blood component preparations Flashcards
a single blood unit can provide transfusion therapy to multiple patients in the form of? (4)
- RBCs
- platelets
- fresh frozen plasma
- cryoprecipitate
enumerate the approved preservatives
- phosphate
- adenine
- dextrose
- sodium citrate
binds calcium in exchange for sodium salt
sodium citrate
supports metabolism of RBCs
phosphate
preservative
function of dextrose
- maintain RBC membrane
- substrate for ATP production
provides energy for the RBCs and increaes ADP levels
adenine
provided by the manufacturer in the whole blood collection set and mixed with the donor blood during the collection process
anticoagulants
enumerate the approved anticoagulant preservative solutions
- acid citrate-dextrose (formula A): ACD-A
- citrate-phosphate dextrose: CPD
- citrate-phosphate double dextrose: CP2D
- citrate-phosphate-dextrose-adenine: CPDA-1
anticoagulant that has a storage time of 21 days
- ACD-A
- CPD
- CP2D
storage time of citrate-phosphate-dextrose-adenine
CPDA-1
35 days
adenine is not present in what anticoagulant preservative?
- ACD-A
- CPD
- CP2D
additive solutions is developed to further extend the —
this contains —
extend the shelf-life of RBCs
contains saline, adenine, and dextrose
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
replace RBC to provide oxygen-carrying capacity and replace plasma for volume expansion
whole blood
volume:
PCV:
stored at:
one unit can increase — PCV and — Hemoglobin
vol: 450 ml
PCV: 38%
stored at 1-6C
3–5% PCV | 1-1.5 g/dL hemoglobin
whole blood are not used for — replacements
why?
platelet, WBCs, and clotting factor
since it does not survive on stored whole blood
packed RBCs are prepared from whole blood via?
centrifugation or sedimentation after donation
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
packed RBCs
volume removed should be 80% of the total plasma
packed RBCs
decreased RBC mass may be caused by?
- decreased production
- decreased RBC surviva
- trauma or surgical bleeding
packed RBCs
critical levels that indicates transfusion
contraindicated in patients with well compensated?
<6 g/dl
well compensated anemia
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
hemoglobin level to 1-1.5 g/dL and the hematocrit level to 3-5% in a typical 154 lbs
RBC aliquots are used for?
neonatal patients or infants under 4 months old
neonatal transfusion may require how many volume?
one aliqout can incr. the hgb and hematocrit of infants at what level?
10-25 mL
hgb: 2-3 g/dL hematocrit: 6-9%
irradiated RBCs
RBC units with irradiated T cells to prevent?
this is done with cesium— or —
to prevent graft-versus-host disease
done with cesium-137 or cobalt-60
irradiated RBCs are intended for? (3)
recommended minimum dose of gamma irradiation?
- immunocompromised patients
- bone marrow transplant patients
- fetus undergoing intrauterine transfusion
recommended minimum dose of gamma irradiation: 25 Gy
irradiated RBCs
this is used to confirm irradiation (darkening of the film)
expiration date?
radiochromic film
28 days from the time of irradiation
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
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
shelf life of leukoreduced RBCs
24 hours
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
enumerate the methods of pre-storage leukoreduction
- in-line method
- plasma removal
- sterile docking device
pre-storage leukoreduction
this method can be attached to the whole blood unit and filtered via gravity
in-line method (in-line filter)
pre-storage leukoreduction
plasma is initially removed, and the remaining cells pass thru an in-line filter, this method refers to?
plasma removal method
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
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
frozen RBCs can be stored up to?
10 years
frozen RBCs can be intended for? (3)
- patients with rare phenotypes
- backup blood supply
- autologous use
chemicals in anticoagulant solutions
chelates calcium and prevents clotting.
this is present in?
CITRATE (sodium citrate | citric acid)
ACD-A, CPD, CP2D. CPDA-1
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
chemicals in anticoagulant solutions
substrate for ATP production (cellular energy)
this is present in?
DEXTROSE
ACD-A, CPD, CP2D, CPDA-1
chemicals in anticoagulant solutions
for production of ATP
extends shelf-life from 21-35 days
this is present in?
ADENINE
CPDA-1
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
RBC freezing
enumerate the disadvantages (4)
- time-consuming process
- higher cost of equipment and materials
- storage requirements (-65C)
- higher cost of product
cryoprotective agents
this involves small molecules that cross the cell membrane into the cytoplasm
penetrating
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
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
40% weight per volume
increases the cryoprotective power of glycerol
high glycerol
high and low glycerol
enumerate the initial temp of the two.
H: -80C
L: -196C
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
low glycerol require — for the freezing process
LG refers to minimal glycerol cryoprotection
liquid nitrogen
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
this has rapid and more controlled freezing procedure
give the w/v
LOW GLYCEROL
20% w/v
this removes all WBC and plasma
deglycerolization
deglycerolization done at what temp? unit should be used within?
temp: 1-6 C
used within 24 hours
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
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
removes plasma proteins that cause most allergic reactions. this refers to?
WASHED RBCs
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
washed RBCs
T or F. 5-10% RBCs are lost in the process.
FALSE.
10-20% RBCs
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
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.
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
platelet concentrate should contain adequate plasma of — and a pH of?
50-70 mL
pH: 6
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
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
T or F: platelets survive without agitation for a maximum of 24 hours
TRUE
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
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
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)
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
platelet concentrate
6-8 units can be pooled in — bag.
shelf life is —
1 bag
shelf life: 4 hours
why platelets can be leukoreduced?
to prevent febrile non-hemolytic reactions
done via leukoreduction filter designed for platelets.
plasma can be prepared from whole blood via?
centrifugation or sedimentation
(HEAVY SPIN)
plasma is the liquid portion of whole blood which contains?
all coagulation factors
PLASMA is used to treat patients with? (6)
- liver failure
- DIC
- vitamin K deficiency
- warfarin overdose
- single factor deficiencies
- massive transfusion
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
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
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
how liquid plasma obtained?
from whole blood to the extraction of plasma, the plasma is not frozen, therefore all plasma is liquid
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
if done in water bath, cover the unit to protect the bag from water contamination
thawing is less with what factor/s?
Factor V, VII, VIII, X
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
AABB requires that at least — of fibrinogen must be in each unit of cryoprecipitate
150 mg
cryoprecipitate
once thawed, the cryoprecipitate is stored at RT and must be transfused asap because?
factor VIII levels decline 2 hours after thawing
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
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
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.
cryoprecipitate
shelf-life thawed
6 hours or 4 hours if pooled
fibrinogen replacement is done in patients with?
- liver failure
- DIC
- congenital fibrinogen deficiency
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
factor VIII is from?
this is acquired via?
plasmapheresis of donors
acquired via fractionation and lyophilisation of pooled plasma.
factor VIII is intended for?
factor VIII deficiency patients
HEMOPHILIA A
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
Immune Serum Globulin
enumerate the indications (3)
indications:
- prophylactic treatment to patients exposed to hepatitis
- measles or chickenpox
- treatment of congenital hypogammaglobulinemia
Normal Serum Albumin
storage: ?
this contains — (enumerate)
stored 20-24C: 3 yrs
stored 1-6C: 5 yrs
96% albumin | 4% globulin
rejuvenation is the regeneration of?
RBCs should be — after expiration
ATP and 2,3 DPG
less than 3 days after expiration
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
the impact of this altered environment on the blood product is referred as?
storage lesions
RBC storage lesion
enumerate the “decreased” (5)
- % viable cells
- glucose
- ATP
- pH
- 2,3-DPG
RBC storage lesion
enumerate the “increased”
- lactic acid
- plasma K+
- plasma hemoglobin
RBC storage lesion
oxygen dissociation curve
shift to the left
increase in hemoglobin and oxygen affinity; less oxygen delivered to tissues.
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!
duration of storage depend on the lifespan of the —?
anticoagulant
RBC do not contain enough —- to support its life
organelles and nutrients
lifespan of RBC
+/- 120 days
centrifuge used to separate blood components inside a blood bag
floor type centrifuge
first step in separating blood components
separate plasma from the cells
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
the second bag that contain plasma will undergo another centrifugation to?
separate the platelets which is then placed on another bag
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
consequences of transfusing all components of blood instead of only transfusing the needed component
circulatory overload
fresh whole blood can be separated into
platelet rich plasma (200-250 cc)
packed RBC (200-250 cc)
platelet rich plasma can be separated into
platelet poor plasma (200 cc)
platelet concentrate (50-70 cc)
platelet poor plasma can also be stored as
fresh frozen plasma
fresh frozen plasma can be separated into
cryosupernate (180-200 cc)
cryoprecipitate (15-20 cc)
fresh whole blood is given to patients experiencing
hypovolemia
hypovolemia is usually due to
patients experiencing accidents
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
if the patient needs cellular element and volume expansion, what is the best blood component to be given?
the whole blood
if there is no centrifuge, how can you separated pRBCs from whole blood?
sedimentation
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
disadvantage of sedimentation
time consuming
why do pRBCs have better adjustment compared to whole blood?
because the RBC is already separated
define a graft-vs-host disease
where the organs transplanted are incompatible with the recipient
this can trigger a graft-vs-host disease
transfused RBCs
immune serum globulin
shelf life if intravenous or intramuscular
intramuscular: 3 yrs
intravenous: 1 yr
washed RBC is considered as (open/closed) system?
open system
consequences of transfusing unwashed rbc
allergic reactions
transfusion reactions
most of the storage lesions are caused by
RBC metabolism
RBC storage lesion: explain why there is decreased pH
active metabolism result to increased acidity
RBC storage lesion: explain why there is increased K and hgb
lysed RBCs during storage release K and hgb
cryprecipitate
AABB requires — of fibrinogen must be in each unit of cryoprecipitate
150 mg of fibrinogen