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S3B4 Pathology > Blood Bank II > Flashcards

Blood Bank II Flashcards

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?

A

concentrates of WBC, collected by apheresis

23
Q

Granulocytes require what type of testing prior to administration?

A

cannot be washed

RBC crossmatching required

24
Q

Granulocytes are stored at what temperature? They have to be used within what time period post-collection?

A

stored 20-24 degrees C

transfused within 24 hours of collection

25
Q

What are the indications for use of granulocytes?

A

neutropenia

severe infections

26
Q

What two blood bank components are stored at room temperature?

A

granulocytes & platelets

27
Q

What are the clinical factors to consider before giving a patient a transfusion?

A
  • 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
Q

Why don’t you give every patient all components of blood?

A

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
Q

What are the packed red cell treatment guidelines?

A
  • 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
Q

What risks are associated with plasma transfusion?

A

allergic reaction

anaphylaxis

transfusion-related acute lung injury (TRALI)

still have risk of infection and volume overload, like with RBCs

31
Q

What steps must happen before the patient can actually receive the blood transfusion?

A

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
Q

What is a transfusion reaction?

When does it usually occur?

A

any adverse effect that occurs because of the administration of a blood product or derivative

usually occurs during transfusion or shortly after

33
Q

What is an acute hemolytic transfusion reaction & what is is usually caused by?

A

intravascular hemolysis due to IgM antibodies in recipients serum, directed against donor red blood cells

almost always due to ABO incompatibility

ALL ARE LIFE-THREATENING

34
Q

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

A

Acute Hemolytic Reactions

34
Q

What is a delayed hemolytic transfusion reaction & what is is usually caused by?

They are associated with what antibodies?

A

extravascular hemolysis, usually due to IgG antibody

3-14 days after transfusion

anti-D, Jka (Kidd), K

35
Q

What lab findings are associated with delayed hemolytic transfusion reaction?

A

positive DAT

bilirubinemia

anemia

36
Q

What is a febrile non-hemolytic reaction & what is the usual cause?

A

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
Q

What symptoms are often seen with febrile non-hemolytic reaction?

Treatment? Prevention?

A

chills or rigors

treat with anti-pyretics (acetaminophen)

prevent with premedication (benadryl) or leuko-reduced blood

38
Q

What are urticarial reactions?

Treatment?

A

rash or hives +/- wheezing

due to reaction to donor plasma proteins

very common

pre-treat with anti-histamines or used washed RBC

39
Q

Anaphylactic reactions most commonly occur in what groups of people?

Symptoms?

Treatment?

A

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
Q

What does TRALI stand for?

A

transfusion related acute lung injury

41
Q

TRALI most commonly occurs after what type of transfusion?

A

fresh frozen plasma

42
Q

What is the cause of TRALI & what are the typical symptoms?

Treatment?

A

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
Q

How can you differentiate TRALI from TACO?

A

in TACO bp will go up not down

TRALI bp will go down

44
Q

What does TACO stand for?

A

transfusion-associated circulatory overload

45
Q

What is TACO & what are its clinical manifestations?

A

circulatory overload due to rapid infusion / excessive volume

nonproductive cough, cyanosis, dyspnea, rales, hypertension, tachycardia & congestive heart failure – no fever

46
Q

TACO most commonly occurs in what demographics?

Treatment?

A

elderly and children

slow infusion and/or give diuretics

47
Q

What is a septic transfusion reaction?

Symptoms?

A

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
Q

What patients are at most risk of septic transfusion reactions? Why?

A

most common with platelet transfusion - stored at room temp

neutropenic patients at high risk or death

49
Q

What can cause citrate coagulation?

symptoms?

Most commonly occurs in what group of poeple?

A

hypocalcemia

circumoral tingling – common in those with decreased liver function

50
Q

How do you prevent hypothermia in a patient receiving massive transfusion?

A

pre-warming

51
Q

What do you do if your transfusion patient experiences iron overload?

A

iron chelation

52
Q

What happens in a graft vs. host disease?

How can you prevent this from happening?

A

viable donor T-cells proliferate & recognize the recipient’s cells as foreign

prevent by giving irradiate products

53
Q

What is the only thing you can infuse with packed RBC? If not, what can happen?

A

only normal saline

pseudo-hemolytic reactions

NEVER add medications to blood components; NEVER use lactated ringer or D5W with transfusions

54
Q

What infections are associated with transfusions?

A

hepatitis C

HIV

CMV

Syphilis

HTLV-1

malaria

Babesia

55
Q

What is the general management of transfusion reactions?

A

stop the transfusion

notify the transfusion service ASAP

recheck ID of patient & donor

maintain IV fluids & urine output - monitor vitals

56
Q

What samples should be sent to the lab in the event of a transfusion reaction?

A

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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