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BOC Review > Blood Bank > Flashcards

Blood Bank Flashcards

1
Q

Three things to be performed to donate blood?

A

-registration;n
-medical history
-physical examination

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2
Q

Collection of donor blood:

Ascetic technique, scrub site for minimum of _____ seconds with ______________.

A

30, providine-iodine scrub

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3
Q

No more than ________mL of whole blood per kilogram of body weight, including samples.

A

10.5

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4
Q

Donor interval for whole blood?

A

8 weeks (16 for double red)

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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

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6
Q

temp for blood donations cannot exceed….

A

99.5 F or 37.5 C

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7
Q

min. weight for blood donations?

A

110lb or 50k

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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

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9
Q

min. hematocrit for blood donations?

A

-greater than or equal to 38% for females
-greater than or equal to 39% for males

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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.)

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11
Q

Blood pressure for blood donations?

A

-90-180 systolic
-50-100 mmHg diastolic or medical director exception

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12
Q

Expiration with ACD/CPD/CPD2?

A

21 days

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13
Q

expiration with CPDA-1?

A

35 days

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14
Q

expiration of blood products with additives?

A

42 days

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15
Q

What do rejuvenating solutions restore?

A

2,3-DPG and ATP

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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)

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17
Q

what is the age limit for autologous donations?

A

no limit (no bacteremia)

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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

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19
Q

Autologous donations must be >_____ hours prior to surgery or transfusion.

A

72

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20
Q

Are autologous units segregated from allogeneic units?

A

yes, only used for original donor

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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

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22
Q

What three things fall under the cytapheresis category?

A

plts, granulocytes, and leukocytes

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23
Q

Cytapheresis:

Donations must be at least ____ days apart and no more than ___ in any ___ day period.

A

2, 2, 7

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24
Q

Apheresis RBC collection:

must wait ____ weeks to donate again.

A

8

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25
Q

RBC apheresis deferral is _____ weeks for two units.

A

16

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26
Q

A two-unit RBC donation must not decrease the donor’s hematocrit below ____% or hemoglobin below ___g/dL.

A

30, 10

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27
Q

Where can hematopoietic cells be collected from?

A

peripheral circulation

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28
Q

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.

A

hematopoietic progenitor and stem cells

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29
Q

hematopoietic progenitor and stem cells:

cells are obtained from…

A

bone marrow, umbilical cord blood and peripheral blood (apheresis)

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30
Q

Allogeneic marrow - HLA-identical match lowers the risk of GVHD. Is ABO compatibility required?

A

no

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31
Q

What types of tests are performed on donor blood?

A

-ABO
-Rh (weak D if needed)
-Antibody screens
-Serologic tests
-Viral diseases

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32
Q

Donor blood processing:

What can be prepared from blood with clinically significant antibodies? What cannot be prepared?

A

-plts and cryoprecipitate can (contain minimum plasma volume)
-FFP can not be prepared from these units

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33
Q

When is whole blood used?

A

rarely used
used in cases of severe shock where blood loss is greater than 25%

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34
Q

Packed Red Blood Cells”

____% hct (indicates sufficient plasma removal); _____% Hct if additive solution used.

A

80, 55-65

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35
Q

One unit of pRBCs raises Hgb by ____g/dL or hematrocrit by ___%

A

1, 3

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36
Q

changes in plasma during storage:

what is increased?
what is decreased?

A

NH4 and K+

pH and Na+

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37
Q

Unit of blood cannot be returned and reissued if greater than ________ C of if seal disturbed.

A

10

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38
Q

What is RBC washing primarily used for?

A

-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

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39
Q

When do washed RBCs expire?

A

24 hours after the seal is broken

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40
Q

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.

A

60, 50

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41
Q

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.

A

5x10^6, 51

42.5

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42
Q

Leukocyte reduced Red cells _____% of red cells retained.

A

85

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43
Q

Leukocyte-reduced Red cells:

final WBC count is less than ______ to prevent febrile nonhemolytic reactions, HLA alloimmunization, and the transmission of CMV.

A

5 x 10^6

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44
Q

leukocyte-reduced red cells are prepared by…

A

filtration during processing or at the bedside

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45
Q

What are leukocyte-reduced red cells primarily used for?

A

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

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46
Q

What is used to protect cells from ultra low temps?

A

40% glycerol

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47
Q

In what cases is glycerol-frozen cells done?

How long is it good for?

A

used for storage of autologous units and rare units

expires in 10 years.

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48
Q

What must be done before using glycerol-frozen units?

A

-thawed at 37C
-glycerol removed
-greater than 80% RBC recovery

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49
Q

what is the storage for units before and after the deglycerolization process?

A

-less than or equal to 65C
-1-6C for 24 hours after declycerolizing (open system)

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50
Q

How is FFP prepared?

A

separating cells and plasma by centrifugation and freezing plasma within 8 hours of collection

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51
Q

FFP:

expires __ years from date of collection when stored at less than 18C or ____ years when stored at less than 65C

A

1, 7

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52
Q

What is the thawing temp for FFP?

A

30-37C

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53
Q
A
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54
Q

Once FFP is thawed (between 30-37C), expires in ____hours, if stored at _____C

A

24, 1-6

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55
Q

FFP must be ________ compatible.

A

RBC (not necessarily ABO identical)

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56
Q

What is FFP used for?

A

multiple coagulation deficiencies, Factor XI deficiency, and other congenital def for which no concentrate is available.

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57
Q

FFP collection is from what population? and why?

A

males or never pregnant females to prevent TRALI

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58
Q

PF24:

Plasma frozen to less than or equal to ____C within ____ hours of collection from whole blood or apheresis.

A

-18, 24

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59
Q

PF24:

apheresis plasma kept at ____C for 24 hours and then frozen at ______C

A

1-6, less than -18

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60
Q

Cryoprecipitate is also called

A

Cryoprecipitate antihemophilic factor

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61
Q

How is cryoprecipitate formed?

A

when FFP is frozen within 8 hours of whole blood collection is thawed at 1-6C, a cold insoluble portion of plasma forms -CRYO

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62
Q

CRYO is separated from __________ and refrozen within ___ hours.

A

FFP, one

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63
Q

CRYO must contain ____ mg or greater of fibrinogen***

A

150

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64
Q

CRYO must contain ____ IU/bag or greater of factor VIII***

A

80

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65
Q

CRYO also contains…

A

vWF, ristocetin cofactor activity, Factor XIII, and fibronectin

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66
Q

What are the storage requirements for CRYO?

A

-18C or less for one year from date of phlebotomy; room temp after tawing

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67
Q

CRYO:

Transfuse within _____ hours of thawing; ____ hours after pooling in an open system; _____ hours after pooling in a closed system.

A

6

4, 6

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68
Q

CRYO is most commonly used to replace…..

A

-fibrinogen loss due to DIC and/or
-massive bleeding
-dysfibrinogenemia with active bleeding

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69
Q

What is recombinant (most common) or virally inactivated Factor VII used to treat?

A

moderate to severe Hemophilia A and von Willebrands disease (use Factor VIII labeled as containing vWF)

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70
Q

What is used to treat Hemophilia B?

A

Prothrombin complex concentrates (virally inactivated), recombinant, or virally inactivated Factor IX concentrate

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71
Q

Prothrombin complex concentrates contain vitamin-K-dependent factors: 2, 7, 9, and 10 that may increase the risk of ___________?

A

thrombosis

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72
Q

Recombinant activated Factor ______ treats Hemophilia A and B in patients with inhibitor antibodies (bypass Factor VIII in cascade) or those with Factor VII deficiency.

A

VIIa

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73
Q

What is DDAVP used to treat?
what does it increase?

A

-mild* hemophilia A and type 1 vWD
-increases circulating Factor VIII and vWF

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74
Q

What is the processing procedure for platelets from whole blood?

A

-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

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75
Q

What product is used for severe thrombocytopenia and platelet dysfunction?

A

platelets

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76
Q

Platelet products are contradicted in….

A

TTP, ITP, and heparin-induced thrombocytopenia (HIT)

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77
Q

Platelets from what donors should not be used as a “single source” (apheresis product or single unit for a newborn)

A

platelet donors who are within 48 hours of taking drugs that impair platelet function.

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78
Q

Platelet refractoriness is usually due to what?

A

antibodies to HLA class I antigens or platelet-specific antigens***

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79
Q

1 unit of platelets raises platelet count by…

1 apheresis unit raises the platelet count by…

A

5,000-10,000/uL

20,000-60,000 /uL

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80
Q

Platelets:

Transfuse within ______ hours after pooling in an open system

A

4

81
Q

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?

A

-6.2 or greater
-40-70 mL for whole blood derived platelets

82
Q

What is the min platelets per unit requirement?

A

-5.5 x10^10 or greater in 75% of platelets tested or
-3 x 10^11 platelets/plateletpheresis in 90%of units tested

83
Q

Whole blood-derived leukoreduced platelets: less than ________ leukocytes.

leukoreduced pooled platelets or platelephresis product must be less than _______ leukocytes in ____% of units tested.

A

8.3 x 10^5

5 x 10^6, 95

84
Q

What are the storage requirements for platelets?

A

continuous gentle agitation at 20-24C (room temp)

85
Q

How many days are platelets good for?

A

5 days

86
Q

True or false:

must have a method to detect and limit bacterial contamination with platelets.

A

true

87
Q

Because platelets may have residual RBCs what could be considered for some patients?

A

administrating RhIg to RhD neg women of childbearing age who have received D pos platelets

88
Q

What is used to increase granulocyte pheresis yield?

A

granulocyte colony-stimulating factor (G-CSF)

89
Q

What patients are granulocyte pheresis units used for?

A

neutropenic patients with documented gram-negative sepsis who have not responded to antibiotics

90
Q

What can happen if granulocyte pheresis units are not irradiated?

A

-transmit CMV
-induce HLA immunization
-and cause GVHD

91
Q

What are the storage requirements for granulocyte apheresis?

A

-without agitation at 20-24C for up to 24 hours
-should be transfused ASAP

92
Q

Granulocyte pheresis should be ABO-compatible, crossmatch if greater than _____mL of RBCs

A

2

93
Q

What is irradiated blood and components used for?

A

to prevent GVHD (inactivates T cells)

94
Q

List the different reasons irradiated blood components may be needed

A

-fetus receiving intrauterine transfusions
-the donor is a blood relative of recipient
-donor is HLA matched
-or congenital immunodeficiency

95
Q

Irradiated blood components:

Min of ___Gy (gray) or _____ cGy (centigray) delivered to the center of container: minimum dose of 15Gy to any point.

A

25, 2500

15

96
Q

When do irradiated components expire?

A

RBCs on the original date or 28 days after irradiation, whichever is first.

97
Q

What temp must blood and components be kept at while being transported?

A

1-10C for Red cells
20-24 for platelets and granulocytes
frozen kept frozen

98
Q

What is the expiration of blood/components when the seal is broken (packing cells or pooling components)?

A

-1-6C good for 24 hours
-20-24 good for 4 hours

99
Q

Expiration of pooled components:

Platelets: ____ hours (open system)
CRYO: ____ hours (open system) and ____ hours (closed system)

A

4
4, 6

100
Q

What A cells would be pos for ANTI-A1?

A

A1

-A2 and A3 would be negative

101
Q

What acts as an anti-A1 reagent?

A

dolichos biflorus

102
Q

What A subgroups contain less A antigen and more H antigen?

A

A3, Ax, etc.

103
Q

Lack of H antigen is called?

A

genetically hh (Bombay phenotype -Oh)

104
Q

What is needed for the attachment of A and/or B sugars?

A

H (HH or Hh)

-H is converted into A and/or B

105
Q

What blood group has the greatest amount of H? the least?

A

O, A1B

106
Q

list the blood groups in order from greatest amount of H to least amount.

A

O > A2 > B > A2B > A1 > A1B > Oh (Bombay)

107
Q

what is the phenotype of Bombay?

A

Oh

108
Q

Anti-H lectin (____________) will NOT agglutinate Bombay cells (hh) but will agglutinate O cells (HH or Hh)

A

Ulex europaeus***

109
Q

What gene allows the expression of A, B, H, and Le(b) in body fluids?

A

Se (secreter) gene

110
Q

Le antigens are __________ antigens that absorb onto red cells as individuals mature.

A

plasma

111
Q

Individuals with H and Le (but not Se gene) genes will have what on red cells? and what in saliva?

A

red cells: H and Le(a)
saliva: Le(a) only

112
Q

Se gene is not needed for the presence of _____ in saliva, but it is for _____.

A

Le(a), H

113
Q

An individual who has H, Se, and Le genes will have what on their red cells? and what in saliva?

A

H and Le(b) on the red cells
Saliva: H, Le(b), and decreased amounts of Le(a) in the body fluids

114
Q

What could be the problem if Rouleux is seen?

A

failure to wash cells

115
Q

What should you do if there is a discrepancy due to subgroups?

A

test with anti-A1 for A subgroups

116
Q

What will Bombay not agglutinate with?

A

Anti-H

will agglutinate with A1, and B cells, Group O screening cells

117
Q

What can be done in the case of increased serum proteins that cause Rouleux? (ex: MM or Waldenstrom’s)

A

saline replacement

118
Q

What are the IgM antibodies?

A

I, H,
M, N
P1
Lea, leb

119
Q

What are the IgG antibodies?

A

D, C, c, E, e
M (some),
K, k
Fya, Fyb
Jka, Jkb

120
Q

Why is Rh null (no D, C, E, c, e) associated with hemolytic anemia?

A

Rh structure is integral part of RBC membrane

121
Q

Anti-C, -c, -E, -e react stronger with ________ treated cells.

A

enzyme

122
Q

Can Lewis antibodies cause HDFN?

A

DO NOT cause HDFN (usually IgM)

123
Q

Lewis antibodies are frequently seen in ___________ who may temp. become Le(a-b-)

A

pregnant women

124
Q

Is I and i alleles?

A

no

125
Q

I may mask clinically significant alloantibody?

A

yes

126
Q

Remove anti-I to detect underlying antibodies by….

A

-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
Q

P1 antigen strength deteriorates upon ________.

A

storage

128
Q

P1 substance is in what type of fluid?

A

hydatid cyst fluid

129
Q

What anti-P can be neutralized to reveal other clinically significant alloantibodies?

A

anti-P1 (NOT anti-P)

130
Q

Anti- ____

Autoantibody- IgG; Donath-Landsteiner biphasic antibody found in Paroxysmal Cold Hemoglobinuria

A

Anti-P

131
Q

Anti-P reacts with all….

A

P or P1 cells

132
Q

True or false?

M/N and S/s are not codominant alleles?

A

false. They are codominant alleles

133
Q

Will M and N antigens react with enzyme treated cells?

A

no. Will NOT react with enzyme treated cells (destroyed by enzymes)

134
Q

Anti-M may require __________ of serum to identify.

A

acidification

135
Q

Anti-M:

Many examples are _______ and can cause _______

A

IgG, HDFN

136
Q

Anti-S and Anti-s are Ig___

A

G (also anti-U)

137
Q

Anti-U is typically formed by what individuals?

A

by African Americans who lack S, s, and U

138
Q

K and k are _____________ alleles

A

codominant

139
Q

______% of people are K negative

A

91

140
Q

Kell antigens are inactivated with….

A

2-ME, DTT, or AET

141
Q

JKa and JKb are __________ alleles.

A

codominant

142
Q

associated with delayed transfusion reactions

A

KIDD

143
Q

____% of African Americans are Fy(a-b-) or FyFy

A

68

144
Q

____________-homozygous for Fya (FyaFya)

A

Caucasians

145
Q

___________-probably heterozygous for Fya (FyaFy); can cause dosage problems.

A

African Americans

146
Q

What is enhanced by enzymes?

A

Kidd, I, P1, Lewis, and Rh

147
Q

What is destroyed by enzymes?

A

Duffy, M, N, S, and s

148
Q

What could a positive autocontrol mean?

A

-may indicate a delayed transfusion reaction
-if pos along with all panel cells, autoantibody may be indicated

149
Q

When can prewarmed technique be used? what is the purpose?

A

-after proving no clinically significant antibodies also present
-eliminate reactions due to cold antibodies

150
Q

What are the steps for prewarmed technique?

A

-warm serum and cells separately to 37C before mixing together
-wash with warm saline prior to further testing (crossmatch panel, etc)

151
Q

what does PEG do?

A

-increases antibody uptake; removes water which increases antibody concentration which promotes antibody uptake

152
Q

What antigens are exposed by enzymes?

A

-Kidd
-Rh
-Lewis
-I
-P1

153
Q

What antigens are destroyed by enzymes?

A

-Fya, Fyb
-M, N, S (s variable when using in house treated cells)

154
Q

What is absent from cord cells?

A

I, Lewis, and Sda

155
Q

What are the most common compliment binding antibodies?

A

-Anti-I
-Anti-Lea and Leb

(IgM)

156
Q

What antibodies exhibits dosage?

A

-Kidd
-Duffy
-Rh
-M, N, S, s

157
Q

What are the cold reacting antibodies?

A

-Lewis
-H
-I
-P1
-M, N

158
Q

What are the warm reacting antibodies?

A

-Rh seen at 37C
-Kell, Duffy, Kidd, S, and s (warm but go further to antiglobulin testing)

159
Q

DAT:

antiglobulin added to ________cells

A

3-4 washed cells

160
Q

What is the purpose of adding check cells when doing a DAT?

A

proves AHG was added and not neutralized due to insufficient washings

161
Q

(pos DAT) Protein Coating Red Cell with Autoimmune Hemolytic Anemia?

Warm autoantibodies (WAIHA)?

A

IgG and/or complement

162
Q

(pos DAT) Protein Coating Red Cell with Autoimmune Hemolytic Anemia?

Cold Hemagglutinin Disease (CHD)?

A

Complement

163
Q

(pos DAT) Protein Coating Red Cell with Autoimmune Hemolytic Anemia?

Mixed type AIHA?

A

IgG and Complement

164
Q

(pos DAT) Protein Coating Red Cell with Autoimmune Hemolytic Anemia?

Paroxysmal Cold Hemoglobinuria (PCH)?

A

Complement

165
Q

(pos DAT) Protein Coating Red Cell with drug induced hemolytic anemia (DIHA)?

A

IgG and/or complement

166
Q

(pos DAT) Protein Coating Red Cell with…
-Hemolytic disease of the newborn
-Transfusion Reaction

A

IgG

167
Q

this procedure breaks antigen-antibody bonds to release the antibody into solution

A

elutions

168
Q

purpose of elutions?

A

-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
Q

True or false:

cannot elute off complement

A

true

170
Q

What eluate method is used for ABO antibodies?

A

Lui freeze-thaw

171
Q

What should be done prior to elution?

A

red cells should be thoroughly washed to remove any residual serum (antibody)

172
Q

What should be done before performing elution or in parallel with eluate?

A

Test “last wash” (supernatant)

*last wash should show NO reactivity with reagent cells

173
Q

What does pos test results using “last wash” indicate?

A

-serum antibody contamination of supernatant
-If performed before elution, wash again, if performed in parallel, test is invalid, repeat.

174
Q

Sda substance is most abundant in _______.

A

urine

175
Q

Neutralization allows detection of alloantibodies “masked” by what antibodies?

A

-Lewis substance
-P1 substance
-Sda
-Chido and Rodgers substances

176
Q

Inactivation:

What destroys or weakens Kell systems antigens?

A

AET and DTT

177
Q

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

A

ZZap: enzyme + DTT

178
Q

what destroys or diminishes activity of IgM antibodies-cleaves disulfide bonds

A

DTT and 2-ME

179
Q

What does Chloroquine diphosphate do?

A

-removes IgG from RBCs (does not remove complement)
-With IgG removed, cells can be phenotyped
-may cause some denaturation of Rh antigens

180
Q

How does acid glycine/EDTA work as an inactivator?

A

-dissociates antibodies RBCs
-destroys Kell system antigens

181
Q

What are absorptions used for?

A

-separate multiple antibodies
-remove autoantibody-reveal alloantibody “masked” by autoantibody
-confirm antigen existence on RBC
-Confirm antibody specificity

182
Q

What is autoadsorption?

A

(patients own serum and cells) can be used for patients not recently transfused

183
Q

What is allogeneic adsorptions?

A

(patients serum and other cells) can be used on patients recently transfused

184
Q

Pretransfusion testing:

reattain sample and an RBC segment for ___ days after transfusion.

A

7

185
Q

When would a crossmatch need to be carried through to 37C incubation with AHG?

A

if current antibody screen positive or prior history of clinically significant antibodies

186
Q

How to find the probability of antigen negative units?

A

multiply by antigen neg (converted to decimal)

if need 3 units do 3/X = to probability, then solve for X

187
Q

True or false:

In an emergency, D pos can be administered if no D neg is available.

A

true. RhIg should follow especially if the recipient is a women of child bearing age.

188
Q

What is a key characteristic of extravascular hemolytic transfusion reaction (delayed)?

A

Pos DAT

189
Q

symptoms of TRALI

A

-acute respiratory insufficiency
-bilateral pulmonary edema by x ray without cardiac failure
-chills
-fever
-hypotension
-may be accompanied with transient neutropenia or leukopenia

190
Q

What causes TRALI to happen?

A

-caused by antibodies in the DONOR to neutrophils or HLA antigens: occasionally caused by antibodies in recipient

191
Q

What is the cause of TRALI?

A

donor antibody to recipient HLA or neutrophil antigens

192
Q

HDFN:

What is a critical titer for most antibodies?
for anti-K?

A

16, 8

193
Q

What are the requirements for blood that is used in intrauterine transfusion?

A

-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
Q

Exchange transfusion:

what are acceptable samples for crossmatch?

A

-maternal sample
-eluate from infant’s cells
-infant serum/plasma

195
Q

What blood preservative is needed for neonatal transfusions?

A

CPDA-1

196
Q

If rossette screening test is pos what testing should be done?

A

-Kleihauer-Betke acid elution
-flow cytometry

to quantify maternal bleed

197
Q

KB test:

fetal cells resist acid elution and appear ______.

A

pink

-adult cells are ghost cells

198
Q
A

BOC Review (3 decks)

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