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2.2 Transfusion Science > Blood Component Preparation Red Cell Transfusion > Flashcards

Blood Component Preparation Red Cell Transfusion Flashcards

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1
Q

What are the benefits of dividing blood up into components?
(4)

A

Ensures maximum use of the blood donation - minimises wastage

Products can be ‘tailor made’ for the underlying clinical disorder e.g. factor deficiencies

Avoids unnecessary volume overload

Different optimal storage conditions for red cells, plasma and platelets

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2
Q

At what temperature should you store red cells

A

4 degrees Celsius

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3
Q

At what temperature should you store plasma

A

-20 degrees Celsius

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4
Q

At what temperature should you store platelets?

A

+22 degrees

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5
Q

List the main blood components
(4)

A

Red blood cells
White blood cells
Platelets
Frozen plasma

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6
Q

Why do we use centrifugation

A

By using centrifugation the different densities of blood components allow separation by centrifugation

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7
Q

What are the two types of centrifugation used?

A

Soft spin
Hard spin

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8
Q

What does a soft spin do?

A

Separates blood into Plasma rich in platelets and white blood cells and into Red cells

e.g. PRP and RCC

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9
Q

What does a hard spin do?

A

Separates blood into Plasma poor in platelets, buffy coat and Red cell concentrate

PPP, Buffy Coat and RCC

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10
Q

What is found in the buffy coat?
(4)

A

Plasma
Platelets
White cells
Red cells

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11
Q

Why might someone have a red cell transfusion

A

To improve oxygen carrying capacity

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12
Q

Why might someone have a platelet transfusion?

A

To prevent or stop bleeding

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13
Q

Why might someone have a plasma transfusion?

A

To replace clotting factors or proteins

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14
Q

Why did we stop using glass bottles and start using plastic

A

Once the glass bottle was opened the blood could no longer be used as it was no longer sterile

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15
Q

What anti-coagulant do we use?

A

Citrate

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16
Q

What do we do with freshly donated blood?

A

Mix it to ensure it is thoroughly mixed with he anti-coagulant

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17
Q

How long does it take to donate blood

A

About 12 mins, or more accurately 10 minutes

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18
Q

What happens if it takes 15 minutes to donate blood?

A

This sample won’t be used for platelets as this is too slow

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19
Q

What must you do to the line when the donation is finished?

A

strip the line to make sure blood in line has also mixed with anti-coagulant

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20
Q

When would you realistically administer plasma

A

Used in major haemorrhage

Coagulation factors found in plasma help stop bleeding

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21
Q

What is given to patients in America if they have a mass bleed?

A

Whole blood not plasma and packed red cells

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22
Q

What packs are used for gathering plasma and red cells?

A

Top and top bags used as we are not gathering platelets

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23
Q

What do you do with the first 20mls of blood in a pack

A

This is diverted

24
Q

Why is the first 20mls of blood donated diverted
(2)

A

There will be a bore of skin in the needle from puncturing the skin

This bore will be in the stream of blood

25
Q

What do we do with the first 20ml of diverted blood?

A

Virology testing is carried out on this diverted blood

26
Q

How do we leukocyte deplete red blood cells
(4)

A

Use SAG-M additive solution

Leucocyte filter for the red cells

Additive solution is poured through the filter into the red cells -> this primes the filter

Red cells and additive solution is ran through the filter -> leucocyte depleted packed rbcs result

27
Q

Give three examples of anticoagulant solutions used

A

ACD
CPD
CPDA-1

28
Q

What is ACD?
(3)

A

Acid-citrate-dextrose

Dextrose doesn’t boil so it can be autoclaved while other sugars would make caramael

Used as a preservative in 1945 by the army

29
Q

What is CPD?
(3)

A

Citrate-phosphate-dextrose

Phosphate is a buffer

pH stabiliser

30
Q

What is CPDA-1

A

CPD with adenine + 25% glucose than CPD

Introduced in 1980 and also used as a storage solution

31
Q

How does CPDA (Citrate, phosphate, dextrose, adenine) work?

A

Citrate chelates calcium ions which prevents blood from clotting (anticoagulant)

Phosphate stabilises pH

Dextrose is a nutrient which supports red cell metabolism by maintaining Na/K pump and ATP levels

Adenine - increased nucleotide content leading to high in vivo red cell survival by maintaining ATP

32
Q

Give three examples of additive solutions

A

SAGM (sodium chloride adenine glucose mannitol)

AS1-5 (additive solution) - used in USA, if used have to pay royalties, must have similar composition to SAGM

PAGG SM (phosphate adenine glucose guanosine sodium chloride mannitol)

33
Q

How does SAGM work
(4)

A

Sodium chloride provides isotonicity

Adenine maintains ATP for cell viability

Glucose supports red cell metabolism

Mannitol helps reduce red cell lysis

34
Q

How are red cells stored
(6)

A

Temperature of 4 degrees +- 2 degrees

For 35 days

No agitation is needed

Monitored all the time

Electronic temperature monitor in the fridges

Can be reused if not left out of the fridge for more than 30 mins and if not punctured

35
Q

How should plasma be stored?
(5)

A

-20 degrees or below usually below 30

Can be stored for up to 24 months

No agitation needed

Quarantine period in some countries

Cannot be refrozen once thawed for a patient

36
Q

How should platelets be stored?
(4)

A

22 degrees +- 2 degrees

7 days

Requires good gas exchange

Must be continually agitated usually on flatbed platelet agitator

37
Q

Why do we irradiate our platelets?
(3)

A

Kills DNA material in WBCs

This stops WBCs from reproducing

Prevents graft versus host disease

38
Q

What is graft versus host disease
(3)

A

Immunodeficient patient such as chemotherapy patient is give a platelet transfusion containing WBCs

These WBCs will assume they are back in the bone marrow when transfused and will start growing a reproducing

The compromised patient won’t be able to fight back these invading white blood cells

39
Q

How do we ensure blood doesn’t get left out of fridge for too long?
(3)

A

Each time product is removed from a fridge it must be scanned

If brought up to theatre the product will be scanned again

If product has been out for more than 30 mins you won’t be able to put it back in the fridge -> system won’t allow it

40
Q

How long can plasma be left out of the fridge

A

4 hours

41
Q

Why do platelets need to be agitated

A

Platelets are very reactive

Need to be kept agitated so they don’t react

42
Q

Why do platelets need good gas exchange
(3)

A

Platelets produce carbon dioxide

This needs to get out of the pack other wise it will form carbonic acid which will alter the pH

We use a breathable plastic to allow this

43
Q

Write about apheresis
(4)

A

Donor on machine for up to 4 hours but usually less than 2 hours

Blood goes into the machine

Platelets are removed

Red cells and plasma are returned

44
Q

What is leukodepletion?
(4)

A

Removal of white blood cells

Products must contain less than 5x10^6 leucocytes per unit

Buffy coat removal alone will not achieve this

Filtration is now the accepted method of preparation, using ‘third generation’ filters

45
Q

What is the most efficient way of leucodepletion?

A

Leucocyte filters remove 99.99%

46
Q

What are the two types of leucocyte filters?

A

Red cell filters

Platelet filters

47
Q

Where can leucofiltration be done?
(3)

A

At the bedside

In the laboratory before issue

Leucodepletion using in-line filters

48
Q

How do filters work?
(4)

A

They utilise cotton wool, cellulose acetate, polyester

WBCs trapped in the small pores and by adherence

Can be influenced by temperature, speed of blood flow and the pre-filtration wbc count

Up to 10-15% loss of the component being processed

49
Q

How do we irradiate blood?
(4)

A

Gamma irradiation using caesium or cobalt

25 Gy dose

WBCs unable to divide afterwards

Prevents transfusion associated GVHD

50
Q

Why would we irradiate products?
(5)

A

Bone marrow transplant
Congenital immunodeficiency
Premature infants
Intrauterine transfusions
First degree relatives

51
Q

How is blood frozen
(4)

A

Glycerol concentration is 40%

Initial freezing is at -80 degrees of -65 degrees

Storage at -65 for 10 years

More common method used

52
Q

Why would someone need a red cell transfusion
(5)

A

To increase the oxygen carrying capacity so as to improve tissue oxygenation

Rarely needed if Hb greater than 9 g/dl

Almost always used if Hb less than 6 g/dl

Take into account other factors such as if an old patient has decreased oxygen demand or is on bed rest etc

Follow Maximum Surgical Blood Order Schedule (MSBOS)

53
Q

When would whole blood transfusion be carried out

A

Rarely used for allogeneic transfusion, despite supplying most deficits

Restricted to autologous transfusion

54
Q

When would Red Cells (Leucocyte depleted) be transfused

A

Product of choice
To increase oxygen carrying capacity without the blood volume expansion of whole blood

55
Q

What affect will a red cell transfusion have

A

For ever one unit of red cells transfused there should be a raise in Hb by 1 g/sl

2.2 Transfusion Science (22 decks)

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