Transfusion lecture 2 Flashcards
(29 cards)
How do we protect the donor during transplantation?
Make sure they are age 17-70 Over 8 stone (51 kg) Must be volunteer and must volunteer blood on own accord Must be checked for anaemia Must sign declaration
What happens at donation?
Blood pressure is checked
Local anaethic given as needle is in for a while and can be painful
Blood taken into sterile bag thats been treated with anticoagulants
Additional samples taken for testing
Everything must be labeled with the same bar code
Stored at 2-6 degrees until used
Shelf life 35-42 days
How do we protect the recient during transplantation?
All donations are tested for ABO and Rh groups, clinically important antibodies, HIV1 and 2, syphelis, Hep B and Hep C and cytomegalovirus CVM
What is the aim of transfusion?
Right blood, right time, right place, right person
How do you carry out positive patient ID checks?
Idenitify wristband with full name, DOB and hospital no. Patient should be able to give all the deets when prompted and we hsould double check.
Unconcious patient should have typerex wristband
If ID bag removed, should be replaced immediately
How do you carry out better blood transfusions?
Blood should only be taken from one patient at a time
ID patients by asking them and reading their wristband
Label the sample by hand and by the patient’s bedside with full Id, date and signature
Do not prelable tubes
Do not use addressograph labels
How to fill out a request card for blood from blood bank
Full patient Id: minimum 3 needed Obstetrics and full transfusion history required blood group or antibodies number of units of blood and what type location where blood is required when blood is required reason why required If there are any special requirements
How to collect blood from blood bank??
Evidence of patient ID required (at least 3) Check that patient details match Check blood bag labels match Check blood unit number (barcode) Check still in date Check it looks OK if in doubt, ask
How to administer blood
Blood must be prescribed by doctor or registered nurse
final bedside check by at lease one person
transfusion must begin within 30 minutes of removing blood from bank - if not, must be put back
Blood can be warmed (for elderly patient) but only in blood warmers
No drugs should be added
Blood must be replaced at least every 12 hours
Canula must be flushed and cleaned before using for anything else
What are the bed side checks that must be perfomed?
Patient onbservation: base line 30 mins before transfusion starts
during first 15 minutes check up
every hour after that
patient checked up one hour after transfusion
What causes acute haemolytic transfusion reactions?
ABO incompatibility. Happens within first 15 mins. Patient become agitated or apprehensive and there is pain at the infusion site, abdoment, flank or chest. Patient is flustered and intravascular haemoloysis
What are the signs of a reaction?
Fever, hypotension, sweating, rashes, pain, excess Hb, Hb in urine, nauea, bruising
What is a delayed transfusion reaction
Non-detectable blood group antibodies
10-15 days post transplant, rare and not usually life threatening. Extravascular haemolysis.
What is extravascular red cell destruction
Normal RBC breakdown occurs in liver/spleen Cells aged/damaged Hb broken down into haem and globin Haem converted to biliruben Degraded in liver Free Hb circulating in blood is avoided
What is intravascular haemoglobin?
Broken down in blood vessels
Haem removed by binding to haptoglobin. Haptoglobin levels in circulation are reduced. Haem-haptoglobin complex removed by returculo endothelial system
What is the mechanism of acute intravascular haemolysis
Antibodies in patient plasma binds to antigen on donor red cell membrane
If antibodies are compliment-fixing antibodies, compliment protiends bind to red cell membrane
Activation of compliment leads to membrane damage. Causes paid haemolysis of RBS - DIC, acute renal failure, shock, death
What are the serious hazards of transfusion? SHOT
incorrect component being requested and issued to patiend. Failure of beside check to pick up errors. Wrong pack from blood bank. Wrong blood in tube: blood in tube not from patiend whose details appear on request card. Transmission of disease
What casuses adverse affects of blood transfusion?
Infectious agents, transfused red cells, transfused white cells, transfused platelets, transfused plasma, transfused coagulation concentrates
Why do we transfuse red cells?
Correction of anaemia or if patient is symptomatic of a disease that would give them low red cell count. They might have have a family history or an ilness that cannot be corrected by other methods
They might have active bleeding due to preoperative or trauma
What are the adverse effects of RBC transfusion?
Acute haemolytic transusion reactions - intravascular haemolysis due to destruction of red cells
Alloimmunisation - antibody production
Febrile reactions - reaction to donor white cells although uncommon because white blood cells are now filtered
Uticaria - reaction to donor plasma proteins
Bacterial infection
Iron overload
Volume overload
Who do we transfuse white blood cells to?
Only the severely ill: bone marrow failure, severe neutropaenia, abnormal neutrophl function with persisstent infection or genetics
What are the adverse reactions of WBC transfusion??
Transfusion related aquired lung injury TRALI
Pulmonary infiltration
Adult respiratotu disress syndrome
What is TRALI?
transfusion related aquired lung injury donor has granulocyte specific antibody enzyme is relased increases permeability of capillaries sudden oaedema within 6 hours of transfusion
Why are platelets transfused?
To prevent bleeding in thrombocytopenia. Stops or prevents injury.
Sort our abnormalities of platelet function
bernard solidier
glanzmannz thrombobasthenia
vascular surgery
