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Transfusion - Coggle Diagram
Transfusion
METHOD
donation=470mls blood+64mls anticoagulant
RBCs+optimal additive solution
expiry date 35days
plasma
makes cryoprecipitate
fresh frozen plasma
replacement of coagulation factors
where no concentrate available
treatment of
coagulation failure in liver disease
massive haemorrhage
virally inactivated pooled product
non UK.irish donors
LG-Octaplas
derivatives
albumin
IM (normal, anti-D)/IV immunoglobulin
FVIII, FIX, FIX complex(II, IX,X), FVII, fibrinogen, fibrin sealant
platelets
pools from buffycoats of whole blood donation
4 donations
apheresis concentrates
cell separator
one donor
250 mls=standard dose
leucodepletion
less febrile reactions
less alloimmunisation
less GVHD
reduce immunosuppressive effects
introduced to reduce risk of vCJD transmission
storage
whole blood/RBCs
2-6degC
35days
use within 4hrs of removal from blood fridge
platelets
20-24degC
stored on agitator for 5-7days
solvent detergent frozen plasma
-30degC
12mths
use within 8hrs of thawing
compatibility test
indirect antiglobulin test
looking for agglutination/lysis after incubation of pt serum and donor cells
if recipients Ig's target donors RBC's
form antibody-antigen complex
anti human IGs added
will bind to recipients Igs bound to RBC;s
agglutination of RBCs
anti human IgG added after incubation at 37C
ABO
ABH antigens
glycolipids/glycoproteins
expressed on most body cells
red cells lacking antigens
antibodies to A and/or B
A
serum=anti b
31%
can receive
a
o
B
serum=anti a
11%
can receive
o
b
AB
2.5%
can receive
ab
a
b
o
O
serum=anti ab
56%
can receive
o
Antibodies
IgM&IgG
fix complement
intravascular haemolysis
Rh
Rh(D) pos
85%
Rh(D) neg
15%
antibodies
non complement binding
extravascular haemolysis
Haemolytic disease of the newborn
anti-D> anti c> anti e
Haemolytic disease
RhD+ baby&RhD- mother
mother produces anti d antibodies
first baby ok
next RhD+ baby
neonatal jaundice
anaemia
hydrops
intrauterine death
prevention
anti d immunoglobulin
treatment
antenatal antibody monitoring
US/doppler
intrauterine transfusion
after birth
phototherapy
IVIG
exchange/top up transfusion
DONOR SCREENING
Health questionnaire
microbiological screening
donor criteria
age
18-70
weight
more than 50kgs
general health
specific illnesses
contact with inf.
travel to malarial area(12mths)
travel to tropical area(3mths)
HIV/Hepatitis risks
medication
vCJD risks
^Hb
Deferral
had blood transfusion in ROI
on/after Jan1st 1980
blood transfusion outside ROI
at anytime
used needle for unprescribed drugs
has/partner has HIV/HTLV
jaundice of uncertain cause
after 13yrs of age
previous hep b/c
sexual contact in last 4mths
anyone with HIV/HEP B/C/HTLV
STI
money/drugs for sex
injected drugs
for 12mths if
visited malarial area
pregnant/gave birth
autologous tranfusion
imprisoned
snorted cocain/other drugs
for 4mths
acupuncture not by
registered medical practioner
general nurse
chartered registered physio
piercing
tattoo
semi-permanent make up
endoscopy
new/>1 sexual partner
snorted cocaine/other drugs
HIV pre/post exposure prophylaxis
drugs before/during sex
short term
1mth
inf.disease not previously inf. with
mumps
measles/german measles
chicken pox
2wks
recovery from
flu
gastroenteritis
acute inf.
off antibiotics for at least 1wk
1wk
dental extraction
24hrs after
uncomplicated filling/scaling
monkey pox
at least 28 days since dx
at least 14 days since full recovery
7 days post antiviral therapy
a contact
28 days since contact
no symptoms
discharged from surveillance
cancer
ADVERSE EVENTS
most common
circulatory overload
immediate hazards
febrile non haemolytic reactions
1C rise in temp and/or chills
alloimmunisation to HLA antigens-pregnancy/previous transfusion
cytokine generation during component storage
bacterial contamination on blood component
allergic/anaphylactic reactions
1-3% transfusions-urticarial
slow/stop transfusion rate
administer iv antihistamine
chlorpheniramine 10-20mg
no progression after 30mins-transfusion can proceed
prevention
prophylactic antihistamines?
severe reaction
stop, follow anaphylaxis protocol
may require specialised products in future
acute haemolytic reactions
most common cause
ABO incompatibility
10mls incompatible blood initiates reaction
intravascular haemolysis
features
fever
not always
feeling of overwhelming doom
back/chest pain
dark urine
hypotension/collapse
major complication=renal failure
septic shock due to bacterial contamination
transfusion assoc. circulatoy overload
1% of transfusions
features
dyspnoea
hypertension
crepitations
risk of
volume overload
resp. distress
esp. in small/elderly patient
largely avoidable by
attention to fluid balance
prior admin of diuretics
transfusion related acute lung injury
89% assoc. with
granulocyte antibodies or
HLA antibodies
highest risk in plasma containing products
5-15% no antibodies detected
2 hit model pathogenesis
recipient underlying condition
neutrophil priming by lipid?
delayed reactions
delayed haemolytic transfusion reactions
typically 7-14 days after
pre-existing antibody to minor red cell antigen e.g duffy/kidd
^undetectable at cross-matching but stimulated by transfusion
features
fever
falling Hb
evidence of intra/extravascular haemolysis
post transfusion purpura
transfusion assoc. GVHD
viral inf - parasitic inf. - prions
immunosuppression
iron overload in multi-transfused recipients
transmissible diseases
Hep B,C,E
HIV 1&2
HTLV1 1&11
Syphilis
CMV
bacterial contamination
malaria
dengue
WNV
PCR-NAT testing introduced
donors with travel hx to area must be deferred 1 mth/tested for WNV DNA
chikungunya
zika
travel hx
28 days deferral
sexual contact
28 days from last contact
vCJD
sources of risk
infectious but seronegative window period
immunosilent inf
variants of known agents
lab error
DONATION TESTING
microbiology markers
anti HIV 1+2
HIV PCR
HBsag
HBc assay
HBV PCR
anti HCV
HCV PCR
HEV PCR
anti HTLV1/2
syphilis
bacterial culture of platelets
anti CMV
Travel hx
west nile virus
malaria antibody test
previous residents of malarial area
PHx malaria
Blood grouping and screening for high titre antibodies
quality monitoring
OTHER GROUPS
Kell system
McLeod phenotype
reduction of antigen expression
antibodies
IgG1
occassionally complement binding
haemolytic disease of the newborn
Duffy system
Fy glycoprotein
receptor for plasmodium vivax