coomb's test
Anti-human globulin to detect incomplete IgG antibodies
131
Positive Coomb's test
1. Red cells coated with IgG antibody (anti-Rh in Rh +ve) 2. Anti-human globulin added 3. Visible agglutination
132
Transfusion related lung injury
5-10% fatal, donor has antibodies to recipient's leucocytes, activated WBC lodge in pulmonary capillaries and release substances > endothelial damage and capillary leak
133
Diagnosis of TRALI
Sudden onset, within 6 hours, acute lung injury (hypoxemia, bilateral chest x-ray infiltrates, no vol overload)
134
TRALI recovery
Within 72-96 hours
135
Transfusion-associated circulatory overload (TACO) presentation
Sudden dyspnea, orthopnoea, tachycardia, hypertension, hypoxemia, raised BP, elevated JVP
136
TACO risk factors
Elderly, children, compromised LV function, increased vol of transfusion/rate of transfusion
137
Minor allergic reactions
Urticarial/hives rash, wheeze, hypersensitivity to 'random' plasma protein
138
Severe allergic reactions
Anaphylaxis - severe, wheeze/asthma, increased pulse, low BP, laryngeal/facial oedema
139
Allergic reactions laboratory investigations
IgA and anti-IgA antibodies
140
Febrile non-haemolytic transfusion reactions (FNHTR)
Due to cytokines accumulating, self-limited, fever, shakes, rigors, increase pulse

Clinical Pathology (60 decks)

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