blood component preparations Flashcards
1
Q
a single blood unit can provide transfusion therapy to multiple patients in the form of? (4)
A
- RBCs
- platelets
- fresh frozen plasma
- cryoprecipitate
2
Q
enumerate the approved preservatives
A
- phosphate
- adenine
- dextrose
- sodium citrate
3
Q
binds calcium in exchange for sodium salt
A
sodium citrate
4
Q
supports metabolism of RBCs
A
phosphate
5
Q
preservative
function of dextrose
A
- maintain RBC membrane
- substrate for ATP production
6
Q
provides energy for the RBCs and increaes ADP levels
A
adenine
7
Q
provided by the manufacturer in the whole blood collection set and mixed with the donor blood during the collection process
A
anticoagulants
8
Q
enumerate the approved anticoagulant preservative solutions
A
- acid citrate-dextrose (formula A): ACD-A
- citrate-phosphate dextrose: CPD
- citrate-phosphate double dextrose: CP2D
- citrate-phosphate-dextrose-adenine: CPDA-1
9
Q
anticoagulant that has a storage time of 21 days
A
- ACD-A
- CPD
- CP2D
10
Q
storage time of citrate-phosphate-dextrose-adenine
A
CPDA-1
35 days
11
Q
adenine is not present in what anticoagulant preservative?
A
- ACD-A
- CPD
- CP2D
12
Q
additive solutions is developed to further extend the —
this contains —
A
extend the shelf-life of RBCs
contains saline, adenine, and dextrose
13
Q
whole blood contains all cellular and liquid element + anticoagulant and/or preservatives. this is intended to replace RBC to — and plasma for — on bleeding patience
A
replace RBC to provide oxygen-carrying capacity and replace plasma for volume expansion
14
Q
whole blood
volume:
PCV:
stored at:
one unit can increase — PCV and — Hemoglobin
A
vol: 450 ml
PCV: 38%
stored at 1-6C
3–5% PCV | 1-1.5 g/dL hemoglobin
15
Q
whole blood are not used for — replacements
why?
A
platelet, WBCs, and clotting factor
since it does not survive on stored whole blood
16
Q
packed RBCs are prepared from whole blood via?
A
centrifugation or sedimentation after donation
17
Q
this is intended for patient that needs to increase its RBC mass and oxygen carrying capacity without increasing the circulatory volume.
volume removed should be — of the total plasma
A
packed RBCs
volume removed should be 80% of the total plasma
18
Q
packed RBCs
decreased RBC mass may be caused by?
A
- decreased production
- decreased RBC surviva
- trauma or surgical bleeding
19
Q
packed RBCs
critical levels that indicates transfusion
contraindicated in patients with well compensated?
A
<6 g/dl
well compensated anemia
20
Q
packed RBCs
one unit can increase hemoglobin level to — and the hematocrit level to — in a typical 154 lbs. human
note: adjustment is quicked compared to whole blood
A
hemoglobin level to 1-1.5 g/dL and the hematocrit level to 3-5% in a typical 154 lbs
21
Q
RBC aliquots are used for?
A
neonatal patients or infants under 4 months old
22
Q
neonatal transfusion may require how many volume?
one aliqout can incr. the hgb and hematocrit of infants at what level?
A
10-25 mL
hgb: 2-3 g/dL hematocrit: 6-9%
23
Q
irradiated RBCs
RBC units with irradiated T cells to prevent?
this is done with cesium— or —
A
to prevent graft-versus-host disease
done with cesium-137 or cobalt-60
24
Q
irradiated RBCs are intended for? (3)
recommended minimum dose of gamma irradiation?
A
- immunocompromised patients
- bone marrow transplant patients
- fetus undergoing intrauterine transfusion
recommended minimum dose of gamma irradiation: 25 Gy
25
# irradiated RBCs
this is used to confirm irradiation (darkening of the film)
| expiration date?
radiochromic film
| **28 days** from the time of irradiation
26
this refers to the RBC unit with a WBC count reduced to <5 x 106 and with at least 85% of the original RBC mass
| original unit may contain?
LEUKOREDUCED RBCs
| orig unit: **2 x 109** reduced to 1 x 10^4
27
# leukoreduced RBCs
donor WBCs can cause?
enumerate the 5
- febrile non-hemolytic transfusion reactions
- transfusion-associated graft-versus-host disease
- transfusion-related immune suppression
- HLA alloimmunization
- may introduce **cytomegalovirus**
28
shelf life of leukoreduced RBCs
24 hours
29
this facilitates removal of 99.9% leukocytes, and via?
| retains --- of the RBC mass
**PRE-STORAGE LEUKOREDUCTION**
multiple layers of **polyester** or **cellulose acetate nonwoven fibers**
| retains **85%** of the RBC mass
30
enumerate the methods of pre-storage leukoreduction
1. in-line method
2. plasma removal
3. sterile docking device
31
# pre-storage leukoreduction
this method can be attached to the whole blood unit and filtered via gravity
in-line method (in-line filter)
32
# pre-storage leukoreduction
plasma is initially removed, and the remaining cells pass thru an in-line filter, this method refers to?
plasma removal method
33
# pre-storage leukoreduction
used to attach a leukocyte reduction filter to a unit of RBCs, which is allowed to flow via gravity. this method refers to?
sterile docking device
34
WBCs are removed in the blood bank prior to issuing blod or at the bedside before transfusion. this refers to?
| this reduce leukocytes to 5 x 106 or lower
post-storage leukoreduction
| **third-generation filters**
35
frozen RBCs can be stored up to?
10 years
36
**frozen RBCs** can be intended for? (3)
- patients with rare phenotypes
- backup blood supply
- autologous use
37
# chemicals in anticoagulant solutions
chelates calcium and prevents clotting.
| this is present in?
CITRATE (**sodium citrate | citric acid**)
| ACD-A, CPD, CP2D. CPDA-1
38
# chemicals in anticoagulant solutions
maintains pH during storage; necessay for maintenance of adequate levels of 2,3-DPG
| this is present in?
monobasic sodium phosphate
| ACD-A, CPD, CP2D, CPDA-1
39
# chemicals in anticoagulant solutions
substrate for ATP production (cellular energy)
| this is present in?
DEXTROSE
| ACD-A, CPD, CP2D, CPDA-1
40
# chemicals in anticoagulant solutions
for production of ATP
extends shelf-life from 21-35 days
| this is present in?
ADENINE
| CPDA-1
41
# RBC freezing
enumerate the advantages (4)
- long-term storage (10 yrs)
- maintenance of RBC viability and function
- low residual leukocytes and platelets
- removal of significant amounts of plasma proteins
42
# RBC freezing
enumerate the disadvantages (4)
- time-consuming process
- higher cost of equipment and materials
- storage requirements (-65C)
- higher cost of product
43
# cryoprotective agents
this involves small molecules that cross the cell membrane into the cytoplasm
penetrating
44
# cryoprotective agents
the osmotic force of the agent prevents water from migrating outward as extracellular ice is formed, preventing cellular dehydration.
| give an example of this cryoprotective agents
PENETRATING
| **glycerol**
45
# cryoprotective agents
this comprises large molecules that do not enter the cell but insted form a shell around it, preventing loss of water and nonsubsequent dehydration.
| give an example of this cryoprotective agent
NONPENETRATING
| **hydroxyethyl starch**
46
40% weight per volume
increases the cryoprotective power of glycerol
high glycerol
47
# high and low glycerol
enumerate the initial temp of the two.
H: **-80C**
L: **-196C**
48
# high and low glycerol
frozen units are stored at ---
(freezing temp)
| also freeze a serum of a donor for additional testing in the future.
HG: **-65C**
LW: **-120C**
49
low glycerol require --- for the freezing process
| LG refers to **minimal glycerol cryoprotection**
liquid nitrogen
50
**thawing process** takes about ---
units are placed in a --- and washed with solutions of decreasing osmolarity
| expiration? stored at ---
takes about **30 mins**
units a placed in a **37C water bath**
| expiration: **24 hours** | stored at **1-6C**
51
this has rapid and more controlled freezing procedure
give the w/v
LOW GLYCEROL
20% w/v
52
this removes all WBC and plasma
deglycerolization
53
deglycerolization done at what temp? unit should be used within?
temp: **1-6 C**
used within **24 hours**
54
# high glycerol: **fill in the blanks**
- initial freezing temp:
- need to control freezing rate:
- type of freezer:
- maximum storage temp:
- shipping requirements:
- effect of changes in storage temp:
- initial freezing temp: **-80C**
- need to control freezing rate: **NO**
- type of freezer: **MECHANICAL**
- maximum storage temp: **-65C**
- shipping requirements: **DRY ICE**
- effect of changes in storage temp: **CAN BE THAWED AND REFROZEN**
55
# low glycerol: **fill in the blanks**
- initial freezing temp:
- need to control freezing rate:
- type of freezer:
- maximum storage temp:
- shipping requirements:
- effect of changes in storage temp:
- initial freezing temp: **-196C**
- (yes/no) need to control freezing rate: **YES**
- type of freezer: **LIQUID NITROGEN**
- maximum storage temp: **-120C**
- shipping requirements: **LIQUID NITROGEN**
- effect of changes in storage temp: **CRITICAL**
56
removes plasma proteins that cause most allergic reactions. this refers to?
**WASHED RBCs**
57
**washed RBCs** are intended for patients with? (2)
| shelf-life after washing: ---
* rare IgA deficiency and anti-IgA
* anemic patients with history of febrile reaction
| shelf-life after washing: **24 hours**
58
# washed RBCs
T or F. 5-10% RBCs are lost in the process.
FALSE.
**10-20% RBCs**
59
this is acquired from whole blood processing in which the platelets must be separated from the whole blood within 8 hours of collection.
platelet concentrate
60
**PLATELET CONCENTRATE** are intended for patients with?
| T or F: this may be contaminated with RBCs or WBCs
- thrombocytopenic patients
- cancer patient
- thrombocytopenic preoperative patients
| **true!** so follow transfusion rules.
61
random-donor platelet concentrates contains about --- platelets
| this is stored in a --- environment with ---
5.5 x 10^10 platelets
| stored in **20-24C environment with agitation**
62
platelet concentrate should contain adequate plasma of --- and a pH of?
**50-70 mL**
pH: **6**
63
# platelet concentrate
T or F: one unit should decrease platelet count to 5000-10000/ul in a 70 kg person.
FALSE.
one unit should **increase**
64
# platelet concentrate
facilitates oxygen transfer into the platelet bag and oxygen consumption of platelets
| shelf-life: --- | if opened: ---
agitation
| shelf life: **5 days** | if opened: **6 hours**
65
T or F: platelets survive without agitation for a maximum of 24 hours
TRUE
66
**single-donor platelets** contains at least --- platelets that are stored in **22-24C** environment with agitation and contains about --- plasma. its shelf life is?
contains at least **3x10^11 platelets**
contains about **300 mL plasma**
| shelf life: **5 days**
67
# platelet concentrate: **preparation**
1st: whole blood is centrifuge at --- **light spin** at --- RPM in --- mins.
| what is the product of this step?
centrifuge at **22C**
3200 RPM in **2-3 mins**
| **platelet-rich plasma**
68
# platelet concentrate: **preparation**
2nd: platelet rich plasma is centrifuge at:
- --- C
- heavy spin or light spin
- --- RPM in --- mins
| what is the product of this step?
- 22C
- **heavy spin**
- 3600 RPM in **5 mins**
| **platelets** (50-70 mL)
69
# platelet concentrate: **preparation**
3rd: platelets is stand for how many hours and at what temp?
- after that, it is stored at --- to avoid ---
stand for **1-2 hrs at 20-24C**
* stored at 20-24C with **constant agitation** to avoid CONTAMINATION
70
# platelet concentrate
6-8 units can be pooled in --- bag.
shelf life is ---
1 bag
shelf life: **4 hours**
71
why platelets can be leukoreduced?
to prevent febrile non-hemolytic reactions
| done via **leukoreduction filter** designed for platelets.
72
plasma can be prepared from whole blood via?
centrifugation or sedimentation
(**HEAVY SPIN**)
73
**plasma** is the liquid portion of whole blood which contains?
all coagulation factors
74
**PLASMA** is used to treat patients with? (6)
- liver failure
- DIC
- vitamin K deficiency
- warfarin overdose
- single factor deficiencies
- massive transfusion
75
plasma is frozen shortly after --- or within --- of collection
| frozen within 6 hours if the preservative is?
after **separation from the whole blood** or **within 8 hours of collection**
| preservative: **ACD**
76
**FRESH FROZEN PLASMA** is intended for patients? (2)
| one unit contains --- mL of plasma
who are **actively bleeding** and have **multiple clotting factor deficiencies**
| 1 unit of plasma: **150-250 mL plasma**
77
# fresh frozen plasma: **storage**
temperatures
* if stored up to 1 yr after collection: ?
* for 7 yrs: ?
* liquid plasma: ?
- **-18C**: 1 yr after collection
- **-65C**: 7 years
- **1-6C**: liquid plasma
78
how liquid plasma obtained?
from whole blood to the extraction of plasma, the plasma is **not frozen**, therefore all **plasma is liquid**
79
# thawing of fresh frozen plasma
thawed at what temp:
shelf-life:
stored at:
thawed at what temp: **30-37C**
shelf-life: **24 hrs**
stored at: **1-6C**
## Footnote
if done in water bath, cover the unit to protect the bag from water contamination
80
**thawing** is less with what factor/s?
Factor V, VII, VIII, X
81
cryoprecipitate is used primarily for? (4)
| this contains what factors?
- fibrinogen replacement
- factor XIII deficiency
- treatment for hemophilia A
- Von Willebrand disease
| **VIII, XIII, FIBRINOGEN, VON WILLEBRAND FACTOR, FIBRONECTIN**
82
AABB requires that at least --- of fibrinogen must be in each unit of cryoprecipitate
**150 mg**
83
# cryoprecipitate
once thawed, the cryoprecipitate is stored at RT and must be transfused asap because?
factor VIII levels decline **2 hours** after thawing
84
# cryprecipitate
when plasma is thawed at 4C, the --- that precipitate out of the plasma can be collected by?
the **cold-insoluble proteins**
can be collected by *centrifugation at 1-6C*
85
# cryoprecipitate
the supernatant is removed via --- to the next bag to maintain the close system.
| supernatant is also known as?
via INTERNAL ACCESS PORT
| **cryo-poor plasma**
86
# cryprecipitate
about --- of plasma is retained on the cryoprecipitate. the cryoprecipitate must be refrozen within --- of being removed from the cold environment, and stored at --- or lower for up to 1 year
about **5-15 mL** of plasma is retained on the cryoprecipitate. the cryoprecipitate must be refroen within **1 hour** of being removed from the cold environment, and stored at **-18C** or lower for up to 1 year.
87
# cryoprecipitate
shelf-life thawed
6 hours or **4 hours if pooled**
88
fibrinogen replacement is done in patients with?
- liver failure
- DIC
- congenital fibrinogen deficiency
89
cryo-poor plasma product contains?
| this is refrozen within --- and stored at --- or colder for 1 year.
albumin, factor II, V, VII, IX, X, XI
| refrozen within **24 hrs** and stored at **-18C**
90
factor VIII is from?
| this is acquired via?
plasmapheresis of donors
| acquired via **fractionation and lyophilisation** of pooled plasma.
91
factor VIII is intended for?
factor VIII deficiency patients
**HEMOPHILIA A**
92
# **Factor IX concentrate (prothrombin complex)**
shelf life: ?
storage temp: ?
indication: ?
shelf life: **varies on expiratio n date on the vial**
storage temp: **1-6C**
indication: **hemophilia B**
93
# **Immune Serum Globulin**
enumerate the indications (3)
indications:
- **prophylactic treatment** to patients exposed to hepatitis
- measles or chickenpox
- treatment of **congenital hypogammaglobulinemia**
94
# **Normal Serum Albumin**
storage: ?
| this contains --- (enumerate)
stored 20-24C: **3 yrs**
stored 1-6C: **5 yrs**
| **96% albumin | 4% globulin**
95
rejuvenation is the regeneration of?
| RBCs should be --- after expiration
ATP and 2,3 DPG
| **less than 3 days** after expiration
96
# rejuvenation
incubate for --- hrs at ---C with rejuvesol
| enumerate the rejuvesol (4)
incubate for **1-4 hrs** *37C*
**Rejuvesol** is only the FDA approved rejuvenation solution in U.S.
| rejuvesol: **phosphate, inosine, pyruvate, adenine**
97
the impact of this altered environment on the blood product is referred as?
storage lesions
98
# RBC storage lesion
enumerate the **"decreased"** (5)
- % viable cells
- glucose
- ATP
- pH
- 2,3-DPG
99
# RBC storage lesion
enumerate the **"increased"**
- lactic acid
- plasma K+
- plasma hemoglobin
100
# RBC storage lesion
oxygen dissociation curve
**shift to the left**
increase in hemoglobin and oxygen affinity; less oxygen delivered to tissues.
101
# added storage lesions
- 50% decrease of factor --- in 24 hrs
- 50% decrease of factor --- in 10-14 days
| **T or F** : platelets and WBCs loss of function after few hours.
- **factor VIII** in 24 hrs
- **factor V** in 10-14 days
| **TRUE!**
102
duration of storage depend on the lifespan of the ---?
anticoagulant
103
RBC do not contain enough ---- to support its life
organelles and nutrients
104
lifespan of RBC
+/- 120 days
105
centrifuge used to separate blood components inside a blood bag
floor type centrifuge
106
first step in separating blood components
separate plasma from the cells
107
some blood bags have an extra bag connected with it, what is its purpose?
after separation, the tube connecting the primary blood bag and the extra bag will transfer the separated plasma from the red cells on the primary bag unto the extra bag
108
the second bag that contain plasma will undergo another centrifugation to?
separate the platelets which is then placed on another bag
109
why do we need to separate whole blood unto components?i
there are instances that the patient only need a specific component, not the entire whole blood itself
110
consequences of transfusing all components of blood instead of only transfusing the needed component
circulatory overload
111
fresh whole blood can be separated into
platelet rich plasma (200-250 cc)
packed RBC (200-250 cc)
112
platelet rich plasma can be separated into
platelet poor plasma (200 cc)
platelet concentrate (50-70 cc)
113
platelet poor plasma can also be stored as
fresh frozen plasma
114
fresh frozen plasma can be separated into
cryosupernate (180-200 cc)
cryoprecipitate (15-20 cc)
115
fresh whole blood is given to patients experiencing
hypovolemia
116
hypovolemia is usually due to
patients experiencing accidents
117
T or F: the half-life of coagulation factors are the same
false; it varies, because there are labile in certain conditions while some are stable
118
if the patient needs **cellular element** and **volume expansion**, what is the best blood component to be given?
the whole blood
119
if there is no centrifuge, how can you separated pRBCs from whole blood?
sedimentation
120
how is sedimantation done?
allow the blood bag to stand and the RBCs will then sink at the bottom of the tube due to gravity
121
disadvantage of sedimentation
time consuming
122
why do pRBCs have better adjustment compared to whole blood?
because the RBC is already separated
123
define a graft-vs-host disease
where the organs transplanted are incompatible with the recipient
124
this can trigger a graft-vs-host disease
transfused RBCs
125
# immune serum globulin
shelf life if intravenous or intramuscular
intramuscular: **3 yrs**
intravenous: **1 yr**
126
washed RBC is considered as (open/closed) system?
open system
127
consequences of transfusing unwashed rbc
allergic reactions
transfusion reactions
128
most of the storage lesions are caused by
RBC metabolism
129
RBC storage lesion: explain why there is decreased pH
active metabolism result to increased acidity
130
RBC storage lesion: explain why there is increased K and hgb
lysed RBCs during storage release K and hgb
131
# cryprecipitate
AABB requires --- of fibrinogen must be in each unit of cryoprecipitate
150 mg of fibrinogen
