Transcription
Hello everyone, and this is Air, the estim of FRC Path Part One preparatory session teacher.
Today, we had three transfusion essays in the transfusion week of FRC Path Part One preparation. The first essay was about acute transfusion reaction due to bacterial contamination. The second one was about TACO. The third one was about a mismatch transplant complicated by passenger lymphocy syndrome. So, I will discuss the main points only here in this short video.
The important stuff in the acute transfusion reaction. The first one is to stop the, uh, stop the transfusion immediately and then assessment of the patient. The next important step in immediate management is duty of candor. You need to tell the patient what has happened and what you are going to do next. Third important thing is to inform your transfusion consultant and the, um, the blood blood transfusion lab and to return the blood bag to your, uh, to your transfusion lab.
After that, uh, these are, uh, transfusion management cases. So you have to mention both clinical management and the governance as well. Governance means you have to detex this case. Dex in UK means you have to, uh, inform the responsible body, uh, about the unwanted event. So you either complete an incident form or you say that I will detect, uh, this case. After dexing, the, the responsible body will pick up the, will pick up the case and they will start investigations. In case of transfusion, it is the hospital transfusion, uh, hospital transfusion team which will, which will do this. The hospital transfusion team consists of the transfusion practitioners, and the hospital transfusion committee is something different, which consists of different, uh, specialties like hematologists, orthopedists, the surgeons, the ICU, which need a lot of, uh, which consumes a lot of blood, uh, during their services.
So, uh, the first step in governance is dataxing. Second step is, uh, investigation by the hospital transfusion team. Third, third step is discussing these investigations and analysis of these investigations in the hospital transfusion incident meeting or in MDT. Then allocating occurs. The process of investigation previously used to be called as, uh, root cause analysis. Now it is called as PSIRF, which is the, uh, framework for the investigation of transfusion reaction. And then, once the cause is found, then we suggest corrective and preventive actions, which are then audited after, uh, some time to find out whether the corrective actions that we have suggested has made any difference in the hospital practice or not. And then, an important step is to update the patient, uh, about your investigations. Obviously, these cases are short reportable. So you cannot, uh, forget to report these cases to SHOT and MH. If you forget SHOT and MH, uh, it means you fail the, uh, essay in the exam.
Second step, second question was about the, uh, TACO, which is quite common during the practice. It has the same management step: to stop the, uh, transfusion immediately, assess the patient. Uh, give him some oxygen and diuretics and involve the ICU team if, if required, and duty of candor to inform the patient what has happened and what you are going to do next. And then, same governance step as well.
The third question was about, uh, mismatch. We discussed how to differentiate between major mismatch and minor mismatch. It depends on the recipient status. If the recipient has a lot of antibodies, um, than donor, it is major mismatch, and if the recipient has less antibodies than donors, it is a minor mismatch. For example, our patient was group A, and the donor was group B. So, group A patient has only anti-B antibodies, and group O patient has, um, both anti-A and anti-B antibodies. So, donor has more antibodies, recipient has less. So, this is minor mismatch.
And then we discussed about the, uh, blood transfusion requirements for the components. I personally have anyone from DRR for minor ABO mismatch. D stands for donor. R stands for R. So, I know the, uh, sequence of blood components that we write during our practice. First one is red cell, second is platelet, third FFP, and then granulocyte, granulocyte plus minus, because we, um, rarely use them, uh, in, in transplant. Um, so DRR, D for donor, R for recipient, platelets, R for recipient, FFPs, and D for donor red cells. So, DRR, so donor red cells, recipient platelets, and recipient FFPs, because I know the, uh, sequence of the blood components. First is red cells, second is platelets, third is FFP.
Then another important thing which majority of the candidates forgot to mention, uh, is irradiation. These blood products should be irradiated. If, if you do not mention them in your essay, you fail. Because if you give non-irradiated platelets to a patient, uh, which needs, uh, irradiated platelets in your practice, it makes a lot of, uh, mess during the practice. The case is investigated, reported to SHOT, patient is at risk of TAG VHD. So, um, in, in even the exam, you cannot afford missing, uh, irradiation where it is required.
Remember, we have only two types of granulocytes in UK: O and A groups. There is no B group granulocyte. There is no AB group granulocyte. So, these guidelines are given in NHSBT. Granulocyte guidelines are given in the NHSBT guideline. If you just mention NHSBT guideline in Google, they will all appear, and the mismatch guidelines are mentioned in the, um, in the guidelines as well, NHSBT guidelines. Just write NHSBT clinical guidelines in Google. They will appear. Okay. NHSBT is the, uh, UK guidelines.
The last part of the question was about passenger lymphocy syndrome, and it was a discussion question. So, you need to write what is passenger lymphocy syndrome, what are the blood parameters, and when, when does it happen? After peripheral blood, uh, stem cell collection and after bone harvest, in these two types of transplants, when does they happen? And management, it can be mild, it can be moderate, it can be severe. Mild is just observation and folic acid. Moderate is requiring transfusion, immunosuppression with folic acid, and the severe one needs plasma exchange.
So, this is the summary of the, uh, summary of the, uh, today's hemost, today's transfusion session, and, um, we will be back with the summary of the next session next week. Thank you.