Ha - Blood Transfusion

Question 1

What proteins determine blood group

Answer 1

ABs and Ags - ABO and RhD

Question 2

What happens if ABO is incompatible

Answer 2

Intravascular haemolysis - can be fatal

Question 3

What % of people are RhD+

Answer 3

85

Question 4

What happens if RhD- gets RhD+ blood

Answer 4

Make immune anti D

Question 5

What do immune anti D ABs cause

Answer 5

Delayed haemolytic transfusion reaction

Question 6

Immune anti D ABs do not cause what to RBCs?

Answer 6

NOT direct agglutination of RBCs - therefore no immediate reaction, but a delayed one

Question 7

Do anti D cross placenta? Why/why not?

Answer 7

YES - IgG so they do

Question 8

What 2 tests do they do for ABO group testing

Answer 8

Forward group - anti A/B/D reagents against pt’s RBC
Reverse group - known A/B groups RBCs against pt plasma

Question 9

Who gets other RBC Ags auto reactions

Answer 9

Frequent transfusers eg sickle / pregnancy

Question 10

What is IAT

Answer 10

Indirect anti globulin technique
Bridges RBC coated by IgG, which can’t themselves bridge 2 RBCs
Forms clumps - visible after 30 mins

Question 11

When can you do electronic issue of blood, and what is the benefit

Answer 11

Negative AB screen
Faster, fewer staffs remote work

Question 12

How do you do a serological cross match

Answer 12

IAT - put pt plasma incubated with donors for 30 mins to observe any reaction

Question 13

What is the donor blood labelled with

Answer 13

ABO and RhD type
Kell
Other are Ag

Question 14

What is the legal requirement for all blood products

Answer 14

They should be 100% traceable to donor

Question 15

3 pillars of patient blood management

Answer 15

Optimise haemopoeisis
Minimise blood loss and bleeding
Harness and optimise physiological tolerance of anaemia

Question 16

How is blood loss minimised pre transfusion

Answer 16

Tranexamic acid
Stop anticoagulant
Cell salvage

Question 17

Why should blood be given

Answer 17

Bleeding
Anaemic
Sx
Transfusion will solve the problem
Benefits vs risk
Alternative Tx not appropriate

Question 18

Tx alternatives to blood products

Answer 18

Iron
B12
EPO
Folate
Cell salvage

Question 19

Emergency blood

Answer 19

O-

Question 20

How are red cells stored & given

Answer 20

4 degrees for 35 days
Transfuse within 4 hours of leaving fridge, IV over 2-3 hours

Question 21

How are platelets stored / used

Answer 21

20 degrees (room temp) for 7 days
Transfuse IV over 20 to 30 mins

Question 22

Do platelets have ABO/RhD

Answer 22

Yes - weakly expressed but not massively

Question 23

What is the risk with platelet transfusion and why

Answer 23

Bacterial infection - stored at room temp

Question 24

Do FFP/cryoprecipitate have ABO/RhD

Answer 24

ABO but not RhD

Question 25

How is FFP/cryo stored / given

Answer 25

30 to 40 mins to thaw FFP - keep at 4 degrees for 24 hours Cryo - keep at RT and use within 4hrs Transfuse IV over 20 to 30 mins

Question 26

What type is the universal plasma donor

Answer 26

AB - neither ABs in

Question 27

What is the maximum surgucal blood ordering schedule for / how does it work

Answer 27

Predicted blood loss for planned surgery to allow them to decide what is normal Then do G&S then can do electronic issue within 10 mins when requested Do cross match if Hx of ABs reactivity

Question 28

Indicators for RBC

Answer 28

Haemorrhage - >30% volume lost Peri op /crit care - hb <70 Post chemo - <80

Question 29

Indications for platelets

Answer 29

Big transfusion aim >75 Post chemo <10 Surg <50 Plt dysfunction, only if active bleeding

Question 30

When are platelets CI

Answer 30

HiTT or TTP

Question 31

Indications for FFP

Answer 31

TTP Deficiency of coagulation factors when active bleeding

Question 32

How is cryoprecipitate different to FFP

Answer 32

More fibrinogen in cryo vs FFP

Question 33

How much does cryo raise the fibrinogen by

Answer 33

1g/L

Question 34

What is the closest used alternative to autologous blood transfusions

Answer 34

Cell salvage during operations

Question 35

When is CMV- blood needed

Answer 35

Pregnant / neonates / IU

Question 36

When is irrigated blood needed

Answer 36

Highly immune suppressed

Question 37

When is washed blood needed

Answer 37

Severe allergic reaction to donor blood previously

Question 38

% of UK that are O vs A vs B vs AB

Answer 38

47% O 42% A 8% B 3% AB

Question 39

Acute reactions to transfusion (<24hrs)

Answer 39

ABO incompatible Allergy TACO - transfusion associated circulatory overload Incorrect component transferred

Question 40

Delayed reaction to transfusions (>24hrs)

Answer 40

Iron overload GVHD Malaria and other infections

Question 41

Sx of acute transfusion reaction

Answer 41

Fever, rigors, chest/loin pain, collapse

Question 42

Monitoring done for acute transfusion reactions

Answer 42

Baseline temp / pulse / RR / BP Repeat after 15 mins Repeat hourly Repeat after transfusion finished

Question 43

What is febrile non haem transfusion reaction inc when it occurs

Answer 43

During / soon after Rise of temp by 1 degree, chills, rigors

Question 44

Mx febrile non haem transfusion reaction

Answer 44

Slow / stop transfusion

Question 45

Mx of allergy to transfusion product

Answer 45

Slow / stop transfusion Antihistamines if needed

Question 46

Sx of wrong blood given

Answer 46

Low BP High HR, temp Restless Chest / loin pain Collapse

Question 47

Mx of wrong blood given

Answer 47

Send cross match Call haem

Question 48

Sx of bacterial contamination of blood

Answer 48

Restless, fever, vomiting, flushing, collapse Low BP, high HR, high temp

Question 49

In which blood product is bacterial contamination the most common and why

Answer 49

Platelets - kept at room temp

Question 50

What is the protocol if RBCs have been out of fridge for up to 30 mins and aren’t needed anymore

Answer 50

Return to fridge for min 6 hours Transfuse over max 4 hours

Question 51

Cause of anaphylaxis to blood product

Answer 51

IgE ABs in pt cause mast cell release of granules and vasoactive substances

Question 52

Most common resp complication of transfusion

Answer 52

TACO

Question 53

What is TACO

Answer 53

Transfusion associated circulatory overload - fluid overload

Question 54

What does TACO look like on CXR

Answer 54

Pulmonary oedema

Question 55

When does TACO present

Answer 55

Within 6hours of transfusion

Question 56

RFs for TACO

Answer 56

Cardio / resp disease <50kg IV fluids / fluid balance Diuretics CKD

Question 57

Prevention of TACO

Answer 57

Single unit transfusion and reassess

Question 58

What is TRALI

Answer 58

transfusion related acute lung injury

Question 59

What is TRALI similar to

Answer 59

ARDS

Question 60

Mechanism of TRALI

Answer 60

anti HLA ABs

Question 61

Why are transfusions still only given sparingly

Answer 61

Still a potential risk of infection

Question 62

What causes delayed haemolytic transfusion reaction (inc % of people)

Answer 62

1-3% of people develop immune AB to RBC Ag

Question 63

Ix and results for delayed haemolytic transfusion reaction

Answer 63

Haemolysis screen - high BR, high LDH, low Hb U&Es G&S - any new ABs formed

Question 64

Mechanism of TA-GvHD

Answer 64

Donor blood contains lymphocytes that can divide Recipient is imm supp so can’t destroy the foreign lymphocytes Donor lymphocytes destroy host tissues

Question 65

How do you prevent TA-GvHD

Answer 65

Leucodepletion Irradiation of blood products for imm supp

Question 66

Prognosis of post transfusion purpura

Answer 66

Clears in a few weeks Can increase bleeding

Question 67

How many transfusions cause iron overload

Answer 67

>50

Question 68

Tx and Tx threshold for iron overload

Answer 68

Iron chelation (exjade tablet) once ferritin >1000

Question 69

Mechanism of haemolytic disease of newborn

Answer 69

Foetal RBCs enter mothers circulation causing RhD anti D production if mum is RhD- and foetus RhD+ 2nd preg —> anti D from mother crosses placenta and enters foetal circulation, attacking foetal RBCs if RhD+ Causes foetal anaemia and hydrous fetalis

Question 70

Tx of haemolytic disease of newborn

Answer 70

G&S at booking and 28 weeks If AB present - check fathers RhD status to see if baby could be RhD and monitor anti D levels in preg MCA Doppler to monitor foetus for anaemia Deliver early IU transfusion to baby if needed

Question 71

How to prevent sensitisation events for RhD

Answer 71

Always given RhD neg blood if unknown blood group / RhD- mother Give anti D within 72hrs of sensitisation event

Question 72

What are the doses for anti D

Answer 72

250IU if event before 20 weeks 500IU if event after 20 weeks, inc at delivery

Question 73

What test is done to determine how much anti D to give

Answer 73

Kleihaur