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Blood Bank > Blood Bank Exam 4 > Flashcards

Blood Bank Exam 4 Flashcards

1
Q

What blood types can an A- person receive?

A

A neg and O neg

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2
Q

What blood types can an A+ person receive?

A

A pos, A neg, O pos, O neg

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3
Q

What are the 6 steps to ensure patient safety for pre-transfusions?

A
  1. Positive patient identification
  2. Review of blood bank history
  3. ABO, Rh, Antibody screen must agree with history
  4. Selection of ABORh compatible donor red cells
  5. Perform crossmatch
  6. Compatible units must be labeled properly
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4
Q

Every blood bank sample is good for ____ hours.

A

72 (3 days)

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5
Q

What is a crossmatch?

A

Patient plasma mixed with donor red cells to detect ABO incompatibilities

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6
Q

What is an immediate spin crossmatch vs extended spin crossmatch?

A

Immediate spin will detect ABO incompatibilities while extended spins will detect antibody incompatibilities.

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7
Q

When can you perform an electronic cross match?

A

When a patient has no current/history of clinically significant antibodies and they have 2 ABO/Rh tests on file.

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8
Q

What must be included on a properly labeled compatible unit?

A

Name, MRN, Unit number, Unit ABORh, Patient ABORh, Expiration date, Product type, and Compatibility status

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9
Q

What are 2 things a compatible crossmatch will NOT guarentee?

A
  • Normal survival of transfused cells
  • Will not prevent immunization of recipient
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10
Q

What are 4 causes for an incompatible crossmatch?

A
  1. Incorrect ABO of donor or patient
  2. Allo-antibody in the patient that reacts against an antigen on the donor cells
  3. Auto anitbody that reacts against antigen donor cells
  4. Positive DAT in donor
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11
Q

During an emergency release, what blood types will you give?

A

Group specific if available, if not give group O.

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12
Q

During emergency release of blood product, what would you give to young women and children?

A

O-

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13
Q

During emergency release of blood product, what would you give to males and females over childbearing ages?

A

O+

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14
Q

T/F: Blood is crossmatched before an emergency release.

A

FALSE; blood is crossmatched after blood has already been given.

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15
Q

Emergency release blood is at the discretion of the blood banker (T/F).

A

False; it is at the discretion of the physician and you need written consent.

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16
Q

Why should you always retain a segment of blood from issued donor unit during an emergency release?

A

There is a retrospective T/S + crossmatch performed after the blood has already been issued. If incompatibility is found, notify doctor and BB physician.

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17
Q

What is an MTP?

A

Massive Transfusion Protocol: a total volume exchange of blood within a 24 hour period.

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18
Q

Average male has ___-___ units of blood in circulation.

A

10-12

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19
Q

How long must you maintain recipient specimen and donor samples for post MTP?

A

7 days

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20
Q

What do you give during a massive transfusion protocol?

A

pRBCs, FFP, Cryo, and platelets

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21
Q

What is an autologous unit?

A

Patients donate their own RBC for a procedure and it is transfused back into that patient when required.

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22
Q

T/F: Autologous units can be used for patients other than the one who donated them.

A

FALSE; if the blood is not used for the patient who donated them, they must be discarded.

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23
Q

Why do you only do forward typing on neonatal transfusions <4 months of age?

A

they are unable to produce their own antibodies. Look at maternal reverse type for antibodies.

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24
Q

During transfusion of neonates, if the maternal antibody screen is negative, what do you give them?

A

ABO/Rh compatible syringes from initial unit with no repeat screens on current admission

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25
Q

During transfusion of neonates, if the maternal antibody screen is positive, what do you give them?

A

Antigen negative units and ABO/Rh compatible

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26
Q

Neonatal RBC transfusions are given in a _________.

A

Syringe (aliquot from mother/main unit)

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27
Q

What are the special standards for neonatal transfusion?

A
  • Forward typing only
  • Must be less than 7 days old
  • O neg blood or compatible with mother and infant
  • CMV-negative and leukocyte-reduced/irradiated
  • Hemoglobin S negative for hypoxic newborns
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28
Q

What is the dose for the transfusion of a neonate?

A

10 mL/kg over 2 to 3 hours

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29
Q

What are the requirements for the reissue of blood back to the blood bank?

A

Must be within 10 degrees C and within 30 minutes of issue; must have at least one segment of the donor tubing attached to the container; container closure has not been disturbed

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30
Q

What is MSBOS?

A

Maximum Surgical Blood Order Schedule; establishes realistic blood ordering levels for certain procedures based off OR needs

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31
Q

When is MSBOS problematic?

A

When inventory is low with active traumas that also need blood

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32
Q

If a sample is received at 8/22/22 at 6:09 pm, when does the sample expire?

A

8/25/22 at 11:59 pm.

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33
Q

What is the expiration date of a normal T/S specimen in the blood bank?

A

3 days

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34
Q

Someone with blood type B neg needs a transfusion. List the order of blood in preference of issue.

A

B neg, O neg

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35
Q

Someone with A+ blood needs a transfusion. List the order of blood in preference of issue.

A

A+, A neg, O pos, O neg

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36
Q

Someone with AB+ blood needs a transfusion. List the order of blood in preference of issue.

A

AB+, AB neg, A pos, A neg, B pos, B neg, O pos, O neg

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37
Q

What are unexpected antibodies?

A

Antibodies other than those that naturally occur or that are expected to detect (like anti B for an A blood type)

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38
Q

What are autoantibodies?

A

Antibodies that react with antigens present on the antibody producer’s red cells - violates Landsteiner’s rule

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39
Q

Cold auto-antibodies

A

React at or below RT (IgM)

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40
Q

Warm auto-antibodies

A

React best at 37C (IgG)

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41
Q

What is the DAT/AC results expected to be if a person has an autoantibody?

A

Positive

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42
Q

What is the purpose of an antibody screen?

A

To detect (yes or no) if antibodies are present.

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43
Q

When would you perform an antibody screen and what tube type would they come in?

A

EDTA lavender top or SST red top; perform prior to transfusion

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44
Q

What are the reagent cells in antibody screns?

A

Group O cells

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45
Q

Is an antibody screen an IAT or DAT?

A

IAT

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46
Q

What is an antibody screen?

A

Patient plasma/serum mixed with reagent RBCs using in-vitro sensitization to look for the presence of antibodies

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47
Q

What are the 3 phases of testing for an antibody screen?

A

Immediate spin/room temp –> IgM
37 C –> IgG
AHG and CC (If AHG reaction is negative)

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48
Q

What are enhancement medias LISS and PEG used for?

A

During 37C and AHG testing for antibodies to increase antibody binding

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49
Q

What to do next after positive antibody screen?

A

Antibody panel –> Antigen typing –> Crossmatching

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50
Q

T/F: Positive antibody screen is a critical result.

A

TRUE: nurse/doctor should be notified of a delay if blood products are needed

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51
Q

What is an ABID and what does it tell us?

A

An antibody identification panel that uses 10-20 type O panel cells telling us which antibody is present

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52
Q

What is an autocontrol?

A

Patient cells mixed with patient serum to determine auto-antibodies (AC = positive if autoantibodies present)

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53
Q

What are the 4 different enzymes available to treat cells?

A

Ficin, Papain, Trypsin, Bromelin

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54
Q

What enzymes will denature Kell?

A

DTT to make ZZAP

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55
Q

What antibodies are enhanced by enzymes?

A

Rh, Kidd, Lewis, I, P

56
Q

What antibodies are destroyed by enzymes?

A

M, N, S, Duffy

57
Q

What antibodies are unaffected by Ficin, Bromelin, Trypsin, and Papain?

A

Kell

58
Q

LISS vs PEG

A

LISS increases rate of antibody uptake
PEG concentrates the antibody in the test environment in LISS

59
Q

What are adsorptions for?

A

Remove unwanted antibody from serum or plasma like cold or warm autoantibody

60
Q

Alloadsorption

A

Tested with cells of known phenotype, other than the patients cells

61
Q

Auto-adsorptions

A

Tests with the patients cells, Ab/Ag complexes removed and repeat

62
Q

Adsorptions can be combined with ________ for increased antibody recovery and testing.

A

Elution studies

63
Q

What do elutions do?

A

Remove antibodies bound to RBCs for ID and testing and can be removed by acid or freezing

64
Q

When are elutions used?

A

On Positive DAT or AC with recent transfusion history

65
Q

What serves as the QC during elutions?

A

Buffer washes are used to prepare the RBCs and the last buffer wash must be saved for QC. Last wash must be negative for eluate to be valid.

66
Q

Elutions are helpful for suspected _____ and _______.

A

HDFN and AIHA

67
Q

Adsorptions vs elutions

A

Adsorptions remove antibody from serum/plasma.
Elutions remove antibody from RBCs.

68
Q

Acid elution

A

Uses digitonin, RBCs are destroyed, IgG can be collected from supernatant

69
Q

Lui-Freeze elution

A

Freeze cells to hemolyze them; RBCs lyse during freeze thaw (not as common, not as good)

70
Q

How to perform a rule out:

A

Only perform rule outs on negative reactions and then perform homozygous antigen rule outs.

71
Q

Exceptions to Kell antigen during rule outs

A

Finding a homozygous K is difficult, so must have 2-3 heterozygous negatives to rule out K

72
Q

T/F: In ABID rule outs, if more than one phase of reactivity was performed like in tube, then all phases must be evaluated if there is any differences in reactivity between the 3 phases

A

True

73
Q

What is the rule of 3?

A

Used after you have determined the antibody’s specificity; must have 3 negative and 3 positive reactions for the antibody you think is causing the reactivity.

74
Q

Having to use another panel to find another cell to satisfy the rule of three are known as _______

A

select cells

75
Q

When would you use select cells?

A

When you need more donor cells to identify the antibody or more cells are needed to satisfy the rule of three

76
Q

What do you do next if the antibody ID is known or partially known?

A

Use a new panel and use donor cells that are negative for the antibody’s reactivity but are also homozygous positive for the antigens you want to rule out OR
use select cells that are positive or negative for the antibodies’ specificity to complete the rule of 3

77
Q

What do you do next if the antibody ID unknown after the first panel?

A

Run a new panel of cells for additional rule outs

78
Q

Positive AC vs Negative AC

A

Positive AC = autoantibody
Negative AC = alloantibody

79
Q

If the AC is positive, what is ordered? What if that is also positive?

A

DAT is ordered after positive AC. If DAT is positive and the patient was recently transfused, elution may be indicated.

80
Q

DAT: in vivo or In vitro?
AC: in vivo or in vitro?

A

DAT in vivo
AC in vitro

81
Q

After confirming the antibody from an ABID, what do you do next?

A

Perform antigen typing if the patient has not been transfused within the past 3 months

82
Q

What is the formula to determine # of antigen units to type?

A

units = the number of request units/the negative antigen frequency per antibody

83
Q

The most feared hazard of blood transfusions is ________.

A

hemolysis

84
Q

Intravascular hemolysis

A

Antibody initiates attachment of complement to the cell membrane and cells lyse in the blood stream (bad hemolysis)

85
Q

Which antibodies are great complement activators?

A

IgM

86
Q

____ antibodies are capable of intravascular hemolysis.

A

ABO

87
Q

Extravascular hemolysis

A

Antibody remains attached as immunoglobulins on the surface of circulating cells; Complement sequence goes no further than the attachment of C3b (better controlled hemolysis)

88
Q

List the acute transfusion reactions

A

Acute hemolytic transfusion reaction
Febrile, non-hemolytic reaction
Allergic reaction
Bacterial contamination
Anaphylactic reaction
Transfusion associated circulatory overload
Transfusion related acute lung injury

89
Q

Acute hemolytic transfusion reaction

A

Intravascular hemolysis due to activation of Complement; usually due to ABO incompatibility through negligence or clerical error

90
Q

DAT results in acute hemolytic transfusion reaction

A

Positive DAT

91
Q

Diagnosis of acute hemolytic transfusion reaction

A

Positive DAT, decreased Hgb, Increased bilirubin, decreased haptoglobin

92
Q

What is the most common type of transfusion reaction?

A

Febrile, non-hemolytic reactions

93
Q

What is febrile, non-hemolytic reaction?

A

Acute reaction caused by HLA antibodies present in recipient’s plasma against antigens on transfused WBCs and/or platelets

94
Q

T/F: Febrile, non-hemolytic reactions are more common in men.

A

False- more common in women because of exposure to more antigens during pregnancy

95
Q

DAT in febrile, non-hemolytic reactions

A

DAT negative

96
Q

How to prevent and treat febrile, non-hemolytic reactions?

A

Leukoreduced blood products to prevent; antipyretics to treat

97
Q

Allergic reaction transfusion reaction

A

Acute; due to allergen present in donor plasma that elicits an immune response

98
Q

DAT/hemolysis in allergic reaction transfusion reaction?

A

Negative DAT; no hemolysis

99
Q

Symptoms of allergic reaction transfusion RXN?

A

erythema and pruritus

100
Q

Bacterial contamination or Transfusion Associated Sepsis (3 infection routes)

A
  1. during donor phlebotomy
  2. during component preparation
  3. pre-existing infection in the donor
101
Q

When is bacterial contamination in transfusions more common?

A

Room temperature products (aka platelets)

102
Q

What bacteria can survive blood products and can be associated with bacterial contamination during a transfusion?

A

Yersinia, Pseudomonas, Serratia

103
Q

Diagnosis of bacterial contamination during transfusion

A

Negative DAT, gram stain blood bag, culture blood bag, culture patient

104
Q

How to prevent bacterial contamination in transfusions?

A

Inspect blood before you use it, if there are clots, it is cloudy, or it is purple in color it is bad.

105
Q

Anaphylactic transfusion reactions

A

Acute; seen in IgA deficient patients who develop anti-IgA through pregnancy or transfusion - requires units to be washed

106
Q

Diagnosis of anaphylactic reactions

A

Negative DAT, IgA deficiency workup

107
Q

Transfusion Associated Circulatory Overload (TACO)

A

Hypervolemia (fluid overload in lungs) due to excessive volume or speed or infusion

108
Q

What population does TACO mostly occur?

A

Elderly or compromised cardiac/pulmonary function

109
Q

Symptoms of TACO

A

Severe hypoxemia, increased BP, jugular vein distension,

110
Q

Diagnosis of TACO

A

Chest X-ray will show pulmonary edema, cardiomegaly and distended pulmonary artery, atrial hypertension

111
Q

Transfusion Related Acute Lung Injury (TRALI)

A

Immune-based damage to lungs due to HLA specific donor antibodies directs against the patient’s granulocytes - activates complement

112
Q

Symptoms of TRALI

A

Fever, hypoxemia, chills/cough, low BP, cyanosis, pulmonary edema

113
Q

Diagnosis of TRALI

A

Chest x ray will show bilateral lung infiltrates
Donor test for HLA antibodies
Recipient tested for HLA antigens

114
Q

Delayed vs Acute transfusion rxns

A

Acute is during or right after a transfusion
Delayed is weeks or months after transfusion

115
Q

Is delayed or acute hemolytic transfusion reaction more common?

A

Delayed

116
Q

Delayed hemolytic transfusion reaction

A

Seen about 5-7 days post transfusion; antibody is produced against an antigen on the transfused cells

117
Q

Delayed hemolytic transfusion reaction DAT

A

Positive

118
Q

Transfusion transmitted diseases

A

Delayed reactions caused by diseases such as hepatitis, CMV, malaria, syphilis, HIV etc

119
Q

Why are transfusion transmitted diseases delayed and not acute like bacterial contamination?

A

Have to replicate in host genome which takes time

120
Q

What can prevent transmission of CMV in transfusions?

A

Leukoreduced or IRR blood products

121
Q

All blood products in US and Europe are ___.

A

LR

122
Q

What causes Syphilis?

A

Treponema pallidum

123
Q

Why can you not donate blood for a year if you have had a recent tattoo or piercing?

A

HIV window period is critical and can take time to develop antibodies so can be a false negative via testing for blood donor centers

124
Q

What is the cause of GVHD?

A

donor lymphocytes engraft or react against recipient foreign tissues (in normal situation, people can reject lymphocytes. in immunosuppressed, cannot reject lymphs and they proliferate and grow in recipients body)

125
Q

What community is the biggest problem with GVHD?

A

immunosuppressed patients, BM transplants, chemo patients, infants and fetuses

126
Q

Diagnosis of GVHD

A

Pancytopenia, identify donor engraftment

127
Q

Prevention of GVHD

A

Gamma irradiation of cellular blood components as necessary

128
Q

Post Transfusion Purpura

A

Caused by anti-HPA-1a antigen - destroys all PLTs

129
Q

What population of people are most commonly associated with post transfusion purpura?

A

Women with multiple pregnancies because they have been antigenated so many times

130
Q

Symptoms of post transfusion purpura

A

bleeding, generalized purpura, severe thrombocytopenia

131
Q

Diagnosis of PTP

A

thrombocytopenia, HPA antibodies

132
Q

Iron Overload

A

Causes multiple organ failure - patients receiving chronic transfusions are at risk

133
Q

Diagnosis of iron overload

A

Increased ferritin levels

134
Q

Responsibilities of the blood bank post transfusion

A
  1. perform clerical check
  2. compare pre and post transfusion specimens for signs of icterus or hemolysis
  3. perform ABORh check on post transfusion specimen
  4. Perform DAT on post transfusion specimen
  5. Perform T/S on new sample and invalidate old sample
135
Q

What are other tests that can be ordered to confirm a transfusion reaction?

A

Urine sample to test for free hgb, bilirubin test, serum haptoglobin

136
Q

Why is it important to irradiate blood products?

A

To eliminate WBC to prevent graft vs host disease

137
Q

How much irradiation must be delivered to irradiate blood?

A

25 gray units to the center, 15 gray units to the periphery

Blood Bank (7 decks)

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