Transfusion medicine

Question 1

What is the usual transfer time of 1 unit RBC?

Answer 1

1.30-3h - 4h limit from removal from cold storage to end of transfusion

Question 2

How is RBC kept healthy during storage?

Answer 2

plasma is removed to leave concentrated red blood cells

replaced by a solution of electrolytes, glucose and adenine

Question 3

Why are patients transfused with RBC?

Answer 3

To prevent symptoms of anaemia
To improve quality of life of anaemic patients
To prevent ischemic damage of end organs in anaemic patients

Question 4

What is the transfusion threshold (trigger)?

Answer 4

lowest concentration of Hb that is not associated with symptoms
varies between different subgroups of patients

Question 5

How long is the shelf life of platelets?

Answer 5

5 days from collection

Question 6

What is the adult therapeutic dose of platelets?

Answer 6

platelets from 4 pooled donations

Question 7

When do you transfuse platelets?

Answer 7

bleeding due to severe thrombocytopenia (low platelets)
platelet dysfunction
prevention of bleeding

Question 8

When you transfer fresh frozen plasma?

Answer 8

coagulopathy with bleeding/surgery
massive haemorrhage
thrombotic throbocytopenic purpura

Question 9

What are the contraindications of plasma?

Answer 9

warfarin reversal.

replacement of single factor deficiency

Question 10

What is used for emergency reversal of life-threatening warfarin over-anticoagulation?

Answer 10

Prothrombin Complex Concentrate (PCC) - Plasma-derived Vit K dependent factors: II VII IX X

Question 11

What is the group and screen test?

Answer 11

determination of ABO and Rh(D) group

patients plasma screened for antibodies against other clinically significant blood group antigens

Question 12

What is an anti-globulin test?

Answer 12

testing the patient’s plasma against a panel of red cells containing all the clinically significant blood groups

Question 13

What is a crossmatching compatibility test?

Answer 13

correct ABO and Rh donor selected

Patients plasma is mixed with aliquots of donor red cells to see if agglutination or haemolysis occurs

Question 14

What are the immunological acute transfusion

reaction complications/ adverse effects of transfusion?

Answer 14

Acute haemolytic transfusion reaction
ABO incompatibility
Allergic /anaphylactic reaction
TRALI (Transfusion-related acute lung injury)

Question 15

What are the non immunological acute transfusion

reaction complications/ adverse effects of transfusion?

Answer 15

Bacterial contamination
TACO (transfusion associated circulatory overload)
Febrile non-haemolytic transfusion reaction

Question 16

What are the immunological delayed transfusion

reaction complications/ adverse effects of transfusion?

Answer 16

Transfusion-associated graft-versus-host disease (TA-GvHD)

Post transfusion purpura

Question 17

What are the non immunological delayed transfusion

reaction complications/ adverse effects of transfusion?

Answer 17

Transfusion Transmitted Infection (TTI) –viral/prion

Question 18

Before what time period after transfusion is a acute reaction?

Answer 18

24 hours

Question 19

After what time period after transfusion is a delayed reaction?

Answer 19

24 hours

Question 20

What infections come under infective risk of blood transfusions?

Answer 20

Hepatitis B
HIV
Hep C

Question 21

What is a sign of a transfusion reaction when giving a transfusion?

Answer 21

Oozing from venepuncture sites

Question 22

What blood group can only receive itself but donate to anyone?

Answer 22

O

Question 23

What blood group can receive from anyone but donate only to themselves?

Answer 23

AB

Question 24

What is acute haemolytic reaction?

Answer 24

caused by ABO incompatibility
release of free Bh
deposition of Hb in the distal renal tubule = acute renal failure.
stimulation of coagulation results = microvascular thrombosis
stimulation of cytokine storm

Question 25

What are the signs and symptoms of acute haemolytic reaction?

Answer 25

``` Fever and chills Back pain Infusion pain Hypotension /shock Hemoglobinuria (may be the first sign in anesthetized patients) Increased bleeding (DIC) Chest pain Sense of “impending death" ```

Question 26

When does acute haemolytic reaction first present?

Answer 26

``` severe = within the first 15 mins milder = later but usually before the end of transfusion ```

Question 27

What are the signs and symptoms of delayed haemolytic reaction?

Answer 27

``` fatigue, jaundice, and/or fever Drop in Hb Increased LDH Increased indirect bilirubin Positive direct antiglobulin test ```

Question 28

When does delayed haemolytic reaction first present?

Answer 28

Onset 3-14 days following a transfusion of RBC

Question 29

What is delayed haemolytic reaction?

Answer 29

due to immune IgG antibodies against RBC antigens other than ABO after the transfusion

Question 30

What is transfusion related acute lung injury?

Answer 30

Donor has antibodies to recipient’s leucocytes Activated WBC lodge in pulmonary capillaries Release substances that cause endothelial damage and capillary leak

Question 31

When does transfusion related acute lung injury present?

Answer 31

within 6 hours of transfusion

Question 32

What are the signs and symptoms of transfusion related acute lung injury?

Answer 32

Hypoxemia New bilateral chest X-ray infiltrates No evidence of volume overload

Question 33

What is the treatment for transfusion related acute lung injury?

Answer 33

Mild forms may respond to supplemental oxygen therapy. | evere forms may require mechanical ventilation and ICU support

Question 34

What are the signs and symptoms of transfusion-associated circulatory overload (TACO)?

Answer 34

``` sudden dyspnea orthopnoea - shortness of breath which occurs when lying flat tachycardia hypertension hypoxemia Raised BP elevated jugular venous pulse ```

Question 35

What are the risk factors of transfusion-associated circulatory overload (TACO)?

Answer 35

``` elderly patients small children patients with compromised left ventricular function increased volume of transfusion increased rate of transfusion ```

Question 36

What presents in an allergic reaction after a transfusion?

Answer 36

Urticarial Rash | wheeze

Question 37

What are the symptoms of anaphylaxis after a transfusion?

Answer 37

``` Severe, life-threatening soon after transfusion started Wheeze/ asthma raised pulse low BP (shock) Laryngeal oedema/ facial oedema ```

Question 38

What is febrile non-haemolytic transfusion reactions (FNHTR)?

Answer 38

cytokines or other biologically active molecules that accumulate during storage of blood components

Question 39

What are the signs and symptoms of febrile non-haemolytic transfusion reactions (FNHTR)?

Answer 39

Fever shakes/rigors raised pulse