[17] CHAPTER VIII LESSON 1

Question 1

can be defined as the use of serologic principles and tests to ensure compatibility and prevent an immune-mediated hemolytic transfusion reaction.

Answer 1

Pretransfusion testing

Question 2

defines blood components as pharmaceuticals because of the intent of their use to cure, mitigate, treat, or prevent disease.

Answer 2

Food and Drug Administration (FDA)

Question 3

Under the auspices of the [?], the Centers for Medicare and Medicaid (CMS) have the authority to regulate pretransfusion testing.

Answer 3

Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88)

Question 4

Facilities providing blood components and laboratory services are subject to. [?] by either entity at any given time.

Answer 4

inspections

Question 5

In addition to maintaining regulatory compliance, many facilities participate in quality driven programs to achieve [?].

Answer 5

accreditation

Question 6

The [?], now known simply as AABB, is an accrediting organization whose goals include enhancing the quality and safety of services provided by blood banks and transfusion services.

Answer 6

American Association of Blood Banks

Question 7

Adequate pretransfusion testing does not guarantee [?] in the recipient’s circulation, but strict adherence to all facets of pretransfusion testing and donor unit selection is imperative to ensure safe transfusion therapy.

Answer 7

normal survival of transfused red blood cells

Question 8

STEPS IN PRETRANSFUSION TESTING
1. Request for[?]
2. Identification of [?] and blood specimen collected
3. Testing of transfusion recipient’s [?]
4. Donor [?]
5. Donor [?]
6. [?] (crossmatch)
7. Labeling of [?] with the recipient’s identifying information and issue.

Answer 8

transfusion

transfusion recipient

blood specimen

RBC unit testing

red blood cell unit selection

Compatibility testing

blood or blood components

Question 9

Testing of transfusion recipient’s blood specimen:
a. Evaluation of specimen for testing [?]
b. [?]
c. [?] (Weak D testing is optional when testing the patient)
d. Screening for [?] to red cell antigens
e. [?] if unexpected antibodies are detected
f. Comparison of [?], and any discrepancies shall be investigated and appropriate action taken before a unit is issued for transfusion

Answer 9

suitability

ABO group

Rh type

unexpected antibodies

Antibody identification

current and previous test results

Question 10

4. Donor RBC unit testing:
   a. ABO group confirmation and Rh type confirmation for [?]

Answer 10

Rh-negative RBC units

Question 11

5. Donor red blood cell unit selection:
   a. Selection of components of ABO group and Rh type that are compatible with the transfusion recipient and with any [?]

Answer 11

unexpected allogeneic antibodies

Question 12

6. Compatibility testing (crossmatch):

Answer 12

a. Serologic
b. Computer or electronic

Question 13

SPECIMEN COLLECTION

Question 14

Clerical errors and [?] continue to occur and have potentially serious, clinical consequences.

Answer 14

ABO-incompatible transfusions

Question 15

• greatest threat to safe transfusion therapy

Answer 15

Clerical error

Question 16

Clerical error Examples:
-misidentification of the recipient when the [?] is drawn
-[?] during handling in the laboratory
-misidentification of the recipient when the [?] is given

Answer 16

blood sample

mix-up of samples

transfusion

Question 17

Errors include

Answer 17

phlebotomy and testing errors, administration to the wrong recipient, or issuance of the wrong donor unit.

Question 18

continue to be a significant risk necessitating system to prevent failures in patient identification, specimen labeling, and administration.

Answer 18

Transfusion errors

Question 19

In order to prevent patient misidentification and administration failures, most institutions require patients to wear a [?] upon admission until discharge

Answer 19

facility-generated ID wristband

Question 20

facility-generated ID wristband must contain two unique identifiers, typically the

Answer 20

patient’s first and last names and date of birth or medical record number

Question 21

require two unique identifiers to identify patients and ensure that correct medicine and treatment are administered.

Answer 21

Joint Commission’s National Patient Safety Goals

Question 22

Prior to specimen collection, the phlebotomist must confirm the [?] is accurate and contains all required information.

Answer 22

wristband information

Question 23

Common practice includes asking the patient to state his or her[?], if they are coherent.

Answer 23

name and date of birth

Question 24

Once collected, the specimen must be accurately [?] at the bedside.

Answer 24

labeled

Question 25

Patient information on the [?] must be in complete agreement.

Answer 25

label, wristband, and request

Question 26

Furthermore, specimen draw [?] and the collecting individual must be traceable back to the collection of the patient sample.

Answer 26

date and time

Question 27

are acceptable for pretransfusion testing.

Answer 27

Anticoagulated or clotted specimens

Question 28

are often preferred due to ease of handling.

Answer 28

Anticoagulated specimens

Question 29

are ideal for preparing a uniform cell suspension for testing.

Answer 29

Red blood cells from an anticoagulated sample

Question 30

may require additional washing steps to minimize interference in test interpretations.

Answer 30

Clotted red blood cells

Question 31

is unacceptable, and the use of hemolyzed samples should be avoided.

Answer 31

Intravenous line (IV) contamination

Question 32

Specimens should be collected from the arm [?] the IV catheter and never [?] it.

Answer 32

opposite above

Question 33

If venous access is limited and the specimen must be collected from the IV line, the [?]must be stopped and the line flushed.

Answer 33

infusion fluid

Question 34

It is recommended that an amount of blood equal to[?] the dead space of the catheter be discarded.

Answer 34

three or more times

Question 35

The date of the collection is considered day 0, and the specimen expires at [?].

Answer 35

midnight on day 3

Question 36

For example, if a specimen was collected on a Monday (day 0), it may be used for transfusion on Tuesday (day 1), Wednesday (day 2), and [?].

Answer 36

Thursday (day 3) until 11:59 p.m

Question 37

The [?] minimizes the risk of an adverse reaction due to an emerging alloantibody in a recipient that has been recently transfused.

Answer 37

3-day testing window

Question 38

Pretransfusion specimens and donor unit segments are typically stored at [?] and must be retained in the event that additional testing is warranted.

Answer 38

2° to 8°C

Question 39

The patient sample and a segment from the donor unit must be retained post-transfusion for at least [?].

Answer 39

7 days

Question 40

are performed to prevent an immune-mediated hemolytic transfusion reaction.

Answer 40

Compatibility tests

Question 41

Compatibility tests include: determining the recipient’s [?], screening for any [?], and [?] the donor unit with the recipient’s plasma.

Answer 41

ABO group and Rh type unexpected antibodies crossmatching

Question 42

Current results such as ABO group and Rh type, detection of clinically significant antibodies, significant adverse events, and special transfusion requirements must be compared to historical records.

Answer 42

Review of Records

Question 43

For patients with no historical records, many facilities have implemented an additional specimen draw for a blood type confirmation.

Answer 43

Review of Records

Question 44

Any discrepancy between historical records and current test results must be resolved prior to transfusion.

Answer 44

Review of Records

Question 45

ABO grouping, Rh typing, and screening for unexpected antibodies must be performed within 3 days prior to the scheduled transfusion except in the previously mentioned situations for which the pretransfusion testing window may be extended.

Answer 45

Recipient Testing

Question 46

requires licensed reagents and can be performed using tubes, column-agglutination technology, or in microtiter plates used in solid-phase red cell adherence tests.

Answer 46

ABO grouping

Question 47

Required reagents include anti-A and anti-B for detecting the antigens on the red blood cells and A1 and B cells for confirming the naturally occurring antibodies in the plasma.

Answer 47

ABO grouping

Question 48

is performed to detect the presence or absence of the D antigen.

Answer 48

Rh Typing

Question 49

Licensed anti-D reagents are monoclonal blends of IgM and IgG components.

Answer 49

Rh Typing

Question 50

In addition, an Rh control must be tested in parallel with anti-D reagent in the indirect antiglobulin test for weak D determination.

Answer 50

Rh Typing

Question 51

The test for weak D is optional in transfusion recipients but is required for donor units during manufacturing.

Answer 51

Rh typing

Question 52

Antibodies to blood group antigens must be detected and their clinical significance assessed.

Answer 52

Antibody Screening

Question 53

Clinically significant antibodies have been associated with red blood cell destruction, hemolytic transfusion reactions, and hemolytic disease of the fetus and newborn (HDFN).

Answer 53

Antibody Screening

Question 54

The FDA mandates that red blood cells used in antibody detection tests must express the following antigens:

Answer 54

D, C, E, c, e, K, k, Fya, Fyb, Jka, Jkb, Lea, Leb, P1, M, N, S, and s.

Question 55

A common goal shared by blood suppliers and transfusion services is to provide a safe and efficacious blood component that benefits the intended recipient.

Answer 55

SELECTION OF DONOR UNITS

Question 56

Blood suppliers are required to perform a battery of tests on blood components prior to distribution

Answer 56

Donor Unit Testing

Question 57

Tests performed are ABO grouping, Rh typing, a weak D test if the initial Rh typing result is negative, and a screen for antibodies to common blood group antigens.

Answer 57

Donor Unit Testing

Question 58

Required infectious disease testing on donor units includes HBV DNA, HBsAG, HBc antibodies, HCV antibodies, HCV RNA, HIV1/2 antibodies, HIV-1 RNA, HTLV I/II antibodies, WNV RNA, and a serologic test for syphilis.

Answer 58

Donor Unit Testing

Question 59

In addition, each donor must be tested at least once for antibodies to Trypanosoma cruzi

Answer 59

Donor Unit Testing

Question 60

Recently, the FDA provided guidance and recommended universal testing for the Zika virus.

Answer 60

Donor Unit Testing

Question 61

2. Selection Criteria

Question 62

ABO antigens on the donor unit red blood cells must be compatible with the naturally occurring anti-A and/or anti-B in the recipient’s plasma.

Answer 62

ABO/Rh

Question 63

If whole blood is the only option, the product and the recipient must be ABO identical due to the plasma portion of the blood component.

Answer 63

ABO/Rh

Question 64

If a patient has a history of, or has detectable clinically significant antibodies, donor units selected for transfusion must be negative for the corresponding antigen(s).

Answer 64

Antigen-Negative

Question 65

AB 1st Choice: 2nd Choice: 3rd Choice: 4th Choice:

Answer 65

AB A B O

Question 66

A 1st Choice: 2nd Choice:

Answer 66

A O

Question 67

B 1st Choice: 2nd Choice:

Answer 67

B O

Question 68

O 1st Choice:

Answer 68

O

Question 69

No compatibility testing is required for the transfusion of platelets, thawed plasma, and cryoprecipitate.

Answer 69

Platelets, Thawed Plasma, and Cryoprecipitate

Question 70

Either a current or a historical ABO grouping is sufficient.

Answer 70

Platelets, Thawed Plasma, and Cryoprecipitate

Question 71

Rh typing is ignored because these components contain very few red blood cells as a result of collection methods or frozen storage.

Answer 71

Platelets, Thawed Plasma, and Cryoprecipitate

Question 72

ABO-identical platelet units should be selected whenever possible to ensure adequate platelet survival.

Answer 72

Platelets, Thawed Plasma, and Cryoprecipitate

Question 73

Plasma units should be compatible with the recipient’s ABO red blood cell antigens.

Answer 73

Platelets, Thawed Plasma, and Cryoprecipitate