Blood Bank II Flashcards
How long are platelets good for after being received at the blood bank? Why?
5 days
they are stored at room temperature
What are the two main types of platelet collections?
random donor single donor (apheresis)
Do platelets need to be crossmatched?
no
Compare the collection method for single donor vs. random donor platelets. What volume is collected in each?
- 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
What is the benefit of single donor platelets?
limits exposure to infection, immunization
considered leukocyte reduced
When are HLA Matched Single Donor Platelets indicated?
used when patient does not respond to platelet transfusion
one of the few indications for directed donations
What are the indications for transfusion of platelet concentrates?
- 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
For which types of thrombocytopenias is it not indicated to provide platelet concentrate transfusion?
- 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
Identify the platelet count that is associated with each level of bleeding risk:
What is the expected response after transfusion of a single donor unit or pooled 6-pack of random donor platelets?
should raise platelet count about 30 - 60,000
helps only w/ microvascular bleeding; large vessel bleeding is a suture deficiency
How long do platelets usually survive in the blood after a transfusion?
What conditions lead to decreased survival time?
6 - 7 days
- Decreased survival time
- sepsis
- DIC autoimmunization
- hypersplenism
- ITP
What are FFP & FP-24?
How are they prepared?
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
Both FFP & FP-24 contain what factors?
Both have all coagulation factors
FFP & FP-24 are used in what patient populations?
- 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
What is the storage life of FFP & FP24?
12 months if frozen
24 hours after thawed– may be used for an additional 5 days, unless need factor VIII
thawing takes 30 minutes
Do FFP & FP24 require crossmatching?
no, but ABO compatibility is a must
Administration of FFP and FP24 comes with what risks?
hepatitis
volume overload
Administration of FFP and FP24 comes with what risks?
hepatitis
volume overload
What is cryoprecipitate?
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
How long can you store cryoprecipitate?
12 months frozen
What are the indications for using cryoprecipitate?
- hypofibrinogenemia & afibrinogenemia
- hypofibronectinemia
- massive transfusions (dilutional coagulopathy)
- reversal of thrombolytic therapy with bleeding
- uremic coaguopathy
- manufacture of fibrin glue/sealants
What are coagulation factor concentrates?
What are the 2 types?
concentrates of a single factor
-
Plasma-derived: collected from pools of donors who twice test negative for viral markers
- undergoes heat-inactivation step
-
Recombinant
- genetically engineered, not from human donors
- no risk viral transmission
What are granulocytes?
concentrates of WBC, collected by apheresis
What are granulocytes?
concentrates of WBC, collected by apheresis
Granulocytes require what type of testing prior to administration?
cannot be washed
RBC crossmatching required
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
What are the indications for use of granulocytes?
neutropenia
severe infections
What two blood bank components are stored at room temperature?
granulocytes & platelets
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
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
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
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
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
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
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
almost always due to ABO incompatibility
ALL ARE LIFE-THREATENING
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
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
What lab findings are associated with delayed hemolytic transfusion reaction?
positive DAT
bilirubinemia
anemia
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
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
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
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
What does TRALI stand for?
transfusion related acute lung injury
TRALI most commonly occurs after what type of transfusion?
fresh frozen plasma
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
How can you differentiate TRALI from TACO?
in TACO bp will go up not down
TRALI bp will go down
What does TACO stand for?
transfusion-associated circulatory overload
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
TACO most commonly occurs in what demographics?
Treatment?
elderly and children
slow infusion and/or give diuretics
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
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
What can cause citrate coagulation?
symptoms?
Most commonly occurs in what group of poeple?
hypocalcemia
circumoral tingling – common in those with decreased liver function
How do you prevent hypothermia in a patient receiving massive transfusion?
pre-warming
What do you do if your transfusion patient experiences iron overload?
iron chelation
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
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
What infections are associated with transfusions?
hepatitis C
HIV
CMV
Syphilis
HTLV-1
malaria
Babesia
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
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
