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Year 2 clinical pathology > week 10 transfusion medicine > Flashcards

week 10 transfusion medicine Flashcards

(75 cards)

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1
Q

What are the different blood components?

A

RBC
platelets
Plasma

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2
Q

What is leucodepletion?

A

Whole blood is filtered before further processing to remove white cells

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3
Q

What are the 3 procedures can occur to the plasma after blood components?

A

Fresh frozen plasma
cryoprecipitate
Fractionation

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4
Q

What is the plasma fractionated to?

A

Factor concentrates (FVIII, FIX, prothrombin complex)
Albumin
immunoglobulin

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5
Q

How is RBC stored?

A

Stored at 4oC for up to 35 days from collection.

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6
Q

What is the name of red cells when the plasma is removed?

A

concentrated red cells

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7
Q

What replaces plasma cells in concentrated red cells?

A

Replaced by a solution of electrolytes, glycose and adenine to keep the red cells healthy during storage

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8
Q

What is the trasfusion policy of red blood cell transfusion

A

Usual transfusion time: 1.30 -3hrs

4 hr limit from removal from cold storage to end of transfusion

Use blood warmer for rapid transfusion

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9
Q

Why do we transfuse patients?

A

To normalize the Hb in anaemic patients
To prevent symptoms of anaemia
To improve quality of life of anaemic patients
To prevent ischemic damage of end organs in anaemic patients.

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10
Q

Does transfusion stop anemia?

A

No it is just used to improve the quality of life by removing symptoms

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11
Q

What is the mains ymptom of anaemia?

A

Tissue hypoxia

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12
Q

What is Transfusion threshold (trigger)?

A

is the lowest concentration of Hb that is not associated with symptoms of anaemia.

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13
Q

What are the mechanisms of adaption to anaemia?

A 
Increased cardiac output
Increased cardiac artery blood flow
Increased oxygen extraction 
Increase of red blood cell 2,3 DPG (diphosphoglycerate)
Increase production of EPO
Increase erythropoiesis
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14
Q

Does transfusion threshold differ betwen subgroups?

A

Transfusion thresholds differ in various subgroups of patients depending on the balance between mechanisms of adaptation to anaemia and O2 requirements.

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15
Q

What is the affect on respiration in acute anaemia?

A

In acute anaemia the respiration rate is more markedly increased than in chronic anaemia

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16
Q

Why is oxgen extraction increased in chronic anaemia?

A

In chronic anaemia the O2 extraction is increased due to the rise of the levels of 2,3 DPG.

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17
Q

What is the response of kidney to chronic anaemia?

A

In chronic anaemia kidneys respond to hypoxia by increasing the production of erythropoietin and this in turn results in increased erythropoiesis.

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18
Q

What are the parameters that affect the adaptation mechanisms to anaemia?

A

Acute/chronic anaemia
Underlying conditions
Transfusion of RBC

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19
Q

For a patient with mild symptoms of anaemia how much red blood cell would you transfuse?

A

Transfusion of ≤70 g/L for patients with mild symptoms of anaemia

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20
Q

For a patient with cardiovascular disease how much red blood cell would you transfuse?

A

Transfusion of ≤80 g/L for patients with cardiovascular disease

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21
Q

What is anaemia?

A

Is a condition in which there is a deficiency of red cells or of haemoglobin in the blood, resulting in pallor and weariness.
Origin

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22
Q

What caues of anaemia is treated rather than doing RBC transufsion?

A

Iron deficiency

B12 and folate deficiency

Erythropoietin treatment for patients with renal disease

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23
Q

How can you correct coagulopathy without the use of transfusion?

A

Discontinuation of antiplatelet agents

Administration of anti-fibrinolytic agaents

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24
Q

What is cell salvage?

A

Is a medical procedure involving recovering blood lost during surgery and re-infusing it into the patient.

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25
At what calss of haemorrhage is indication for transfuon neccessary?
Class 3 and definetly at class 4
26
What is the objectives forPatients on regular transfusions due to myeloid failure syndromes
Symptomatic relief of anaemia Improvement of Quality of Life Prevention of ischemic organ damage
27
What do you have to take into consideration when treating chronic anaemia?
co-morbidities that affect cardiac, respiratory function iron overload adaptation to anaemia
28
What is the aim of Hb for patients who have chronic anaemia?
Threshold Hb 80-100g/dl
29
What is the objective for a patient on regular transfusions due to inherited anaemia?
suppression of endogenous erythropoiesis to avoid complications due to expansion of the endogenous erythropoiesis
30
What is the threshold that needs to be aimed at for a patient that has thalassaemia?
Threshold 90-95, target 100-120g/L
31
What do you take into consideration of thalassaemia?
iron overload
32
How is platelets stored and what is the transfusion time?
Stored at “room temperature” (22oC) Shelf-life 5 days from collection Transfusion time: 30 mins/unit
33
What is adult therapeutic dose?
Adult therapeutic dose” is platelets from 4 pooled donations
34
Why transfuse platelets?
Treatment of bleeding due to severe thrombocytopenia (low platelets) or platelet dysfunction
35
What are you trying to prevent when doing transfuse plateletes?
Prevention of bleeding : Massive haemorrhage Bone marrow failure Prophylaxis for surgery
36
What are the contraindications of transufe platelets?
Heparin induced thrombocytopenia & thrombosis | thrombotic thrombocytopenic purpura
37
What is thrombocytopenia?
deficiency of platelets in the blood.
38
How is fresh frozen plasma stored, the usual dose and trasfusion time?
Stored at –300C for up to 24 months Thawed immediately before use (takes 20-30 min) Usual dose 12-15 mL/kg (4-6 units for average adult) Usual transfusion time: 30 mins/unit
39
What is the main indication of fresh frozen plasma?
coagulopathy with bleeding/surgery, massive haemorrhage thrombotic thrombocytopenic purpura
40
When do you not transfuse fresh frozen plasma?
Warfarin reversal Don’t treat bleeding causes by single factor deficiency such as haemophilia
41
What is the aim of the group and screen testing?
Determination of ABO and Rh(D) group | Patient’s plasma “screened” for antibodies against other clinically significant blood group antigens
42
If the patient plasma screen is positive what is the next action?
Antibody identification: testing the patient’s plasma against a panel of red cells containing all the clinically significant blood groups, using the Antiglobulin Test
43
What is the cross matching test?
Patients plasma is mixed with aliquots of donor red cells to see if a reaction (agglutination or haemolysis) occurs
44
What are the two outcomes of cross matching testing
No reaction RBC units compatible No risk of acute haemolysis Reaction RBC units incompatible Risk of acute haemolysis
45
What are the two groups for the complications of transfusion?
Acute reactions present 24 hours of transfusion
46
What is the immunological complciations that occurs in acute transfusion reaction?
Acute haemolytic transfusion reaction ABO incompatibility Allergic /anaphylactic reaction TRALI (Transfusion-related acute lung injury)
47
What is the non immunological complciations that occurs in acute transfusion reaction?
Bacterial contamination TACO (transfusion associated circulatory overload) Febrile non-haemolytic transfusion reaction
48
What is the non immunological complciations that occurs in delayed transfusion reaction?
Transfusion Transmitted Infection (TTI) –viral/prion
49
What is the immunological complciations that occurs in delayed transfusion?
Transfusion-associated graft-versus-host disease (TA-GvHD) Post transfusion purpura
50
What is purpa?
A rash of purple spots on the skin caused by internal bleeding from small blood vessels.
51
What is the outcome of Acute haemolytic reaction-ABO incompatibility?
Release of free Hb due to: Deposition of Hb in the distal renal tubule results in acute renal failure. Stimulation of coagulation results in microvascular thrombosis Stimulation of cytokine storm Scavenges NO resulting in generalized vasoconstriction
52
What is the onsent of Acute haemolytic reaction-ABO incompatibility?
Severe reactions may occur early in the transfusion, within the first 15 min Milder reactions may occur later but usually before the end of transfusion
53
What is the signs and symptoms of Acute haemolytic reaction-ABO incompatibility?
``` 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” ```
54
What percentage of Acute haemolytic reaction-ABO incompatibility is fatal?
20-30%
55
What is the cause of Acute haemolytic reaction -ABO incompatibility ?
Always a human error either due to mistake in patient identification or the correct product use
56
What is the cause of delayed haemolytic reaction?
Delayed haemolytic reaction is due to immune IgG antibodies against RBC antigens other than ABO The antibodies are formed after the transfusion
57
What is the onset time of delayed haemolytic reaction?
Onset 3-14 days following a transfusion of RBC
58
What is the clinical features of delayed haemolytic reaction?
fatigue, jaundice, and/or fever
59
What is the libaoratory findings of delayed haemolytic reaction?
Drop in Hb Increased LDH Increased indirect bilirubin Direct antiglobulin test is Positive
60
What is a serious complication of transfusion?
Transfusion related acute lung injury
61
What is the cause of transfusion related acute lung injury?
Donor has antibodies to recipient’s leucocytes
62
What is the effect of transfusion related acute lung injury on the lung pathology?
Activated WBC lodge in pulmonary capillaries Release substances that cause endothelial damage and capillary leak
63
What type of transfusion is complicated by transfusion related acute lung injury?
Almost always complicates transfusion of plasma rich components
64
What is the onset of transfusion related acute lung injury?
Sudden onset of “Acute Lung Injury” occurring within 6 hours of a transfusion
65
What are the clinical signs of transfusion related acute lung injury?
Hypoxemia New bilateral chest X-ray infiltrates No evidence of volume overload
66
What is the treatment for TRALI?
Mild forms of TRALI may respond to supplemental oxygen therapy. Severe forms may require mechanical ventilation and ICU support.
67
Is diuretics or corticosteroids used in TRALI?
There is no role for diuretics or corticosteroids
68
What are the laboratory investigations of TRALI?
Donor is tested for HLA and granulocyte antibodies. The recipient is tested for expression of neutrophil antigens
69
How do you confirm the diagnosis of TRALI?
Donor has antibodies against antigens that are expressed on recipient’s granulocytes.
70
What is the presentation of Transfusion-associated circulatory overload?
``` Symptoms: sudden dyspnea orthopnoea tachycardia hypertension hypoxemia. ``` Signs Raised BP elevated jugular venous pul
71
What are the risk factors of TACO?
``` elderly patients small children Patients with compromised left ventricular function increased volume of transfusion increased rate of transfusion ```
72
What is the cause of urticarial Rash?
Hypersensitivity to a ‘random’ plasma protein
73
What is anaphylaxis?
Severe, life-threatening reaction soon after transfusion started
74
What is the consequence of anaphylaxis?
Wheeze/ asthma, increase in pulse and decrease in BP (shock) Laryngeal oedema/ facial oedema
75
What are the laboratory investigations for anaphylaxis?
Quantification of IgA, testing for anti-IgA antibodies.

Year 2 clinical pathology (21 decks)

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