Parenteral drug use Family history of Creutzfeldt-Jakob disease Treated w/ growth hormone Viral Hepatitis after 11th birthday Repeatedly reactive Anti-HBc, Anti-HCV, Anti-HIV Babesiosis Chaga's Disease Cancer Patient Bleeding disorders Anemic

Blood Banking Flashcards by Keizel Galupo

Order

Blood Donor Selection
Blood Collection
Unit Processing & Component Preparation
Compatibility Testing
Blood Transfusion
Transfusion Reactions

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Donor screening includes:

medical history, physical examination, serologic testing

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Why is medical history very important in blood donation? (2)

To make sure that donor is well fit for donation; to make sure that blood is safe and beneficial to the recipient of the blood.

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1) The medical history questionnaire consist of questions answerable of ___________.

2) When should the questions be answered?

1) Yes or No
2) Same day as the donation

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Evaluated under physical examination (7)

Weight
Temperature
Pulse
Blood Pressure
Hemoglobin
Hematocrit
Age

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NV of the ff:

Weight:
Temperature:
Pulse:
Blood Pressure:
Hemoglobin:
Hematocrit:
Age:

Weight:
50kg or 110 lbs
Temperature:
37.5 °C (99.5 °F)
Pulse:
50 - 100 bpm
Blood Pressure:
Systolic: 90 - 160 mmHg (not exceed 180)
Diastolic: 60 - 100 mmHg
Hemoglobin:
≥ 12.5 g/dL (125 g/L)
Autologous: >11 g/dL
Hematocrit:
≥ 38%
Autologous: >33%
Age:
18 - 65 years old
17: Need parent’s consent
Above 65: Physician’s consent

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A statement document to be signed by donors after being informed of the procedure for ndonating blood and its potential risks.

Consent to donate

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Volume of the blood should be adjusted when:

The blood donor weighs less than 50 kg or 110 lbs

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Volume adjustment:

1) Volume of blood to draw

2) Amount of anticoagulant needed

3) Amount of anticoagulant to be removed

1) Donor’s weight/Ideal weight x 450 mL

Note: 50 kg/110 lbs (Ideal Weight)

2) Volume of blood to draw/100 x 14

3) 63 mL - AC needed

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Hemoglobin Testing can be done via ______.

If mass donation, __________ method can be used.

CBC

CuSO4 (Copper Sulfate)

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CuSO4 method:

1) Up to how many tests can be done in one container?

2) Acceptable result

3) NV of hemoglobin

1) 30

2) Drop of blood sinks in the sol’n within 15 seconds

3) ≥ 12.5 g/dL

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A donor who donates blood for his or her own use. This is most commonly used in patients with upcoming surgery.

Autologous Donors (Donor Patient)

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Advantages and Disadvantages of Autologous Donors

Advantages:
Decreased risk to:
Disease transmission
Transfusion reaction
Transfusion allloimmunization
Blood of person with rare blood groups

Disadvantages
Bacterial Contamination
Circulatory Overload
Cytokine-mediated Reactions
Misidentification
Higher cost

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This pertains to the the donor not being eligible to donate based on the current requirements

Deferral

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How long will the person with this conditions be deferred?

1) Not feeling well
2) Drunk
3) Skin lesions at venipuncture site

1) Temporarily
2) 12 hours
3) Until fully recovered

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3 Days Deferral

Aspirin-containing medications

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2 weeks deferral

Measles Vaccine
Mumps Vaccine
Polio Vaccine
Acute Febrile Illness (2-3 weeks/until fully recovered)

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12 months (1 year) deferral: GASH SITE THT

Gonorrhea
Animal Bite
Syphilis
Hepatitis Vaccine

Skin penetration with sharp contaminated with blood
Imprisoned
Tattoo
Ear Piercing

Tooth extraction
Household, sexual contact with individual w/ Hepatitis or HIV
Travel to area endemic for malaria

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3 years deferral

From an area (citizen) endemic for Malaria

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Permanent deferral

Parenteral drug use
Family history of Creutzfeldt-Jakob disease
Treated w/ growth hormone
Viral Hepatitis after 11th birthday
Repeatedly reactive Anti-HBc, Anti-HCV, Anti-HIV
Babesiosis
Chaga’s Disease
Cancer Patient
Bleeding disorders
Anemic

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Used to identify donor and is carefully monitored to avoid duplication of wrong identification.

numeric and alphanumeric system

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The phlebotomist must identify the donor and make sure that the _____________ and ___________ match.

donor name & identification number

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Donor Blood Collection:

1) Who states the name?

2) Donation should not exceed how many percent of donor’s blood volume?

3) Donor bleeding

4) Donation intervals

1) Donor
2) 10%
3) 7-10 mins (PH standard = <15 mins)
4) 3-4 months

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Blood Collections Sets:

1) Approved by

2) Set conditions (SUTH)

3) Key properties for containers (FPT)

4) Should be kink and __________ resistant

5) Should allow adequate ___________________ but prevent ______________.

1) Food and Drug Admininstration

2) Sterile, Uncolored, Transparent, Hermetically Sealed

3) Flexibility, Pliability, Toughness

4) scratch

5) gas exchange of O2 and CO2; evaporation of liquid

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Blood Collection Sets: 6) Refers to the whole blood collection set 7) Maintains sterility of the blood 8) During component preparation, what is not introduced into the system? 9) Allows the transfer of components from bag to bag 10) Filter integrally incorporated into the set to filter WBCs

6) Closed system 7) Closed system collection 8) external air 9) internal access port or cannula 10) leukoreduction filter

When is a set considered an "open system"

If the seal is broken and compromised; expiration date and time is changed

Collection Proper: 1) Bloods bags should be inspected for ... 2) Used to select a good site for venipuncture 3) Technique to follow 4) Used to disinfect 5) Scrub selected area at least how many cm and how long? 6) Substitute to iodine (bc donor sensitive to it)

1) defects, cuts, discoloration 2) tourniquet or BP cuff 3) Aseptic technique 4) Povidone-iodine or polymer iodine complex 5) 4 cm; min. 30 seconds 6) chlorhexidine gluconate/ isopropyl alcohol

Collection Proper: 1) Donor should be asked to open and close the hand every how many seconds? 2) Blood bags should be swirled every __________ to mix blood and anticoagulant 3) Method to recap needle 4) How long should donor be remained seated after collection? 5) Means of sealing the tubing into segements

1) 10-12 seconds 2) 45 seconds 3) Fish-out method 4) 10-30 mins. 5) Heat seal

Donor Management: 1) Fainting (anxiety/ hypoglycemia) 2) Convulsions (anxiety/underlying disease) 3) Cardiopulmonary disease (heart disease)

1) FAINTING • Stop donation • Administer glucose if necessary • Position donor that prevents him/her from any possible fall 2) CONVULSIONS • Stop donation • Maintain airway • Restrain to prevent injury • Warn for possible loss of involuntary control of urine or stool 3) CARDIOPULMONARY DISEASE • Stop donation • Apply ventilation, pulmonary resuscitation (if necessary) • Donor taken to the ER

Donor Management: 1) Hematoma 2) Jet-like bleeding w/ bright red blood 3) Lightheadedness, Weakness, Tingling Sensation, Palpitations

1) HEMATOMA • Stop donation • Apply pressure on to site (5 mins.) • Apply cold packs • Reassure donor 2) JET-LIKE BLEEDING W/ BRIGHT RED BLOOD • Stop ASAP • Apply dressing on site • Follow up on donor for additional care 3) LIGHTHEADEDNESS, WEAKNESS, TINGLING SENSATION, PALPITATIONS • Reassure conversations • Elevate donor’s feet at 45 degrees for few mins. and lower to 20 degrees to increase venous flow • Apply cold, wet towel on the neck and forehead • Provide juice even before donation • Have the donor breath into a paperbag • Last resort: Stop donation

Due to fragile veins, unskilled phlebotomist, uncooperative donor

Hematoma

Inadvertent puncture of artery

Jet-like bleeding with bright red blood

Due to anxiety and hypoglycemia

Lightheadedness, weakness, tingling sensation, palpitations < also fainting >

When should all units be processed?

Before compatibility test and transfusion

Unit processing includes: ASA C U

ABO and Rh typing Serologic Testing Antibody Screening Component preparation Unit storage

Serologic testing includes:

Syphilis, Hepatitis B, Anti-HCV, Anti-HIV, Malaria

Unit Storage

ASAP after processing at 1-6C

This should be confirmed of the donor blood

ABO blood type

Typing for ABO

Forward and Reverse

Should also be collected for reverse typing

Donor serum

Reagent used for Rh typing

Anti-D reagent

Tested for every negative typing

Weak-D

A single blood unit can provide transfusion therapy to multiple patients in the form of __________ (4)

RBCs Platelets Fresh frozen plasma Cryoprecipitate

Approved preservatives (PADS)

Phosphate Adenine Dextrose Sodium Citrate

Identify the approved preservative: 1) Supports metabolism of RBCs 2) Binds calcium in exchange of sodium salts 3) Provides energy for RBCs & increases ADP levels 4) Maintains RBC membrane; Substrate for ATP production

1) Phosphate 2) Sodium Citrate 3) Adenine 4) Dextrose

Provided by the manufacturer in the whole blood collection set and mixed with the donor blood during the collection process.

Anticoagulants

Anticoagulants (half-life??) 1) Acid-Citrate-Dextrose (ACD) 2) Citrate-Phosphate-Dextrose (CPD) 3) Citrate-Phosphate-Double-Dextrose (CP2D) 4) Citrate-Phosphate-Dextrose-Adenine (CPDA-1)

1-3: 21 days 4: 35 days

Developed to further extend the shelf-life of RBCs

Additive solutions

1) Components of additives solutions 2) Purpose

1) Saline, Adenine, Dextrose 2) Purpose: • To suspend the solutes • For increasing survival of RBCs • To provide energy for RBCs • RBC membrane stabilizing agent

Composition of whole blood

• Cellular and liquid elements • Anticoagulants • Preservative

1) Intended to replace RBC and Plasma on bleeding patients 2) Provide oxygen-carrying capacity 3) For volume expansion

1) Whole blood 2) RBC 3) Plasma

Whole blood: 1) Volume 2) Storage 3) 1 unit can increase ___% PCV, and _____ g/dL Hemoglobin

1) 450 mL; PCV—38% 2) 1-6C 3) 3-5%; 1-1.5 g/dL

Whole blood is not used for the ff. replacements since it does not survive on stored whole blood.

Platelets; WBCs; and Clotting Factor Replacements

Packed RBCs are prepared from whole blood via _____________ (2).

Centrifugation or Sedimentation after donation

Packed RBCs: Volume of RBCs = Plasma = Hematocrit =

Volume of RBCs = 200 mL Plasma = 100 mL Hematocrit = 70%

Packed RBCs volume to be removed of the total plasma

80%

Intended for patients that needs to increase its RBC mass and oxygen- carrying capacity without increasing the circulatory volume

Packed RBCs

Causes of decreased RBC mass

Decreased production Decreased RBC survival Trauma/Surgical Mass

[Packed RBC] Critical levels that indicates transfusion

<6 g/dL

Contraindicated in patients with well compensated anemia

Packed RBCs

[Packed RBC] 1 unit can increase ______ PCV, and ________ Hemoglobin in a typical ___ human (adjustment is quick compared to whole blood)

3-5% 1-1.5 g/dL 154 lbs

Used for neonatal patients or infants under 4 months

RBC aliquot

Neonatal transfusion may require only how many mL of blood?

10-25 mL

[RBC Aliquot] 1 aliquot can increase ______ of infant’s hemoglobin, and _____ PCV

2-3 g/dL 6-9%

RBC units with irradiated T-cells to prevent ____________________.

Graft-versus-host disease

Irradiated RBCs are intended for:

• Immunocompromised patients • Bone marrow transplant patients • Fetus undergoing intrauterine transfusion

Recommended minimum dose of gamma irradiation

25 Gy

Irradiated RBCs is done with these gamma sources

Cesium-137 or Cobalt-60

Used to confirm irradiation (darkening of the film)

Radiochromic film label

Expiration date of Irradiated RBCs

28 days from the time of irradiation

[Leukoreduced RBCs] RBC unit with a WBC count reduced to __________ and with at least ________ of the original RBC mass Original unit may contain about ___________.

5x10^6 85% 2x10^9

Leukoreduced RBC is reduced to

1x10^4

Shelf life of Leukoreduced RBCs

24 hours

Donor WBCs can cause:

• Febrile non-hemolytic transfusion reaction • Transfusion-associated graft-versus-host disease • Transfusion-related immune suppression • HLA alloimmunization, and may introduce CYTOMEGALOVIRUS

1) Prestorage leukoreduction facilitates removal of 99.9% leukocytes via ______________. 2) % of retained original RBC mass

1) Multiple layers of polyester or cellulose acetate nonwoven fibers 2) 85%

1) Prestorage leukoreduction methods 2) Can be attached to the whole blood unit and filtered via gravity 3) Used to attach a leukocyte reduction filter to a unit of RBCs, which is allowed to flow via gravity 4) initially removed, and the remaining cells pass thru an in-line filter

1) Sterile docking device, in-line method, plasma removal 2) In-line method 3) Sterile docking device 4) Plasma removal

WBCs are removed in the blood bank prior to issuing blood or at the bedside before transfusion

Post-storage Leukoreduction

Filters that reduce leukocytes to 5x10^6

Third generation filters

• Storage of frozen RBCs • Intended for patients with: (BAR)

• Up to 10 years • Rare phenotypes, autologous use, backup blood

1) Frozen RBCs are cryoprotective against: (2) 2) Comprises large molecules that do not enter the cell but instead form a shell around it, preventing water loss and subsequent dehydration 3) Involves small molecules that cross the cell membrane into the cytoplasm. The osmotic force of the agent prevents water from migrating outward as the extracellular ice is formed, preventing cellular dehydration

1) Penetrating & Nonpenetrating 2) Nonpenetrating 3) Penetrating

Examples of Frozen RBCs 1) Penetrating 2) Nonpenetrating

1) Glycerol 2) Hydroxyethyl Starch

Most common frozen RBC; 40% weight per volume

High Glycerol

1) Initial temperature of High Glycerol provided by the freezer 2) Freezing temperatures 3) RBCs should be placed in the freezer within how many hours of opening the system 4) RBCs should be frozen within how many days of collection (if CPD or CPDA-1)

1) -80 C 2) -65 C 3) 4 hrs 4) 6 days

[High Glycerol] 1) How long with thawing process take? 2) Units are placed in? And washed with? 3) Expiration 4) Storage

1) 30 mins. 2) 37C water bath; solution of decreasing osmolality 3) 24 hours 4) 1-6C

Frozen RBCs

High Glycerol Low Glycerol Deglycerolization

1) 20% weight per volume 2) Required for the freezing process 3) Initial freezing temperature: 4) Frozen units are stored at:

1) Low glycerol 2) Liquid nitrogen 3) -196 C 4) -120 C

1) Removes almost all WBC and plasma 2) Storage 3) Units should be used within

1) Deglycerolization 2) 1-6C 3) 24 hours

1) Removes plasma proteins that cause most allergic reactions 2) Answer in 1 is intended for 3) Shelf life 4) RBCs lost in the process

1) Washed RBCs 2) Rare IgA deficiency; Anti-IgA; Anemic patients w/ history of febrile reaction 3) 24 hours after washing 4) 10-20%

Acquired from whole blood processing (random-donor)

Platelet concentrate

[Platelet concentrate] 1) Platelets separated from whole blood w/in? 2) Intended for 3) May be contaminated with these blood cells 4) Random-donor concentrates 5) Stored in a __________ environment with agitation, and should contain adequate plasma of __________ and a pH of _________ 6) Shelf life; if opened

1) 8 hours of collection 2) Thrombocytopenic, Cancer Patients, Thrombocytopenic preoperative patients 3) RBC & WBC 4) 5.5x10^6 5) 20-24C; 50-70 mL; 6 6) 5 days; 6 hours

Facilitates oxygen transfer into the platelet bag and oxygen consumption of platelets

Agitation

Preparation: 1) Whole blood 2) Platelet rich plasma 3) Platelets 4) How many units can be pooled in 1 bag? (Shelf life reduced to 4 hours)

Both centrifuged at 22C 1) Whole blood: Light spin (3200 rpm in 2-3 mins.) 2) Platelet Rich Plasma: Heavy Spin (3600 rpm in 5 mins.) 3) Stand for 1-2 hours at 20-24C with constant agitation; avoid bacterial contamination 4) 6-8 units

1) Platelets can be leukoreduced to ... 2) Via

1) Prevent febrile non-hemolytic reactions 2) Leukoreduction filter

1) Liquid portion of the blood which contains all coagulation factors 2) Answer in #1 is used to treat patients with

1) Plasma 2) Liver failure, DIC, Vitamin K Deficiency, Warfarin overdose, single factor deficiencies, massive transfusion

Fresh frozen plasma has less factors ______, _______, ________, _______

V, VII, VIII, X

Used primarily for fibrinogen replacement, Factor XIII deficiency, treatment for Hemophilia A, and Von Willebrand Disease

Cryoprecipitate

Factors in cryoprecipitate

VIII, XIII, Fibrinogen, VWF, Fibronectin

1) Cryo-poor plasma is refrozen within ________ and stored at ________ or colder for 1 year 2) Factors

24 hours; -18C Albumin, Factor II, V, VII, IX, X, XI

From plasmapheresis of donors Acquired from Intended for

Factor VIII Fractionation and lyophilization of pooled plasma Factor VIII deficiency patients (Hemophilia A)

In rejuvenation, there is regeneration of (2)

ATP; 2,3 DPG

Only FDA approved rejuvenation solution in US

Rejuvesol

Impact of altered environment

Storage lesions