Transfusion

Question 1

IUT specification

Answer 1

ABO compatible mother and infant
K neg
Negative to maternal allo-ab
IAT x-match compatible maternal serum
Repeat donor
Mandatory micro neg, leukodepleted
PANTS tested
CMV negative
HbS negative
HT negative
<5 days old
Irradiated <24 hours ago
In CPD
HCT 0.7-0.85

Question 2

Neonatal RCEX specification

Answer 2

ABO compatible mother and infant
K neg
Negative to maternal allo-ab
IAT x-match compatible maternal serum
Repeat donor, neg all micro tests
PANTS tested
CMV negative
HbS negative
HT negative
<5 days old
Irradiated <24 hours ago
In CPD
HCT 0.5-0.6

Question 3

Paeds blood specification categories

Answer 3

NHSBT release
Unit processing
Local blood bank release

Question 4

NHSBT characteristics paeds specification

Answer 4

Repeat/new
Mandatory screen, leucodeplete
PANTS
CMV
HbS
HT

Question 5

Processing characteristics paeds specification

Answer 5

Irradiated/Time since irradiation
Shelf life
Diluent
HCT

Question 6

Blood bank release characteristics paeds specification

Answer 6

ABO/D
K
Allo-abs
X-match

Question 7

Non-immune causes platelet refractoriness

Answer 7

Fever
Sepsis
Splenomegaly
DIC
Antibiotics (vanc, ambisome)
Bleeding
VOD
GvHD

Question 8

Definition platelet refractoriness

Answer 8

Failed increment with at least 2 ABO matched platelet units

Question 9

Important HPA in UK

Answer 9

HPA-1
HPA-5
HPA-2
HPA-15

Question 10

Strategies to reduce blood usage

Answer 10

Cell salvage
PBM
This needs sorting / dividing up

Question 11

NAIT

When to investigate

Answer 11

Fetal/neonatal thrombocytopenia
Fetal anemia (hydrops)
Fetal ICH
Neonatal bleeding
FHx NAIT

Question 12

NAIT

Investigations

Answer 12

Detect anti-HPA antibodies with PIFT and MAIPA (both use panel platelets)

Genotype parents and infants at HPA loci 1-6, 9, 15
Can calculate risk depending on paternal genotype

NHSBT Filton will test for serum reactivity against paternal, maternal and neonatal platelets

Question 13

NAIT

Antenatal management

Answer 13

If personal or sister hx of NAIT refer to specialist MDT

Fetal HPA typing to assess risk

Inform blood centre and obs/haem/paeds

Arrange for HPA compatible platelets to be available

Commence IVIg 1g/kg/week from 12 weeks for women with previous NAIT-ICH. If no history start from 20 weeks.

Consider fetal platelet count from 28 weeks

If platelets remain low then 2x IVIg dose, add pred, consider IUT platelets (2x conc platelets)

Planned delivery, consider C-section, if VD then avoid scalp sampling

Woman needs HPA negative red cells (if not risk PTP)

Question 14

NAIT

Neonatal management

Answer 14

Cord blood count, if plt <100 send venous blood

Inspect for bleeding/bruising, if clinical suspicion don’t delay for FBC results

Use HPA-1a/5b double neg patelets for caucasian

Transfuse platelets to aim plt >100 for ICH or GI bleed

Aim plt >30 if asymptomatic

Cranial USS within 24 hours

IVIg not first line but consider if protracted low plt

Question 15

DAT - frequent Q

Question 16

Irradiation specification

Answer 16

99% have <1M leukocytes
90% have <5M leukocytes

Question 17

Response to NEQAS

Answer 17

Redo sample
Ask for new samples
Review IQC
Review pre-, post- and analytical variables
Review SOP and training
Ask neighbouring labs for asistance

Question 18

Post transfusion purpura NHSBT 2011

Mechanism

Answer 18

Happens with any blood product that contains platelets
Less post leukodepletion (cuts down platelets as well)
Patient pre-sensitised to HPA antigens (e.g. parous women)
Creates bystander destruction of transfused and own platelets

Question 19

Post transfusion purpura NHSBT 2011

Investigation

Answer 19

Detection of anti-HPA antibodies in serum with antigen capture ELISA

Question 20

Post transfusion purpura NHSBT 2011

Management

Answer 20

IVIg 1g/kg consecutive days, total dose 2g/kg
Platelet transfusions not normally effective but give ABO matched if bleeding
PLEX if IVIg doesn’t work
Report to SHOT