Blood Product Modifications, Administration and Labeling

Question 1

How many leukoctyes does the average red cell unit have (that has not been leukocyte reduced)?

Answer 1

2x10^9

Question 2

What problems can a high number of leukocytes cause in a donor?

Answer 2

Febrile non-hemolytic transfusion reactions, TA-GVHD, transfusion related immune suppression, cytomegalovirus

Question 3

When leukocyte reducing red cells what is the maximum level of leukocytes that can remain in the red cell unit?

Answer 3

5x10^6

Question 4

What will washing a red cell unit remove?

Answer 4

Removes the plasma and all the proteins in the plasma (antibodies such as IgA, ions (potassium), proteins that can cause allergic reactions, etc.)

Question 5

List the clinical indications for transfusion of a washed red cell unit.

Answer 5

Patients with severe allergic reactions (usually to proteins), IgA deficient patients, babies that do not have fresh RBCs available (to remove the potassium)

Question 6

What is the expiration of a washed red cell unit?

Answer 6

24 hours from when processing begins

Question 7

What does irradiation do to a red cell unit?

Answer 7

It decreases the mitogenic capacity of transfused T-cells which makes them immunoincompetent. This can help prevent TA-GVHD in immunocompromised patients.

Question 8

What three conditions must be met for TA-GVHD to occur?

Answer 8

The patient must be transfused immunocompetent T-lymphocytes there must be histocompatibility differences between the donor and recipient must be immunocompromised

Question 9

What causes TA-GVHD?

Answer 9

Transfused T-lymphocytes mount an immune response against foreign recipient HLA tissue. If the recipient is immunocompromised their lymphocytes are unable to counterattack to destroy the donor T-lymphocytes.

Question 10

List the clinical indications for irradiation.

Answer 10

Congenital immunodeficiencies, Hodgkin’s lymphoma, leukemia, bone marrow transplant, intrauterine/neonatal transfusion, HLA matched platelets, donation from blood relatives, oncology patients/chemotherapy

Question 11

Why must donations from blood relatives be irradiated?

Answer 11

Blood relatives are more likely to share HLA haplotypes. This becomes an issue when a donor with a homozygous haplotype is shared with a heterozygous recipient. The recipient will not recognize the donor homozygous HLA haplotype as foreign since they both share it and therefore won’t eliminate the T-lymphocytes. The donor T-lymphocytes will recognize the non-shared haplotype as foreign and mount an attack.

Question 12

How does irradiation change the expiration date on a red cell?

Answer 12

The expiration date decreases to 28 days from collection.

Question 13

What information about the blood center processing the unit must be on a unit label?

Answer 13

Collection facility and unique facility identifier (FDA registration number)

Question 14

What information about the blood product must be on the component label?

Answer 14

Name of blood component, anticoagulant used, approximate volume, storage temperature, expiration date/time, ABORh

Question 15

What information about the blood product donor must be on the component label?

Answer 15

Donor ID number, whether they are a volunteer or paid donor

Question 16

What instructions to the transfusionist must be on the component label?

Answer 16

Rx only, may transmit infectious agents, identify intended recipient, see circular for information for indications, contraindications, cautions and methods of infusion

Question 17

How long can red cell products be out of storage and still be acceptable for use?

Answer 17

30 minutes

Question 18

With what product should red cells be transfused?

Answer 18

Saline

Question 19

Within what period of time must a unit of blood be transfused?

Answer 19

Transfuse over 2-4 hours but no more than 4 hours

Question 20

What verifications must be performed at the bedside before blood is administered?

Answer 20

Recipient’s 2 identifiers on wristband and unit of blood recipient and donor ABO/Rh, interpretation of crossmatch tests, special transfusion attributes were performed, blood product is not expired.