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MS3 - Haematology > Transfusion medicine > Flashcards

Transfusion medicine Flashcards

1
Q

Blood donations tested for?

A
  • ABO group and RhD type

Infection

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2
Q

Which infections are blood donations tested for?

A
  • HIV 1+2 abs
  • Hepatitis BsAg
  • Hepatitis C ab
  • Syphilis ab
  • HTLV ab
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3
Q

Processing of blood donations?

A
  1. Leucocyte depletion
  2. centrifuged:
    - red cells
    - platelets
    - Plasma
  3. Platelets sampled for
    bacterial testing
  4. Special processes (eg irradiation, washing, hyperconcentration)
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4
Q

Plasma centrifuged to which components?

A

Fresh frozen plasma

Cryoprecipitate

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5
Q

Red cells in blood donations

  1. shelf life?
  2. storage temp?
  3. how much time once out of fridge
A
  1. 35 day shelf life
  2. at 4 degrees
  3. transfuse < 4 h after removing from fridge
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6
Q

2 methods of getting them platelet concentrates in blood donations?

A

I. Pool 4-6 donors blood
II. Apheresis
- single donor

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7
Q

Platelet concentrates in blood donations

  1. shelf time?
  2. storage temp
A
  1. max for 7 days

2. Storage: 22oC

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8
Q

Fresh frozen component in blood donations

  1. storage
  2. shelf-time
  3. special processing
A
  1. Plasma frozen to -30oC
  2. 2 yr storage
  3. I.Viral inactivation
    -Methylene Blue
    II. Solvent detergent
    treatment (Octaplas)
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9
Q

Fresh frozen component in blood donations use?

A

For clotting factor replacement if bleeding

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10
Q

Cryoprecipitate

  1. how is it formed?
  2. use
A
  1. Precipitate that forms
    when thawing FFP
  2. Fibrinogen
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11
Q

When to give blood transfusion in anaemia?

A

If below Hb < 7g/dL

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12
Q

acute haemolytic transfusion reaction timing?

A

are defined as fever and other symptoms/ signs of haemolysis within 24 hours of transfusion

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13
Q

acute haemolytic transfusion reaction types?

A

I. transfusion-related acute lung injury (TRALI),
II. transfusion-associated circulatory overload (TACO),
III. transfusion-associated dyspnoea (TAD)

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14
Q

acute haemolytic transfusion reaction sx?

A

Fever, renal failure

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15
Q

Donor PLASMA compatibility: (also same with Platelets, FFP, cryoprecipitate)

A 
Different from RBC compatibility 
A receives from A or AB
B receives from B or AB
O receives from any
AB receives from AB
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16
Q

Blood clotting pathway (haemostasis)

A
  1. Collagen and tissue factor exposed
  2. Von Willebrand Factor binds collagen
  3. Platelets adhere to vWF-collagen
  4. Platelets activate and aggregate
  5. Tissue factor initiates rapid thrombin generation on activated platelets
  6. Thrombin converts fibrinogen to fibrin and
    completes platelet activation
  7. Stable fibrin-platelet clot is formed
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17
Q

How TF (tissue factor) initiates rapid thrombin generation on activated platelets

A

by causing release of Proteases FVII, FX, FIX, FXI and Co-factors FVIII and FV

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18
Q

3 regulations of haemostasis

A
  1. vWF activity is regulated by ADAMTS 13
  2. Thrombin is regulated by Antithrombin and Activated protein C
  3. Fibrin cleaved by Plasmin into fibrin degradation products (D-dimer)
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19
Q

2 types of clinical disorders of haemostasis?

A
  • Primary haemostasis disorders

- Coagulation pathway disorders

20
Q

Primary haemostasis disorders cause?

A
  • defects in
    Platelets,
    VWF,
    vessel wall
21
Q

Primary haemostasis disorders sx?

A
  • mucocutaneous bleeding eg epistaxis, purpura

- immediate bleeding

22
Q

Coagulation pathway disorders causes?

A
  • defects in:
  • Coagulation factors
  • fibrinogen
23
Q

Coagulation pathway disorders presentation

A
  • deep tissue bleeding (joints)
  • delayed bleeding (weak clot forms and breaks, followed by secondary bleeding)
    Both can cause GI/CNS bleeds
24
Q

Laboratory investigations of bleeding?

A 
1. Platelet count + blood film
Indicates platelet number (not function)
2. Coagulation screen
I. PT time 
II. aPTT time
25
Q

PT time?

A 
Prothrombin time (PT)
Time to fibrin clot formation
26
Q

aPTT time?

A

Activated partial thromboplastin time (aPTT)

Time to fibrin clot formation

27
Q

PT time result interpretation?

A

Detects abnormal

FVII, (extrinsic pathway)

FX, FV, FII, Fibrinogen (common pathway)

28
Q

aPTT time result interpretation?

A

Detects abnormal

FVIII, FIX, FXI (intrinsic factors)

FX, FV, FII, Fibrinogen (common pathway)

29
Q

How long Group and Save takes?

A
  • takes 40 mins
30
Q

Group and save procedure?

A
  • perform Indirect Antiglobulin Test
    screening and store sample
  • request this if blood might be needed but not inevitable.
31
Q

how long Crossmatch takes

A

5-40 mins

32
Q

Cross-match involves?

A
  • laboratory will assign units for specific patient
  • 5 minutes if recent group and save
  • 40 mins if antibodies/no previous G+S (IAT crossmatch)
33
Q

Acute haemolytic transfusion reactions (AHTR) diagnosis?

A

confirmed by one or more of the following:
• a fall of Hb
• rise in LDH
• positive direct antiglobulin test (DAT)
• positive crossmatch

34
Q

Delayed haemolytic transfusion reactions (DHTR) def?

A

are defined as fever and other symptoms/ signs of haemolysis more than 24 hours after transfusion

35
Q

Delayed haemolytic transfusion reactions (DHTR) confirmed by? ?

A
  • a fall in Hb or failure of increment

- rise in bilirubin

36
Q

Transfusion-related acute lung injury (TRALI)

A
  • SOB
  • hypoxia
  • bilateral pulmonary infiltrate

within 6 hours of transfusion

37
Q

TRALI diagnosis?

A

any 4 of:

  • high HR
  • high BP
  • Pulmonary oedema
  • Fluid retention
  • respiratory distress
38
Q

Transfusion-associated dyspnoea (TAD)

A
  • respiratory distress within 24 hours of

transfusion that does not meet the criteria for TRALI, TACO or allergic reaction.

39
Q

what blood component mostly affected during transfusion?

A

IRON
• 1 unit red cells contains ~250mg iron
• Maximum iron excretion ~3mg/day

40
Q

which organs are in danger of iron overload post transfusion?

A 
heart 
liver 
pancreas 
joints
pituitary
41
Q

Main cause of iron overload

A

Regular transfusion (several years) -iron overload

42
Q

Management of iron overload

A

• minimise transfusion
• long term iron chelation (desferrioxamine [s/c] or deferasirox /
deferiprone [oral] )

43
Q

Transfusion associated circulatory overload (TACO) sx?

A

raised pulse & BP at 15 mins post transfusion

44
Q

Transfusion associated circulatory overload (TACO) mx?

A

Slow down the infusion and give frusemide.

45
Q

Major haemorrhage def?

A
  • 50% of total blood volume lost in less than 3 hours
  • Loss of more than one blood volume within 24 hours
    (around 70 mL/kg, >5 litres in a 70 kg adult)
46
Q

Major haemorrhage primary management?

A

tranexamic acid bollus for 10 min followed by 8 hours iv infusion

MS3 - Haematology (5 decks)

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