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CBS Clinical Guide, Even Numbered Chapters > Chapter 2: Blood Components > Flashcards

Chapter 2: Blood Components Flashcards

1
Q

What components are whole blood donations separated into?

A

Cellular components:
1. RBCs
2. Pooled platelets
3. Apheresis platelets
4. Pooled platelets psoralen-treated

AND

Plasma components
1. FP
2. CSP
3. Cryoprecipitate

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2
Q

In the context of blood collection, what is a closed system? Why is this important?

A

Whole blood is collected directly from the donor into a collection pack with multiple connected bags. This is important because it allows blood to be transferred aseptically between bags.

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3
Q

Name the 2 possible configurations of a blood collection pack at CBS.

A

B1: buffy coat collection set
B2: while blood filtration set

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4
Q

What components are the B1 and B2 collection sets used to produce?

A

B1: RBC, platelets, plasma

B2: RBC, plasma components including cryoprecipitate

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5
Q

What preservative do blood collection bags contain at CBS? What purpose does this preservative serve?

A

CPD (Citrate -phosphate-dextrose)
Anticoagulant

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6
Q

How does apheresis technology work?

A

Automated process

Whole blood goes from donor into collection chamber

Centrifugation to separate cellular components from plasma

Eirher plasma or platelets suspended into plasma are collected into a bag

Remaining blood constituents are returned to the donor

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7
Q

What are the differences between the B1 and B2 manufacturing methods?

A

B1:
WB cooled to 18-24C then centrifugation then extraction of plasma, buffy coat, RBC finally, RBC leukoreduced/ filtered and buffy coat is made into PP

B2: WB cooled, but only to 1-6C
Filtration/leukoreduction occurs before centrifugation target than at the end, so platelets get removed
Final products are RBC and plasma

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8
Q

What additive is used in RBC units at CBS? What are the ingredients in this additive?

A

SAGM
Saline
Adenine
Glucose
Mannitol

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9
Q

What is the volume of a total RBC unit issued by CBS?

A

285 mL

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10
Q

How many grams of Hgb in a unit of red cells?

A

55 g

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11
Q

What is the average hematocrit of an RBC unit?

A

0.67%

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12
Q

What is the average residual WBC count in an RBC unit?

A

6 x 10*8

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13
Q

What types of testing, in general terms, does donated blood undergo at CBS?

A

ABO typing
RhD typing
Kell typing
Other clinically significant antibodies stuck as C, c, E, e, Jka, Jkb, Fya, Fyb, S, s (some units only)

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14
Q

What information is on a standard RBC unit label at CBS?

A

ISBT Donation number
Collection date/time
Expiration date/time
Product name/description
ISBT product code
ABO Rh blood group
Results of special/extended testing (e.g. antigen phenotyping)

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15
Q

What is the primary indication of a red cell transfusion?

A

To increase O2 carrying capacity of blood

E.g in anemic patients with evidence of impaired O2 delivery

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16
Q

What is the expected increment in hemoglobin following transfusion of one RBC unit?

A

10 g/L

(70kg non-bleeding adult)

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17
Q

What criteria must an unused RBC unit fulfill to be returned to inventory?

A

Bag intact
Visual inspection okay
Maintained at an acceptable temperature OR
Not out of temperature control for >60 min

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18
Q

What is the shelf like of a standard unmodified RBC unit?

A

42 days from collection

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19
Q

What modifications/factors shorten shelf life of an RBC unit?

A

Washing

Irradiation

Opening unit without a sterile connection device

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20
Q

What is the storage temperature for RBCs?

A

1-6C

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21
Q

What features or requirements must an RBC storage device have?

A

Temperature control
Alarm
Fan
Continuous monitoring device
Records to maintain traceability from source to disposition and to ensure appropriate conditions

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22
Q

What is the maximum transportation time for an RBC unit?

A

24 hours per ISBT

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23
Q

What is the required storage temperature for RBCs? Is there any difference for short (<24 hours) transportation times?

A

1-6C

Yes; 1-10C if transported for <24h

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24
Q

Disposition documentation purpose?

A

To record whether a unit was transfused or discarded

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25
Q

What manufacturing method is used to extract platelets?

A

B1 buffy coat

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26
Q

How is one unit of pooled platelets prepared?

A

4 ABO identical donations along with plasma from one of those donors (a male) are pooled then LR/filtered

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27
Q

When can a pooled platelets be labeled as Rh neg?

A

All 4 donors are Rh neg

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28
Q

When can a pooled platelets unit be labeled as low anti-A/B?

A

All 4 donors have anti-A and anti-B levels below a predetermined cutoff

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29
Q

Average volume of a pooled platelet unit?

A

320 mL
(Less if apheresis- 220 mL)

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30
Q

Average platelet count in a pooled platelet unit?

A

340 x10*9

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31
Q

Average platelet count in a pooled platelet unit?

A

340 x10*9
(Slightly less if apheresis - 333)

32
Q

Residual WBC count in a pooled platelet unit?

A

5 x 10*8
(MORE if apheresis- 10)

33
Q

Shelf life of a pooled or apheresis platelet unit?

A

7d from collection

34
Q

When is platelet transfusion indicated?

A

Bleeding patient with thrombocytopenia or dysfunctional platelets

Prophylaxis in patients with thrombocytopenia or rapidly dropping platelet count due to chemo or bone marrow disorders

35
Q

Are platelet transfusions useful in ITP, HIT, or TTP?

A

Not recommended for patients with rapid platelet destruction unless clinically significant and/or life threatening bleeding

36
Q

Are platelet transfusions useful in ITP, HIT, or TTP?

A

Not recommended for patients with rapid platelet destruction unless clinically significant and/or life threatening bleeding

37
Q

What is the expected count increment from one unit of platelets after 1 hour?

A

15-25x10*9/L

38
Q

What are the storage conditions for platelets?

A

. 20-24°C under continuous agitation

39
Q

What types of plasma products does CBS manufacture or provide?

A
  1. FP
  2. CSP
  3. Cryoprecipitate
  4. S/D plasma/ octaplasma
40
Q

When might a plasma donation be discarded?

A

If any clinically significant Ab are detected on screening at CBS

41
Q

How much time after collection is a plasma unit frozen?

A

within 24 hrs

42
Q

What is the residual WBC count in a plasma unit?

A

<5x10*6/L

43
Q

Why aren’t plasma units labeled as LR?

A

WBC levels can be highly variable

44
Q

What Is FP-divided plasma & its volume?

A

smaller divided doses/Units for peds patients. Almost always group AB.
Volume 125-150mL

45
Q

Why must plasma be frozen at -18°C or lower?

A

FV & FVIII are labile and not stable at refrigerated temperatures

46
Q

According to Canadian standards, how much factor VIII must a unit of FP contain?

A

Minimum 0.52 IU/L in at least 75% of tested units

47
Q

How is CSP/CPD (cryosupernatant plasma) produced?

A

FP is slowly thawed

Thawed FP is centrifuged to separate plasma from insoluble cryoprecipitate

Cryoprecipitate is refrozen

Plasma is refrozen and becomes cryosupernatant plasma

48
Q

What is convalescent plasma? What is it used for?

A

Plasma collected from people who have recovered from an infection. The plasma contains neutralizing antibodies against the causative pathogen.

Experimental therapy for: SARS, Ebola, H1N1, COVID-19

For COVID, donors must have had positive COVID test in the past and must be free of symptoms for 28 days/4 weeks

49
Q

What is the volume of an average FP unit?

A

283 mL

50
Q

How much FVIII is in the average FP unit?

A

0.87 IU/mL

51
Q

What is the average volume of a unit of CSP?

A

273 mL

52
Q

What coag factors are in FP?

A

All, but slightly reduced amounts of FV and FVIII

53
Q

What clotting factors are in CSP?

A

All, but reduced HMW VWF and fibrinogen

54
Q

What is the volume of a typical octaplasma unit?

A

200 mL

55
Q

How many g off human plasma proteins are in a unit of octaplasma?

A

9-14 g (45-70 mg/mL)

56
Q

What is the minimum amount of each clotting factor in an octaplasma unit?

A

0.5 IU/mL

57
Q

What steps does octaplasma undergo?

A

Solvent detergent
Immune neutralization
Sterile filtration

Purpose is to remove our inactivate pathogens, cells, allergens, antibodies

58
Q

What is the indication for FP or S/D plasma?

A

Treatment or prevention of clinically significant bleeding due to coagulation factor deficiency even there is no appropriate alternative therapy

E.g. DIC
Severe liver disease
Patient on warfarin undergoing invasive procedure before vitamin K reversal can occur
TTP patients on PLEX

Reconstitution of whole blood

59
Q

What are the indications for CSP?

A

PLEX for TTP
Patients with multiple factor deficiencies but don’t need fibrinogen replacement
Patient on warfarin bleeding or undergoing invasive procedures before vit K reversal, if pcc is unavailable or contraindicated

60
Q

Is plasma indicated for hypovolemic patients as volume replacement?

A

No
User crystalloids: NS or RL

61
Q

Are FP and SD plasma interchangable?

A

Yes

62
Q

How do you thaw FP or CSP?
How do you thaw SD plasma?

A

12-30 min in water bath 30-37C for FP or CSP

30-60 min in water bath at 30-37C or in a dry tempering system for SD

Store at 1-6C for up to 5 days after thawing

63
Q

What are the storage and transportation conditions for frozen plasma components?

A

-18C for up to 12 mos for FP and CSP
Up to 4 years for octaplasma!!!

Products can’t be out of a temperature controlled storage for >30 min

64
Q

How much fibrinogen in a unit of cryoprecipitate?

A

365 mg

65
Q

What is the volume of a unit of cryoprecipitate?

A

10+/-2 mL

66
Q

Indication for cryoprecipitate?

A

Fibrinogen replacement

67
Q

Advantage of fibrinogen concentrate over cryoprecipitate?

A

Fibrinogen concentrate is pathogen reduced and availablein freeze dried lyophilized form so it’s easier to reconstitute and administer

68
Q

What fibrinogen level is an indication for replacement?

A

<1.0g/L
<1.5 g/L in non obstetric patients with massive bleed or APL
<2.0 g/L in bleeding obstetric patients

69
Q

Is fibrinogen indicated in hemophilia A or VWD?

A

No, use fibrinogen concentrate

70
Q

What video sizes/doses of RhIg are available?

A

600, 1500, and 5000 IU
120 ug, 300ug, 1000 ug, respectively

71
Q

Uses of RhIg?

A

Prevent alloimmunization to RhD Ag
Treat ITP

72
Q

RhIg contraindications

A

RhD positive patient
RhD alloimmunized patients
H/o anaphylaxis or severe reaction to Ig or plasma products
IgA deficiency

73
Q

Routes of administration for RhIg?

A

IV or IM

74
Q

Within how many hours of a sensitizing event does RhIg need to be given?

A

Within 72h, but can still give up to 28 days after

75
Q

RhIg dose for RhD neg patient following transfusion with Rh positive RBCs?

A

90-120 IU/mL of RhD positive RBCs or 45-60 IU/mL for whole blood

Rule of thumb:
1500 IU (300 ug) per 15 ml RBC or 30 ml whole blood

Can give multiple doses of 600 ug q8h until desired dose for large volume exposure

CBS Clinical Guide, Even Numbered Chapters (3 decks)

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