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Diagnostic Studies > Blood Bank > Flashcards

Blood Bank Flashcards

1
Q

Important Immunoglobulins in Blood Testing

(2, explain)

A
  1. IgG - will cause transfusion rxns (at 37%)
  2. IgM - significant in ABO antibodies
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2
Q

Complete Antibody

(define, most common)

A

Define: antibodies that are able to directly agglutinate RBC suspended in saline via compliment binding

Type: Usually IgM, esp when dealing c ABO rxns

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3
Q

Lethal Volume of Transfused ABO Incompatible Bld

A

30 cc, depending on the person

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4
Q

Expected Results of ABO Grouping

(testing c Anti-A, Anti-B, A cells, B cells)

A

See chart. Labs have anti-A, antigen, anti-B atigen, known A cells and known B cells on hand for testing

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5
Q

Pretransfusion Testing

(3 tests)

A
  1. ABO typing, both forward and reverse
    • ​screening test
  2. Rh Typing (D Typing)
    • ​screening test
  3. Antibody Screens/Compatibility testing (crossmatch)
    • This test will detect clinically significant Antibodies 99% of the time!
      • Expected antibodies: anti-A and anti-B
      • Unexpected antibodies: varies, usually only c prior transfusions or pregnancy
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6
Q

D/RhO Screening

A

Test for Rh/D antigen on RBC. Second most immunogenic antigen that can be transfused

Results:

  • Rh positive individuals have the D antigen on their RBC
  • Rh negative individuals do not have D antigen
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7
Q

Crossmatch Testing

(defintion, results)

A

**Definition: **Testing patient (pt) serum against donor red cells (donated blood from the population)

**Results: **Evidence of agglutination or hemolysis indicates incompatible donor unit for that patient
​

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8
Q

Blood Bag Segments

A

Tubes on the top of the blood bag that allows for small extractions of blood for compatibility testing.

second to the left in picture

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9
Q

RBC Ab Work-up

A
  1. Conduct the screening test. This test contains 12 different common antibody tests
  2. If the pt’s blood is positive for one of the antigens the test will be positive. Further testing will result in attempt to identify the specific antigen.
  3. After specific antigenic identification, test donor units that lack the antigen to the ab present in pt

*Ease of finding antigen compatible units depends on frequency of antigen in donor population. Red Cross holds units of blood c rare antibodies that you can request. *

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10
Q

Antigen Freuquencies

(For anti-K, anti-Lub, Anti-c/E/Fya)

A
  • Anti - K: 10%
  • Anti Lub: 99.8%
  • Anti-c, E, Fya: 80%, 30%, and 66% resp.
    • Together, 5 units out of 100
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11
Q

Blood Type Percentages

(8 blood types, relative frequency is more impt than numbers)

A
  1. O Rh Pos = 38%
  2. A Rh Pos = 34%
  3. B Rh Pos = 9%
  4. O Rh Neg = 7%
  5. A Rh Neg = 6%
  6. B Rh Neg = 2%
  7. AB Rh Pos = 3%
  8. AB Rh Neg = 1%
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12
Q

Blood Screening Result Duration

A

Pt’s antibody screening lasts 3 days. Repeat transfusers must screen every time.

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13
Q

Component Testing

(define, advantage)

A

Definition – use particular component of blood for specific need

Advantages – conserve blood, facilitate optimum treatment

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14
Q

Processing for Bld Components

(vehicle, 4 separated components)

A
  • Vehicle - Blood bags
    • Use permitted centrifugation and separation of components
      • centrifuge temp varies c desired component
    • Sterilized during manufacture
  • Separation into:
    • Packed cells
    • Plasma
    • Platelets
    • Cryoprecipitate
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15
Q

Whole Blood Transfusion

(volume, HCT, shelf life)

A

Volume: 400-550 ml plus 63 ml of CPD (Citrate, phosphate, dextrose, anticoagulant)

Hematocrit (HCT): 36-44%, ideally try to match pt

Shelf life: dependent on the anti-coagulant/preservative used

  • shortest = 21 d
  • avg = 42 d
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16
Q

RBC Transfusion Indications

(Hgb levels, s/sx)

A
  • General guidelines for transfusion
    • Hgb < 7 g/mL
      • Symptomatic
      • Recent/active bleeding
      • Hx of cerebro/cardiovascular disease
    • Hgb > 10g/dL and increased oxygen consumption, e.g. sepsis
  • Signs and symptoms supporting need for transfusion
    • Syncope
    • Angina
    • Dyspnea
    • Tachycardia
    • Rapid fall in Hgb (active bleeding)
17
Q

RBC Transfusion

(origin, 3 indications, dose)

A

Origin: Prepared from whole blood

Indications:

  1. Restores blood volume and O2 carrying capacity
  2. Actively bleeding with > 25% blood loss
  3. Increase red cell mass

Dose and administration:

  • 1g/dL Hgb or 3% Hct increase (adults)
  • 8mL/kg – 1g/dL Hgb increase (peds)

Most things on the shelf are packed RBC (Exception analogous (self) transfusion in surgery)

18
Q

Packed RBC Administration Requirements

(4)

A
  1. ABO and Rh compatible c pt
  2. Transfuse 4 hours; use filter
    • ​if transfusion is not complete in 4 hrs, stop and dispose of extra bld
  3. May hang units with NS, albumin or plasmanate
  4. NEVER WITH D5W, LACTATED RINGERS OR MEDICATION
    • D5W creates hypotnic situation
    • Lactated ringers will have calcium in it, coagulation imminent
19
Q

Leukoreduced RBC

(definition, preparation, indications)

A

**Definition: **Leukoreduced blood <5 X 106 WBC/unit (Regular PRBC - 1-3 x 109 WBC/unit)

**Preparation: **Accomplished by filtration at the collection center

Indications:

  1. prevent febrile nonhemolytic reactions
  2. reduce HLA alloimmunization (rxn in pt)
  3. prevent TA-CMV infection (these viruses reside in WBC)
20
Q

Washed RBC Transfusion

(definition, preparation, shelf life, indications)

A

Definition: RBC that are literally cleaned before infusion to produce the following qualities

  • 70-80% Hct
  • 98% plasma free
  • Reduced leukocytes, platelets

Preparation: 20 min wash in NS. Some facilities have a washer on hand but if not the Red Cross will do it

Shelf Life: 24 hrs (10-12% red cell loss)

Indications: pts c recurrent/severe allergix rxns to plasma pro

21
Q

Frozen, deglycerolized RBC

(def, prep, indications)

A

Definition: cytoprotected cells frozen to preserve blood for longer periods of time

Prep:

  • Add glycerol as a cryoprotectant (prevents ice crystals from forming in RBC)
  • Stored -65º C for 10 years
  • Thaw and wash with saline/glucose solution to remove glycerol
    • results in washed RBC unit!
  • 70-80% Hct
  • 24 hour shelf life
    • REQUIRES AT LEAST 4 HOURS EXTRA TIME TO PROCESS

Indications:

  1. Long term preservation
  2. Autologous donations – rare, only if surgery is postponed. May be only about 6 months of storage
22
Q

Irradicated PRBC

(definition, shelf life, indication)

A

Definition: Packed cells treated to innoculate T-lymphocyte DNA (c 1500-3000 RADS)

Shelf Life: 28 days or the shortest outdate of the unit because it damages the RBC membrane

Indication: Prevent graft vs host disease (GVHD). Common recipients include

  1. Intrauterine transfusions
  2. Neonates <1200 g
  3. Congenital immunodeficiency
  4. Bone marrow transplant recipients
  5. Blood from blood relatives

Picture shows indication of irradiation. Non-irradiated will say “NO” in the black box

23
Q

Graft vs Host Disease

A

T lymphocytes from donor get into recipients tissues and recognize them as foreign and start to break down the host’s tissue.

Pts look burned and the GI tract gets really badly mangled

24
Q

Cytomegalovirus Transfusion Safety

(indications, prep)

A

Indications: Prevent TA-CMV infection from a seropositive donor. Usually the following pts

  1. CMV seronegative mother
  2. Bone marrow transplant recipients
  3. Solid organ transplants

Prep: To create a seronegative sample, leukoreducing reduces risk to 0.3%

25
Q

Platelet Transfusion

(2 prep types, #platelets/unit, shelf life for one)

A
  1. CONCENTRATES
    • From centrifuged whole blood
    • ~5.5 x 1010 plts/unit (50 ml)
    • Shelf Life: 5 days, stored at RT with constant agitation
    • Pooling 5 units reduces shelf life to 4 hours
  2. APHERESIS
    • From single donor
    • ~3x1011 plts/unit (200-400 ml)
26
Q

Apheresis

(Define)

A

Selective blood collection technique. Machine separates out desired blood element and transfuses the rest back into the donor

27
Q

Platelet Transfusion

(prep, dose)

A

Prep:

  • ABO compatible preferred
  • Irradiation to prevent GVHD
  • Leukoreduction

Dose: Pool of 5 units or 1 apheresis platelet will raise the platelet count 25,000 – 50,000 µL (nml = 150,000 - 400,000)

28
Q

Platelet Refractoriness

(define, 6 causes)

A

Define: platelet admin c initial plt increase followed by decrease to pre-transfusion levels

Causes:

  1. bleeding
  2. fever
  3. sepsis
  4. DIC
  5. medications
  6. splenomegaly
29
Q

Fresh Frozen Plasma Transfusion

(prep/storage, volume per unit, dosage)

A

Prep/storage: separate and freeze plasma from whole blood within 8 hrs of collection. Remain at -18ºC for up to one year

Volume: 200-250 ml/unit

Dosage: Weight based calculation, 10-20 ml/kg (most pts take b/w 2 and 4 units, depending on condition)

30
Q

Thawed Plasma

(3 indications, 3 contraindications, 4 monitoring techniques)

A

Indications:

  1. Bleeding
  2. Multiple coagulation deficiencies (like liver disease)
  3. Congenital factor deficiency and no factor concentrate available

Contraindications: because plasma may carry disease

  1. Hemophilia
  2. Nutritional support
  3. Volume expansion

dose and administration varies upon clinical situation but should be ABO compatible. Monitor c the following

  1. Pro-time
  2. aPTT
  3. INR
  4. Specific factor assays
31
Q

Cryoprecipitate

(5 contents, prep, 2 indications, dose/admin)

A

Contents:

  1. Factor VIII (80 IU)
  2. Fibrinogen (150 mg)
  3. vWF (vonWillibrand’s factor) (Factor VIII)
  4. Factor XIII
  5. Fibronectin

Prep: Separated from frozen - thawed plasma that was stored at -18ºC for up to 1 yr

Indications:

  1. 2nd line therapy for vonWillibrand disease and Hemophilia A (factor VIII)
  2. Fibrinogen

Dose/admin:​

  • 1 unit – increase fibrinogen 5 mg/dL (adult)
  • ABO compatible preferred but not necessary
  • Usually given in pools of ten for adult dose
32
Q

Transfusion Truggers

(for RBC, Platelet, Plasma, and Cryoprecipitate transfusions)

A

RBC - Hgb < 7 g/dL

Platelets - dose varies c counts under 10,000, 20,000, or 50,000

Plasma - prolonged PT/PTT

Cryoprecipitate - inappropriate fibrinogen level

33
Q

General Infusion Instructions

(5)

A
  1. Blood products are stored at the proper temperatures
  2. The intended recipient must be properly identified
  3. Sterility must be maintained
  4. Blood components are transfused through a standard filter (170-260-micron filter)
  5. Transfusion must be completed within 4 hours of time it is signed out of the blood bank.

Diagnostic Studies (11 decks)

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