Transfusion medicine flashcards
13 high-yield MRCP Part 1 cards from the Intellect Medicos Haematology & Oncology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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Two hours into a platelet transfusion, a patient develops a temperature of 38.4 °C and chills. Observations are otherwise stable and there are no signs of haemolysis. What is the likely reaction and its management?
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Febrile non-haemolytic transfusion reaction — slow or pause the transfusion and give paracetamol.
Why? Cytokines released by donor white cells build up during storage, especially in platelets stored at room temperature.
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Which patients classically develop anaphylaxis to blood products, and what should they receive in future?
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IgA-deficient patients with anti-IgA antibodies; future transfusions should be washed red cells or IgA-deficient donor products.
Why? The anti-IgA antibodies react with IgA in donor plasma, triggering mast cell degranulation.
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What is the usual cause of an acute haemolytic transfusion reaction?
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ABO incompatibility, almost always from a clerical or patient-identification error.
Why? Recipient IgM anti-A/anti-B antibodies fix complement, causing intravascular haemolysis within minutes, with risk of AKI, DIC and shock.
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An 84-year-old with heart failure becomes breathless during her second unit of red cells. BP 172/94 mmHg, raised JVP and bibasal crackles. What is the diagnosis, and which drug is given?
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Transfusion-associated circulatory overload (TACO) — stop the transfusion, sit her up, give oxygen and IV furosemide.
Why? The heart cannot handle the extra volume, causing cardiogenic pulmonary oedema with hypertension and a positive fluid balance.
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Which features point to TRALI rather than TACO in a patient breathless after transfusion?
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Hypotension, normal or low JVP, normal BNP and no fluid overload.
Why? TRALI is non-cardiogenic pulmonary oedema: donor anti-HLA/anti-leucocyte antibodies activate recipient neutrophils in the lungs.
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A patient with a past history of Hodgkin lymphoma needs red cells. Which special product requirement applies?
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Irradiated blood components (lifelong requirement).
Why? Irradiation inactivates donor T-lymphocytes, preventing transfusion-associated graft-versus-host disease.
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In major haemorrhage, what is the tranexamic acid dose and time window?
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1 g IV over 10 minutes, then 1 g over 8 hours — ideally within 3 hours of bleeding onset.
Why? Early antifibrinolysis reduces bleeding deaths; benefit falls with delay.
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NICE restrictive red cell transfusion threshold: Hb ______ g/L (target 70–90 g/L); in acute coronary syndrome the threshold is 80 g/L.
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70
Why? Restrictive thresholds are as safe as liberal ones and reduce transfusion-related harm.
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NICE restrictive red cell transfusion threshold: Hb 70 g/L (target 70–90 g/L); in acute coronary syndrome the threshold is ______ g/L.
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80
Why? Restrictive thresholds are as safe as liberal ones and reduce transfusion-related harm.
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The universal red cell donor is group ______; the universal plasma (FFP) donor is group ______.
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O RhD-negative; AB
Why? O-negative cells carry no A, B or D antigens; AB plasma contains no anti-A or anti-B antibodies.
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Which blood component carries the highest risk of bacterial contamination, and why?
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Platelets — because they are stored at room temperature (20–24 °C).
Why? Warm storage lets skin-derived bacteria multiply, so transfusion-transmitted sepsis is most often linked to platelets.
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When is anti-D immunoglobulin given to an RhD-negative pregnant woman?
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Routinely in the third trimester (around 28 weeks), within 72 hours of delivery of an RhD-positive baby, and within 72 hours of any sensitising event.
Why? Anti-D clears RhD-positive fetal cells before the mother makes her own anti-D, preventing haemolytic disease of the fetus and newborn in later pregnancies.
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Which electrolyte disturbance is caused by the citrate in blood products during massive transfusion?
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Hypocalcaemia (citrate binds ionised calcium).
Why? Low ionised calcium worsens coagulopathy and cardiac contractility, so it must be checked and replaced.