Haematology 14 - Blood Transfusion 1 & 2 Flashcards Preview

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Flashcards in Haematology 14 - Blood Transfusion 1 & 2 Deck (54)
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1

Recall 2 ways in which patients' blood group is tested

1. Using anti-A,B and O reagents against the patient's red blood cells
2. Also use 'reverse group' - known A and B group RBCs against the patient's plasma

2

Describe the process of antibody testing of blood

Group and screen
- Use 2 or 3 reagent red blood cells containing all the important RBC antigens between them
- Then incubate the patient's plasma using the indirect antiglobulin technique

3

What is the purpose of 'immediate spin' blood testing?

Used in emergencies only
Incubation for just 5 minutes
Determines ABO compatibility only

4

What are the 3 pillars of patient blood management?

1. Optomise haematopoiesis
2. Reduce bleeding (eg stop anti-platelt drugs, cell-salvage techniques)
3. Harness and optomise physiological tolerance of anaemia

5

For which blood products is D compatibility required?

Red cells and platelets (but not FFP or cryoprecipitate)

6

What is the storage temperature of red cells, platelets, FFP and cryoprecipitate?

Red cells: 4 degrees C
Platelets: 20 degrees C
FFP: 4 degrees C once thawed
Cryoprecipitate: Room temp once thawed

7

What is the storage length of red cells, platelets, FFP and cryoprecipitate?

Red cells: 35 days
Platelets: 7 days
FFP: 24 hours
Cryoprecipitate: 4 hours

8

What is the transfusion rate of red cells, platelets, FFP and cryoprecipitate?

Red cells: 1 unit over 2-3 hours
Platelets: 1 unit over 20-30 mins
FFP: 1 unit over 20-30 mins
Cryoprecipitate: 1 unit over 20-30 mins

9

How much blood loss counts as 'major'?

>30% blood volume lost

10

When are platelets contra-indicated?

TTP/ heparin-induced TTP

11

How low does haemaglobin need to be to require transfusion peri-operatively vs post-chemo?

Peri-op/ crit care: <70g/dL
Post-chemo: <80g/dL

12

In what type of surgery is post-operative cell salvage most often done?

Knee surgery

13

What are the steps of intra-operative cell salvage?

Centrifuge, filter, wash and re-infuse blood

14

What special blood reuquirements do pregnant women have?

CMV neg

15

What special blood reuquirements do highly immunocompromised patients have?

Blood needs to be irradiated

16

What special blood requirements do patients who have had severe reactions in the past to transfusion have?

Washed cells

17

Recall the 10 classes of transfusion reaction, and which are acute/ delayed?

Acute (<24 hours):
1. Acute haemolytic (ABO incompatible)
2. Allergic/ anaphylaxis
3. Bacterial infection
4. Febrile non-haemolytic
5. TACO/TRALI

Delayed:
6. Delayed haemolytic transfusion reaction (antibodies)
7. Transfusion-associated GVHD
8. Infection (malaria, CJD)
9. Post-transfusion purpura
10. Iron overload (thalasaemia patients mostly)

18

What monitoring should be done during a blood transfusion as minimum?

1. Baseline temp, HR, RR, BP
2. Repeat obs after 15 mins
3. Repeat hourly after end of transfusion

19

What are the features of febrile non-haemolytic transfusion reaction?

Temp increase >1%
Chills and rigors

20

Why is febrile non-haemolytic transfusion reaction rare nowadays?

Blood is now leucodepleted to reduce risk of febrile non-haemolytic transfusion reaction

21

How should febrile non-haemolytic transfusion reaction be managed?

Stop/ slow the transfusion and give paracetamol

22

What is the pathophysiology of febrile non-haemolytic transfusion reaction?

Cytokines released by white blood cells during storage cause a febrile reaction upon transfusion

23

What should be the management of an allergic transfusion reaction?

Stop/ slow transfusion
IV antihitamines

24

What are the symptoms of ABO incompatibility?

Shock and fever
Restlessness, fever, vomiting and collapse

25

What is the appropriate management for ABO incompatibility?

Stop transfusion
Check patient and component
Repeat cross match and DAT

26

What are the symptoms of bacterial contamination of blood?

Presents very similar to wrong blood - shock, increased temp, restless, fever, vomiting, collapse

27

How does bacterial contamination of blood cause symptoms?

Bacterial growth --> endotoxin which causes immediate collapse

28

Recall some protocols for prevention of bacterial contamination of blood

Donor questionning
Arm cleaning
Diversion of first 20mls of blood
Proper storage

29

Which patients are at most risk of anaphylactic reaction to a blood transfusion?

Those with IgA deficiency

30

How quickly does TACO/TRALI present?

Within 6 hours

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