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Transfusion Medicine Fellowship > Blood products incl. special prep > Flashcards

Blood products incl. special prep Flashcards

1
Q

What is the “storage lesion” physiologically driven by?

A

Membrane changes (eg. microvesiculation), increases in free potassium, hemoglobin, and lysophospholipids, and decrease in pH, ATP, and 2-3-DPG.

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2
Q

What is the requirement for red cell yield after storage?

A

75% of the cells must survive in circulation 24hrs after transfusion. Less than 1% hemolysis is permitted.

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3
Q

Do platelets suffer from storage lesion?

A

Yes, they metabolize sugars and fatty acids to generate carbonic acid.

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4
Q

What are the indications for blood product irradiation?

A

Hematopoietic stem cell transplant
Directed donation
Intrauterine transfusion
Generally, impaired cellular immunity.

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5
Q

What is the required dose of irradiation for irradiated products?

A

25Gy to center of bag

15Gy to rest of bag

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6
Q

What are the requirements for leukoreduction?

A

3-log reduction in leukocytes (>99.9%)
For RBCs and pheresis platelets, no more than 5 x 10*^6 leukocytes.
For WB-derived platelets, no more than 8.3 x 10^5 leukocytes.

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7
Q

Can platelets be volume reduced?

A

Yes, but they should be allowed to sit 20-60min before re-agitation or dispensation.

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8
Q

What are the indications for washing of blood products?

A

Deglycerolization
Selective plasma protein deficiencies (IgA, Haptoglobin)
HPA-1a antibodies or post-transfusion purpura
IUT

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9
Q

How much cell loss is permitted with washing?

A

20% loss of red cell yield

33% loss of platelet yield

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10
Q

How should whole blood be reconstituted?

A

Use group O RBCs and group AB plasma and aim for a hematocrit of about 50%.

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11
Q

What is aliquoting? What are its indications?

A

Splitting into low-volume containers. For pediatric transfusions (reduces number of donor exposures) or for very slow infusions (which must complete in 4hrs)

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12
Q

What percentage of D-negative patients alloimmunize after receiving D-positive RBCs? Platelets?

A

22% immunize after RBCs.
2% immunize after platelets.
May be able to reduce with RhIG

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13
Q

What rate of transfusion defines massive tranfusion?

A

8+ RBCs in 24hrs, or 4+ RBCs in 1hr.

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14
Q

After a patient receives emergency-release blood products, how should the presence of anti-A or anti-B be treated?

A

Respect it, even if it is passively acquired. You may have to continue to only give group O RBCs.

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15
Q

What is the crossmatch to transfusion ratio?

A

The number of units that gets crossmatched for surgery relative to the number actually transfused. A high ratio indicates units being needlessly held up in crossmatch.

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16
Q

What are the benefits of pre-storage leukoreduction?

A

Leukoreduction reduces FNHTRs, alloimmunization, and CMV transmission.

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17
Q

What are the requirements for leukoreduction to be effective?

A

3-log reduction in leukocytes (<99.9%), down to <5 x 10^6 leukocytes per unit (sixth that for acrodose platelet)

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18
Q

What is in cryoprecipitated AHF?

A

Fibrinogen, factor VIII, vWF, fibronectin, and factor XIII.

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19
Q

What is the recommended number of granulocytes per transfusion?

A

4 x 10^10

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20
Q

How many units are in a pool of cryoprecipitate

A

Formerly 10, now 5

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21
Q

From what products can cryoprecipitate be made?

A

FFP, PF24, or PF24RT24

22
Q

What are the minimum and expected amounts of fibrinogen and factor VIII in a unit of cryo?

A

Fibrinogen: 150mg minimum. 250mg expected.
fVIII: 80 IU

23
Q

What are the indications for cryoprecipitate?

A

Correction of hypofibrinogenemia (liver dz, obstetrical hemorrhage, trauma/DIC), uremic coagulopathy, and rarely correction of fXIII deficiency.

24
Q

What are the risks associated with cryo transfusion?

A

Infectious disease risk
Prothrombotic complications (due to fXIII, vWF)
TRXNs as seen in plasma-rich products.

25
Q

How is cryoprecipitate dosed for fibrinogen?

A

Multiply delta fibrinogen level (mg/dL) by patient blood volume (in dL). Divide by fibrinogen per dose (250mg/unit, or 1250mg/pool)

26
Q

How is cryoprecipitate dosed for factor VIII?

A

Multiple delta activity by 40 and patient bodyweight in kg. Divide by fVIII per unit (80).

27
Q

What alternatives exist for cryoprecipitate?

A

RiaStap (plasma-derived fibrinogen concentrate)
Recombinant factor VIII (many products)
Corifact (plasma-derived fXIII)
VonVendi (recombinant vWF)

28
Q

Whose blood cannot be leukoreduced?

A

Sickle trait paitents (clogs filters).

29
Q

How much RBC mass should survive leukoreduction?

A

At least 85%

30
Q

What radioisotopes are used for irradiation?

A

Cesium 137

Cobalt 60

31
Q

What is the downside of irradiation?

A

Cost, hyperkalemia (only a concern in small children)

32
Q

How should units be handled in quarantine?

A

They must be kept physically separate from transfusible product, ideally in another fridge. OK to work on splitting and processing while in quarantine.

33
Q

What must be on every blood product label?

A

ISBT 128 code
Barcode: Facility ID, donor lot, product code
ABO/Rh of donor
Any additional labels indicating special processing or tie tags

34
Q

What is the purpose of the acid in ACD?

A

Stops dextrose from caramelizing during sterilization

35
Q

What are the primary benefits of whole blood over components?

A

Less AC, faster transfusion, easier logistics

36
Q

What is a typical yield loss in deglycerolization?

A

10-20%

37
Q

What is the difference between PF24 and PF24RT24?

A

PF24 should be refrigerated within 8 hours. RT can be held at room temperature. Both have less V, VIII, and probably C and S.

38
Q

What is the expiry time of liquid plasma?

A

26 days

39
Q

What are some accepted methods of plasma pathogen reduction?

A

Heating
Methylene blue + UV
Solvents/Detergents (eg. Octaplas)
INTERCEPT, Mirasol…

40
Q

If a platelet unit is visibly red, what red cell content is present?

A

At least 0.5% by volume.

41
Q

What is the “platelet swirl”?

A

A visible phenomenon caused by tight platelet clumping, indicating platelet death usually by acid or bacteria.

42
Q

What is a typical factor VIII level in a cryo unit, and what factors can influence this?

A

Average ~150U. Group O donors have less (due to increased vWF clearance)

43
Q

What is a recommended granulocyte dose by weight? how much is in a granulocyte unit?

A

Recommend 0.6 x 10^9/kg, but the average unit only has 4 x 10^10 (only satisfies up to 67kg recipient)

44
Q

Why might a blood transfusion service (not a donor/manufacturing service) require an FDA license?

A

Any product modifications including pooling and irradiation requires re-labeling of the new product.

45
Q

Why may blood for neonatal purposes ideally not contain adsol?

A

Adenine and mannitol may be nephrotoxic to infants.

46
Q

What volume should be used in washing? How can the product quality be checked?

A

1-2L NS.

Check last wash for Hb content; should have < 300mg

47
Q

How can platelets be extended to 7d expiry?

A 
Verax testing (PDG test)
Delayed/subsequent sampling
48
Q

What is in platelet additive solution?

A

Acetate (“fuel” for platelet metabolism; doesn’t generate lactate), potassium, magnesium, phosphate

49
Q

How is liquid plasma made?

A

It is only derived from whole blood, never apheresis. It is never frozen. It should always be irradiated.

50
Q

How does pathogen reduction with methylene blue affect the factor levels in plasma rich products?

A

Reduces fibrinogen and factor VIII.

51
Q

When should platelets be rested?

A

After hard-spin, washing, INTERCEPT illumination…

52
Q

How long are platelets stored in syringes fully functional?

A

At least 6 hours.

Transfusion Medicine Fellowship (34 decks)

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