Lecture 16 - blood Prudcts In The Treatment Of Disease Flashcards Preview

Block 4 - Heamatology > Lecture 16 - blood Prudcts In The Treatment Of Disease > Flashcards

Flashcards in Lecture 16 - blood Prudcts In The Treatment Of Disease Deck (25)
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3 parts of donor screening

- donor questionnaire form: identifies risk behavior, wording is covered by legislation, legal document
- Donor interview: confidential 1-1, auditory and visual privacy. Ensures that it is safe to donate and safe to receive
- donation undergoes mandatory testing


Every donation is tested and negative for

- HBsAF and HBV
- HCV Ab and NAT
- HIV Ab and NAT
- syphillis

- ABO and RhD
- RBC antibody screen
- selected red cell phenotypes
- CMV ab
- malarial antibody testing


Fresh components distributed by the blood service

- whole blood: no longer available
- RBC: leucodepleted. Thse may be washed, irradiated and or phenotyped
- platelets: Buffy coat poor pooled (leucodepleted), apheresis (leucodepleted), paediatric apheresis (leucodepleted)
- Plasma: FFP, Cryoprecipitate, cryo-depleted plasma
- Plasma products: coag factor, intragam P, immunoglobulins, albumex


Red cells

- leucodepleted
- in additive
- store at 4 degrees
- 42 day shelf life


Pre-transfusion testing of patient

- ABo and Rh blood group
- test for red cell antibodies
- cross match when requested


ABO antigens and antibodies

- O: anti-a, anti-B
- A: anti-B
- B: Anti-A
- AB: Nil


REd blood cell transfusion

- donor red cell and recipient plasma are ABo compatible
- contains a minimal amount of plasma (ABO alloantibodies) - can be used in situations of ABO non-identical compatibility
- group O RCC to Group A, B, AB
- group A or B to AB

- one unit should raise the haematocrit by 3% or the haemoglobin by 10g/L in an adult patient with an intact spleen


Types of platelet products

- PRP platelets: historical
- BCP pooled LD platelets: whole blood derived, suspended in platelet additive solution, plasma-reduced
- apheresis platelets: non-matched and suspended in plasma, antigen-matched, crossmatch compatible. HLA type at diagnosis patients who may become refractory


Pooled platelet LD

- made from 4 whole blood donations
- whole blood nto buddy coat, FFP, red cells
- leucodepleted
- store on platelet shaker at 20-24 degrees
- 5 day shelf life


Apheresis platelets

- leucodepleted
- store on platelet shaker at 20-24 degrees
- 5 day shelf life


Platelet transfusion

- to treat or prevent bleeding due to thrombocytopenia or functionally abnormal platelet
- chemotherapy, consumptive coagulopathy
- thrombocytopenia does not equal platelet transfusion
- rarely used in situations of rapid platelet destruction: ITP, TTP
- contraindicated in heparin induced thrombocytopenia


Functionally abnormal platelets

- muelodysplastic disorders
- drugs which affect platelets: aspirin, clopidogrel, NSAIDS
- congenital platelet dysfunction
- platelet trasnfusion may be required even in the presence of a normal platelet count


Crossing the ABO barrier in platelet tranfusion: plasma incompatibility

- platelets should be ABO compatible with the patient whenever possible
- crossing the ABO barrier may be considered whtn you rransfuse a special type of platelet or when the only platelet available is a different group to the patient


Transfusing anti-A or anti-B into a patient who is A or B

- usually not clinically significant
- occasional positive DAT
- less plasma in pooled platelets than in apheresis platelets


Transfusing Groups A or B platelets into a patient who has circulating Anti-A or anti-B

- recovery slightly reduced but not clinically significant
- ABO compatible platelets preferred


Patients blood group vs preferred choice for paltelet

- O: O>A>B/AB
- A: A>O, low titre antiA/B> AB or B>O
-B: B>O, low titre anti A/B>AB or A>O
- AB: AB>O, low titre anti A/B>B or A>O


Platelet storage

- 20-24 degrees
- with agitation, use within 5 days
- with no agitation, use ASAP
- platelets that are refrigerated quickly become irreversibly damaged


Fresh frozen plasma

- store at 30 degrees C
- 12 months shelf-life
- plasma can be separated into cryoprecipitate (risch in f8 and fibrinogen) or cryodepleted plasma (cryosupernatant)


Indications for fresh frozen plasma

control of bleeding due to deficiency of coag factor:
- liver disease
- warfarin overdose
- massive transfusion

- not indicated for volume replacement or specific factor deficiencies for which factor concentrates are available


Indications for cryoprecipitate and cryo-depleted plasma

- cryoprecipitate: fibrinogen replacement: congenital hypofibrinogenemia, acquired hypofibrinogenemia (DIC)

- cryodepleted plasma: TTP (replacement fluid for plasma exchange), warfarin reversal


Side effects of fresh blood components

- results of receiving allogeneic graft: infectious complication, alloimmunisation, allergic reaction, TRALI, transfusion - associated GvHD
- Results of storage
- result of adverse event
- result of massive transfusion: Acute (TACO) or chronic (iron overload)


Infectious complications: clinical features of bacterial contamination

- symptoms and signs of a septic reaction: pain at IV site, fever or hypothermia, rigors, tachycardia, hypo/hypertension, haemolysis, shock or multiple organ failure

- at hospital level: consider bacterial contamination in all severe febrile reaction: stop transfusion immediately, manage the hemodynamic complication of sepsis


Transfusion associated pulmonary sequelae

- lung injury: RARE
- circulatory overload: avoidable fluid assess
- resp manifestation to allergic foreign plasma protein
- DDx: bacterial contamination, intravascular hemolysis, acute respiratoryu distress syndrome, intercurrent illness


Male predominant frozen plasma components from july 2007

- implicated components in TRALI cases were commonly associated with female donors
- donord who have had one or more pregnancies or donors who have been previously transfused
- females more likely to have HLA or granulocyte antibodies than males, due to exposure to fetal antigens during pregnancy


TRALI: transplant related acute lung injurey

- during or within 6hour of transfusion, no competing aetiology
- transfusion of a plasma or granulocyte containing component
- onset between 1-6 hours
- normal SVP if available
- severe bilateral pulmonary oedema, severe hypoxemia, tachycardia, fever, hypotension, hypertension, cyanosis