Core Haematology - Blood Transfusion (35) Flashcards Preview

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

Flashcards in Core Haematology - Blood Transfusion (35) Deck (140):
1

Leucodepletion

Whole blood filtered, then WBC removed

2

Leucodepletion

Whole blood filtered, then WBC removed

3

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

1.5-3 hours

4

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

4 hour limit

5

Does warmer or colder blood transfuse faster?

Warmer

6

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

4 degrees for up to 35 days from collection

7

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

Electrolytes, glucose and adenine to keep RBC healthy

8

Why do we transfuse patients?

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

9

Symptoms of anaemia are due to

Tissue hypoxia

10

Transfusion threshold (trigger)

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

11

Mechanism of adaption to anaemia

Increased:
- CO
- Cardiac artery blood flow
- Oxygen extraction
- RBC 2,3 DPG (diphosphoglycerate)
- Production of EPO
- Erythropoiesis

12

Things that affect adaption to anaemia

- Acute/Chronic
- Underlying (CVD, drugs, resp disease)
- Elderly
- Transfusion

13

When transfuse RBC?

-

14

When not transfuse? (treatable causes)

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

15

When not to transfuse? (coagulopathy)

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

16

BSCH guideline for transfusion in acute anaemia due to blood loss

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

17

Alternative to transfusion

Cell salvage

18

Chronic anaemia

Regular transfusions due to myeloid failure syndromes

19

Reason for regular transfusion for chronic anaemia

- Symptomatic relief of anaemia
- Improvement of QoL
- Prevention of ischaemic organ damage

20

Threshold (target) for chronic anaemia transfusion

Hb 80-100g/dl

21

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

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

22

Objectives in thalassaemia

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

23

Threshold for Thalassaemia

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

24

What temperature at platelets stored at?

22 degrees

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

Decks in Clinical Pathology Class (60):