Blood Component Preparation and Therapeutic Cytapheresis Flashcards
used to treat patients who have abnormally elevated platelet counts (plt ct > 1,000,000/uL) such as polycythemia vera
equivalent to 6-10 random plt conc
plateletpheresis
used to treat patients with leukemia (wbc > 100,000/uL) such as Hairy cell leukemia, AML, Cutaneous T cell lymphoma
uses either HES or corticosteroids
leukapheresis
means of producing immunosuppression in conditions like RA, SLE, kidney transplant rejection, and autoimmune and alloimmune dses
lymphocytapheresis
sedimenting agent used for granulocyte collection w/c causes red cells to form rouleaux thus allowing WBCs to be harvested more efficiently
HES (hydroxyethyl starch)
administered to the donors 12-24hrs before pheresis to increase the number of circulating granulocytes by pulling them from the marginal pool
Corticosteroids
for young pxs w/ certain hematologic disorders especially thalassemia syndromes
transfusion of young rbcs “neocytes”
neocytapheresis
used to treat various complications of sickle disease such as priapism, impending stroke. Also in pxs w/ severe parasitic infections from malaria or babesia
erythrocytapheresis
an exchange transfusion
Predetermined quantity of red cells is removed from px and replaced w/ homologous blood
erythrocytapheresis
o To remove the offending agent in the plasma causing clinical symptoms in cases of paraproteinemia (e.g. multiple myeloma, waldenstrom macroglobulinemia, etc.)
o To collect rare red and white cell abs
o Beneficial particularly in disease that involve malfunction of the immune system (SLE, RA)
Therapeutic Plasmapheresis
(Plasma Exchange)
Replacement fluids used are NSS, NSA, PPF, FFP
Therapeutic Plasmapheresis (Plasma Exchange)
each unit of blood bag contains?
450 mL blood
63 mL anticoagulant
what is the reference lab for patient who tested reactive for infectious screening
std/aids cooperative central laboratory - san lazaro hospital
how often do you mix blood bag?
mix periodically - 1-2x per min. or every 30-45 sec.
what blood components are transferred to transfer bag 1 and 2?
1 - PRP
2 - PPP
if acid-citrate-dextrose anticoagulant is used, the unit must be processed within how many hours?
within 6 hours
In refrigerated centrifuge. for plasma concentrate temperature should be adjusted at?
room temp
skin to vein insertion using 16 gauge of needle in a __ degrees angle
20 degrees angle
why patients with in-vitro clotting only suitable to donate red cell components?
platelets and coag factprs are partially consumed and will be insufficient for patient use
the blood donation duration procedure is about 8 to 12 minutes with an average of _?
10 minutes
hard or heavy spin
3500-3600 rpm for 5 minutes
soft or light spin
3000-3200 rpm for 2-3 minutes
storage temp of leukoreduced rbcs
1-6C
storage temp of cryoprecipitate
-18C or colder
required temp for transport or shipping of blood bag
1-10C
shipped with dry ice
plasma components
shipped with no ice
buffy components
shipped with wet ice
red cell components
fresh whole blood (450-500 cc) will undergo:
a) soft spin
b) hard spin
a) soft spin
what will be the upper and lower layer after soft or light spinning of fresh whole blood?
upper: platelet-rich plasma (transferred into transfer bag 1)
lower: packed red blood cells (left in the main bag)
what spin will PRP undergo?
hard or heavy spin
5 mins @ 3500-3600 rpm
what are the upper and lower layer of PRP after hard spin?
upper: platelet-poor plasma
(transferred to 2nd transfer bag)
lower: platelet concentrate
(left in the 1st transfer bag)
It will be directly put inside freezer to freeze and yield a fresh frozen plasma
Platelet-poor plasma
it contains all coagulation factors
FFP
FFP will undergo ___ to give cryosupernate and cryoprecipitate
cold thawing
- slow cold thawing from freezer temp to ref temp
it is rich in fibronectin, F1, F8, F13, vWF
cryoprecipitate
it has same coagulation factors as FFP, however it precipitated so it specifically decreased in some.
cryosupernate
what is the immediate effect of WB?
1-3% increase in hematocrit
what are indications for use of fresh whole blood?
active bleeding, hemorrhagic shock, exchange transfusion, when both oxygen-carrying capacity and volume expansion is required
labile factors significantly decreases after __
2 days of storage
white blood cells and platelets are no longer viable after _
24 hours of storage
what is the shelf life of these anticoagulants?
ACD, CPD, CP2D
21 days
anticoagulant that is mostly used in apheresis
ACD
most commonly used anticoagulant in whole blood prep
CPDA-1
shelf life of CPDA-1
35 days
enumerate the RBC additives and its contents
RBC additives - adsol (AS-1), nutricel (AS-3), optisol (AS-5), SOLX (AS-7)
contents: SAMG
saline
adenine
mannitol
glucose
AS-1 and AS-5 has mannitol
AS-3 has citrate & phosphate
what are the contents of PRBCs?
hematocrit should be 80% or less
should retain small vol of plasma, otherwise rbcs not supported
what is the immediate effect of PRBCs after transfusion?
3% increase in hematocrit
and
1g increase in hemoglobin
what is the indication for use of PRBCs?
anemia
PRBCs restores oxygen carrying capacity
what is the indication for use of leukopoor or leukoreduced RBCS?
for anemic patients with history of febrile reactions
for patients in need to decrease alloimmunization to WBC, HLA antigens, and CMV transmission
what is the best technique in removing WBCs?
mechanical separation using leukoreduction filters
what is the content of leukoreduced or leukopoor RBCs?
5x10^6 residual WBC
rejuvenated red blood cells involve the addition of a rejuvenation solution, what is the action of this solution?
to regenerate ATP and 2,3 DPG
PIPA AND PIGPA stands for?
phosphate, inosine, pyruvate, and adenosine
PIGPA - G for glucose
what is the primary use of rejuvenated RBCs?
to salvage rare blood units
what is the storage temp of rejuvenated RBCs?
1-6C
it’s the only FDA approved rejuvenation solution
REJUVESOL
do you wash rejuvenated RBCs prior transfusion? yes or no? and why?
yes, we have to wash it properly to remove rejuvesol.
after washing it must be transfused within 24hrs
what is the shelf-life of washed red blood cells?
open system - 24hrs
what is the QC of washed RBCs?
plasma removal
what are the indications for use of washed red blood cells?
for anemic patients with hx of febrile rxns
patients with PNH
for px w/ plasma proteins abs reduced to allergic rxns (for IGA-deficient px)
frozen RBC is also known as _
glycerolized or cryoprotected RBC
what are two common cryoprotective agents of frozen RBCs?
penetrating and non-penetrating cryoprotective agents
utilizes low molecular weight agent, most commonly used: GLYCEROL
penetrating
utilizes high molecular weight, most commonly used: hydroxyethyl strach
non-penetrating
its action is to protect the cell’s surface against extremely low temp
sole action of non-penetrating agent
it prevents dehydration, formation of ice crystals, and also protects cell membrane from extremely low temp storage
penetrating cryoprotective agent
what is the shelf life of deglycerolized RBCs?
24 hrs
shelf life of frozen RBCs?
10 yrs
temp storage of low glycerol 20%
-120C using liquid nitrogen
temp storage of high glycerol 40%
-65C using mechanical freezer
temp storage of 79% glycerol with dextrose fructose and EDTA
-65C
what is deglycerolizing process?
use of hypertonic solution in decreasing concentration until isotonic solution conc is reached
enumerate the 3 steps cell washing and its corresponding use
- 12% hypertonic solution - removes glycerol
- 1.6% saline - completely removes glycerol without rbc shrinking
- 0.2% dextrose in NSS - serves as energy while maintaining rbc morphology
after washing off cyroprotective agents, it should be transfuse within how many hrs?
24hrs
what are the indications for use of frozen<thawed<deglycerelized RBC?
- anemia
- long term storage of rare units and autologous units
what is the shelf life and storage temp of platelet concentrates from random donor prepared from WB?
20-24C for 3-5 days with constant agitation
platelet concentrate random donor prepared from WB is composed of _
5.5 x 10^10 plts in 50-65 ml of plasma
what are the indications for use of plt conc random donor?
- Thrombocytopenia
- DIC
- Bleeding disorder
- Platelet disorder
what is the immediate effect of random donor plt conc after transfusion?
increase plt ct by 5,000 to 10,000 per unit corrected plt ct (plt/ul)
what is the formula used in calculations of random donorplt conc?
posttransfusion - pretransfusion x BSA /
no. bags x 0.55
what is the shelf life and storage temp of plt conc single donor prepared by pheresis?
5 days (closed system)
24 hrs (open system)
3-5 days 20-24C with constant agitation
what is the content of plt conc from a single donor prepared by pheresis?
3.0 x 10^11 in approx. 300mL of plasma
what are the indications for use of plt conc from single donor prepared by pheresis
- Thrombocytopenia
- px refractory to random plts due to plts abs
what is the immediate effect after transfusion with plt conc from single donor prepared by pheresis?
30,000 to 60,000 increase in plt ct
it extends shelf life of plt conc from 5 days to 7 days
intersol
give the shelf life and storage temp of FFP.
- thawed - 24hrs at 1-6C
- frozen - 1yr at -18C
give the contents of FFP.
- all coagulation factors
- 400mg fibrinogen
what are the indications for use of FFP?
- treatment for multiple coagulation factor deficiencies (caused by massive transfusion, trauma, liver disease, DIC)
- treatment for antithrombin III deficiency, TTP, HUS.
give the shelf life and storage temp of SDP liquid and frozen.
- liquid - 5 days beyond at WB 1-6C
- frozen - 5 years at -18C
what is the indication for use of SDP liquid / frozen?
treatment of stable clotting factor deficiencies
What is the most possible blood component to administer to your patient suffering from graft-versus-host disease?
Irradiated blood
give the shelf life and storage temp of cryoprecipitate.
- frozen - 1 yr at -18C
- thawed - 6hrs at 20-24C
- pooled - 4hrs
what are the contents of a cryoprecipitate?
- FVIII:C - 80-150 IU
- FVIII:vWF - 40-70%
- fibrinogen - 150-250 mg
- FXIII - 20-30%
what are the indications for use of cryoprecipitate?
- hemophilia A
- von willebrand’s disease
- fibrinogen deficiency
- FXIII deficiency
what is the shelf life and storage temp of a granulocyte concentrate?
- 24 hrs
- 20-24C without agitation
what is the content of granulocyte concentrate?
1 x 10^10 wbc
what are the indications for use of granulocyte concentrate?
- to correct severe neutropenia
- fever unresponsive to antibiotic therapy
- myeloid hypoplasia of BM
what are plasma derivatives?
concentrates of plasma proteins that are prepared from pools of plasma
enumerate the plasma derivatives.
- FIX conc
- FVIII conc
- NSA
- PPF
- Rhogam
- ISG
They have the same shelf life that varies on vial and 1-6C (lyophilized) temp storage.
FIX conc & FVIII conc
indication for FIX conc
hemophilia B
indication for FVIII conc
hemophilia A
what is the shelf life and temp storage of both NSA and PPF?
shelf life:
3 yrs at 20-24C
5 yrs at 1-6C
what is the same indication for use of both PPF and NSA?
plasma volume expansion: trauma, burns, surgery
what are the contents of NSA?
96% albumin
4% globulin
what are the contents of PPF?
80-85% albumin
15-20% globulin
what are synthetic volume expanders?
crystalloids:
Ringer’s lactate
Electrolyte solution
NSS
colloids:
Dextrans
HES
what is the storage temp and shelf life of Rhogam?
3 yrs at 1-6C
what are the contents of rhogam?
full dose 300ug anti-d
mini dose 50ug anti-d
rhogam full dose 300ug anti-d
neutralize 30ml WB or 15ml of PRBCs FMH
antenatal administration at 3rd trimester, full term deliver within 3d
rhogam mini dose 50ug anti-d
neutralize 5ml WB or 2.5ml PRBCs
amniocentesis, ectopic rupture, 1st preg the miscarriage
what are the indications for use of rhogam?
- prevents Rho (D) immunization
- prevent HDFN
what is the target of irradiated blood?
lymphocyte t cells
what is the shelf life of irradiated blood?
28 days or the normal dating period of blood whichever comes first
irradiation uses?
cesium-137
cobalt-60
what are the indications for use of irradiated blood?
- GVH reactions
- exchange transfusion
- IUT
- direct donation from relative
- transfusion for immunocompromised px
- BM transplant
how ISG can be administered and give its shelf life?
- IM - 3yrs
- IV - 1yr
what are the indications for use of ISG?
- prophylactic treatment for px exposed to hepatitis
- measles and chicken pox
- treament of hypogammaglobulinemia
In RBC additive solution, if glucose is for energy, then adenine is for what?
To support ATP levels
This is recommended if patient is actively bleeding, has hemorrhagic shock, or will undergo exchange transfusion. Also indicated when both oxygen-carrying capacity and volume expansion is required.
Whole Blood (450-500 mL)
what is the shelf-life of CPD-AS (Additive Solution)?
42 days
True or False
After 36 hours of storage, the WBC and platelets in WB are no longer viable.
True
after 24 hrs of storage wbcs and plts are no longer viable
what is the expected increase in coagulation factors when patient is administered with FFP?
20-30% increase in coagulation factors
for every unit of FFP
what is the immediate effect of cryoprecipitate?
5-10 g/dL increase in fibrinogen
immediate effect of granulocyte concentrate
it will increase WBC ct by 1-2 x 10^10 per infusion 4 daily doses
equivalent to 6-10 random platelet concentrates
content: 3 x 10^10 plts
plateletpheresis
It is used to treat patients who have abnormally elevated platelet count
e.g. patients with polycythemia vera
plateletpheresis
It is used to treat patients with leukemia
e.g. patients with hairy cell leukemia / AML / cutaneous T cell lymphoma
leukapheresis
It is used as means of immunosuppression in conditions like SLE, RA, autoimmune & alloimmune disease, or transplant rejection
lymphocytapheresis
transfusion of neocytes or young rbcs
neocytapheresis
it is used for young patients with certain hematologic disorders especially thalassemia syndromes
neocytapheresis
it is used to treat various complications of SCD. Also used in patients with severe parasitic infections from babesia & malaria
erythrocytapheresis
It is used to remove offending agent in the plasma causing clinical symptoms in cases of paraproteinemia
e.g. multiple myeloma, waldenstrom macroglobulinemia
therapeutic plasmapheresis
confimatory laboratory for donors who tested reactive in infectious screening.
Transfusion Transmissible Infection - National Reference Laboratory - Research Institute for Tropical Medicine
