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TXN243 > Blood Products > Flashcards

Blood Products Flashcards

1
Q

RED BLOOD CELL PRODUCTS
-Ordered as packed cells or PRBC
-Processed by one of two different filtration systems which are:
1.
2.
-Anticoagulant is ________ _________ __________ and additive is SAGM (______, ________, _________ and _________)

A

-Whole Blood Filtration
- Buffy Coat Production

Citrate Phospate Dextrose (CPD)

Saline, Adenine, Glucose, Mannitol

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2
Q

____mL of WB collected in ___mL of CPD
* Collected in DEHP plasticized bags
* Each unit raises Hgb by __g/L

A

480; 70
10

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3
Q

______ system- Move contents of whole blood between bags without exposure to air.
-its Shelf life is valid for ___days if stored at 1-6C in the original closed system bag (SAGM used).
Avg vol is ____+/- 26 mL

A

Closed
42
293

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4
Q

Entering the bag after component separation at the hospital

The port is ‘_______’
-purpose: To modify contents or to remove an aliquot for a small volume transfusion

A

breached

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5
Q

What happens to the shelf life if you ‘enter’ or ‘breach’ the bag?

  • Increased risk of bacterial contamination
  • Adjusted Expiry Date
  • Must be used within ____ hours stored at 1-6 ˚C
  • Transfusing a unit of blood through infuser must be done within __ hours
A

24

4

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6
Q

Testing of Red Cell Products

Prior to making blood components available for transfusion the donor blood is tested for:
1) Antibodies to HIV-1 and HIV-2, HCV, HTLV and HBcore
2) HBsAg
3) Viral RNA HIV-1 and HIV-2
4) DNA HBV
5) Syphilis (Treponema pallidum)
6) WNV and Chagas are performed on at risk donors
7) CMV results will be indicated on label if tested

A
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7
Q

Storage and Handling

-RBCs are stored in the fridge at a temp between 1C to 6C
-The shelf life or ‘expiry date’ is based on the _________ and the ________ solution

-CBS processes WB and RBC in a ‘closed’ sterile system so that blood is not exposed to air and potential bacterial contamination

The shelf life is __ days unless otherwise specified

-Modifications will change the storage method and the expiry date
-Modifications at the hospital will also change the expiry date example is a Neonatal Unit

A

anticoagulant
additive

42

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8
Q

After a packed cell is issued and NOT used, it can be returned within ___ mins, after __ mins it is discarded.

IF issued in a cooler, unit can be returned within the __-hour time frame.

A

60; 60

3

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9
Q

Indications and Contraindications

-RBC LR SAGM PC is not suitable for clinical situations where limited oxygen carrying capacity is not due to RBC deficiency or dysfunction.

___________- also known as volume depletion or volume contraction and loss of salt and water.

A

Hypovolemia

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10
Q

Indications and Contraindications

Hypovolemia without significant red cell mass deficit is best managed with _________ solutions such as albumin or 10% Pentastarch or crystalloid solutions.

A

colloid

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11
Q

Indications and Contraindications

-Transfused red blood cells increase the oxygen carrying capacity of the blood by increasing the circulating RBC mass
-Alternatives to transfusion should be considered prior to the transfusion of RBC
-Anemias should be treated with appropriate specific non-blood derived therapy such as iron, Vitamin B12, folic acid and recombinant erythropoietin.

A
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12
Q

Indications and Contraindications

-Acute blood loss (maintain >__ g/L during active bleeding)
-Chronic anemia
-Cardiopulmonary compromise (maintain >__ g/L)
-Disease and medication effects associated with bone marrow suppression
-Pre-operative patients
-Pediatrics

-Decision to transfuse should not be based on a single Hgb value, must consider all critical physiologic and surgical factors affecting oxygenation and clinical status of the patient.

A

> 70

> 80

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13
Q

Indications and Contraindications

-Choosing Wisely suggests to NOT transfuse if patient is asymptomatic, nonbleeding, in patients with a Hgb of ___ g/L.
-Examine the possibilities for reversal of anemias by non transfusion treatment

A

70

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14
Q

Warnings and Precautions

-Red Blood cells must be ___ compatible
-Pre-transfusion testing is required unless withholding blood might result in loss of life
* Rh negative recipients should receive __ ________ red cells
* DEHP plasticizer gradually leaches into the RBC during storage (populations who may be at most risk include fetuses, newborns who require massive transfusions)
* Currently no scientific proof suggesting it is toxic risk for patients
* Minimize exposure by using freshest possible unit

A

ABO

Rh Negative

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15
Q

Warnings and Precautions

-Less than __-__ days old should be considered when large volumes are transfused to neonates
-Fetus requiring IUT use _______ and ____ negative product

  • Alloimmunization of recipient may be of a consequence
  • Patients transfused with large volumes of RBC should be monitored for circulatory overload (TACO)
  • Transmission of infectious diseases

-Adverse events related to blood transfusion range in severity from minor to life threatening
-Evaluated to determine if transfusion should continue or be restarted
* Report to transfusion BBK department and Canadian blood Services

A

7-14

irradiated and CMV negative

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16
Q

Dose and Administration

Dose: Each Unit should raise the hemoglobin concentration in an average size nonbleeding adult by approximately __ g/L

Common pediatric dosing is __-__ mL per kg body weight

Recommendations for keeping HGB / HCT at a certain level based on patient condition

-A standard blood administration set containing a ___- ___ micron filter approved by Health Canada
* A blood warmer maybe used at discretion of physician

-Co-administration of 0.9 % sodium chloride injection, ABO compatible plasma or 5% albumin can be performed at the discretion of the physician.

All transfusions should be complete within __ hours

-During transfusion patients are closely observed during the first __ mins and in intervals

A

10

10-15 mL

170-260

4 hours

15 minutes

17
Q

Modifications to RBC products

  1. __________ _________ ___________
    -Frozen in glycerol and can be stored for 10 years
    -Used for transfusion of patients who may need rare or specific phenotypes
    -Especially patients who require regular transfusions & have multiple antibodies
A

DEGLYCEROLIZED RED CELL

18
Q

Modifications to RBC products

  1. ____________
    -Gamma Rays destroy the lymphocytes ability to divide
    -Cells are exposed to gamma irradiation

*** Recipients are immunocompromised **:
1) Newborns
2) Congenital T cell Immunodeficiency
3) Acquired deficiency
4) Cell transplant / BM

  • Chemo patients who have CLL, Lymphoma, BM transplant and certain drugs.
    -Used in recipients who are not capable to eliminate these cells
    -Reduces the risk of GVHD

Expires __ days post irradiation or __ days post collection

GVHD has a mortality rate of __% and leads to bone marrow failure; happens __-__ days post transfusion

A

Irradiated

14 days
28 days

90%
8-10 days

19
Q

Modifications to RBC products

  1. _________ ______
    –Original red blood cell unit is collected or stored into a special Quad pack
    -A blood bag with smaller volume satellite packs attached
    * One unit can be used for several smaller transfusions without ‘entering’ a port
    * Used for neonatal transfusions
    * Can be done at CBS
    * sterile system: no change in expiry date
    * Not the same as manually entering packs
    * if a regular unit is ‘entered’ at the hospital it must be used in ___ hours
A

Divided packs

24

20
Q

Modifications to RBC products

  1. _____ __________
    -used for intrauterine transfusion as per indication by National Advisory Committee for blood and blood products in Canada
    -Difficulty in detecting and monitoring fetal infection, lack of effective utero therapy
A

CMV Negative

21
Q

-it is a type of infection Contracted through BF, Blood transfusion and transplants (Organs and tissues).
–Healthy individuals are asymptomatic, mild nonspecific illness similar to mono.
-Immunocompromised can develop CMV disease and pneumonia, hepatitis and Colitis.
-Immune response is to develop CMV IgG antibody (6-8 weeks)
-Virus is dormant (latent) in monocytes of WBC and can react later, never cleared from the system

A

CMV (Cytomegalovirus human herpes virus- 5 DNA)

22
Q

Modifications to RBC products

  1. _______ ________
    -USED IF THERE IS AN INCREASE RISK OF ANAPHYLACTIC REACTION WITH STANDARD RBC PRODUCTS
    -IgA deficient individuals can produce Anti-IgA
    –Decreases the level of residual substances (antibodies, serum proteins such as IgA, additive solutions, potassium, cellular metabolites and cytokines).
    -RBCs are washed with 1-2 L of normal saline and total volume remaining is 180 mL

________ ________ - -Must be done within first 2 weeks of storage, used within 7 days of expiry

____ deficient- Labelled with RBC LR washed or RBC LR extra washed

_______ _______- must be used within 24 hours due to increase of possible bacterial contamination

A

Washed Cells

Automated wash

IgA

Manual Wash

23
Q

Identify the Modified component:

Description:
-most of the plasma is removed; unit contains >=75% red blood cells from original unit after washing. ______ RBCs are suspended in 100 mL SAGM

INDICATION:
-recipient with a history of severe or repeated reactions to blood components (unresponsive to pre-medication)

Storage:
1-6C: transfuse within 7 days
20-24C: transfuse within 4 hours

A

Washed Cells
washed

24
Q

Identify the Modified component:

DESCRIPTION:
most of the plasma removed; unit contains >=75% of RBCs from original unit after washing. ____ RBCs are resuspended in 100 mL SAGM

INDICATION:
-igA-deficient recipient with anti-IgA

STORAGE:
1-6C: transfuse within 7 days
20-24C: transfuse within 4 hrs

A

Extra Washed (IPA deficient)

25
Q

Identify the Modified component:

DESCRIPTION:
Glycerol added and unit frozen within 21 days of collection. Once thawed, washing removes glycerol and supernatant fluid in a process known to retain an average of >=80% of RBCs from original cryopreserved unit and a HCT of <=0.80 L/L

INDICATION:
RBCs for patients requiring specific or rare phenotypes not available in liquid inventory

STORAGE:
Frozen: up to 10 years
1-6C: In AS-3, transfuse within 24 hours or 14 days, as indicated on the product label

1-6C in 0.9% NaCl injection with 0.2% dextrose, transfuse within 24 hrs

If stored above 6C: within 4 hrs

A

Deglycerolized

26
Q

Identify the Modified component:

DESCRIPTION:
-cells are exposed to gamma irradiation

INDICATION:
-recipients who are immunocompromised or who receive units from closely matched HLA or related/directed donor

STORAGE:
1-6 C: 14 days post-irradiation or 28 days post collection, whichever comes first
Washed, Extra Washed and Irradiated:
1-6 C: 48 hrs post-irradiation or original expiry date, whichever comes first

A

Irradiated

27
Q

Identify the Modified component:

DESCRIPTION:
An integral satellite pack is attached to the unit to facilitate transfusion of aliquots

INDICATION:
Neonates

STORAGE:
1-6 C: 42 days unless otherwise specified

A

DIvided Pack

28
Q

Neonatal Transfusion

-At birth the neonates Hgb is ___ g/L,
at 24 hrs the Hgb is ___ g/L,
at first 3 months the Hgb is ____ g/L and
at age 12 Hgb is the same as an adult.

Birth to 6 months the concentration of Vit K dependent factors (II,VII,IX,X) and inhibitors (protein C/S) are_____than adult levels but gradually increase at __ months and concentrations reach approximately adult level.

Purposes of transfusion medicine, neonate is defined as an infant up to __ months of age.

_______ typing is not performed because the ABO antibodies in blood initially are of maternal origin

Generally the hospital policy is to give Group ___ Rh ________ Irradiated unit

If the mother has an antibody, PRBC Unit must be ___________ for the antigen before
transfusion.

Indications for RBC transfusion in neonates are different from those of children an adults

A

165
184
115

lower
6

4

Reverse

Group O Rh negative

phenotypes

29
Q

Neonatal Transfusion

-Indications for transfusion have been well studied yet somewhat controversial for these reasons:
* Difficulty to determine due to varying levels of HbF and HbA
* Difficult to assess the clinical indications and how symptoms are defined
* Hgb concentration may not be accurate and reflect the blood cell mass in preterm or newborns

Various publications exist and guidelines for transfusion include:
1) Acute blood loss of >__%
2) Hgb less than ___ g/L with symptoms of
anemia (apnea, bradycardia)
3) Hgb <____ g/L in infant with respiratory
distress syndrome or congenital heart disease

A

10
80
120

30
Q

Neonatal Transfusion
-In general a dose of 15ml/kg can be expected to raise the baby’s hemoglobin concentration by about __g/L
* Common practice is to transfuse neonates with fresh red blood cells
* Increased amount of potassium in stored red blood cells
* Decreased levels of 2,3-DPG with extended storage

-Possibility to aliquot into 2 units to limit exposure to neonate (Must be used within 24 hours)

A

20

31
Q

Pediatric Transfusion
-Infants older than 4 months are essentially the same as an adult (Testing)

Guidelines for transfusion of RBC are:
1) Acute blood loss >__ % total blood volume
2) Hemoglobin <__ g/L
3) Corrective Therapy is not available
4) Hgb <___ g/L ON extracorporeal membrane oxygenation (cardiopulmonary bypass to support infants with respiratory/cardiac failure)
5) Chronic transfusion programs for disorders of RBC
production i.e. Beta Thalassemia major

A

15
70
130

32
Q

Neonatal Recipient of Platelets

  • Transfusions are indicated to prevent or decrease bleeding associated with quantitative or qualitative platelet disorders
  • Considered the etiology and natural history of the thrombocytopenia
  • Neonates may require platelets at a higher threshold because of their increase bleeding tendency and higher risk of intracranial hemorrhage
  • Generally given in doses of 5-10 mL per kg and expected to increase the platelet count by ___-____ x 10 9/L
  • Only ___ compatibility is required

-Childhood ITP is only transfused in there is severe bleeding since platelets will have shortened survival and minimal benefit

A

50-100
Rh

33
Q

________ Transfusions
- The primary indication for transfusion is for the correction of bleeding due to multiple acquired coagulation factor deficiencies.
-Infants up to 6 months of age have decreased levels of factors II, VII, IX, X, Protein C and S.
-If safer product is available with same therapeutic goal, than avoid plasma.
* Virus inactivated recombinant factor
concentrates

A

Plasma

34
Q

Blood Selection for Sickle Cell Patients

-* Patients with Sickle Cell Disease who become Allo-immunized often develop multiple antibodies
-* This can limit the availability of compatible blood in crisis

  • Usually all new patients with Sickle Cell disease or any combination of the Sickle Cell trait and other abnormal hemoglobin variations (SC disease or Thalassemia Disease) will be phenotyped before transfusion.

-* ____, _______, _______, _______ and ___ will be phenotyped and results will be faxed to CBS, Brampton Centre Immunohematology Department.

  • Patients with clinically significant antibodies must receive antigen negative blood to the corresponding antibody and closely matched antigen negative blood.
  • If patient does not have an antibody, they can receive___ and _______ matched units.

-* It is not necessary to match units for Fyb since it has been documented that they rarely produce the Anti-Fyb due to the ______ ______ mutation.

A

Rh, Duffy, Kell, Kidd and Ss

GATA gene

35
Q

Cord Testing

Cord Blood will be collected and stored in Blood bank
Cord blood is tested when:
1) Requested by physician
2) Mother is Rh _______
3) Mother has a clinically significant Antibody (implicated in HDFN)

____ and ____ is performed
A and B antigens are not fully developed at
birth
_______ Grouping not performed
Weak D testing is done if neonate is typed as Rh _______ and mother is Rh ________
Weak D testing cannot be performed if DAT
is ______

A

negative

ABO and DAT
Reverse
negative; negative
positive

TXN243 (4 decks)

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