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S3B4 Pathology > Blood Bank II > Flashcards

Blood Bank II Flashcards

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1
Q

How long are platelets good for after being received at the blood bank? Why?

A

5 days
they are stored at room temperature

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2
Q

What are the two main types of platelet collections?

A 
random donor
single donor (apheresis)
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3
Q

Do platelets need to be crossmatched?

A

no

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4
Q

Compare the collection method for single donor vs. random donor platelets. What volume is collected in each?

A
  • Single Donor
    • collected from a single donor via apheresis
    • equivalent to 6-10 units random donor platelets
  • Random Donor
    • collected by routine phlebotomy - separated from other blood components
    • each small bag from one donor contains >5.5 x 1010 platelets
    • 6 - 10 units pooled prior ot transfusion
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5
Q

What is the benefit of single donor platelets?

A

limits exposure to infection, immunization

considered leukocyte reduced

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6
Q

When are HLA Matched Single Donor Platelets indicated?

A

used when patient does not respond to platelet transfusion

one of the few indications for directed donations

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7
Q

What are the indications for transfusion of platelet concentrates?

A
  • bleeding due to thrombocytopenia or platelet dysfunction
  • bleeding prophylaxis if platelet count is <10,000/microliter
  • thrombocytopenia caused by bone marrow failure or non-imune consumption
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8
Q

For which types of thrombocytopenias is it not indicated to provide platelet concentrate transfusion?

A
  • thrombotic thrombocytopenic purpura TTP/HUS
  • heparin-induced thrombocytopenia (HIT)
  • Use ABO identical if available
    • platelets do not have Rh antigens, but RBCs do

get abnormal activation of platelet → forming microthrombi in small vessels that can cause severe ischemia

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9
Q

Identify the platelet count that is associated with each level of bleeding risk:

A
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10
Q

What is the expected response after transfusion of a single donor unit or pooled 6-pack of random donor platelets?

A

should raise platelet count about 30 - 60,000

helps only w/ microvascular bleeding; large vessel bleeding is a suture deficiency

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11
Q

How long do platelets usually survive in the blood after a transfusion?

What conditions lead to decreased survival time?

A

6 - 7 days

  • Decreased survival time
    • sepsis
    • DIC autoimmunization
    • hypersplenism
    • ITP
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12
Q

What are FFP & FP-24?

How are they prepared?

A

Prepared by centrifugation & removal fo plasma from single donor unit

  • Fresh Frozen Plasma (FFP)
    • frozen within 8 hrs
  • 24-hour Plasma (FP-24)
    • frozen within 24 hrs of collection
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13
Q

Both FFP & FP-24 contain what factors?

A

Both have all coagulation factors

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14
Q

FFP & FP-24 are used in what patient populations?

A
  • multiple factor deficiencies (liver disease)
  • massive transfusion
  • bleeding in DIC with prolonged PT/PTT
  • bleeding due to warfarin overdose
  • Plasma exchange for TTP/HUS
  • Deficiencies of factors II, V, X or XI
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15
Q

What is the storage life of FFP & FP24?

A

12 months if frozen

24 hours after thawed– may be used for an additional 5 days, unless need factor VIII

thawing takes 30 minutes

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16
Q

Do FFP & FP24 require crossmatching?

A

no, but ABO compatibility is a must

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17
Q

Administration of FFP and FP24 comes with what risks?

A

hepatitis

volume overload

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17
Q

Administration of FFP and FP24 comes with what risks?

A

hepatitis

volume overload

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18
Q

What is cryoprecipitate?

A

collect unit of whole blood, separate plasma out of it, freeze the plasma within 8 hrs, thaw in the refrigerator & you get a precipitate which you can then refreeze

fibrinogen, fibronectin, factor VIII, vWF, and factor XIII

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19
Q

How long can you store cryoprecipitate?

A

12 months frozen

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20
Q

What are the indications for using cryoprecipitate?

A
  • hypofibrinogenemia & afibrinogenemia
  • hypofibronectinemia
  • massive transfusions (dilutional coagulopathy)
  • reversal of thrombolytic therapy with bleeding
  • uremic coaguopathy
  • manufacture of fibrin glue/sealants
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21
Q

What are coagulation factor concentrates?

What are the 2 types?

A

concentrates of a single factor

  1. Plasma-derived: collected from pools of donors who twice test negative for viral markers
    1. undergoes heat-inactivation step
  2. Recombinant
    1. genetically engineered, not from human donors
    2. no risk viral transmission
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22
Q

What are granulocytes?

A

concentrates of WBC, collected by apheresis

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22
Q

What are granulocytes?

Study These Flashcards
A

concentrates of WBC, collected by apheresis

23
Granulocytes require what type of testing prior to administration?
cannot be washed RBC crossmatching required
24
Granulocytes are stored at what temperature? They have to be used within what time period post-collection?
stored 20-24 degrees C transfused within 24 hours of collection
25
What are the indications for use of granulocytes?
neutropenia severe infections
26
What two blood bank components are stored at room temperature?
granulocytes & platelets
27
What are the clinical factors to consider before giving a patient a transfusion?
* patient age & general health * severity of the anemia * rapidity of the onset of the anemia * estimated blood loss * vital signs * degree of atherosclerosis * degree of cardiac and/or pulmonary disease * types of medications
28
Why don't you give every patient all components of blood?
Don't want to give patients products they don't need b/c 1- they're expensive 2- there are lots of risks that go along with transfusion
29
What are the packed red cell treatment guidelines?
* *Treat underlying cause of anemia* * use clinical judgment between Hgb of 6-10 * Usually _symptomatic if Hgb \<6_ * Few patients with Hgb \> 10 need transfusion, except in cases of **hemorrhage** * **consider symptoms first**
30
What risks are associated with plasma transfusion?
allergic reaction anaphylaxis transfusion-related acute lung injury (TRALI) still have risk of infection and volume overload, like with RBCs
31
What steps must happen before the patient can actually receive the blood transfusion?
Informed consent signed physician's order is written & in the chart the transfusionist has verified the order is there and that the component matches the order
32
What is a transfusion reaction? When does it usually occur?
any adverse effect that occurs because of the administration of a blood product or derivative usually occurs during transfusion or shortly after
33
What is an acute hemolytic transfusion reaction & what is is usually caused by?
**intravascular hemolysis** due to **IgM antibodies** in recipients serum, directed against donor red blood cells ## Footnote **almost always due to ABO incompatibility** **ALL ARE LIFE-THREATENING**
34
The provided symptoms are associate with what problem? pain at infusion site fever & tachycardia feeling of impending doom agitation flank pain shock bleeding hemoglobinuria hemoglobinemia
Acute Hemolytic Reactions
34
What is a delayed hemolytic transfusion reaction & what is is usually caused by? They are associated with what antibodies?
extravascular hemolysis, usually due to IgG antibody 3-14 days after transfusion anti-D, Jka (Kidd), K
35
What lab findings are associated with delayed hemolytic transfusion reaction?
positive DAT bilirubinemia anemia
36
What is a febrile non-hemolytic reaction & what is the usual cause?
temp rise of at least 1 degree C or 1.8 degrees F during or within 2 hours of a transfusion due to patient antibodies to donor leukocytes or platelets, and/or cytokines
37
What symptoms are often seen with febrile non-hemolytic reaction? Treatment? Prevention?
chills or rigors treat with anti-pyretics (acetaminophen) prevent with premedication (benadryl) or leuko-reduced blood
38
What are urticarial reactions? Treatment?
rash or hives +/- wheezing **due to reaction to donor plasma proteins** very common pre-treat with anti-histamines or used washed RBC
39
Anaphylactic reactions most commonly occur in what groups of people? Symptoms? Treatment?
patients with severe IgA deficiency who have anti-IgA hypotension and shock but **no fever** stop transfusion; supportive therapy future transfusions should be of **washed packed RBCs or IgA deficient products**
40
What does TRALI stand for?
transfusion related acute lung injury
41
TRALI most commonly occurs after what type of transfusion?
fresh frozen plasma
42
What is the cause of TRALI & what are the typical symptoms? Treatment?
caused by antibodies in donor plasma to recipient HLA or HNA antigens pulmonary edema within 6 hrs of transfusion usually resolves within 24 hrs - minimize transfusion of plasma products & platelets
43
How can you differentiate TRALI from TACO?
in TACO bp will go up not down TRALI bp will go down
44
What does TACO stand for?
transfusion-associated circulatory overload
45
What is TACO & what are its clinical manifestations?
circulatory overload due to rapid infusion / excessive volume nonproductive cough, cyanosis, dyspnea, rales, **hypertension**, tachycardia & congestive heart failure – **no fever**
46
TACO most commonly occurs in what demographics? Treatment?
elderly and children slow infusion and/or give diuretics
47
What is a septic transfusion reaction? Symptoms?
transfusion or bacterially-contaminated products dramatic onset of fever \> 39 degrees C, chills, hypotension, shock, tachycardia, nausea, comiting, during or within 4 hrs or end of transfusion
48
What patients are at most risk of septic transfusion reactions? Why?
most common with platelet transfusion - stored at room temp neutropenic patients at high risk or death
49
What can cause citrate coagulation? symptoms? Most commonly occurs in what group of poeple?
hypocalcemia circumoral tingling – common in those with decreased liver function
50
How do you prevent hypothermia in a patient receiving massive transfusion?
pre-warming
51
What do you do if your transfusion patient experiences iron overload?
iron chelation
52
What happens in a graft vs. host disease? How can you prevent this from happening?
viable donor T-cells proliferate & recognize the recipient's cells as foreign prevent by giving irradiate products
53
What is the only thing you can infuse with packed RBC? If not, what can happen?
only **normal saline** pseudo-hemolytic reactions _NEVER_ add medications to blood components; _NEVER_ use lactated ringer or D5W with transfusions
54
What infections are associated with transfusions?
hepatitis C HIV CMV Syphilis HTLV-1 malaria Babesia
55
What is the general management of transfusion reactions?
stop the transfusion notify the transfusion service ASAP recheck ID of patient & donor maintain IV fluids & urine output - monitor vitals
56
What samples should be sent to the lab in the event of a transfusion reaction?
post-reaction blood & urine samples transfusion reaction investigation request blood bag with attached administration set & IV solutions

S3B4 Pathology (6 decks)

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