6. Donor selection & processing Flashcards
donor temperature requirement
≤37.5° C or ≤99.5° F
HR requirement
50-100 bpm, or 40-49 if a healthy athlete
BP requirement
90-180 systolic/50-100 diastolic
hemoglobin requirement
≥12.5 g/dL (female) or ≥13 g/dL (male)
hematocrit requirement
≥38% (female) or ≥39% (male)
vCJD permanent deferral
Lived in the UK from 1980-1996
receiving …… results in permanent deferral (4)
stem cell transplant
dura mater
human pituitary GH
xenotransplant product
infectious disease permanent deferrals (4)
HBsAg confirmed positives
Repeat reactive anti-HBc
Infection with HIV, HCV, or HTLV
History of babesiosis
aseptic technique is most important for which blood products?
platelets
stored at room temp
aseptic technique procedure (4)
- Scrub venipuncture site 2 inches in all directions from center for 30 seconds with iodine swab. For allergic donors, you can use chlorhexidine.
- Using a second swab, start at the center and move outward in a concentric spiral 1.5 inches in all directions.
- Let stand for at least 30 seconds to allow for bactericidal action.
- Cover the prepped skin site with on sterile 2x2 gauze.
cannot be made from long draw (15-20 mins)
FFP
common donor reactions
lightheadedness
dizziness
nausea
skin rash/irritation
donor reactions causing the donation to be stopped
vomiting
chills
hyperventilation
fainting
convulsions
uncommon adverse donor events
hematoma
arterial puncture
nerve injury
hemoglobin requirement for autologous donation
11 g/dL
autologous donor units do not require normal infectious disease testing if…
staying at the same facility
irradiating directed donations from blood relatives prevents…
transfusion-associated graft vs host disease (TA-GVHD)
Performed to decrease the red cell volume
therapeutic phlebotomy
therapeutic phlebotomy indications
polycythemia
hemochromatosis
therapeutic phlebotomy blood can be used for donations if patient has…
Hereditary hemochromatosis
indications for therapeutic apheresis for plasma
Goodpasture’s
TTP
acute Guillian-Barre
indications for therapeutic apheresis for red cells
sickle cell
methemoglobin
ALL infectious disease testing required on donor units (8)
- 3 Hepatitis B tests (HBV DNA, HBsAg, Anti-HBc)
- 2 Hepatitis C tests (HCV RNA, Anti-HCV)
- 2 HIV tests (HIV-1 RNA, Anti-HIV-1/2)
- Syphilis (RPR)
- HTLV (Anti-HTLV I/II)
- Trypanosoma cruzi; at least once per donor
- West Nile Virus (WNV-RNA)
- Babesias; endemic states only
HLA 1/2 testing female donors prevents…
transfusion-related acute lung injury (TRALI)
donors 16-18 years of age special test
ferritin
pRBC (AS) shelf life
42 days
pRBC (CPDA-1) shelf life
35 days
pRBC (CPD) shelf life
21 days
frozen RBC with 40% glycerol shelf life
10 years
thawed frozen RBC shelf life
24 hours
washed RBCs shelf life
24 hours
FFP & plasma frozen w/i 24h shelf life (frozen)
1 year
FFP & plasma frozen w/i 24h shelf life (thawed)
24 hours
thawed plasma shelf life
(not “FFP”)
5 days
liquid plasma shelf life
CPD: 26 days
CPDA1: 40 days
cryo AHF (frozen) shelf life
1 year
cryo AHF (thawed) shelf life
6 hours in same bag
4 hours pooled
platelet concentrates shelf life
5 days
pooled platelet concentrates shelf life
4 hours
apheresis platelets shelf life
7 days
granulocytes shelf life
24 hours
products stored at 1-6° F (6)
- pRBCs
- thawed frozen RBCs
- washed RBCs
- thawed FFP & plasma frozen w/i 24h
- thawed plasma
- liquid plasma
products stored at ≤ -65° (1)
- frozen RBCs
products stored at ≤ -18° (3)
- FFP (frozen)
- plasma frozen w/i 24h (frozen)
- cryo AHF (frozen)
products stored at 20-24° (3)
- cryo AHF (thawed)
- platelet products (in continual motion)
- granulocytes
products stored at 1-6° can be shipped at ——°, using…
1-10°
wet ice
frozen products shipped to maintain frozen state use…
dry ice
desired unit volume
450-550 mL
low volume unit
product prepared
342-449 mL
pRBCs only
unexpected conditions that can affect donations (4)
Severely lipemic units may not be able to be tested
Long draw may cause clots in pRBC
Hemolysis
Foreign objects (ie broken cannula)
WBCs in leukocyte-reducted product
< 5 x 10^6
Platelets collected by apheresis are WBC reduced by…
the continuous flow separation process
CMV safe if filtered within—–days of collection
3-5
leukocyte reduction reduces risk of… (3)
febrile nonhemolytic transfusion reactions
CMV transmission
HLA alloimmunization
Explain process for making pRBCs, platelets from WB, and FFP (6)
- Start with WB at RT—light spin
- PRP (platelet rich plasma) is expressed into 3rd bag
- AS is added to RBCs; pRBC bag is cut off
- Heavy spin on PRP bag
- Plasma is expressed into 2nd bag; FFP bag is cut off and frozen
- Platelet bag rests for 1 hour and is massaged; then put on rotator
female plasma
salvaged plasma
long draw, low volume, not processed within 24 hours plasma
salvaged plasma liquid
names for platelets from WB
“Random donor platelets”
”WB-derived platelets”
Explain process for making cryoprecipitate via separation-insolubility at low temperatures
- Allow FFP to thaw at 1-6° until slushy; cryo precipitates out
- Hard spin
- 2nd bag hangs off counter, and CP (cryo-poor) plasma rapidly flows into it, leaving cryo and 15 mL plasma in the 1st bag
- CP plasma is discarded (usually)
- Cryo is frozen
name of the process for making cryo
separation-insolubility at low temperatures
open system expirations
24-hour expiration at 1-6°
4-hour expiration at 20-24°
4 things required on each donor unit label
Unit number
Component code
ABO/Rh type
Expiration date
Explain parts of the unit number
W — collected in the USA
Next 4 numbers — facility code
Next 2 numbers — year
Sequential number for each unit collected in one year
00 and boxed number are for lab process control
pRBC indications (2)
symptomatic anemia
reduced O2 carrying capacity
function of glycerol in freezing RBCs
protects the RBCs from freezing injury by reducing the formation of ice crystals and preventing intracellular dehydration and volume reduction
RBC units for freezing are frozen within —- days of collection
placed in freezer within —- hours of glycerol addition
6 days
4 hours
Bacterial contamination management of —— is required
platelets
expected count for random donor platelets
> 5.5 x 10^10
storage volume of apheresis platelets
100-400 mL
explain bacterial contamination management for apheresis platelets
Blood cultures collected 24-36 hrs
Initial results for labeling after 20 hrs
apheresis platelet count
3 x 10^11
aphereis platelets approximately equal to —– random donor platelets
4-8
apheresis platelets are visually inspected for…
platelet clumps, discoloration, or excessive lipemia
platelets indications (4)
thrombocytopenia
abnormal platelet function
DIC
prevention of bleeding from bone marrow hypoplasia
expected platelet increment after one transfusion of random donor platelets
5,000 to 10,000/uL
granulocyte indications (2)
low WBC count
infection that does not respond to antibiotics
average FFP volume
250 mL
FFP indications (4)
general coagulation deficiency
liver disease
TTP
massive transfusion
only difference plasma frozen w/i 24h has from FFP in composition
reduction in levels of labile coagulation factors V and VIII
cryo indications (2)
decreased fibrinogen (DIC or massive bleeding)
secondary tx for hemophilia A & vonWillebrand disease if specific factors are not available
given for volume replacement
albumin
albumin lacks…
Ig
coagulation factors
IVIg indications
weakened immune systems (lupus, multiple sclerosis, etc)
factor concentrate indications
Factor deficiencies (FVIII, vWF, FXIII, etc)
