Blood Bank Osler 3-4 Flashcards by Ben Saylor

Whole blood expires based on anticoagulant?

How to store?
Transport?

21 days for CPD and CP2D and 35 days CPDA1

Store: 1-6 degrees C

Transport: 1-10 degrees C

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RBCs:
What protects from hemolysis?

Anticoagulant?
Additive solution increases shelf life to, Hct needed?

Di-(2-ethylhexyl)-phthalate

CPD CP2D; Hct 65-85%

Additive: 42 day shelf life, HCt 55-65%: Bade from 21 day old whole blood and remove plasma and add solution

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Apheresis RBCs need how much Hemoglobin?

FDA and AABB BB/TS standards address (3 things)?

at least 60 g hemoglobin (or 180 mL red cell volume)

Donor selection and monitoring, Maximal RBC loss and QC and record requirements

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Tranfusion guidelines in adults?

Can you transfuse blood at any age?

No indicated if Hgb >7 g/dL in hospitalized adult patients who are hemodynamically stable

Does not apply in ACS or severe thrombocytopenia or chornic transfusion
2. Subgroups: Orthopedic, CV surgery, and preexisiting CV disease can transfuse at Hgb 8 g/dL

Yes should receive any blood in licesned period

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1 U of RBCs expected to raise Hct and Hgb?

When to test Hct and Hgb if you want to give a second unit?

3% and 1 g/dL

15 min after transfusion can do H and H

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Frozen red cell are good for?
Washed RBC shelf life?

Storage ant transport?

Irradiated shelf life?

10 years
Washed: 24 hrs, Store 1-6 degree C, Transport 1-6 degree C

Irrad: Original expiration of 28 days form radiation, which ever is shorter

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What fluids can you not use with a transfusion?

What fluids can you use?

Lactated Ringers (Ca caust ppt); 0.45% Normal saline (hemolysis), Sterile water, and other meds

Use: Normal Saline, ABO compatible plasma, 5% albumin

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Plt transfusion guidelines?

Count <10k overall

Prophylatic transfusion for central venous catheter if count less than 20k

Lumbar puncture if elective <50k

Prophylactic transfusion if major elective non neuro surgery: <50k

Cardiopulmonary bypass: Perioperative bleeding with thrombocytopenia or plt dysfunction

Can’t recommend agaqinst in patient on antiplatelet therapy for intracranial hemorrhage

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Plt count should increase after 1 unit apheresis plts?

Plt shelf life (apheresis and Prestorage pooled)?
Storage?
Transport?

Amount of plts needed in each unit?

30k-60k

5 days (7 with release testing)

Storage: 20-24 C with gentle agitation

Transport: as close to 20-24 without agitation: 30 hours max time

Apher: 3e11 and whole blood (5.5e10)/unit

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How long to incubate plt culture, is it required?

Leukocyte reduced definition for RBCs?

Leukocyte reduced definition for Whole blood plts?

24 hours; BacT/ALERT, eBDS; YES!!; cannot swirl or gram stain to check for bacteria

RBC: <5e6 WBCs (95%)
WBCs: <8.3e5 (95%)

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Why leukocyte reduce?

Leukocyte reduction contraindications?

Irradiation doses?

Decreased ebrile rxns, decreased HLA immunization, decreased CMV

Contraindications: To prevent GVHD (irradiate), Frozen products, Granulocytes

25Gy to center portion of container and 15Gyto any point

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What won’t irradiation not prevent?

How long are irradiated RBCs good for?

Irradiated plt expiration?

CMV transmision
28 days or shorter

Not changed from 5 days

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Frozen RBCs what is the storage media?

Indications for Forzen RBCs

When should hte be frozen?

40% glycerol (20% can be used); remove before transfusion

Rare units, autologous donations

Withitn 6 days of collection; frozen before expiration if Rare; 10 years at -65C

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Deglycerolized RBC’s?
Open Storage?

Open Transport?

Closed (or FDA approved)
Storage?
Transport?

Open 24 hrs at 1-6 C, 24 hrs 1-10 C
Closed: 14 days 1-6 C and 14 days 1-10 C

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Why wash blood components?
Storage of washed plts?

IgA deficency?
Severe allergic reaciton

Neonatal alloimmune thrombocytopenia (Maternal anti-HPA-1a)

Stoarge plts: 4 hrs 20-24 C continuous agitation

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When to use plasma?

Risks of plasma?

Massive transfusion also for INR >2

Reversal of Warfain in pts with intracranial hemorrhage; just use K-Centra

TTP

Lung injury; TRALI; TACO; etc.

When to give plasma?
Dose?

When to measure coagulation labs?

Right before surgery, (same with RBCs and Plts)
10-20 mL/kg**; can give multiple units

Before and 5 hours after (VII has 5 hr half life)**

Plasma universal donor?

Plasma universal recepient?

What coag factors does plasma have?

AB (no Anti-A or B)
O (No target for Anti-A or Anti-B)

All of them including AT3 AND ADAMTS13

Thawed plasma and Frozen within 24 hours have decreases in what 2 factors?

FFP and PF24 shelf life?

Thawed plasma shelf life?

Liquid plasma shelf life, missing what, used for?

VIII, V (Labile factors); other than that FFP, PF24, and thawed are equal

FFP and PF24: -18 for 12 months, -65 C 7 years for FFP but thawed 1-5 C for 24 hours

Thawed: **1-6C for 5 days

Liquid: 1-6C 5 days AFTER expiration of whole blood: lacks Vit K dependent factors; USED MASSIVE TRANSFUSION ONLY**

What is cryoprecipitate reduced plasma used for?

What is recovered plasma?

TTP

Recovered: Convert plasma and liquid plasma form whole blood; unlicensed, made into derivatives such as albumin and immune globulin

Also pooled solvent/detergent treated, virus inactivated

What factors does Cryoprecipitate have?

Does it need QC?

How long does Frozen last, thawed single unit, thawed pool?

Indications?

Fibrinogen (>150 mg), Factor 8 (>80 IU), also VWF, F8, F13, Fibronectin

Yes, see above

Frozen: -18 C for 1 2 months
Thawed single: 20-24 C for 6 hrs

Thawed pool: 20-24 C 4 hours or sterile connection 6 hrs
Indications: Fibrinogen deficiency (Factor XIII deficency)

Do granulocytes need to be ABO compatible?
What requirements do they need?
WBC requirement?

Storage?

Indications?

Yes

CMV negative, H LA compatible, Irradiated
1.0e10 in 75% of units; MD sets requirements for neonates|

Store: 20-24 C with no agitation; USE ASAP and <24 hrs
No specific indications; clinician discretion

Temps?

RBC?
Plt and granulocytes?
Plasma and cryo?

RBC: Store 1-6 C; transport 1-10 C

Plt and grandulocyte store and transport: 20-24 C
Plasma and cryo store: -18 or colder

Transfusion reaction that causes death the most?

How long to report death to FDA?

Acute Hemolytic Transfusion reaction; is it common?

TRALI, then TACO, then Hemolytic due to non ABO

1 days prelim; 7 days final

Not really 1:76,000

Symptoms of acute hemolytic transfusion? Labs? Tx?

Mild back pain to severe hypotension, dyspnea and shock with DIC Hemoglobinemia and Hemoglobinurea; Positive DAT, **increased hyperbilirubinemia, RBCs with schistocytes and sphereocytes** Tx: Supportive, keep BP up; keep urine at 1 mL/Kg/hr and look for DIC

Febrile nonhemolytic transfusion reactons and definition? Symptoms? Labs? Tx? Prevent?

No specific one; **1 degree C above 37 without explanation** Diagnosis of exclusion Symptoms may occurs during or 1 hr after: Shaking chills, up respiratory rate Labs negative Tx: Stop and give acetaminophen or antipyretic Prevent: Leukocyte reduce and give tylenol/benadryl

Bacterial contamination is most commonly, prevention? Symptoms? Labs? Tx?

Staphylococcus: **Leading cause of blood transfusion sepsis, divert 10-40 mL** Temp \>38 C (100.4 F) with **rise 1 C (1.8 F) PLUS any rigors, hypotension, shock, tachycardia, dyspnea, N/V** Show up within 1 hr and may occur up to 24 hours Labs: Culture IV and blood and patient, Negative DAT +, confirmed positive if patient and unit match Tx: Abx

What cause TRALI? Symptoms? Tx? Preventitive measures?

**Leading cause of fatality**: HLA antibodies degranulate lungs **Onset of symptoms within 6 hours;** see white out appearence in lungs Oxygen, pressors, **diuretics ARE NOT indicated, steroids show no improvement** Prevent: by using Male donors, female never pregnant or antibody negative (Whole blood plts and plasma, NOT RBCs)

Allergic transfusion symptoms? Can you resume the unit? Tx? Prevent?

Most common rxn (1-3%); Localized urticaria and type 1 hypersensitivity **Only reaction where you can RESUME the unit** Administer antihistamine and once symptoms improve resume Prevent by giving antihistamines before (oral 30 min; IV 10 min)

Anaphylactic transfusion reaction symptoms? Tx? Prevention?

**VERY EARLY (few mL):** hypotension, lower airway obstruction, abdominal distress shock Associated with IgA deficiency and/or Anti-IgA antibodies Tx: **Epinepherine** Prevention: wash cellular products, and use IgA deficient plasma

TACO timing/symptoms? X-ray? Tx?

1-2 hours after transfusion; Dyspnea, cyanosis, increased blood pressure (vs hypotension in TRALI), **increased BNP, Pulmonary/Pedal Edema; no WBC change** X-ray: EKG and widened cardiac silhouete Tx: Supportive; oxygen and diuretics

Delayed hemolytic transfusion reaction symptoms? Antibodies that commonly cause this? Labs? Tx?

Hemolysis after 24 hours to weeks; Jaundice, fever unknown origin **Anti-Kidd, Duffy, Kell, MNS,** undetectible intially and come back after transfusion Labs: DAT (positive and mixed field), anemia, positive antibody screen, sphereocytes

Transfusion associated GVHD symptoms? Major complication? Prevention? Who gets radiation?

Rash, mucositis, hepatitis, **Bone marrow failure** **DEATH in almost all cases** Prevent w/ irradiation; 25Gy to center and 15Gy to any other point Indications: **Transfusion form blood relatives, HLA compatible or crossmatched transfusion;** Not full term neonates or HIV

Post transfusion purpura symptoms, timing? Tx? Prevention?

F\>M; purpura and thrombocytopenia (\<10,000) **mean 9 days post transfusion** **Can occur after plts or RBCs** Tx: IVIG Prevent: Avoid transfusions, future Plts should be HLA or autology donation or family donations!

Iron overload, each mL of RBC has how much Fe? Common in? Tx?

1 mg Chronic transfusion; sickle cell and thalassemia Chelating agents

What labs to do if you suspect transfusion reaction? T/F: Syphillis can survive in refrigerated blood? What is the Treponemal test? Can donors who have had reative Treponemal tests donate again?

Clerical check, DAT, and check for hemolysis False; it can only survive a few days T. Pallidum antigen specific immunoflourescence or agglutination Yes, if not from physician saying they have completed treatment and **12 months have passed**