CHAPTER 10: TRANSFUSION SERVICES THERAPY AND BLOOD COMPONENT PREPARATION Flashcards
is a broad term that encompasses all aspects of the transfusion of patients.
“Transfusion therapy”
Each blood component has specific indications for use, expected outcomes, and other considerations.
“Transfusion therapy”
Wide variety of blood components can be prepared from routinely drawn units of whole blood for many different therapeutic applications.
“Transfusion therapy”
are considered drugs because of their use in treating diseases.
• Blood and blood products
• The transfusion of blood cells is also [?], in that the cells must survive and function after transfusion to have a therapeutic effect.
transplantation
• Transfusion therapy is used primarily to treat two conditions: [?] because of anemia or blood loss and [?] to provide adequate homostasis.
inadequate oxygen-carrying capacity
insufficient coagulation proteins or platelets
Normally, approximately 450 mL of blood are collected into a bag containing 63 mL of anticoagulant, usually CPD or CPDA-1.
A. Whole blood
Each unit of packed RBCs contains approximately 250 mL.
Packed cells are prepared by removing approximately 200 to 250 mL of plasma from a unit of whole blood.
B. Packed RBCs
The cells may be prepared in an open system by allowing the cells to sediment, then removing the plasma.
B. Packed RBCs
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.
B. Packed RBCs
The hematocrit of RBCs separated by these methods should not exceed 70% to 80%.
B. Packed RBCs
RBCs to be frozen are collected in CPD, CPDA-1, or other additive systems and normally should be frozen within 6 hours.
C. Deglycerolized frozen RBCs
The cells are warmed and mixed with high molar concentrations of glycerol, then frozen at -65-C.
C. Deglycerolized frozen RBCs
Frozen units must be stored for up to 10 years.
C. Deglycerolized frozen RBCs
The cells must be deglycerolized before they can be transfused.
C. Deglycerolized frozen RBCs
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.
C. Deglycerolized frozen RBCs
One unit of deglycerolized RBCs contains approximately 180 mL of cells.
C. Deglycerolized frozen RBCs
Plasma is removed from whole blood after centrifugation, and the remaining RBCs are washed three times with 0.9% saline.
D. Washed RBCs
Washed RBCs have a shelf life of 24 hours after the original unit is opened, and they should be stored between 10C and 60C.
D. Washed RBCs
The shelf life of whole blood collected in CPD is 21 days when stored between 10C and 60C.
A. Whole blood
The shelf life is extended to 35 days when the blood is collected in CPDA-1 anticoagulant.
A. Whole blood
A unit of blood must be transfused within 24 hours if the seal on the bag is broken to remove plasma.
A. Whole blood
If the blood is not transfused in that time period, it must be disposed.
A. Whole blood
Cells separated in an open system must be transfused within 24 hours.
B. Packed RBCs
If the cells are separated in a closed system, they have the same expiration date as the original unit of whole blood.
B. Packed RBCs
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.
B. Packed RBCs
They should be stored between 10C and 60C.
B. Packed RBCs
Deglycerolized RBCs are stored between 10C and 60C and must be transfused within 2 hours of deglycerolization.
C. Deglycerolized frozen RBCs
Each unit of whole blood should increase the hematocrit from 3%to 5%, or the hemoglobin from 1 to 1.5 g/dL.
A. Whole blood
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.
A. Whole blood
Whole blood may also be used in exchange transfusions, especially in neonates.
A. Whole blood
The increase in hemoglobin and hematocrit in response to a unit of packed RBCs is the same as for whole blood
B. Packed RBCs
Packed RBCs are used to increase the RBC mass in patients who have symptomatic anemia.
B. Packed RBCs
The increase in hemoglobin and hematocrit in response to a unit is the same as for whole blood or packed cells.
C. Deglycerolized frozen RBCs
Freezing cells allows for long-term storage of rare donor units or autologous units.
C. Deglycerolized frozen RBCs
Transfusing deglycerolized RBCs also minimizes febrile or allergic reactions.
C. Deglycerolized frozen RBCs
One unit of washed RBCs increases the hemoglobin and hematocrit by the same amount as do unwashed cells.
D. Washed RBCs
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.
D. Washed RBCs
Washed RBCs are used for the rare patient who has anti-lgA antibodies because of IgA deficiency.
D. Washed RBCs
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.
E Leukocyte-poor ABCs
There are several different methods of obtaining leukocytepoor RBCs, including centrifugation, filtration, and washing.
E Leukocyte-poor ABCs
Plasma is separated from whole blood and frozen within 6 hours of collection.
F. Fresh frozen plasma (FFP)
Plasma can be removed from whole blood using a double bag collection system to preserve a closed system.
F. Fresh frozen plasma (FFP)
The plasma is immediately frozen at or below 180C.
F. Fresh frozen plasma (FFP)
Platelet-rich plasma is separated at room temperature by centrifugation from RBCs within 6 hours of collection of whole blood.
G. Platelets
The platelet-rich plasma is then centrifuged, the platelet concentrate.
G. Platelets
Platelet-rich plasma is separated at room temperature by centrifugation from RBCs within 6 hours of collection of whole blood.
G. Platelets
The platelet-rich plasma is then centrifuged, the platelet concentrate.
G. Platelets
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.
H. Plasma derivatives
The plasma may be pooled, purified, or fractionated into albumin or plasma protein fraction.
H. Plasma derivatives
Cryoprecipitate is the insoluble fraction of plasma.
I. Cryoprecipitate
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.
I. Cryoprecipitate
Each unit of cryoprecipitate contains approximately 15 mL.
I. Cryoprecipitate
It is prepared from FFP that has been partially thawed between 10C and 60C, centrifuged, and has had the supernatant removed.
I. Cryoprecipitate
The remaining cryoprecipitate is immediately frozen at or below -180C.
I. Cryoprecipitate
Granulocyte preparations may be prepared by leukapheresis or from a freshly drawn donor unit.
J. Granulocytes
If a closed preparation system is used, the shelf life is the same as the original unit of blood.
E Leukocyte-poor ABCs
The shelf life is reduced to 24 hours if an open system is used.
E Leukocyte-poor ABCs
Leukocyte-poor RBCs should be stored between 10C and 60C.
E Leukocyte-poor ABCs
After freezing, the plasma should be stored at or below 180C.
F. Fresh frozen plasma (FFP)
has a shelf life of 1 year after collection of the original unit of blood.
F. Fresh frozen plasma (FFP)
It should be thawed at 370C and transfused within 24 hours of thawing.
F. Fresh frozen plasma (FFP)
Thawed should be stored between 10C and 60C if it is not transfused immediately.
F. Fresh frozen plasma (FFP)
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.
G. Platelets
If several units of platelets are pooled, the shelf life is reduced to 4 hours following pooling.
G. Platelets
Plasma derivatives have a shelf life of 5 years when stored between 10C and 60C.
H. Plasma derivatives
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.
I. Cryoprecipitate
The shelf life of granulocyte preparations is 24 hours after separation when stored at room temperature.
J. Granulocytes
should be transfused as soon as possible because their halflife is only 6 hours.
J. Granulocytes
In addition to increasing RBC mass, it also minimize febrile transfusion reactions in patients who have leukocyte antibodies as well as reducing CMV transmission.
E Leukocyte-poor ABCs
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.
F. Fresh frozen plasma (FFP)
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.
G. Platelets
Each unit of concentrate should increase the platelet count by 5,000 to 10,000/uL in a typical 70-kg human.
G. Platelets
Plasma derivatives such as albumin are used primarily as volume expanders.
H. Plasma derivatives
Cryoprecipitate is used in the treatment of hemophilia A, factor XIII deficiency, and hypofibrinogenemia.
I. Cryoprecipitate
The immunologically active lymphocytes present in most blood components can create special problems for immunocompromised patients.
K. Irradiation of blood products
Graft- versushost disease (GVHD) is an especially serious complication for these patients.
K. Irradiation of blood products
can help reduce the risk of GHD and other related complications.
K. Irradiation of blood products
Irradiating blood products
- Indications for use. Irradiated blood products may be indicated for:
• Patients receiving [?]
• [?] who have been immunosuppressed
• [?] neonates
• Patients with [?]
chemotherapy or radiotherapy
Organ transplantation recipients
Low-birth-weight
genetically deficient immune systems
- 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.
1,500 to 5,000 rad
28 days
