Blood Donation Flashcards
1
Q
Donor Registration
A
- Donor’s full name
- Home/Work address
- DOB (>= 17)
- Reason any previous deferrals
- Date of last donation
- Gender
2
Q
Pre-donor screening
A
- Ensure donor healthy enough to donate
- Ensure donation does not harm a recipient
3
Q
Process of donor evaluation
A
- Abbreviated Donor History Questionaire
- Explanation of donor eligibility
- Medication list
- Prospective donors asked to acknowledge in writing that they: have read materials, given a chance to ask questions, provided accurate info
- Prospective donors can elect to leave (self deferral) at that point
- Physical exam
4
Q
Universal Donor History Questionaire
A
- Developed by AABB in conjunction with FDA
- Current version 2.0
- Has 43 questions
5
Q
Cause of Permanent or Indefinite Deferral
A
- CJD risk
- Repeatedly reactive serologic test for: HIV, HBV, HCV, HTLV
- Viral hepatitis after 11 y/o
- History of Babesiosis or Chagas
- History of taking teratogen Tegison
- Have received: dura mater transplant, Pituitary hormone, Bovine insuline injection
- Family history of CJD
- Live in UK > 3 months 1980-1996
6
Q
Cause 3-year deferral
A
- Recovered from Malaria
- Immigrants from malaria-endemic area
7
Q
Cause 1-year deferral
A
- Needlestick
- Sex contact with person with HIV or hepatitis
- Sex contact with person used needles
- Rape victim
- Incarcerated > 72 hrs
- Pay money for sex
- Blood transfusion
- Allogeneic transplant of organ/skin/bone
- Live with person with active hepatitis
- Tattoo/piercings
- Travel to malaria-endemic area
- Syphilis/gonorrhea
- Non-prophylactic rabies vaccination
- Travel to Iraq
8
Q
Other causes for Deferral
A
- Pregnancy
- Medication list
- Heart and Lung Disease
9
Q
Immunization deferrals
A
- No deferral for killed, toxoid, or recombinant/synthetics vaccines
- 4 weeks: Rubella, Varicella
- 2 weeks: Measles, Mumps, Oral polio, Yellow Fever, Oral Typhoid
10
Q
Smallpox immunization
A
- Based on presence/absence of vaccine scab and post vaccine symptoms
- No: Until scab falls off or 21 days
- Yes: Until 14 days after symptoms resolve
11
Q
Medication deferrals
A
- HepB immunoglobin: 1 year
- Unlicensed vaccine: 1 year
- Anti-PLT drugs: aspirin (48hrs), Feldene (48hrs), Clopidogrel (2 wks), Ticlopidine (2 weeks)
- Warfarin: 7 days
- Direct thrombin inh & direct Xa inh & heparin derivatives: 2 days
12
Q
Confidential Unit Exclusion
A
- Donor can request that unit is collected but discarded wo testing
13
Q
Physical exam
A
- General donor appearance
- Arm inspection
- Pulse: 50-100/min w/o irregularities
- Temp: less or equal to 37.5
- BP: 90-180 systolic & 50-100 diastolic
- Weight: >= 110 lbs
- HCT: women (HCT 38%), men (HCT 39%)
14
Q
Cause of Immune hemolysis
A
Warm AIHA Cold agglutination Paroxysmal Cold Hemoglobinuria Transfusion Reaction HDFN
15
Q
Cause of Non-immune hemolysis
A
Microangiopathic (DIC, Mechanical Heart Valve) Paroxysmal Nocturnal Hemoglobinuria Toxins/Medication Thermal burns Infection
16
Q
Purpose of DAT (Direct Coomb’s test)
A
- Determine if RBC coated with IgG & complement or
both - Investigation of: HTR, HDFN, AIHA, Drug Induced Anemia
17
Q
Principles of DAT
A
- EDTA: anticoagulation blood samples
- Test freshly washed RBC with AHG containing IgG and anti-C3d
- AHG activity against: heavy chain (Fc portion of IgG) and complement components
18
Q
Steps of DAT
A
- Wash RBC: remove plasma free globulin and complements
- Polyspecific AHG
- If positive, monospecific reagent (anti-IgG and anti-complement) - If umbilical cord —> ok to use IgG only
- -> DAT is not dx of hemolytic anemia. Need to check pt’s history
19
Q
Warm autoimmune hemolytic Anemia (WAIHA)
A
- 60-70% Immune hemolytic anemia
- Against high-frequency antigens on RBC (Rh proteins)
- Can be secondary to other disease such as: leukamia lymphoma, lupus
- AutoAb: IgG
- Elute: panagglutinin pattern in most cases.
20
Q
WAIHA - Lab test
A
- Polyspecific AHG: Usually positive
- anti-IgG: Usually positive
- anti-C3: Can be positive
- 20% only IgG, 67% both, 13% only C3
21
Q
WAIHA - Treatment
A
- Steroid, immunosuppressive drugs, splenectomy
- Supportive blood transfusion if needed
- Transfusion requires: Antibody ID studies (autoantibody, alloantibody, or both) –> Transfusion accepted in severe case but MUST r/o the presence of alloantibodies
22
Q
WAIHA - Transfusion
A
- Phenotypically matched unit
- R/O underlying alloantibodies, using less sensitive methods such as LISS/saline
- Autoadsorption: treat pt with their own RBC to remove found IgG, modified cells are incubated with pt serums
- Alloadsorption: if pt has been transfused, severe case, not enough sample –> use RBC antigen negative
23
Q
Cold Agglutinin Disease (CAD)
A
- 16-30% of immune hemolytic anemia
- Autoab: mostly IgM, rare IgG and IgGA
- Cold auto-ab facilitate RBC destruction
- 2nd disease assc. with mycoplasma pneumonia (anti-I, anti-IH) and infectious mononucleosis (anti-i)
24
Q
CAD - Lab test
A
- Polyspecific: pos
- anti-IgG: non-reactive
- anti-C3: pos
- May need to maintain at 37C when testing
- Auto-Ab: anti-I, anti-IH, anti-i, anti-Pr
25
Q
CAD - other helpful tests
A
- Antibody titer: two-fold dilution –> High titer (usually > 1:64)
- Thermal amplitude –> Wide thermal amplitude
- Adsorption (auto & allo) at 4C to r/o underlying alloantibodies
26
Q
CAD - Treatment
A
- Avoid corticosteroids
- Keep pt warm
- Anti-CD20 has 50% response rate
- Severe case: remove Ab via plasmapheresis
27
Q
Paroxysmal Cold Hemoglobinuria (PCH)
A
- Rarest form
- Common in children as 2ndary disease to transient viral infection
- Was described with syphillis
- Biphasic IgG auto-ab
28
Q
PCH - Lab test
A
- Polyspecific: pos
- anti-IgG: neg - non reactive
- anti-C3: pos
- Biphasic
- Diagnostic with Donath Landsteiner test
- Usually anti-P specificity
29
Q
PCH - Treatment
A
- Self-limited
- Transfusion if needed with warm blood
- P-neg unit is not needed
30
Q
Donath-Landsteiner Test
A
- 3 sets of 3 tubes: patient serum, pt serum + normal serum, normal serum
- Each sets was incubated at different temp: ice, 37C, ice and then 37C
31
Q
Mixed type of Autoimmunue
A
8%
Serology of both WAIHA and CAD
Severe hemolysis
Cold auto-Ab + Warm auto-Ab
32
Q
Drug-Induced Hemolytic Anemia
A
- 10% immune hemolytic anemia
- Severity varies and DAT varies
- Hapten (chemical compound) can bind protein carrier (albumin) to elicit immune response
- Ab can develop: to haptens, combination hapten-carrier, only carrier
33
Q
Hapten-specific/Drug adsorption
A
- Ab react with drug-treated cells
- Penicillin, ampicillin, cephalosporins (pediatric)
- Variable presentation
- Diagnostic:
+ prepare RBC with suspected drug
+ Pt’s serum and Eluate reacts with treated RBC but not untreated RBC
34
Q
Neoantigen/Immune Complex Deposition
A
- Ab react with untreated cells in presence of solutions of drugs
- Quinine, piperacillin, 2nd and 3rd generation of Cephalosporins
- Ab against drugs or its metabolites
- Assc. with severe hemolysis
- Dx: Incubated pt’s serum + untreated cells + drug solution. Negative control: no drug solution
35
Q
Autoantibody from drugs
A
- Drug-independent Ab with autoab production
- Methyldopa, fludarabine
- Ab against RBC antigens
- Dx: No required drug. Elute will be panreactive and indistinguishable with WAIHA. Pt serum can be nonreactive (Adsorption required to R/O allo-ab)
36
Q
Nonimmunologic Protein Adsorption
A
- Drug independent
- Assc. with cephalothin, cisplatin
- Hemolysis is rare
- Drug modifies RBC membrane –> show protein on membrane –> DAT is positive if antiglobulin/antiprotein is used
37
Q
Type of blood donation
A
- Allogeneic: from s/oelse than self
- Autologous: unit is donated for self
- Directed: unit donated for specific person (PLT, granulocyte, rare blood type)
38
Q
The potential risk of autologous donation
A
- Mixed up with other patients
- Iron depletion with each time
- Increased cost
- Wastage
39
Q
Requirements for autologous donation
A
- Used for: difficult to match, religion,
- Less strict
- Requires: physician order, defer if donor bacteremia, special label, only Medical Director can approve for use for another than donor.
40
Q
Process of WB
A
- Donor ID confirmed
- Primary bag, sample bag
- Vein selected –> Disinfected –> Venipuncture –> Post donation care
- 1st 30-45mL diverted to pouch. Mix frequently
- Collection 8-12 min
- Volume: 450-500 ml, max 50mL for tube. Max volume 10.5mL/kg
41
Q
Anticoagulants and additives used
A
- Anticoagulant: CPD, CPDA1, CPDA2 for primary bag
- Additives: AS-1 (Adsol), AS-3 (Nutricell), AS-5 (Optisol_ for secondary bag
42
Q
Autologous Standard
A
- Interval: 72 hrs prior to surgery/use
- HH: >= 11g/dL or 33%
- Weight, Age: None
- Infection screening: not required
- History of dz of positive test result: Potentially eligible
43
Q
Apheresis Donation
A
- Automate separation of blood into component
- Centrifuge: most common, separation based on density.
- Equipment can collect > 1 product at the same time: RBC, PLT, Plasma, WBC
44
Q
Donor reaction
A
- Vasovagal: most common, breath into the paper bag. More in young
- Local injury related to needle: nerve irritation, vessel injury, infection. More in older
- Apheresis- related: Infiltration (most common), citrate toxicity lead to low Ca,
- Allergic
- Major cardiovascular
45
Q
Plateletepheresis Donor requirement
A
- No aspirin in last 48 hrs
- No clopidogrel or ticlopidine in last 14 days
- Pre-procedure PLT count 150,000/L
