Blood Component Preparation and Storage

Question 1

After collection, a unit of WB intended for platelet production should be stored so that

a. the temperature cools towards 20-24C
b. the temperature cools towards 1-6C
c. the temperature cools towards 1-10C
d. there is no temperature requirement for storing WB prior to component production

Answer 1

Correct: the temperature cools towards 20-24C

Recall that platelets are optimally stored at 20-24C. If you intend to make platelets from the whole blood collected, then you should store the collected whole blood in a manner that will cool the blood towards 20-24C. It would be preferable to put the whole blood units in shipping containers that are NOT refrigerated, but are closer to a 20-24C range. The units will take some time to cool from body temperature (37.5C) to 20-24C

Question 2

A unit of CP2D RBCs has a HCT of________, while a unit of AS-3 RBCs has a HCT of ____.

a. 90%, 55-65%
b. 80%, 55-65%
c. 55%, 80-90%
d. 50%, 75-85%

Answer 2

Correct: 80%, 55-65%

This question is written to mimic a question from the SBB exam. The correct answer is not an entire answer. The technical manual states that a unit of CP2D RBCs has a HCT of 65%-85% and a unit of AS-3 RBCs has a HCT of 55%-65%. None of the responses here match the Technical Manual exactly. When you take the SBB exam, you will quite often be in a position to choose the BEST response. Of the choices given, B is the best response.

To review the components, CP2D RBCs are red blood cells that are collected into a blood bag that contains CP2D anticoagulant. AS-3 RBC’s are Red Blood Cells to which the additive solution AS-3 is added to extend the life of the component.

Question 3

A unit of whole blood collected from a volunteer whole blood donor is expected to yield how many units of factor VIII?

a. 40 IU
b. 80 IU
c. 150mg
d. 250mg

Answer 3

Correct: 80 IU

A unit of whole blood will produce one unit of Cryoprecipitate. The average unit of Cryoprecipitate has 80 IU of Factor VIII

Question 4

Citrate-Phosphate-Dextorse-Dextrose (CP2D) is a common anticoagulant added to whole blood at the time of collection. The purpose of the DEXTROSE in this solution is:

a. to keep the blood from clotting
b. to extended the shelf life of the RBC to 42 days
c. to act as a buffer to control decrease of pH
d. to support ATP generation in RBC metabolism

Answer 4

Correct: to support ATP generation in RBC metabolism

Anticoagulant solutions typically contain Dextrose. The purpose of Dextrose is to support RBC metabolism which produces ATP for energy to maintain the RBC integrity

Question 5

Quality Control is performed on Cryoprecipitated AHF. To perform the QC, 10 units of CRYO are pooled, and the fibrinogen and Factor VIII are assayed. The results are as follows:Total Factor VIII Activity = 910 IU Total Fibrinogen =2000 mg total. According to AABB, is this QC acceptable?

a. Yes. All values meet requirements
b. No. CRYO units may not be pooled when performing QC
c. NO. QC fails for Fibrinogen
d. NO. QC fails for Factor VIII activity

Answer 5

Correct: Yes. All values meet requirements

The AABB requires that Cryoprecipitate units are prepared in such a manner so that the final units of CRYO have a minimum of 80 IU and 150mg Fibrinogen. If you are testing a pool of 10 units, you would divide the assay result by 10 and compare it to the minimum standard. 910/10 = 91 IU Factor VIII and 2000/10 = 200mg Fibrinogen. Both results exceed the minimum QC requirements

Question 6

Cryoprecipitated AHF contains all of the following EXCEPT:

a. Factor VIII
b. von Willebrand factor
c. Fibrinogen
d. Factor VII

Answer 6

Correct: Factor VII

CRYO does not contain Factor VII. That thaws into the plasma during component production of CRYO

Question 7

Cryoprecipitated AHF should be stored at a temperature of ______ and has a shelf life of _____.

a. -18C or below; 1 year
b. -18C or below, 5 years
c. -65C or below, 1 year
d. -65C or below, 5 years

Answer 7

Correct: -18C or below; 1 year

This is straight out of the AABB standards. It is important that you know the storage temperatures and expiration dates for ALL components

Question 8

Thawed Cryoprecipitated AHF has a shelf life of ______ if stored at _______.

(note: we are taking about CRYO that is prepared for transfusion-NOT during the initial component production)
a. 24 hours, 1-6C
b. 6 hours, 20-24C
c. 6 hours, 1-6C
d. 24 hours, 20-24C

Answer 8

Correct: 6 hours, 20-24C

When preparing CRYO for transfusion, the thawed product should be stored at room temperature and used within 6 hours. It is stored at room temperature to keep the cryo reconsituted. It has an expiration time of 6 hours. One thing to note is that we are talking about a CLOSED system here. If units of cryo are pooled in an open system, then the expiration time is lowered to 4 hours to limit the risk of bacterial contamination

Question 9

The maximum shelf life of irradiated RBCs is:
a. 24 hours
b. 21 days
c. 28 days
d .No change from original expiration date

Answer 9

Correct: 28 days

Irradiation can accelerate the lesion of storage in RBCs, therefore the expiration date is shortened to 28 days or the date of the original expiration, whichever is shorter. That is to say that you can not exceed the original expiration date. So if you irradiate a unit of RBCs that is expiring in 5 days, the expiration date remains 5 days and is NOT extended to 28 days. Again, this question is a typical SBB type question. You might be tempted to select the option of “original expiration date” but choosing the maximum of 28 days is the more correct response.

Question 10

RBC storage varies with the anticoagulant/preservative used. All of the following are properly paired items EXCEPT:

a. CPD: 21 days
b. AS: 42 days
c. CPDA1: 35 days
d. CP2D: 35 days

Answer 10

Correct: CP2D: 35 days

CP2D anticoagulant is 21 day expiration

Question 11

If stored at 1-6C, thawed Fresh Frozen Plasma should be transfused within:

a. 4 hours
b. 6 hours
c. 24 hours
d. 5 days

Answer 11

Correct: 24 hours

You may have been tempted to select “5 days”. The reason that is not a correct answer is one of labeling. After the unit is thawed for 24 hours, it is no longer considered “Fresh Frozen Plasma”. It is now “Thawed Plasma”. While it may seem a minor issue of semantics, labeling confers a sense of what the component indications and uses are. “Fresh Frozen Plasma” is a product that is capabale of providing optimal levels of labile and stabile coagulation factors. Once it becomes “Thawed Plasma”, it is capable of providing only optimal amounts of STABILE coagulation factors.

Question 12

Irradiated platelets have an expiration time of:

a. 4 hours from time of irradiation
b. 24 hours from time of irradiation
c. 3 days from date of irradiation
d. no shortened expiration time due to irradiation

Answer 12

Correct: no shortened expiration time due to irradiation

Because Platelets last only 5 days, there is no need to shorten the expiration date due to irradiation

Question 13

he correct temperature for shipping Red Blood Cells (RBCs) is:

a. 1-6C
b. 1-10C
c. 20-24C
d. There is no specific temperature range for shipping RBCs

Answer 13

Correct: 1-10C

Shipping guidelines are more lenient than storage guidelines.

Question 14

A unit of RBCs was returned to the blood bank at 10:45am from the oncology unit. The technologist who receives it inspects the unit, and determines that the container has not been penetrated, and 5 sealed segments remain attached to the RBC unit. She notes that the unit was issued from the blood bank at 7:45am. The technologist logs the unit back into the blood bank computer system, with a comment that the unit was issued and returned. She then places the RBC back in the available inventory. (note: the oncology unit does NOT have a monitored RBC storage refrigerator)The actions taken by this technologist can best be described by which statement below?

a. Actions are acceptable
b. Actions are unacceptable, since RBCs can never be returned once issued to the floor.
c. Actions are unacceptable, since RBC was out of a monitored refrigerator for too long a period
d. Actions are unacceptable, as the RBC should have had its labeling altered to reflect its return status.

Answer 14

Correct: Actions are unacceptable, since RBC was out of a monitored refrigerator for too long a period

Question 15

Which of the following statements is TRUE?

a. To prepare Fresh Frozen Plasma (FFP), plasma must be separated from red blood cells within 24 hours
b. If an additive solution is used, the expiration date for RBCs stored at 1-6C is 42 days after phlebotomy
c. To prepare cryoprecipitated AHF, FFP is thawed at 20-24C.
d. The expiration date for RBCs that are frozen and stored at -65C or below is 5 years from date of freezing.

Answer 15

Correct: If an additive solution is used, the expiration date for RBCs stored at 1-6C is 42 days after phlebotomy

FFP must be prepared by separating the plasma from whole blood and placing into the freezer within 8 hours of collection (or less depending on the type of anticoagulant used-check the manufacturer;s product insert)

When preparing Cryoprecipitated AHF, the plasma is separated from the whole blood, frozen, then thawed at 1-6C and the residual plasma removed.

Frozen RBCs are stored at -65C or below and have an expiration date of 10 years

Question 16

The preferred method for providing leukocyte reduced RBC components is:

a. use of cytomegalovirus CMV-negative units
b. use of a leukocyte reduction filter that leaves a residual of < 5.0 X 106 leukocytes
c. washing
d. irradiation

Answer 16

Correct: use of a leukocyte reduction filter that leaves a residual of < 5.0 X 106 leukocytes

Washing is not validated to remove adequate amounts of WBCs. Irradiation affects the WBCs so they can’t respond to the host, but does not actually remove them. CMV negative units are not necessarily WBC free. The units may be seronegative for CMV but still contain significant amounts of WBCs

Question 17

To prepare a unit of platelets from whole blood, which method below is best?

a. two light spins
b. a hard spin followed by a light spin
c. a light spin followed by a hard spin
d. two hard spins.

Answer 17

Correct: a light spin followed by a hard spin

To prepare platelets from whole blood, first the whole blood unit is spun using a slower RPM (a “light” spin). This separates the whole blood into three layers: RBC layer, buffy coat, and platelet rich plasma. The blood bag is designed to allow the platelet rich plasma to be transferred in a closed system to another bag which has a satellite bag. The two bags are then heat sealed and separated. The two bags together are spun with a longer, faster spin (a “hard spin”) to pack the platelets into the lower portion of the bag. After the second centrifugation, most of the plasma is removed to the satellite bag, leaving the platelets suspended in enough plasma to maintain the component for 5 days.

Question 18

Washed Red Blood Cells are ideal for a patient who requires:

a. RBCs free of leukocytes
b. RBCs that will not alloimmunize the patient
c. RBCs free of IgA proteins in the plasma
d. RBCs that are CMV negative

Answer 18

Correct: RBCs free of IgA proteins in the plasma

The other indications are not valid. Washing removes the plasma, but is not validated to remove WBCs, CMV or RBC antigens

Question 19

What is the purpose of irradiating blood components?

a. To prevent CMV transmission
b. to prevent proliferation of transfused T lymphocytes
c. to remove lymphocytes from the components
d. To prevent HLA alloimmunization

Answer 19

Correct: to prevent proliferation of transfused T lymphocytes

The lymphocytes are still present, but they are inactivated

Question 20

Which of the following RBC units would NOT be suitable for freezing using a high glycerol method?

a. RBCs from a donor who ingested aspirin 48 hours before phlebotomy.
b. RBCs from a donor who has sickle cell trait
c. RBCs from a donor who is CMV+
d. RBCs from a donor who had a HCT of 40% at time of phlebotomy

Answer 20

Correct: RBCs from a donor who has sickle cell trait

I marked this as an extra credit question, because I was not sure how well this would be conveyed in the readings. The statement is implied, but not stated directly in the Technical Manual. I included it to be sure that you would think about the suitability of RBCs for freezing, and to make sure that you learn this. The presence of the Hemoglobin S, even in a heterozygous state, means that the RBCS in a lowered concentration of oxygen can collapse on themselves and form “sickle” shapes. Adding glycerol to the RBCs for freezing maintains the integrity of normal RBC membranes, but the lowered oxygen can result in HbS RBCs to sickle

Question 21

How many autologous units can one person donate before they lose 1 gram of iron?

a. 1 unit
b. 4 units
c. 10 units
d. 6 units

Answer 21

an average unit of RBCs contains approx 200-250mg of iron.

1000mg=1g

200-250mg iron content in one unit of RBCs = 0.20-0.25g iron content in one unit of RBCs

to reach 1g you’ll need 5-4 units

Question 22

The rationale for deglycerolizing frozen RBCs with extensive washing is:

a. Glycerol is not approved by the Food and Drug Administration (FDA)
b. Glycerol is toxic to kidneys
c. Glycerol can cause anaphylaxis
d. Glycerol can cause hemolysis

Answer 22

Inadequately removed glycerol can cause in-vivo or in-vitro hemolysis. The presence of glycerol in the red cells renders them hypertonic relative to the solutions with physiologic osmolalities. If the cells are placed in these solutions, there is movement of water into the cells, resulting in their rupture. During the process of deglycerolization, solutions of prgressively lower osmolality are used to wash the red cells. This allows for the removal of the glycerol from the cells without excess hemolysis. Gloverol is approved by the FDA. It is unknown whether glycerol may cause renal toxicity, anaphylaxis or thrombocytopenia.

Question 23

24 units of whole blood are collected at a mobile blood drive. They are placed into an igloo cooler, and transported to the component production laboratory for RBC production. When the units arrive, the igloo temperature is 18C. Which statement below represents the BEST course of action for these components?

a. make RBCs
b. quarantine all blood products and contact the supervisor
c. make platelets
d. discard all the whole blood units

Answer 23

Correct: Make RBCs.

AABB standards require a validated method to cool blood continuously toward 1-10C if transported from collection site. While there is no mandated temperature with which the components should be deemed acceptable upon arrival, an inspector of a blood collection facility would be more concerned with asking questions such as

How is blood stored and transported to ensure the integrity of the components to be manufactured?

What components does your facility make from whole blood units?

What is the process for qualifying the containers in use?

Take note that there are also requirements in place to cool products to a certain temperature within a particular time frame (for example, RBCs must be refrigerated between 1-6C within 8 hrs of collection) Thus, the above scenario, assuming all approved standard operating procedures of the facility are met, would allow for the production of RBCs. There is no evidence to suggest the whole blood was handled or processed inappropriately.

Question 24

Which of the coagulation factors below will not be viable in a thawed unit of plasma frozen within 24 hours of phlebotomy?

a. V, VII, X
b. II, V, VIII, XI
c. I, V, VII, X
d. V, VIII

Answer 24

Correct: V, VIII

Remember that the labile clotting factors will remain active and at therapeutic levels only 24 hours after thawing. After that time period we can no longer use the component as FFP. We must now call it “plasma” and remove the words “Fresh Frozen”. Fresh Frozen Plasma is expected to have all coagulation factors viable and in the expected amounts present in a normal individual.

Question 25

A unit of CPDA-1 RBC expiring in 35 days is split into 5 small aliquots using a sterile pediatric quad set and prepared in a closed system. Each aliquot must be labeled as expiring in:

a. 6 hours
b. 24 hours
c. 4 hours
d. 35 days

Answer 25

Correct: 35 days

Because the bags are aliquoted into a closed system, the expiration date does not change.

Had you used an open system the expiration date would have been changed to 24 hours from the time the unit was spiked with the pedi-bags.

It may be that you will not use the unit for babies after the 7 days have passed if your SOP requires that you use fresh RBCs. However, this does not affect the expiration date of the RBC units themselves.

Question 26

The Code of Federal Regulations established by the FDA stresses the importance of ensuring blood products are safe, pure, and potent. An important QC test to assess platelet concentrate potency/viability is:

a. plasma potassium concentration
b. plasma pH
c. prothrombin time
d. bleeding time

Answer 26

Correct: Plasma pH

The pH value is established as a quality parameter for stored platelet concentrates. pH values below 6.2 are associated with significant reduction of in vivo survival of the stored platelets.

During storage, platelets generate metabolites, especially lactate which acidify the platelet concentrate.

Plasma pH of platelets has to be maintained at 6.2 or greater during storage.

While the other choices are factors that can shed light on the function and viability of platelets, only pH is included in the component QC testing on blood components.

AABB Stds 32nd ed. 5.7.4.18

Validation and quality control of Platelets prepared from Whole Blood shall demonstrate that at least 90% of units sampled contain ≥5.5 × 1010 platelets and have a pH ≥6.2 at the end of allowable storage. FDA criteria apply

Question 27

A unit of CP2D whole blood was collected for production of AS-3 LRBC.

Due to a plastic shortage there is no more AS-3 available. The technologist has already separated plasma and RBC.

What should be done with the final RBC (all testing acceptable)?

a. Discard the RBC because the AS-3 could not be added
b. Label the RBC with a 21 day expiration date
c. Label the RBC with a 42 day expiration date
d. Discard the units and consult MD

Answer 27

Correct: Label the RBC with a 21 day expiration date

If the AS-3 cannot be added, the RBC is still acceptable but the expiration date is based on the original CP2D anticoagulant, so it should be labeled with a 21 day expiration date.

There is no need to quarantine or discard the units if they can become a different type of product. This is the beauty of allowing for different variables in component production (ex thawing cryo in a cold water bath vs fridge)

Question 28

A regular donor has been recruited to start giving double RBC donations because he is Yta(-). His last donation was an apheresis platelet donation on 04-05-22. The donor is schedule to donate the RBC pheresis on 04-13-22.

On 04-05-22, his post-donation blood work gave the following results:

Platelet count = 135,000/uL HCT = 38% Hgb = 13.0

Which statement below represents the correct way to handle this donor?

a. The post-donation results qualify him to donate on 4/13/22.

b. The platelet count must be retested and found acceptable prior to donating on 4/13/22.

c. The HCT must be retested and found acceptable prior to donating on 4/13/22.

d. The donor must be deferred for 16 weeks after the previous donation and is not qualified to donate on 4/13/22.

Answer 28

Correct: The HCT must be retested and found acceptable prior to donating on 4/13/22.

Remember that RBC pheresis requires donors to have a minimum HCT of 40%

The platelet count is not relevant to erythropheresis, and the deferral period is 48 hours. After he gives the erythropheresis, he will be deferred for 16 weeks.

Question 29

A donor has given platelets pheresis 4 times in 2021, and the most recent donation was 12/30/21. He has been recruited to donate a unit of granlulocytes by apheresis on 04/08/22. His previous donor suitability questions were acceptable and his previous viral marker tests were all nonreactive.

He donates on 04/08/22 and is found to be O Positive, with a negative antibody screen. What should be done concerning the viral marker testing for this donation?

a. Viral marker testing is required before the unit is released to the patient

b. Viral marker testing is not required because he has negative results within the past 6 months.

c. Viral marker testing is not required for granulocyte pheresis collections.

d. The unit may be emergency released to the patient before viral marker testing is performed.

Answer 29

Correct: The unit may be emergency released to the patient before viral marker testing is performed.

Granulocyte pheresis have an outdate of 24 hours, which necessitates that units be emergency released before all testing is completed. We still must perform the testing, however, even if the unit is already released and transfused.

The only exception to this is if the donor gave blood within the past 30 days. If the previous viral marker tests were nonreactive, then we could note that on the label that it was testing within the past 30 days.

Question 30

A patient (born female) is scheduled to donate an autologous WB component. They are evaluated and the following information is noted:

Hgb = 12.0 g/dL

Oral Temperature 37.0F

Medications: Accutane, Tegison, Plavix, Cephalosporin

Donor questions: Donor mentions that they had a GI infection and is taking a 7-day course of antibiotics. They had two days of medications but is now asymptomatic.

What action should be taken with this donor?

a. Accept the donor because their oral temperature is normal and they are asymptomatic

b.

Defer the donor until they have finished the medication

c. Defer the donor because their Hgb is too low

d. Accept the donor and irradiate the unit as a precaution

Answer 30

Correct: Defer the donor until they have finished the medication

We cannot draw a donor with an active infection currently taking antibiotics even if their symptoms have resolved and the oral temperature is normal. Irradiating the unit will not prevent bacterial contamination.

The Hgb is acceptable, so that is not deferring.