CHAPTER 10: TRANSFUSION SERVICES THERAPY AND BLOOD COMPONENT PREPARATION

Question 1

is a broad term that encompasses all aspects of the transfusion of patients.

Answer 1

“Transfusion therapy”

Question 2

Each blood component has specific indications for use, expected outcomes, and other considerations.

Answer 2

“Transfusion therapy”

Question 3

Wide variety of blood components can be prepared from routinely drawn units of whole blood for many different therapeutic applications.

Answer 3

“Transfusion therapy”

Question 4

are considered drugs because of their use in treating diseases.

Answer 4

• Blood and blood products

Question 5

• The transfusion of blood cells is also [?], in that the cells must survive and function after transfusion to have a therapeutic effect.

Answer 5

transplantation

Question 6

• Transfusion therapy is used primarily to treat two conditions: [?] because of anemia or blood loss and [?] to provide adequate homostasis.

Answer 6

inadequate oxygen-carrying capacity

insufficient coagulation proteins or platelets

Question 7

Normally, approximately 450 mL of blood are collected into a bag containing 63 mL of anticoagulant, usually CPD or CPDA-1.

Answer 7

A. Whole blood

Question 8

Each unit of packed RBCs contains approximately 250 mL.

Question 9

Packed cells are prepared by removing approximately 200 to 250 mL of plasma from a unit of whole blood.

Answer 9

B. Packed RBCs

Question 10

The cells may be prepared in an open system by allowing the cells to sediment, then removing the plasma.

Answer 10

B. Packed RBCs

Question 11

A closed system may also be used in which multiple bags are attached to the unit, and the plasma is expressed into one of the satellite bags.

Answer 11

B. Packed RBCs

Question 12

The hematocrit of RBCs separated by these methods should not exceed 70% to 80%.

Answer 12

B. Packed RBCs

Question 13

RBCs to be frozen are collected in CPD, CPDA-1, or other additive systems and normally should be frozen within 6 hours.

Answer 13

C. Deglycerolized frozen RBCs

Question 14

The cells are warmed and mixed with high molar concentrations of glycerol, then frozen at -65-C.

Answer 14

C. Deglycerolized frozen RBCs

Question 15

Frozen units must be stored for up to 10 years.

Answer 15

C. Deglycerolized frozen RBCs

Question 16

The cells must be deglycerolized before they can be transfused.

Answer 16

C. Deglycerolized frozen RBCs

Question 17

Deglycerolization begins with thawing the cells at 37•C, then washing multiple times in a gradient concentration of saline, beginning with hypertonic concentrations and ending with an isotonic saline solution containing glucose.

Answer 17

C. Deglycerolized frozen RBCs

Question 18

One unit of deglycerolized RBCs contains approximately 180 mL of cells.

Answer 18

C. Deglycerolized frozen RBCs

Question 19

Plasma is removed from whole blood after centrifugation, and the remaining RBCs are washed three times with 0.9% saline.

Answer 19

D. Washed RBCs

Question 20

Washed RBCs have a shelf life of 24 hours after the original unit is opened, and they should be stored between 10C and 60C.

Answer 20

D. Washed RBCs

Question 21

The shelf life of whole blood collected in CPD is 21 days when stored between 10C and 60C.

Answer 21

A. Whole blood

Question 22

The shelf life is extended to 35 days when the blood is collected in CPDA-1 anticoagulant.

Answer 22

A. Whole blood

Question 23

A unit of blood must be transfused within 24 hours if the seal on the bag is broken to remove plasma.

Answer 23

A. Whole blood

Question 24

If the blood is not transfused in that time period, it must be disposed.

Answer 24

A. Whole blood

Question 25

Cells separated in an open system must be transfused within 24 hours.

Answer 25

B. Packed RBCs

Question 26

If the cells are separated in a closed system, they have the same expiration date as the original unit of whole blood.

Answer 26

B. Packed RBCs

Question 27

RBCs separated in a closed system with an additive bag can have a second preservative solution added that will extend the shelf life to 42 days.

Answer 27

B. Packed RBCs

Question 28

They should be stored between 10C and 60C.

Answer 28

B. Packed RBCs

Question 29

Deglycerolized RBCs are stored between 10C and 60C and must be transfused within 2 hours of deglycerolization.

Answer 29

C. Deglycerolized frozen RBCs

Question 30

Each unit of whole blood should increase the hematocrit from 3%to 5%, or the hemoglobin from 1 to 1.5 g/dL.

Answer 30

A. Whole blood

Question 31

There are few clinical indications for whole blood transfusions, although they may be appropriate for patients with rapid blood loss when increased volume, as well as increased RBC mass, is needed.

Answer 31

A. Whole blood

Question 32

Whole blood may also be used in exchange transfusions, especially in neonates.

Answer 32

A. Whole blood

Question 33

The increase in hemoglobin and hematocrit in response to a unit of packed RBCs is the same as for whole blood

Answer 33

B. Packed RBCs

Question 34

Packed RBCs are used to increase the RBC mass in patients who have symptomatic anemia.

Answer 34

B. Packed RBCs

Question 35

The increase in hemoglobin and hematocrit in response to a unit is the same as for whole blood or packed cells.

Answer 35

C. Deglycerolized frozen RBCs

Question 36

Freezing cells allows for long-term storage of rare donor units or autologous units.

Answer 36

C. Deglycerolized frozen RBCs

Question 37

Transfusing deglycerolized RBCs also minimizes febrile or allergic reactions.

Answer 37

C. Deglycerolized frozen RBCs

Question 38

One unit of washed RBCs increases the hemoglobin and hematocrit by the same amount as do unwashed cells.

Answer 38

D. Washed RBCs

Question 39

Washing RBCs removes most of the leukocytes and plasma from a unit of blood, which greatly reduces the risk of febrile or allergic (anaphylactic) reactions in susceptible patients.

Answer 39

D. Washed RBCs

Question 40

Washed RBCs are used for the rare patient who has anti-lgA antibodies because of IgA deficiency.

Answer 40

D. Washed RBCs

Question 41

Leukocyte poor RBC preparations have at least 70% of the original white blood cells (WBCs) removed, and at least 70% of the original RBCs are left.

Answer 41

E Leukocyte-poor ABCs

Question 42

There are several different methods of obtaining leukocytepoor RBCs, including centrifugation, filtration, and washing.

Answer 42

E Leukocyte-poor ABCs

Question 43

Plasma is separated from whole blood and frozen within 6 hours of collection.

Answer 43

F. Fresh frozen plasma (FFP)

Question 44

Plasma can be removed from whole blood using a double bag collection system to preserve a closed system.

Answer 44

F. Fresh frozen plasma (FFP)

Question 45

The plasma is immediately frozen at or below 180C.

Answer 45

F. Fresh frozen plasma (FFP)

Question 46

Platelet-rich plasma is separated at room temperature by centrifugation from RBCs within 6 hours of collection of whole blood.

Answer 46

G. Platelets

Question 47

The platelet-rich plasma is then centrifuged, the platelet concentrate.

Answer 47

G. Platelets

Question 48

Platelet-rich plasma is separated at room temperature by centrifugation from RBCs within 6 hours of collection of whole blood.

Answer 48

G. Platelets

Question 49

The platelet-rich plasma is then centrifuged, the platelet concentrate.

Answer 49

G. Platelets

Question 50

Plasma other than that prepared as FFP may be separated from whole blood at any time during the unit's shelf life up to 5 days after the expiration date.

Answer 50

H. Plasma derivatives

Question 51

The plasma may be pooled, purified, or fractionated into albumin or plasma protein fraction.

Answer 51

H. Plasma derivatives

Question 52

Cryoprecipitate is the insoluble fraction of plasma.

Answer 52

I. Cryoprecipitate

Question 53

Each unit contains 80 to 120 units of factor VIII and approximately 150 to 250 mg of fibrinogen, as well as significant amounts of factor XIII and fibronectin.

Answer 53

I. Cryoprecipitate

Question 54

Each unit of cryoprecipitate contains approximately 15 mL.

Answer 54

I. Cryoprecipitate

Question 55

It is prepared from FFP that has been partially thawed between 10C and 60C, centrifuged, and has had the supernatant removed.

Answer 55

I. Cryoprecipitate

Question 56

The remaining cryoprecipitate is immediately frozen at or below -180C.

Answer 56

I. Cryoprecipitate

Question 57

Granulocyte preparations may be prepared by leukapheresis or from a freshly drawn donor unit.

Answer 57

J. Granulocytes

Question 58

If a closed preparation system is used, the shelf life is the same as the original unit of blood.

Answer 58

E Leukocyte-poor ABCs

Question 59

The shelf life is reduced to 24 hours if an open system is used.

Answer 59

E Leukocyte-poor ABCs

Question 60

Leukocyte-poor RBCs should be stored between 10C and 60C.

Answer 60

E Leukocyte-poor ABCs

Question 61

After freezing, the plasma should be stored at or below 180C.

Answer 61

F. Fresh frozen plasma (FFP)

Question 62

has a shelf life of 1 year after collection of the original unit of blood.

Answer 62

F. Fresh frozen plasma (FFP)

Question 63

It should be thawed at 370C and transfused within 24 hours of thawing.

Answer 63

F. Fresh frozen plasma (FFP)

Question 64

Thawed should be stored between 10C and 60C if it is not transfused immediately.

Answer 64

F. Fresh frozen plasma (FFP)

Question 65

are stored at room temperature with continuous gentle agitation and have a shelf life of 3 to 5 days, depending on the type of bag used.

Answer 65

G. Platelets

Question 66

If several units of platelets are pooled, the shelf life is reduced to 4 hours following pooling.

Answer 66

G. Platelets

Question 67

Plasma derivatives have a shelf life of 5 years when stored between 10C and 60C.

Answer 67

H. Plasma derivatives

Question 68

After freezing, the optimal storage temperature is at or below -300C, and the shelf life is up to 12 months following the collection of the original unit.

Answer 68

I. Cryoprecipitate

Question 69

The shelf life of granulocyte preparations is 24 hours after separation when stored at room temperature.

Answer 69

J. Granulocytes

Question 70

should be transfused as soon as possible because their halflife is only 6 hours.

Answer 70

J. Granulocytes

Question 71

In addition to increasing RBC mass, it also minimize febrile transfusion reactions in patients who have leukocyte antibodies as well as reducing CMV transmission.

Answer 71

E Leukocyte-poor ABCs

Question 72

Because it contains all of the coagulation factors, it can be used to treat patients who have - liver failure, vitamin K deficiency, and disseminated intravascular coagulation (DIC), or to patients who have received massive transfusions.

Answer 72

F. Fresh frozen plasma (FFP)

Question 73

concentrate is used to treat patients who have thrombocytopenia, dysfunctional platelets, DIC, and idiopathic thrombocytopenia purpura (ITP), or to patients who have received massive transfusions.

Answer 73

G. Platelets

Question 74

Each unit of concentrate should increase the platelet count by 5,000 to 10,000/uL in a typical 70-kg human.

Answer 74

G. Platelets

Question 75

Plasma derivatives such as albumin are used primarily as volume expanders.

Answer 75

H. Plasma derivatives

Question 76

Cryoprecipitate is used in the treatment of hemophilia A, factor XIII deficiency, and hypofibrinogenemia.

Answer 76

I. Cryoprecipitate

Question 77

The immunologically active lymphocytes present in most blood components can create special problems for immunocompromised patients.

Answer 77

K. Irradiation of blood products

Question 78

Graft- versushost disease (GVHD) is an especially serious complication for these patients.

Answer 78

K. Irradiation of blood products

Question 79

can help reduce the risk of GHD and other related complications.

Answer 79

K. Irradiation of blood products Irradiating blood products

Question 80

1. Indications for use. Irradiated blood products may be indicated for: • Patients receiving [?] • [?] who have been immunosuppressed • [?] neonates • Patients with [?]

Answer 80

chemotherapy or radiotherapy Organ transplantation recipients Low-birth-weight genetically deficient immune systems

Question 81

2. Irradiation Blood components should be irradiated immediately before transfusion. • Doses of [?] are usually used. • Expiration date of [?] from the date of irradiation or the original outdate of the unit, whichever is sooner.

Answer 81

1,500 to 5,000 rad 28 days