Blood Bank Osler 4-5 Flashcards
Inital marker of Hep B infection?
What shows up 4-6 weeks later?
Window period?
HBsAG; Surface antigen!; HBsAb indicates vaccination
HBcAb
38 days!; Period when HbSAg not present and HBcAb not present
Are Hep C carriers defered?
What about people with contact with Hep C individuals?
Antibodies tested for and window period?
Yes
No
Anti-HCV (EIA) or HCV RNA window period 7.4 days!!
Tests for HIV?
Confirmatory tests (if NAT negative)?
Ancillary test?
Anti-HIV 1/2 and HIV-NAT
Immunoflourescence or Western Blot
Anti-HIV-2 if Anti-HIV 1 is negative; VERY RARE IN US
Testing for HTLV I/II?
Confirmatory?
Type 1 vs 2?
Transmission routes
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
What transmits West NIle Virus?
Symptoms?
Testing?
Deferal?
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
What causes Chagas’s disease?
Process?
What seen in blood?
Symptoms?
Chronic phase?
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)
Chagas testing?
Confirmatory test?
How often to test donors?
Deferal?
ChLIA, or EIA
Confirmatorry test; T. Cruzi E. Coli recombinant antigen
Only once but if postive permenant deferal
Is Zika required to be tested for in donors?
What transmits?
Symptoms?
Has it been transmitted by transfusion?
Testing?
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
Is Babesisois required to test for?
How many transfusion transmitted cases?
Is FDA guidence prescent?
No; only in certain area
~200
Just a draft; no licensed tests
Are blood warmers needed routinely?
How many patient identifiers?
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
Can blood be stored on patient floor?
Storage temp?
How long to transfuse blood on floor?
Can spiked unit be retransfused?
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
Needle size for transfusion Adult vs infant/toddler?
How to spike unit?
Start transfusion fast or slow?
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
Can emergency release be signed after the fact?
Massive transfusion definitions?
Avoid what in massive transfusion?
What ratio to transfuse?
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
Benefits of whole blood for Massive transfusion?
AABB allows what blood?
How often to titer donors?
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
Who makes donor regulations?
Federal Government–laws
FDA-guidance as standard of care; NOT LAWS
AABB Standards: need for accredidation
AABB Association Bulletins
What regulation deals wtih Donor Eligibility and Reinstatment?
Do donors need to be notified of positive test results?
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
Donor reinstatment steps; must follow?
What is a look back?
What are REQUIRED look backs?
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
For component retrieval which 3 agents are based on FDA Guidance and AABB recomendations and NOT FDA Code of Federal Regulations?
WNV, Zika, T. Cruzi
What is alloantibody mitigation?
Common practice is to test for?
If positive for antibody extend to?
Transfuse phenotypically matced common antigens.
C, E, and K
Others like Fy, Jk, and S
Warm autoimmune hemolytic anemia has what in DAT?
Cold agglutinin disease, association?
Mixed type autoimmune hemolytic anemia?
Paroxysmal cold hemoglobinuria, associated with?
IgG, IgG+C3, and C3
Cold: C3 only, a/w Anti-I
Mixed: IgG+ C3 and C3
PCH: C3 only, associated with Anti-P
What causes warm auto antibodies?
Tx?
Cold agglutinin disease assoc?
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
PCH associated with?
Lab test?
Causes?
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
What is cause of plt refractoryness?
How long should plts survive?
Ways to tx?
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
HLA match grades?
Perfect?
B1U, X
B2U, UX, X
C
D
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
