Blood Collection and Processing

Question 1

Is whole blood transfusion used often? When is it used?

Answer 1

Not often due to the availability of blood components which are usually a better choice for blood transfusions.

Whole blood is transfused in cases of SEVERE SHOCK and BLOOD LOSS (blood loss >25% of blood volume).

Question 2

What percentage hematocrit of packed red blood cells indicates sufficient plasma removal from the unit?

Answer 2

> 80%

Question 3

1 unit of packed red blood cells raises hemoglobin by how much?

Answer 3

1 gram

Question 4

1 unit of packed red blood cells raises hematocrit by how much?

Answer 4

3%

Question 5

What happens to plasma in packed red blood cells during prolonged storage?

Answer 5

Increased NH4 and K+ due to hemoylsis

Decreased pH (due to increase lactic acid leakage) and sodium (plasma becomes diluted)

Question 6

Can a unit of red blood cells be returned for use if it was transported in 11C container with the seal undisturbed?

Answer 6

NO. Has to be 1-10C transportation and seal undisturbed

Question 7

Can a unit of red blood cells be reissued if it was transported in 1-10C but the seal is broken (open unit)?

Answer 7

NO.

Question 8

Why would a CLS want to wash red blood cells with saline?

Answer 8

To prevent allergic responses to plasma proteins and anaphylactic shock in IgA deficient patients who can create anti-IgA.
(If blood gets transfused to this IgA deficient pt, they can get a reaction from the donor blood that contains normal plasma IgA.)

It also removes anti-HPA-1a from maternal blood
Removes complement

Question 9

What is the expiration of washed red blood cells?

Answer 9

24 hours because the seal has been open (open unit)

Question 10

What should the hemoglobin value be in apheresis RBCs?

Answer 10

> 60g

Question 11

What is the concentration of leukocytes in leukoreduced apheresis RBCs?

Answer 11

< 5x10^6 leukocytes per unit with final hgb of > 51g

Question 12

What does reducing leukocytes in red blood cells do? (Leukocyte-reduced red cells/leukoreduced red cells)

Answer 12

Reduces leukocytes to < 5 x 10^6 to prevent febrile nonhemolytic rxns, HLA alloimmunization and transmission of CMV

Question 13

How do leukocytes/WBCs cause febrile nonhemolytic reactions?

Answer 13

The presence of cytokines released from white cells or alloimmunization to HLA or leukocyte antigens

Question 14

Expiration: Frozen cells

Answer 14

10 years

Question 15

What % of glycerol is used to protect frozen cells in ultra low temperatures?

Answer 15

40% glycerol

Question 16

What temperature must frozen cells be thawed at?

Answer 16

37C

Question 17

What temperature are frozen cells stored at?

Answer 17

< or equal to -65C

If you remove glycerol and wash the cells, store at 1-6C

Question 18

Why would you want to freeze cells?

Answer 18

Usually used to store rare cells.

Question 19

All red blood cell-type units (packed, adenine/saline added, washed, leuko-reduced, irradiated) with the exception of frozen cells, are stored at what temperature??

Answer 19

1-6C

Question 20

What is the most common type of RBC unit used?

Answer 20

RBCs adenine, saline added

Question 21

What is the shelf-life/expiration of RBCs with CPDA-1 additive?

Answer 21

35 days

Question 22

What is the shelf life of RBCs adenine, saline added?

Answer 22

42 days

Question 23

Once a seal has been broken on a unit of red cells, what is its shelf life?

Answer 23

24 hours

Question 24

What does irradiating blood and components do?

Answer 24

Prevents Graft vs Host disease

Question 25

Who would benefit from irradiated blood components?

Answer 25

Anyone at risk for graft versus host disease A fetus receiving intrauterine transfusion Donor is blood relative or recipient Donor is HLA matched Congenital immunodeficiency

Question 26

What does irradiation do at the cellular level?

Answer 26

Inactivates donor T-cells

Question 27

What is the shelf life of irradiated RBCs?

Answer 27

Original expiration or 28 days from irradiation, whichever comes first

Question 28

How is Fresh Frozen Plasma (FFP) prepared?

Answer 28

Centrifuge whole blood, separate plasma from cells. Freeze plasma within 8 hours of collection.

Question 29

Expiration of FFP after initial freeze and after thawed?

Answer 29

1 year if stored at or equal to <-18C once thawed, 24 hours

Question 30

Does FFP have to be ABO compatible or identical with its recipient?

Answer 30

ABO compatible is ok

Question 31

What is FFP used for?

Answer 31

Multiple coagulation deficiencies | Factor XI deficiency

Question 32

Who should FFP never be collected from and why?

Answer 32

FFP should never be collected from pregnant females or females who have been pregnant to prevent TRALI. It is collected from males and never-pregnant females.

Question 33

What is the abbreviation for plasma frozen within 24 hours of phlebotemy?

Answer 33

PF24

Question 34

How is cryoprecipitate prepared?

Answer 34

Prepared by thawing FFP at 1-6C, removing the plasma portion and refreezing it at -18C within 1 hr

Question 35

How much fibrinogen must a bag of cryoprecipitate contain?

Answer 35

> or equal to 150 mg of fibrinogen

Question 36

How much Factor VIII (8) must a bag of cryoprecipitate contain?

Answer 36

> or equal to 80 IU of Factor 8

Question 37

What factors does cryoprecipitate contain?

Answer 37

Fibrinogen Factor VIII (8) vWF Ristocetin cofactor activity

Question 38

Storage temperature for Cryoprecipitate?

Answer 38

-18C

Question 39

Shelf life of frozen cryoprecipitate?

Answer 39

1 year from date of phlebotomy

Question 40

Shelf life of cryoprecipitate after thawed?

Answer 40

Must transfuse within 6 hours of thawing 4 hrs after pooling in an open system 6 hours after pooling in a closed system

Question 41

What is cryoprecipitate used for?

Answer 41

To replace fibrinogen loss due to DIC Massive bleeding Dysfibrinogenemia with active bleeding

Question 42

Recombinant Factor VIII concentrate is given to who?

Answer 42

People with severe to moderate Hemophilia A and von Willebrand disease

Question 43

What would you give to a person who has severe/moderate Hemophilia A versus a person with mild Hemophilia A and type 1 vWD?

Answer 43

Severe/moderate Hemophilia A: Recombinant Factor VIII concentrate Mild hemophilia A/Type1 vWD: DDAVP

Question 44

What concentrate can be given to treat someone with Hemophilia B?

Answer 44

Recombinant Factor IX (9) | Prothrombin Complex Concentrates

Question 45

What do Prothrombin complex concentrates contain?

Answer 45

Vitamin-K dependent factors: II, VII, IX, X | Giving this may increase risk of thrombosis

Question 46

A patient gets into a car accident and is bleeding. She has mild von Willebrand disease. What blood component should be given?

Answer 46

DDAVP - used for ppl with mild hemophilia A or type 1 vWD.

Question 47

What does DDAVP do?

Answer 47

increases circulating Factor VIII and vWF.

Question 48

How are platelets prepared?

Answer 48

Whole blood is centrifuged at a light spin first to remove RBCs Followed by a heavy spin to spin down platelets and WBCs Supernatant plasma is expressed into another bag for freezing (FFP) Remaining plasma, platelets, and WBCs = platelets

Question 49

When would platelets be given?

Answer 49

Severe thrombocytopenia and platelet dysfunction

Question 50

When should platelets not be used? (contraindicated)

Answer 50

TTP and HIT

Question 51

What is platelet refractoriness?

Answer 51

Lack of expected platelet response even after platelet transfusion due to antibodies to HLA class I antigens or platelets specific antigens

Question 52

One unit of platelets raises platelet count by how much?

Answer 52

5000 - 10,000 platelets/ul

Question 53

One unit of apheresis platelets raises platelet count by how much?

Answer 53

20,000 - 60,000 platelets/ul

Question 54

Platelets are stored at what temperature?

Answer 54

20-24C with gentle agitation

Question 55

Expiration of platelets?

Answer 55

5 days

Question 56

What should the pH of platelets be?

Answer 56

> or equal to 6.2 Stored in vol of plasma necessary to maintain pH, usually about 40-70 cc

Question 57

What concentration of platelets should be in one unit?

Answer 57

> or equal to 5.5 x 10^10 platelets/unit

Question 58

What blood component must have a method to detect and limit bacterial contamination?

Answer 58

Platelets. More at risk for bacterial contamination due to storage at RT

Question 59

If an Rh negative woman of child bearing age has received D+ platelets, why might you consider giving RhIg?

Answer 59

Platelets might contain residual RBCs; might become sensitized

Question 60

How are granulocytes obtained/prepared for blood transfusion?

Answer 60

They are collected from apheresis

Question 61

When would granulocytes be transfused?

Answer 61

For neutropenic patients with documented gram negative sepsis who have not responded to antibiotics

Question 62

Why is giving granulocytes risky?

Answer 62

Can transmit CMV, induce HLA immunization, cause graft versus host disease if not irradiated

Question 63

What temperature are granulocytes stored at?

Answer 63

20-24C

Question 64

Expiration of granulocytes?

Answer 64

24 hours, but should be transfused ASAP

Question 65

Why would recombinant factor VII (7a) be a better choice for a patient with Hemophilia A with inhibitors than Factor VIII (8) concentrate?

Answer 65

Factor 7a would bypass Factor 8 and activate Factor 10 to achieve hemostasis. If factor 8 were used, it would be neutralized by the inhibitor and pt would still be bleeding!!

Question 66

If a patient has hemophilia A with inhibitor, what blood component would you use?

Answer 66

Factor 7a