Blood Bank Osler 4-5

Question 1

Inital marker of Hep B infection?
What shows up 4-6 weeks later?
Window period?

Answer 1

HBsAG; Surface antigen!; HBsAb indicates vaccination

HBcAb

38 days!; Period when HbSAg not present and HBcAb not present

Question 2

Are Hep C carriers defered?
What about people with contact with Hep C individuals?

Antibodies tested for and window period?

Answer 2

Yes

No

Anti-HCV (EIA) or HCV RNA window period 7.4 days!!

Question 3

Tests for HIV?

Confirmatory tests (if NAT negative)?

Ancillary test?

Answer 3

Anti-HIV 1/2 and HIV-NAT
Immunoflourescence or Western Blot

Anti-HIV-2 if Anti-HIV 1 is negative; VERY RARE IN US

Question 4

Testing for HTLV I/II?

Confirmatory?

Type 1 vs 2?

Transmission routes

Answer 4

HTLVI/II screen; EIA or ChLIA

Confirm with IFA or line immunoblot; No nucleic acid test

Type 1: Caribean, Asian populations: Adult T-cell lymphoma/leukemia

Type 2: Native Americans, IV drug use
HTLV-myelopathy types I and II

Transmissions: Breast milk, sexual contact, blood exposure, mother to baby

Question 5

What transmits West NIle Virus?

Symptoms?

Testing?

Deferal?

Answer 5

Culix mosquito and birds are natural resvervor

80% asymptomatic: 20% mild few like symptoms

1-150 get severe disease: Encephalitis, meningitis, meningoenchphalitis, flacid paralysis; Death in older patients who are transfused

NAT: Virmeia 1-3 weeks detects RNA

120 days after Reactive NAT

Question 6

What causes Chagas’s disease?

Process?

What seen in blood?

Symptoms?

Chronic phase?

Answer 6

Reduvidae; Triatoma infestans

Bug bites, deficates, host scratches, contraminated feces enters wound

C-shapped triple mastagote in PB

Romana’s sign; SWELLING OF EYE, tiredness, fever, raish, loss of appetite, severe and fatal in young nad old

Chronic: 10-20 yrs after infection; enlarged heart with heart failure, and megacolon (RARE TO TRANSMIT IN BLOOD TRANSFUSION)

Question 7

Chagas testing?

Confirmatory test?
How often to test donors?

Deferal?

Answer 7

ChLIA, or EIA

Confirmatorry test; T. Cruzi E. Coli recombinant antigen

Only once but if postive permenant deferal

Question 8

Is Zika required to be tested for in donors?

What transmits?
Symptoms?

Has it been transmitted by transfusion?

Testing?

Answer 8

Yes
Aedes aegypti and albopictus

Trivial to dengue like

No documented cases in US

Minipoor or individual donor by NAT; Convert to individual donor test for 14 days from last reactive case

Question 9

Is Babesisois required to test for?

How many transfusion transmitted cases?

Is FDA guidence prescent?

Answer 9

No; only in certain area

~200

Just a draft; no licensed tests

Question 10

Are blood warmers needed routinely?

How many patient identifiers?

Answer 10

No; only in trauma or surgery

Cold products can cause hypothermia and cardiac issues

2; Not room number, also ABO and Rh an donor ABO and Rh type

Question 11

Can blood be stored on patient floor?

Storage temp?

How long to transfuse blood on floor?

Can spiked unit be retransfused?

Answer 11

NO: must be in transfusion service fridges

1-6 degree C and 1-10 degree C during transport

4 hours or put into aliquots

Nope must be discarded

Question 12

Needle size for transfusion Adult vs infant/toddler?

How to spike unit?

Start transfusion fast or slow?

Answer 12

20-18 G for adults; 24-25 for infants/toddlers (constant flow infusion device needed)

Aseptic technique; nurses need training records to show they know what they are doing

Slow 2mL/min for 15 min; test vitals after 15 min

Question 13

Can emergency release be signed after the fact?

Massive transfusion definitions?

Avoid what in massive transfusion?

What ratio to transfuse?

Answer 13

Yes; no specific time window; must be signed by MD/DO/MBBS

Loss of 1 BV in 24 hours, 10+ units in 24 hours, 50% BV in 3 hours

Blood failure/lethal triad (hypothermia, acidosis, coagulopathy)
1:1:1 vs 1:1:2 RBC:Plasma:Platelets

Question 14

Benefits of whole blood for Massive transfusion?

AABB allows what blood?

How often to titer donors?

Answer 14

Provides rapid treatment of oxygen debt and coagulopathy; contains Plts that have equivalent or better hemostatic effect

Simplification of resuscitation and balance fluid in 1 bag

Type O or low titer O (facility defined) and must be monitored
Commonly: Up to 256

Anti-A and B doesn’t change but no recommendation

Question 15

Who makes donor regulations?

Answer 15

Federal Government–laws

FDA-guidance as standard of care; NOT LAWS

AABB Standards: need for accredidation

AABB Association Bulletins

Question 16

What regulation deals wtih Donor Eligibility and Reinstatment?

Do donors need to be notified of positive test results?

Answer 16

FDA 21 CFR 610.41; and includes reentry

THen the specifics are in FDA guidance documents and AABB Association Bulletins
YES! and important implications for thier health

Question 17

Donor reinstatment steps; must follow?

What is a look back?

What are REQUIRED look backs?

Answer 17

Set amount of time, then retests must be negative; MUST FOLLOW FDA DEFINED ALGORITHMS EXPLICITLY

FDA and AABB discuss how to do it: Previously collected blood component from donors or who current donation is NAT reactive

Need to look at and pull prior donors materials and notify recepients

HIV and HEP C by LAW; even if recepient dead must notify realitives

Question 18

For component retrieval which 3 agents are based on FDA Guidance and AABB recomendations and NOT FDA Code of Federal Regulations?

Answer 18

WNV, Zika, T. Cruzi

Question 19

What is alloantibody mitigation?

Common practice is to test for?

If positive for antibody extend to?

Answer 19

Transfuse phenotypically matced common antigens.

C, E, and K

Others like Fy, Jk, and S

Question 20

Warm autoimmune hemolytic anemia has what in DAT?

Cold agglutinin disease, association?

Mixed type autoimmune hemolytic anemia?

Paroxysmal cold hemoglobinuria, associated with?

Answer 20

IgG, IgG+C3, and C3

Cold: C3 only, a/w Anti-I

Mixed: IgG+ C3 and C3

PCH: C3 only, associated with Anti-P

Question 21

What causes warm auto antibodies?

Tx?

Cold agglutinin disease assoc?

Answer 21

Idiopathic (50%), malignancies, drugs, autoimmune disease
Compatible blood is usually impossible

Tx: Steroids, immonosuppressants

CAD:Acute- Mycoplasma pneumonia and Anti-I

Chronic: Waldenstroms, Lymphoma, CLL

Question 22

PCH associated with?

Lab test?

Causes?

Answer 22

Auto Anti-P
Biphasic IgG hemolysin–collect 37 and no hemolysis hemolysis once it cools and warms up (Donner-Landsteiner test)

Syphilis and viral infections in kids

Question 23

What is cause of plt refractoryness?

How long should plts survive?

Ways to tx?

Answer 23

20% immune (lab evaluate), 80% non-immune (clinical evaluate)

~3 days after transfusion; if count goes down in 24 hours then non-immune

Try ABO matching, and HLA antibody screening test and then HLA Avoidence

Can cross match plts

Question 24

HLA match grades?
Perfect?

B1U, X
B2U, UX, X

C

D

Answer 24

Perfect: 4 antigen match

B1U: 3 antigens detected in donor, all match, X: 3 donor antigens match 1 cross-reactive

B2U: 2 antigens in donor, both match; UX 3 antigens in donor, 2 match, 1 cross reactive, X: 2 donor antigens match, 2 cross reactive

C: 1 antigen in donor not present in recipient and not cross reactive

D: 2 antigens in donor not present in recipient and not cross-reactive

Question 25

HLA matching limitations?

If plt count is refractors at 10 min to 1 hour think?

Do irradiated platelts affect refractoriness?

Answer 25

Difficult to make database (15-20% donor attrition)
HLA matching doesn’t address non-immune refractoriness

HLA antibodies/immune ( Most comm Claa I HLA antigens on A and B loci); Non immune is a drop over ~24 hours

Nope; just as refractory. Consider HLA matching