Blood Bank Flashcards
1
Q
Three things to be performed to donate blood?
A
-registration;n
-medical history
-physical examination
2
Q
Collection of donor blood:
Ascetic technique, scrub site for minimum of _____ seconds with ______________.
A
30, providine-iodine scrub
3
Q
No more than ________mL of whole blood per kilogram of body weight, including samples.
A
10.5
4
Q
Donor interval for whole blood?
A
8 weeks (16 for double red)
5
Q
Blood donations:
-MD must evaluate medications
-medications taken within _____hours that irreversibly affect platelet function (i.e. aspirin) may not be used as the only source for platelets but can be part of a platelet pool.
A
48
6
Q
temp for blood donations cannot exceed….
A
99.5 F or 37.5 C
7
Q
min. weight for blood donations?
A
110lb or 50k
8
Q
min. hgb for blood donations?
A
-greater than or equal to 12.5g/dl for females
-greater than or equal to 13.0g/dl for males
9
Q
min. hematocrit for blood donations?
A
-greater than or equal to 38% for females
-greater than or equal to 39% for males
10
Q
what is the min and max age for blood donations?
A
-min 16 years or conform to state law
-no max (evaluate by M.D.)
11
Q
Blood pressure for blood donations?
A
-90-180 systolic
-50-100 mmHg diastolic or medical director exception
12
Q
Expiration with ACD/CPD/CPD2?
A
21 days
13
Q
expiration with CPDA-1?
A
35 days
14
Q
expiration of blood products with additives?
A
42 days
15
Q
What do rejuvenating solutions restore?
A
2,3-DPG and ATP
16
Q
What are the storage requirements with rejuvenating solutions?
A
-can freeze unit
-or if used within 24 hours can be stored at 1-6C
-cells must be washed before transfusion (to remove solution)
17
Q
what is the age limit for autologous donations?
A
no limit (no bacteremia)
18
Q
min hct and hgb levels for autologous donations?
A
Hct greater than or equal to 33%
Hgb greater than or equal to 11 g/dl
19
Q
Autologous donations must be >_____ hours prior to surgery or transfusion.
A
72
20
Q
Are autologous units segregated from allogeneic units?
A
yes, only used for original donor
21
Q
Autologous donations:
______mL drawn, label as “Red Blood Cells Low Volume” (other components may not be made from these units.
A
300-400
22
Q
What three things fall under the cytapheresis category?
A
plts, granulocytes, and leukocytes
23
Q
Cytapheresis:
Donations must be at least ____ days apart and no more than ___ in any ___ day period.
A
2, 2, 7
24
Q
Apheresis RBC collection:
must wait ____ weeks to donate again.
A
8
25
RBC apheresis deferral is _____ weeks for two units.
16
26
A two-unit RBC donation must not decrease the donor's hematocrit below ____% or hemoglobin below ___g/dL.
30, 10
27
Where can hematopoietic cells be collected from?
peripheral circulation
28
This is used to reconstitute bone marrow post-chemotherapy/irradiation or replace abnormal marrow cells with normal marrow cells (congenital immune deficiencies, anemias, malignant disorders of bone marrow, red cell disorders, etc.
hematopoietic progenitor and stem cells
29
hematopoietic progenitor and stem cells:
cells are obtained from...
bone marrow, umbilical cord blood and peripheral blood (apheresis)
30
Allogeneic marrow - HLA-identical match lowers the risk of GVHD. Is ABO compatibility required?
no
31
What types of tests are performed on donor blood?
-ABO
-Rh (weak D if needed)
-Antibody screens
-Serologic tests
-Viral diseases
32
Donor blood processing:
What can be prepared from blood with clinically significant antibodies? What cannot be prepared?
-plts and cryoprecipitate can (contain minimum plasma volume)
-FFP can not be prepared from these units
33
When is whole blood used?
rarely used
used in cases of severe shock where blood loss is greater than 25%
34
Packed Red Blood Cells"
____% hct (indicates sufficient plasma removal); _____% Hct if additive solution used.
80, 55-65
35
One unit of pRBCs raises Hgb by ____g/dL or hematrocrit by ___%
1, 3
36
changes in plasma during storage:
what is increased?
what is decreased?
NH4 and K+
pH and Na+
37
Unit of blood cannot be returned and reissued if greater than ________ C of if seal disturbed.
10
38
What is RBC washing primarily used for?
-To prevent allergic response to plasma proteins and anaphylactic shock in IgA-deficient patients with anti-IgA (IgA is in normal plasma)
-removes anti-HPA-la from maternal blood used to neonatal transfusions; removes complement
39
When do washed RBCs expire?
24 hours after the seal is broken
40
Apheresis Red Blood Cells:
hemoglonin should be greater than or equal to ___g in individual units or greater than or equal to ____g in 95% of units tested.
60, 50
41
Apheresis Red Blood Cells:
leukoreduced must be less than ________ leukocytes/unit with final hgb of greater than or equal to _____g in individual units or greater than _____g in 95% of units tested.
5x10^6, 51
42.5
42
Leukocyte reduced Red cells _____% of red cells retained.
85
43
Leukocyte-reduced Red cells:
final WBC count is less than ______ to prevent febrile nonhemolytic reactions, HLA alloimmunization, and the transmission of CMV.
5 x 10^6
44
leukocyte-reduced red cells are prepared by...
filtration during processing or at the bedside
45
What are leukocyte-reduced red cells primarily used for?
patients with repeated febrile nonhemolytic (FNH) reactions; usually due to the presence of cytokines released from white cells or alloimmunization to HLA or leukocyte antigens
46
What is used to protect cells from ultra low temps?
40% glycerol
47
In what cases is glycerol-frozen cells done?
How long is it good for?
used for storage of autologous units and rare units
expires in 10 years.
48
What must be done before using glycerol-frozen units?
-thawed at 37C
-glycerol removed
-greater than 80% RBC recovery
49
what is the storage for units before and after the deglycerolization process?
-less than or equal to 65C
-1-6C for 24 hours after declycerolizing (open system)
50
How is FFP prepared?
separating cells and plasma by centrifugation and freezing plasma within 8 hours of collection
51
FFP:
expires __ years from date of collection when stored at less than 18C or ____ years when stored at less than 65C
1, 7
52
What is the thawing temp for FFP?
30-37C
53
54
Once FFP is thawed (between 30-37C), expires in ____hours, if stored at _____C
24, 1-6
55
FFP must be ________ compatible.
RBC (not necessarily ABO identical)
56
What is FFP used for?
multiple coagulation deficiencies, Factor XI deficiency, and other congenital def for which no concentrate is available.
57
FFP collection is from what population? and why?
males or never pregnant females to prevent TRALI
58
PF24:
Plasma frozen to less than or equal to ____C within ____ hours of collection from whole blood or apheresis.
-18, 24
59
PF24:
apheresis plasma kept at ____C for 24 hours and then frozen at ______C
1-6, less than -18
60
Cryoprecipitate is also called
Cryoprecipitate antihemophilic factor
61
How is cryoprecipitate formed?
when FFP is frozen within 8 hours of whole blood collection is thawed at 1-6C, a cold insoluble portion of plasma forms -CRYO
62
CRYO is separated from __________ and refrozen within ___ hours.
FFP, one
63
CRYO must contain ____ mg or greater of fibrinogen***
150
64
CRYO must contain ____ IU/bag or greater of factor VIII***
80
65
CRYO also contains...
vWF, ristocetin cofactor activity, Factor XIII, and fibronectin
66
What are the storage requirements for CRYO?
-18C or less for one year from date of phlebotomy; room temp after tawing
67
CRYO:
Transfuse within _____ hours of thawing; ____ hours after pooling in an open system; _____ hours after pooling in a closed system.
6
4, 6
68
CRYO is most commonly used to replace.....
-fibrinogen loss due to DIC and/or
-massive bleeding
-dysfibrinogenemia with active bleeding
69
What is recombinant (most common) or virally inactivated Factor VII used to treat?
moderate to severe Hemophilia A and von Willebrands disease (use Factor VIII labeled as containing vWF)
70
What is used to treat Hemophilia B?
Prothrombin complex concentrates (virally inactivated), recombinant, or virally inactivated Factor IX concentrate
71
Prothrombin complex concentrates contain vitamin-K-dependent factors: 2, 7, 9, and 10 that may increase the risk of ___________?
thrombosis
72
Recombinant activated Factor ______ treats Hemophilia A and B in patients with inhibitor antibodies (bypass Factor VIII in cascade) or those with Factor VII deficiency.
VIIa
73
What is DDAVP used to treat?
what does it increase?
-mild* hemophilia A and type 1 vWD
-increases circulating Factor VIII and vWF
74
What is the processing procedure for platelets from whole blood?
-light spin to remove red cells followed by heavy centrifugation to spin down platelets and white cells.
-express supernatant plasma into another bad for freezing (FFP)
-remove plasma, platelets, and white cells = platelets
75
What product is used for severe thrombocytopenia and platelet dysfunction?
platelets
76
Platelet products are contradicted in....
TTP, ITP, and heparin-induced thrombocytopenia (HIT)
77
Platelets from what donors should not be used as a "single source" (apheresis product or single unit for a newborn)
platelet donors who are within 48 hours of taking drugs that impair platelet function.
78
Platelet refractoriness is usually due to what?
antibodies to HLA class I antigens or platelet-specific antigens***
79
1 unit of platelets raises platelet count by...
1 apheresis unit raises the platelet count by...
5,000-10,000/uL
20,000-60,000 /uL
80
Platelets:
Transfuse within ______ hours after pooling in an open system
4
81
What is the min pH for platelets at the end of storage?
What is it stored with to maintain this pH and how much is used?
-6.2 or greater
-40-70 mL for whole blood derived platelets
82
What is the min platelets per unit requirement?
-5.5 x10^10 or greater in 75% of platelets tested or
-3 x 10^11 platelets/plateletpheresis in 90%of units tested
83
Whole blood-derived leukoreduced platelets: less than ________ leukocytes.
leukoreduced pooled platelets or platelephresis product must be less than _______ leukocytes in ____% of units tested.
8.3 x 10^5
5 x 10^6, 95
84
What are the storage requirements for platelets?
continuous gentle agitation at 20-24C (room temp)
85
How many days are platelets good for?
5 days
86
True or false:
must have a method to detect and limit bacterial contamination with platelets.
true
87
Because platelets may have residual RBCs what could be considered for some patients?
administrating RhIg to RhD neg women of childbearing age who have received D pos platelets
88
What is used to increase granulocyte pheresis yield?
granulocyte colony-stimulating factor (G-CSF)
89
What patients are granulocyte pheresis units used for?
neutropenic patients with documented gram-negative sepsis who have not responded to antibiotics
90
What can happen if granulocyte pheresis units are not irradiated?
-transmit CMV
-induce HLA immunization
-and cause GVHD
91
What are the storage requirements for granulocyte apheresis?
-without agitation at 20-24C for up to 24 hours
-should be transfused ASAP
92
Granulocyte pheresis should be ABO-compatible, crossmatch if greater than _____mL of RBCs
2
93
What is irradiated blood and components used for?
to prevent GVHD (inactivates T cells)
94
List the different reasons irradiated blood components may be needed
-fetus receiving intrauterine transfusions
-the donor is a blood relative of recipient
-donor is HLA matched
-or congenital immunodeficiency
95
Irradiated blood components:
Min of ___Gy (gray) or _____ cGy (centigray) delivered to the center of container: minimum dose of 15Gy to any point.
25, 2500
15
96
When do irradiated components expire?
RBCs on the original date or 28 days after irradiation, whichever is first.
97
What temp must blood and components be kept at while being transported?
1-10C for Red cells
20-24 for platelets and granulocytes
frozen kept frozen
98
What is the expiration of blood/components when the seal is broken (packing cells or pooling components)?
-1-6C good for 24 hours
-20-24 good for 4 hours
99
Expiration of pooled components:
Platelets: ____ hours (open system)
CRYO: ____ hours (open system) and ____ hours (closed system)
4
4, 6
100
What A cells would be pos for ANTI-A1?
A1
-A2 and A3 would be negative
101
What acts as an anti-A1 reagent?
dolichos biflorus
102
What A subgroups contain less A antigen and more H antigen?
A3, Ax, etc.
103
Lack of H antigen is called?
genetically hh (Bombay phenotype -Oh)
104
What is needed for the attachment of A and/or B sugars?
H (HH or Hh)
-H is converted into A and/or B
105
What blood group has the greatest amount of H? the least?
O, A1B
106
list the blood groups in order from greatest amount of H to least amount.
O > A2 > B > A2B > A1 > A1B > Oh (Bombay)
107
what is the phenotype of Bombay?
Oh
108
Anti-H lectin (____________) will NOT agglutinate Bombay cells (hh) but will agglutinate O cells (HH or Hh)
Ulex europaeus***
109
What gene allows the expression of A, B, H, and Le(b) in body fluids?
Se (secreter) gene
110
Le antigens are __________ antigens that absorb onto red cells as individuals mature.
plasma
111
Individuals with H and Le (but not Se gene) genes will have what on red cells? and what in saliva?
red cells: H and Le(a)
saliva: Le(a) only
112
Se gene is not needed for the presence of _____ in saliva, but it is for _____.
Le(a), H
113
An individual who has H, Se, and Le genes will have what on their red cells? and what in saliva?
H and Le(b) on the red cells
Saliva: H, Le(b), and decreased amounts of Le(a) in the body fluids
114
What could be the problem if Rouleux is seen?
failure to wash cells
115
What should you do if there is a discrepancy due to subgroups?
test with anti-A1 for A subgroups
116
What will Bombay not agglutinate with?
Anti-H
will agglutinate with A1, and B cells, Group O screening cells
117
What can be done in the case of increased serum proteins that cause Rouleux? (ex: MM or Waldenstrom's)
saline replacement
118
What are the IgM antibodies?
I, H,
M, N
P1
Lea, leb
119
What are the IgG antibodies?
D, C, c, E, e
M (some),
K, k
Fya, Fyb
Jka, Jkb
120
Why is Rh null (no D, C, E, c, e) associated with hemolytic anemia?
Rh structure is integral part of RBC membrane
121
Anti-C, -c, -E, -e react stronger with ________ treated cells.
enzyme
122
Can Lewis antibodies cause HDFN?
DO NOT cause HDFN (usually IgM)
123
Lewis antibodies are frequently seen in ___________ who may temp. become Le(a-b-)
pregnant women
124
Is I and i alleles?
no
125
I may mask clinically significant alloantibody?
yes
126
Remove anti-I to detect underlying antibodies by....
-autoabsorption (if not recreantly transfused)
-RESt adsorption
-using IgG AHG instead of polyspecific
-prewarming- use with caution; can result in decreased activity of some clinically significant antibodies or cause weak antibodies to be missed
127
P1 antigen strength deteriorates upon ________.
storage
128
P1 substance is in what type of fluid?
hydatid cyst fluid
129
What anti-P can be neutralized to reveal other clinically significant alloantibodies?
anti-P1 (NOT anti-P)
130
Anti- ____
Autoantibody- IgG; Donath-Landsteiner biphasic antibody found in Paroxysmal Cold Hemoglobinuria
Anti-P
131
Anti-P reacts with all....
P or P1 cells
132
True or false?
M/N and S/s are not codominant alleles?
false. They are codominant alleles
133
Will M and N antigens react with enzyme treated cells?
no. Will NOT react with enzyme treated cells (destroyed by enzymes)
134
Anti-M may require __________ of serum to identify.
acidification
135
Anti-M:
Many examples are _______ and can cause _______
IgG, HDFN
136
Anti-S and Anti-s are Ig___
G (also anti-U)
137
Anti-U is typically formed by what individuals?
by African Americans who lack S, s, and U
138
K and k are _____________ alleles
codominant
139
______% of people are K negative
91
140
Kell antigens are inactivated with....
2-ME, DTT, or AET
141
JKa and JKb are __________ alleles.
codominant
142
associated with delayed transfusion reactions
KIDD
143
____% of African Americans are Fy(a-b-) or FyFy
68
144
____________-homozygous for Fya (FyaFya)
Caucasians
145
___________-probably heterozygous for Fya (FyaFy); can cause dosage problems.
African Americans
146
What is enhanced by enzymes?
Kidd, I, P1, Lewis, and Rh
147
What is destroyed by enzymes?
Duffy, M, N, S, and s
148
What could a positive autocontrol mean?
-may indicate a delayed transfusion reaction
-if pos along with all panel cells, autoantibody may be indicated
149
When can prewarmed technique be used? what is the purpose?
-after proving no clinically significant antibodies also present
-eliminate reactions due to cold antibodies
150
What are the steps for prewarmed technique?
-warm serum and cells separately to 37C before mixing together
-wash with warm saline prior to further testing (crossmatch panel, etc)
151
what does PEG do?
-increases antibody uptake; removes water which increases antibody concentration which promotes antibody uptake
152
What antigens are exposed by enzymes?
-Kidd
-Rh
-Lewis
-I
-P1
153
What antigens are destroyed by enzymes?
-Fya, Fyb
-M, N, S (s variable when using in house treated cells)
154
What is absent from cord cells?
I, Lewis, and Sda
155
What are the most common compliment binding antibodies?
-Anti-I
-Anti-Lea and Leb
(IgM)
156
What antibodies exhibits dosage?
-Kidd
-Duffy
-Rh
-M, N, S, s
157
What are the cold reacting antibodies?
-Lewis
-H
-I
-P1
-M, N
158
What are the warm reacting antibodies?
-Rh seen at 37C
-Kell, Duffy, Kidd, S, and s (warm but go further to antiglobulin testing)
159
DAT:
antiglobulin added to ________cells
3-4 washed cells
160
What is the purpose of adding check cells when doing a DAT?
proves AHG was added and not neutralized due to insufficient washings
161
(pos DAT) Protein Coating Red Cell with Autoimmune Hemolytic Anemia?
Warm autoantibodies (WAIHA)?
IgG and/or complement
162
(pos DAT) Protein Coating Red Cell with Autoimmune Hemolytic Anemia?
Cold Hemagglutinin Disease (CHD)?
Complement
163
(pos DAT) Protein Coating Red Cell with Autoimmune Hemolytic Anemia?
Mixed type AIHA?
IgG and Complement
164
(pos DAT) Protein Coating Red Cell with Autoimmune Hemolytic Anemia?
Paroxysmal Cold Hemoglobinuria (PCH)?
Complement
165
(pos DAT) Protein Coating Red Cell with drug induced hemolytic anemia (DIHA)?
IgG and/or complement
166
(pos DAT) Protein Coating Red Cell with...
-Hemolytic disease of the newborn
-Transfusion Reaction
IgG
167
this procedure breaks antigen-antibody bonds to release the antibody into solution
elutions
168
purpose of elutions?
-determine antibody specificity in cases of pos DAT due to IgG antibody(ies)
e.g, hemolytic transfusion reactions, HDFN, autoimmune and drug-induced hemolytic anemia
169
True or false:
cannot elute off complement
true
170
What eluate method is used for ABO antibodies?
Lui freeze-thaw
171
What should be done prior to elution?
red cells should be thoroughly washed to remove any residual serum (antibody)
172
What should be done before performing elution or in parallel with eluate?
Test "last wash" (supernatant)
*last wash should show NO reactivity with reagent cells
173
What does pos test results using "last wash" indicate?
-serum antibody contamination of supernatant
-If performed before elution, wash again, if performed in parallel, test is invalid, repeat.
174
Sda substance is most abundant in _______.
urine
175
Neutralization allows detection of alloantibodies "masked" by what antibodies?
-Lewis substance
-P1 substance
-Sda
-Chido and Rodgers substances
176
Inactivation:
What destroys or weakens Kell systems antigens?
AET and DTT
177
What destroys Kell antigens and those antigens destroyed by enzymes (M, N, S, s, Fya, and Fyb); can remove immunoglobulins and complement from RBCs to enhance absorption
ZZap: enzyme + DTT
178
what destroys or diminishes activity of IgM antibodies-cleaves disulfide bonds
DTT and 2-ME
179
What does Chloroquine diphosphate do?
-removes IgG from RBCs (does not remove complement)
-With IgG removed, cells can be phenotyped
-may cause some denaturation of Rh antigens
180
How does acid glycine/EDTA work as an inactivator?
-dissociates antibodies RBCs
-destroys Kell system antigens
181
What are absorptions used for?
-separate multiple antibodies
-remove autoantibody-reveal alloantibody "masked" by autoantibody
-confirm antigen existence on RBC
-Confirm antibody specificity
182
What is autoadsorption?
(patients own serum and cells) can be used for patients not recently transfused
183
What is allogeneic adsorptions?
(patients serum and other cells) can be used on patients recently transfused
184
Pretransfusion testing:
reattain sample and an RBC segment for ___ days after transfusion.
7
185
When would a crossmatch need to be carried through to 37C incubation with AHG?
if current antibody screen positive or prior history of clinically significant antibodies
186
How to find the probability of antigen negative units?
multiply by antigen neg (converted to decimal)
if need 3 units do 3/X = to probability, then solve for X
187
True or false:
In an emergency, D pos can be administered if no D neg is available.
true. RhIg should follow especially if the recipient is a women of child bearing age.
188
What is a key characteristic of extravascular hemolytic transfusion reaction (delayed)?
Pos DAT
189
symptoms of TRALI
-acute respiratory insufficiency
-bilateral pulmonary edema by x ray without cardiac failure
-chills
-fever
-hypotension
-may be accompanied with transient neutropenia or leukopenia
190
What causes TRALI to happen?
-caused by antibodies in the DONOR to neutrophils or HLA antigens: occasionally caused by antibodies in recipient
191
What is the cause of TRALI?
donor antibody to recipient HLA or neutrophil antigens
192
HDFN:
What is a critical titer for most antibodies?
for anti-K?
16, 8
193
What are the requirements for blood that is used in intrauterine transfusion?
-group O-
-neg for antigen to which maternal antibody is directed and crossmatch compatible with maternal serum
-irradiated
-CMV seronegative donor or leukoreduced
-neg for HgbS
-less than 7 days old
194
Exchange transfusion:
what are acceptable samples for crossmatch?
-maternal sample
-eluate from infant's cells
-infant serum/plasma
195
What blood preservative is needed for neonatal transfusions?
CPDA-1
196
If rossette screening test is pos what testing should be done?
-Kleihauer-Betke acid elution
-flow cytometry
to quantify maternal bleed
197
KB test:
fetal cells resist acid elution and appear ______.
pink
-adult cells are ghost cells
198
