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Heme/Onc > Transfusion Biology > Flashcards

Transfusion Biology Flashcards

1
Q

Define blood group antigen

A

carb/protein present on surface of an RBC

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2
Q

Define RBC phenotype

A

combo of antigens on RBC surface

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3
Q

Define RBC genotype

A

genetic sequences at the loci for blood group antigens

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4
Q

Who is a universal recipient of blood

A

AB+

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5
Q

Who is a universal donor of blood

A

O-

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6
Q

Describe the presence or absence of Rh D antigen

A
  • Rh+ if it is present (Can receive Rh+ OR Rh- blood)
  • Rh- if it is not present (Can ONLY receive Rh- blood)
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7
Q

When is an anti-D alloantibody produced

A

When an Rh- person is exposed to small amounts of Rh+ cells (transfusion, pregnancy)

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8
Q

Describe the Bombay blood group

A

Can’t receive blood from A, AB, B, or O and ONLY from Bombay group

(can still donate blood)

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9
Q

Describe pre-transfusion testing

A
  • ABO/Rh(D) typing: determines presence/absence of A, B, and Rh antigens on the patients RBCs
  • Antibody screen: screens antibodies in plasma, done on everyone
  • Compatibility testing/crossmatch: done when there is a high probability that the pt will need a transfusion & makes sure donor blood is compatible
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10
Q

Describe forward typing in ABO/Rh typing

A

test the patients RBCs for presence of A, B, and D antigens using antisera

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11
Q

Describe reverse typing in ABO/Rh typing

A

testing patients serum for presence of Anti-A, Anti-B, and Anti-D antibodies

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12
Q

Describe antibody screening by IAT (indirect antiglobulin test)

A

test for antibodies to common clinically significant RBC antigens

NOT a compatibility test, other Abs aside from ABO & Rh

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13
Q

What does a direct antiglobulin test screen for (DAT, Coombs)

A

used to detect Abs and/or complement on the surfaces of RBCs
- used in hemolytic anemia to detect auto/alloantibodies

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14
Q

What does an indirect antiglobulin test screen for (IAT, Coombs)

A

used to detect allo/autoantibodies in plasma or serum
- used in antibody screening for every pregnancy & compatibility testing before transfusion

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15
Q

If a crossmatch is negative, does that mean the blood product is compatible or incompatible with the patient?

A

compatible

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16
Q

Describe the 3 steps of pre-transfusion testing

A
  1. type (forward & reverse blood typing)
  2. screen (for antibodies)
  3. cross (identifying compatible blood product)
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17
Q

When is a type and screen done vs a type and cross

A

Type and screen
- just in case surgery is needed (minor surgery)
- doesn’t involve finding a compatible product

Type and cross
- transfusion likely needed or is needed (major surgery, trauma)
- does identify a compatible blood product

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18
Q

What special populations may be at greater risk when it comes to transfusion reactions

A
  • infants <4 mos
  • pregnancy
  • sickle cell disease (w/ frequent transfusion hx)
  • stem cell or organ transplant recipients
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19
Q

What non-antibody screening is done on blood products

A

Infectious agents
- HBV, HBC
- HIV
- Treponema pallidum
- Covid-19 Abs
- etc.

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20
Q

What are the major indications for packed RBCs (PRBCs)

A
  • symptomatic anemia including acute blood loss (Hgb <8)
  • asymptomatic w/ Hgb <7
  • exchange transfusion in sickle cell pain crisis or hemolytic disease of a newborn
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21
Q

What do PRBCs do for us

A
  • provide RBC mass and increase oxygen carrying capacity in the blood
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22
Q

What is the downside of transfusing whole blood

A
  • must be stored at 4C
  • platelet dysfunction over time
  • coag factors degrade over time
  • decreased capacity to deliver O2 over time
23
Q

Describe the indications for platelet transfusion

A
  • thrombocytopenia or plt dysfunction (<10k or <50k prior to procedure)
24
Q

What does a platelet transfusion do

A
  • reduces incidence of bleeding
  • provides functionally active platelets for pts with platelet dysfunction
  • 2 unites of Plts can increase the count by appx 10k
25
Q

What is in fresh frozen plasma and what does it do when transfused

A
  • contains all coag factors (except fV and fVIII) and all plasma proteins (except albumin, protein C & S)
  • helps control bleeding
26
Q

What are the indications for fresh frozen plasma transfusion

A
  • correction of coagulopathies (rapid reversal of warfarin in major bleeding)
  • treatment of TTP
  • massive transfusion protocol

(Rh type not a consideration)

27
Q

Who is the universal donor and universal recipient for plasma

A

Universal donor: AB
Universal recipient: O

28
Q

Who is the universal donor and universal recipient for RBCs

A

Universal donor: O
Universal recipient: AB

29
Q

What is in cryoprecipitate and what does it do

A
  • contains plasma proteins, fibrinogen, Factor VIII, Factor XIII, vWF
  • raises fibrinogen level ~100mg to help aid hemostasis
30
Q

What are the indications for cryoprecipitate infusion

A
  • fibrinogen deficiency (Disseminated Intravascular Coagulation, liver disease, VWD)
  • massive transfusion protocol
31
Q

When would cryoprecipitate be ineffective?

A
  • thrombocytopenic bleeding (requires platelets)
  • reversal of anticoagulation (does not have vit-K dependent factors - requires FFP)
32
Q

Describe leukoreduction of blood products

A
  • removal of leukocytes via filtration/washing from PRBCs or platelets
  • prevents CMV infection, fever, alloimmunization

(done to most blood products prior to storage)

33
Q

Who requires leukoreduced blood products?

A

transplant patients & someone who requires multiple platelet transfusions

34
Q

Describe irradiated RBCs

A

Prevents transfusion associated graft vs host disease (TAGVHD)
- shortens half life of RBCs
- used for immunosuppressed recipients

35
Q

Describe washing of blood products

A

removes plasma/supernatant in PRBCs & platelets
- red cells only live 24hrs, platelets 4hrs
- indicated in IgA deficiency, neonatal thrombocytopenic purpura, hx severe allergy to transfusion, sensitive to K+

36
Q

Describe volume reduction of blood products (platelets)

A

removes excess donor plasma
- indicated in pts sensitive to volume overload or when ABO incompatible platelets transfused

37
Q

Describe apheresis of a blood product

A

removal of a targeted cell type or substance in the blood while maintaining isovolemia
- plasmapheresis
- cytapheresis
- photopheresis

38
Q

What does plasmapheresis remove

A

plasma including autoantibodies, immune complexes, protein bound toxins

39
Q

What does leukocytapheresis remove

A

malignant WBCs in pts with leukemia

40
Q

What does erythrocytapheresis treat

A

severe sickle cell, malaria treatment, babiosis

41
Q

What does photopheresis do

A

separates leukocytes from whole blood & exposes to light

42
Q

What is the most common transfusion complication

A

HLA allosensitization

Less common: infection
Extremely rare: graft vs host disease

43
Q
A

B

44
Q
A

A

45
Q
A

TACO & TRALI

(if no fever: TACO)

46
Q

What are 2 RBC breakdown products that can be detected int he setting of acute hemolytic transfusion reactions

A

LDH & bilirubin

47
Q

which electrolyte leaks from blood during storage

A

potassium

48
Q

Describe the etiology & presentation of urticarial transfusion reactions

A
49
Q

Describe the etiology & presentation of febrile non-hemolytic transfusion reactions

A
50
Q

Describe the etiology & presentation of transfusion associated circulatory overload

A

CXR with bilat infiltrates

51
Q

Describe the etiology & presentation of transfusion related acute lung injury (TRALI)

A
52
Q

Describe the etiology & presentation of acute hemolytic transfusion reaction

A
53
Q

Describe the etiology & presentation of transfusion associated graft vs host disease

A

Heme/Onc (16 decks)

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