BLOOD BANK Flashcards
Replacement fluids used for therapeutic plasmapheresis (plasma exchange)
NSS, NSA, PPF, FFP
Therapeutic plasmapheresis helps remove the offending agents in cases of:
Paraproteinemia (e.g. Multiple Myeloma, Waldenstrom Macroglobulinemia, etc.)
Familial Hypercholesterolemia, etc.
Therapeutic __________ is beneficial in diseases that involves malfunction of the immune system (SLE, RA)
Plasmapheresis
Therapeutic indication:
Treat various complications of Sickle cell disease, such as priapism and impending stroke
Also in pxs with severe parasitic infections from malaria and babesia
Erythrocytapheresis
Therapeutic Indications:
for young pxs with certain hematologic disorders especially thalassemia syndromes
Neocytapheresis
Therapeutic Indications:
means of producing immunosuppression in conditions like RA, SLE, Kidney transplant rejection and autoimmune and alloimmunedisease.
Lymphocytapheresis
Therapeutic Indications:
Used to treat patients with leukemia such as Hairy cell leukemia, AML, Cutaneous T cell lymphoma
Leukapheresis
Leukapheresis wbc content:
> 100,000/uL
administered to the donors 12-24 hours before leukapheresis to increase the number of circulating granulocytes by pulling them from the marginal pool
corticosteroids
Sedimenting agent used for granulocyte collection which causes red cells to form rouleaux thus allowing wbcs to be harvested more efficiently
HES (Hydroxyethyl starch)
Therapeutic Indications: Used to treat patients who have abnormally elevated platelet counts such as in cases of Polycythemia vera
Plateletpheresis
Plateletpheresis is equivalent to _____ random platelet concentrates
6-10 random platelet concentrate
Contents of plateletpheresis:
3x10^11
Indications:
GVH reactions
BM transplant
Direct donation from a blood relative
Exchange transfusion
IUT
transfusion for immunocompromised patients
Irradiated blood
Target cells for irradiated blood
Lymphocytes
Cell responsible for the graft vs host reaction for immunocompromised patients
T-cells
Elements used for blood irradiation:
Cesium 137
Cobalt 60
Shelf life of Irradiated blood
28 days
Immunosuppressant that prevents antibody reaction of mother to prevent HDFN
Rho (D) Ig (Rhogam)
Shelf life of Rhogam
3 years
Storage temp of Rhogam
1-6 deg C
Indication:
Prevention of Rho (D) immunization
Given to Rh negative mothers due to incompatible pregnancy
Rho (D) Ig (Rhogam)
Full dose of Rhogam
300 ug Anti-D
Administration of Rhogam: Full dose
3rd trimester; full term delivery, 3 days after delivery
300 ug Anti-D can neutralize ____ of whole blood and ___ mL of PRBC FMH - fetomaternal hemorrhage/bleeding
30/15
Mini dose of Rhogam
50 ug Anti-D
Administration of Rhogam: Mini Dose
ectopic rupture, amniocentesis, miscarriage of rH negative (first born child)
Mini Dose of Rhogam can neutralize ____ mL of whole blood and ___ mL of FMH - fetomaternal hemorrhage/bleeding
5/2.5 mL
Synthetic Volume Expanders: Crystalloids (REN)
Ringer’s lactate
Electrolyte solution
NSS
Synthetic Volume Expanders: Colloids (HD)
Dextran
Hydroxyethyl Starch (HES)
Indication: Plasma volume expansion
Plasma protein fraction
Contents of Plasma protein fraction:
80-85% albumin
15-20% globulin
Shelf life of Plasma Protein Fraction at 20-24 deg C
3 years
Shelf life of Plasma Protein Fraction at 1-6 deg C
5 years
Indications:
Plasma volume expansion:
surgery
trauma
burns
Normal Serum Albumin (NSA)
Shelf life of Normal Serum Albumin (NSA) at 20-24 deg C
3 years
Shelf life of Normal Serum Albumin (NSA) at 1-6 deg C
5 years
Content of NSA:
96% albumin
4% globulin
Indication:
prophylactic treatment to pxs exposed to hepatitis, measles, or chicken pox; treatment of congenital hypogammaglobulinemia
Immune Serum Globulin
Immune Serum Globulin (ISG) shelf life: Intramuscular
3 years
Immune Serum Globulin (ISG) shelf life: Intravenous
1 year
Factor IX Concentrate (Prothrombin complex) shelf life:
varies on expiration date on vial
Factor IX Concentrate (Prothrombin complex) storage temperature:
1-6 deg C (lyophilized)
Indication: Hemophilia B
Factor IX Concentrate (Prothrombin complex)
Indication: Hemophilia A
Factor VIII concentrate
Storage temp for Factor VIII concentrate
1-6 deg C lyophilized
Factor VIII concentrate shelf life
varies on expiration date on vial
Are concentrates of plasma proteins that are prepared from pools (many units) of plasma
Plasma derivatives
Indications: correct severe neutropenia, fever unresponsive to antibiotic therapy, and myeloid hypoplasia of the bone marrow
Granulocyte concentrate
Granulocyte concentrate shelf life:
24 hours
Granulocyte concentrate storage temp:
20-24 deg C without agitation
Contents of granulocyte concentrate:
1 x 10^10 wbc
Indications: Hemophilia A, vWF disease, Fibrinogen deficiency, Factor XIII deficiency
Cryoprecipitate
Cryoprecipitate content: Factor VIII:C
80-150 IU
Cryoprecipitate content: Factor VIII: vWF
40-70%
Cryoprecipitate content: Fibrinogen
150-250 mg
Cryoprecipitate content %: Factor XIII
20-30%
Storage temp: Frozen Cryoprecipitate
-18 deg C or colder
Storage temp: Thawed Cryoprecipitate
20-24 deg C
Shelf life Cryoprecipitate: Frozen
1 year
Shelf life Cryoprecipitate: Thawed
6 hours
Shelf life Cryoprecipitate: Pooled
4 hours
Fibrin glue is made with
Equal volume of cryoprecipitate and thrombin reagent
Active factors in cryoprecipitate
Factor I (fibrinogen) and XIII (fibrin stabilizing factor)
Promotes fibrin clot formation
Thrombin
Stabilizing factor in cryoprecipitate
FACTOR XIII
Used to stop further bleeding and other hemorrhagic conditions to the site of surgery
Fibrin glue
Indication: Treatment of stable clotting factor deficiencies
Single donor plasma (SDP) Liquid/Frozen
Single donor plasma (SDP) Liquid: Shelf-life and Storage
5 days beyond whole blood expiration
1-6 deg C
Single donor plasma (SDP) Frozen: Shelf life and Storage
5 years; -18 deg C or colder
Indication: Treatment of multiple coagulation factor deficiencies (caused by massive transfusion, trauma, liver dse, DIC). Also for treatment of antithrombin III deficiency, TTP, HUS
Fresh Frozen Plasma (Single Donor, prepared from whole blood)
Frozen plasma is thawed at water bath at: _____
37 deg C
Fresh Frozen Plasma (Single Donor, prepared from whole blood) Shelf life and Storage temperature: Frozen
1 year at -18 deg C
Fresh Frozen Plasma (Single Donor, prepared from whole blood) Thawed at Room temperature shelf life:
6 hours
Storage of Fresh Frozen Plasma (Single Donor, prepared from whole blood) Thawed at Room Temp:
6 hours
Fresh Frozen Plasma (Single Donor, prepared from whole blood): -65 deg C shelf life:
up to 7 years
Contents: Fresh Frozen Plasma (Single Donor, prepared from whole blood)
All coagulation factors; 400 mg Fibrinogen
Platelet additive solution:
Intersol
Intersol can extend shelf life of platelets from
5-7 days
Contents of platelets single donor prepared by pheresis:
3.0 x 10^11 platelets in approx. 300 mL of plasma
Indications: Thrombocytopenia; for pxs refractory to random plts. Due to platelet antibodies
Platelets (Single donor prepared by pheresis)
Shelf life of platelets closed system
5 days
Shelf life of platelets open system
24 hours
Storage temp for platelets
20-24 deg C with constant agitation
Platelet concentrate immediate effect: increase platelet count by
5,000 to 10,000 per uL/unit
Indications: Thrombocytopenia, DIC, Platelet disorders, Bleeding
Platelet concentrate
Contents of platelet concentrate:
5.5 x 10^10 platelets in 50-70 mL of plasma
Storage temp for platelet concentrate:
20-24 deg C with constant agitation
Shelf life of platelet concentrate
3 to 5 days (5 days with continuous agitation)
pH of platelet concentrate
pH >= 6.2
Plasma volume of platelet concentrate:
50-70 mL
Indications: anemia, long term storage of “rare” units and/or autologous units
Frozen < Thawed < Deglycerolized RBCs
Frozen RBC also known as
cryoprotected red blood cell, glycerolized RBC
Frozen < Thawed < Deglycerolized RBCs: Frozen shelf life
10 years (longest)
Deglycerolized RBC shelf life
24 hours
Utilizes low molecular weight agent
Penetrating cryoprotective agent
Most common penetrating cryoprotective agent:
glycerol
Actions of glycerol:
Protects the cell membrane for extremely cold temperature storage
Prevents ice crystal formation in the cell
Prevents dehydration
Utilizes high molecular weight
Non-penetrating cryoprotective agent
Most commonly used non-penetrating cryoprotective agent
HES- Hydroxyethyl Starch
Action of non-penetrating cryoprotective agent
protects the cell surface from extremely low temperature
Storage temperature for freezing: Mechanical freezer (High Glycerol: 40%)
-65 deg C
Mechanical freezer in Deglycerolized RBCs additive
79% glycerol with dextrose fructose and EDTA
Storage temperature for freezing: Mechanical Freezer (low glycerol: 20%)
-120 deg C
Liquid Nitrogen Freezer
Temperature for Deglycerolizing Process
1-6 deg C
First wash procedure hypertonic cell shrinkage to remove glycerol from the cell membrane
percentage of saline solution
12% saline solution
Second wash: (hypertonic)- used to completely remove glycerol from cells without modification
percentage of saline
1.6% saline solution
Physiologic agent to provide additional source of ATP and does not change cell morphology:
0.2% dextrose in normal saline solution
Minor crossmatch is no longer used and is replaced with
antibody screening
Indications: anemia with history of febrile reactions
PNH (paroxysmal nocturnal hemoglobinuria)
for pxs with plasma proteins antibodies to reduce allergic reactions (for IgA- deficient pxs)
Washed Red Blood Cells
Shelf life of Washed Red Blood Cells open system:
24 hours
QC requirement for washed red blood cells
Plasma removal
the only FDA approved rejuvenation solution
Rejuvesol
To restore expired donor units
Rejuvenated Red Blood Cell
PIPA for Rejuvenated RBCs
Phosphate, Inosine, Pyruvate, Adenosine
Shelf life of Rejuvenated Red Blood Cells
can be prepared 3 days after expiration date
Storage temp for Rejuvenated RBCs
1-6 deg C
First generation filters
170 um
Second Generation Filters
20-40 um
Third generation filters
3-log filter
Cells that are able to pass through filters
normal platelets, normal RBCs
WBC that are sized are RBCs
Steps in leukocyte removal
1.Centrifugation
2.Washing procedures using saline or glycerol
3.Mechanical separation using leukoreduction filters (most effective)
Indications: Anemia with history of febrile reactions; to decrease alloimmunization to WBC or HLA antigens or CMV transmission
Leukopoor Red Blood Cells
Contents of Leukopoor Red Blood Cells
5 x 10^6 residual WBC
Storage temp for Leukopoor Red Blood Cells
1-6 deg C
Open system shelf life for Leukopoor Red Blood Cells
24 hours
Immediate effect of PRBC transfusion
↑ Hematocrit by 3% ; ↑Hemoglobin by 1g
Indication: Restore oxygen carrying capacity (anemia)
Packed Red Blood Cell
Contents of PRBCs
Hematocrit should be 80% or less
Shelf life of PRBC in CPD, ACD, CP2D
21 days (3 weeks)
Storage temp of PRBCs
1-6 deg C
Shelf life of PRBC in CPDA1
35 days
Shelf life of PRBC in CPD-AS1, AS3, AS5
42 days
Shelf life of PRBC in Heparin
2 days
Components of Red Blood Cell Additive solution: (SAG-M)
Saline
Adenine
Glucose
Mannitol
Result of a failed blood transfusion:
No increase in hematocrit
Immediate effect of a successful whole blood transfusion:
↑ hematocrit by 1-3%
at least 70% of RBC remains viable after patient transfusion
Indications: active bleeding, hemmorhagic shock, exchange transfusion. Both oxygen-carrying capacity and volume expansion are required
Whole blood
WBC and PLT are no longer viable after _______
24 hours of storage
Labile factors significantly decrease after ____ of storage
2 days
Labile factors that decreases after 2 days of storage
FV, FVIII
Whole blood shelf life in CPD, ACD, CP2D
21 days (3 weeks)
Whole blood shelf life in CDPAS1, AS3, AS5
42 DAYS
Most commonly used additive in whole blood
CPDA1
PLASMA PRODUCTS: (FFCS)
Fresh Frozen Plasma (FFP)
Frozen Plasma (FP)
Cryoprecipitate
Stored Plasma
Platelet Products (2)
Platelet Rich Plasma (PRP)
Platelet Concentrates (PC)
Oxygen Carrying Component Products (3)
Red cell concentrates
Leukocyte-poor red blood cells
Frozen-thawed red cells
Whole blood collected should be processed at _____
6 to 8 hours
ACD anticoagulant processing time:
6 hours
CPDA-1, CPD, CP2D processing period:
8 hours
Decreased coagulation factors in cryosupernate:
FI (fibrinogen)
FVIIIc
FXIII
vWF
fibronectin
Present factors in Cryoprecipitate:
FI (fibrinogen)
FVIIIc
FXIII (fibrin clot stabilizing factor)
vWF
Fibronectin
Fresh frozen plasma is transferred at ref temp for thawing __________ component
cryoprecipitate
Platelet agitation is done to _________
prevent aggregation
Hard/Heavy Spin is done to obtain:
Platelet Poor Plasma (Upper portion)
Platelet concentrate (lower portion)
Soft Spin to whole blood:
PRBC
Platelet rich plasma
Frozen component transport:
Transported with dry ice
RBC components transport:
Wet ice
Platelet and WBC components transport
Without ice
Storage for:
Platelet concentrate with continuous agitation
WBC or granulocyte concentrate
Room temperature (20-24 deg C)
Components stored at Freezer temperature (-20 deg C or colder)
Plasma containing components:
Fresh Frozen Plasma
Cryoprecipitate
Frozen Red Blood Cell
Storage temperature for Red Blood Cell Components:
Whole blood
PRBC
Washed Red blood cell
Liquid plasma
Refrigerator temperature (1.5 deg C to 5.5 deg C)
Blood Bank Refrigerator is maintained at _____
1-6 deg C
Blood Bank Refrigerator quality control: maintain the temperature at
+/- 0.5 deg C
Used for cleaning site for blood donation:
PVP iodine complex
PVP iodine complex should cover ______ of the site
4 cm
PVP apply in all direction for ____ seconds
30
Alternative to iodine:
chlorhexidine gluconate solution
alternative to iodine and chlorhexidine gluconate solution:
70% isopropyl alcohol
Velcro application to the site:
3 to 4 inches above the site
Needle gauge for blood collection
16 gauge
Amount of blood collected during blood donation:
450 to 500 mL
Blood donation average time of collecting blood
10 minutes
Patient with clotted blood unit during blood connection, the ff blood units are not allowed:
Plasma component
Platelet component
Soft spin time and RPM
3000 rpm at 2 to 3 minutes
Soft spin is performed on
whole blood
Soft spin is performed to obtain
Platelet Rich Plasma (PRP)
Packed Red Blood cell components
Hard spin time and RPM
Time and RPM: 3500-3600 RPM for 5 minutes
Hard spin is performed on:
Platelet Rich Plasma (PRP)
Hard Spin is done to obtain
Platelet Poor Plasma
Platelet Concentrate
Most common cause of death associated with transfusion
Transfusion-related acute lung injury (TRALI)
Transfusion-associated circulatory overload (TACO)
Transmission-transmitted bacterial infections (TTBIs)
“the collection of information on the complications of transfusion, analysis of these data, and subsequent data-driven improvements in transfusion practices.”
Hemovigilance
The development of non-ABO anti - bodies following RBC transfusion, pregnancy, or transplantation.
Alloimmunization
Healthy blood donors have an incidence of alloimmunization of ____
less than 3 %
30% or greater alloimmunization is seen in chronically transfused patients with: SMAT
Sickle cell disease
Myelodysplastic syndrome
Thalassemia
Autoimmune hemolytic disease
Accelerated destruction of transfused RBCs due to antibody-mediated incompatibility.
Acute Hemolytic Transfusion Reaction (AHTR)
Most common symptom in AHTR and often occurs with chills or rigors
Fever
Acute kidney injury is usually detected biochemically by elevated
Bood urea nitrogen (BUN)
Main causes of renal dysfunction after hemolysis
Shock and Disseminated intravascular coagulation (DIC)
A positive DAT 24 hours to 28 days after transfusion with either a positive eluate or a newly identified alloantibody in the plasma or serum and evidence of hemolysis
Delayed Hemolytic and Serologic Transfusion Reaction (DHTR)
Defined as the same serologic findings as DHTR but without evidence of hemolysis
Delayed serologic transfusion reaction (DSTR)
DHTR appears ______ post transfusion
7-10 days
Rare event associated with acute respiratory distress but a leading cause of mortality due to adverse reactions to transfusion
Transfusion-Related Acute Lung Injury (TRALI)
Second most common cause of transfusion related deaths
Transfusion-Associated Circulatory Overload (TACO)
Diagnosed when dyspnea occurs within 24 hours after transfusion and all other diagnoses are excluded
Transfusion-Associated Dyspnea (TAD)
A nonspecific sign that could be seen in a variety of other transfusion reactions or as part of the patient’s underlying condition
Hypotensive Transfusion Reaction
One of the most common adverse transfusion reactions
defined as fever greater than 100.4°F (38°C) or a change of at least 1.8°F (1.0°C) from the pretransfusion level occurring during or within 4 hours after the end of the transfusion or chills and/or rigors are present
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
Mimic more serious and severe transfusion reactions, such as, AHTR, TRALI, TACO, and transfusion-transmitted bacterial infection.
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
Most common reactions seen with platelet and plasma transfusions, occurring in about 2% of transfused platelets, and are second to FNHTRs in RBC transfusions
Allergic Transfusion Reactions (ATRs)
Are generally mild to moderate reactions and refer to signs and symptoms limited to the skin and gastrointestinal tract
Allergic reactions
Moderately severe reactions that include oral and throat symptoms, more severe GI symptoms, and respiratory complaints
Anaphylactoid reactions
Severe, life-threatening reactions in which there is profound hypotension and shock.
Anaphylactic reactions
It i used for managing mild cutaneous reactions
Diphenhydramine
Associated with severe hypotensive reactions in patients receiving ACE inhibitors
Albumin
A rare but devastating event with a very high mortality rate compared to other transfusion reactions
Transfusion-Associated Graft-Versus-Host Disease
A rare transfusion reaction in which there is a severe and sudden drop in the platelet count, usually occurring 5 to 10 days after transfusion due to alloimmunization to platelet-specific antibodies from prior transfusion or pregnancy
Post transfusion Purpura
Most frequent infection associated with transfusion
Transfusion-Transmitted Bacterial Infections (TTBI)
