Components, Preparation, Donors Flashcards
450 mL size donor bag maximum/minimum amount
450 mL +/- 45mL
500 mL size donor bag maximum/minimum amount
500 mL +/- 50 mL
How many hours after collection must the plasma be frozen if making fresh frozen plasma from units that have CPD, CD2D, or CPDA-1 as the anticoagulant?
8 hours
How many hours after collection must the plasma be frozen if making fresh frozen plasma from units that have ACD as the anticoagulant?
6 hours
Single donor plasma has lost the viability of what labile coagulation factors
V and VIII
NSA (normal serum albumin):
Contains?
Expiration time/temp?
Purpose?
Contains: 80% albumin, 17% globulin
Expiration time/temp: 5 years at 2-10 degree C
Purpose: volume expander (rare) and used with apheresis donors
What are the two categories of synthetic volume expanders and what products are included in each group?
Crystalloids: ringer’s lactate and normal isotonic saline
Colloids: dextran and HES
How many RBC’s are expected to be in a unit of packed cells?
250 mL
Why are the colloid volume expanders used?
Hemorrhagic shock and burn patients
What is the hermetic seal?
Completely enclosed system-reducing exposure to microbes/contaminants. If broken, the unit must be used within 24 hours
Washed RBC indications for use
If patient has history of plasma protein antibodies, PNH diagnosis, severe allergies
Fresh frozen plasma indications for use
For multiple or unknown coagulation factor deficiency
Single donor plasma indication for use
For treatment of stable clotting factor deficiencies
Platelet concentrates indication for use
Thrombocytopenia
Cryoprecipitated Anti-hemophiliac Factor indications for use
Correct FVIII, FXIII deficiencies
Fibrinogen
Packed RBCs indication for use
Restore O2 carrying capacity
Whole blood indication for use
Used for massive blood loss
Treatment of cardiopulmonary bypass patients either intraoperatively or up to 6 hours post operatively
Leukocyte reduced RBC indication for use
History of febrile transfusion reactions, reduced exposure to MHC antigens
Irradiated RBC indication for use
Graft vs. host disease
Component to use for hypovolemia
Crystalloid products (saline or electrolyte) solutions
Component to use for open heart surgery
Preoperative hemodilution and then reinfusion of the collected blood. Any additional units should be as fresh as possible to aid in the overall 2,3 DPG depletion recovery
Component to use for patients with repeated febrile transfusion reactions
Leukocyte-reduced red blood cells
Component to use for leukemia/ repeated transfusions of platelets necessary
Single-donor platelets prepared by pheresis
Component to use for hemophilia A
Factor VIII concentrate or cryoprecipitate antihemophilic factors
Component to use for hemophilia B
Factor IX concentrate
Component to use for disseminated intravascular coagulation
Fresh frozen plasma
Component to use for anemia
Packed RBC’s
Component to use for hypofibrinogenemia
Cryoprecipitate anti hemophilic factor
Component to use for acute blood loss
Packed RBCs
Component to use for severe burns with dehydration
NSA
5-25% (normal serum albumin)
Component to use for massive transfusion from trauma (more than 10 units needed)
Whole blood
What is the cryoprotective agent for frozen red blood cells and recommended storage temp?
High glycerol (40% w/v) - 80 degrees C Low glycerol (20% w/v) - 120 degrees C
How are frozen RBC prepared for transfusion?
1) equilibrate with 12% NaCl
2) wash 1.6% NaCl
3) final washing 0.9% NaCl and 0.2% dextrose
What are the advantages of frozen RBC over banked blood?
1) No plasma for people with PNH or anti-IgA
2) Extended shelf life for rare units
What is the optimum temp for shipping of blood?
1-10 degrees C
2,3 DPG is the most important factor in what RBC function
Hemoglobin affinity for oxygen
ATP is important for what RBC parameters?
RBC viability
Membrane integrity
How is refrigerator temp monitored?
Continuous recorder with alarm system
When inspecting blood each day, what do we look for?
Clot, discolorization
Bacterial contamination
Changes that occur in stored, anticoagulated blood
Decrease in 2,3 DPG
Increased plasma hemoglobin
Increased plasma K
Decrease in ATP
What type of cooling system needs to be included with fresh frozen plasma?
Dry ice
What type of cooling system needs to be included with frozen RBC’s?
Dry ice
What type of cooling system needs to be included with whole/packed cells?
Ice to maintain 2-10 degree C window
What type of cooling system needs to be included with platelets?
Maintain 20-24 degree C window
How old of blood is allowed if a fresh whole blood transfusion is indicated?
<5 days
What is the temp for units of blood during transport?
1-10 degree C
As units of packed cells are stored, what happens to the pH and 2,3 DPG?
Both decrease
What extra qualifications must a donor for platelet pheresis meet?
Apheresis platelet donor must not have taken aspirin-containing medication in last 3 days. Platelet count obtained on donor if donating more frequently than every 8 weeks
What is the expiration limit for apheresed platelets?
5 days in a closed system
24 hours in open system
Factors removed by plasmapheresis
Immune complexes Auto or alloantibodies Inflammatory mediators Protein-bound toxins Lipoproteins Platelet-aggregating factor
What is the average number of platelets in each bag of random donor platelets?
5.5 x 10^10
What is the average number of platelets in a single donor unit?
3.0 x 10^11
What is the requirement for pH in a unit of platelets?
6.2 or greater
A random donor pack of platelets is expected to increase the recipients platelet count by how much?
5,000-10,000 microliter
What is the expected effect in the recipient after receiving 1 unit of packed cells?
Increased Hct by 3%
Increase Hgb 1 g/dL
What is the expected effect in the recipient after receiving 1 unit of random donor platelets?
Increase 5,000-10,000 per unit
What is the expected effect in the recipient after receiving 1 unit of platelets from a single donor by pheresis?
Increase 30,000-60,000 per unit
What is the expected effect in the recipient after receiving 1 unit of whole blood?
Increase Hct 155
Increase Hgb 1 g/dL
What would be the acceptable white blood count if you used a leukoreduced, pooled, random donor platelet component?
<5.0 x 10^6
Why is the correct maintenance of the pH important for the storage of platelets?
Viability
What is the probability of syphilis transmission via blood products?
The syphilis microbe will not be viable after 3 days. Most likely transmission would be from platelets but has not been documented. Testing appears to continue as a general screen for at-risk sexual activity
What is the international coding system used for component labeling?
International Society for Blood Transfusion (ISBT)
Code 128
Why may we test a donor’s ALT?
Elevated liver enzymes to screen for Hepatitis
How many units of FVIII should be in each bag of cyro?
80-150 IU (minimum of 80 IU per plasma collection)
What is Rh immune globulin?
Rh immune globulin is anti-D prepared from humans. It is given to an Rh-neg unsensitized mother of an Rh pos baby within 72 hours post-partum or about 28 weeks antenatal. Mini doses are given antenata
Is there a risk of disease transmission with this product?
Low risk of HIV, Hepatitis A & B, and Hepatitis C antibodies have been identified
How long do RBC’s survive normally?
120 days
What percentage of RBCs in a unit of blood should be viable in the patient 24 hours after transfusion?
75% of donor blood should be viable in patient after 24 hours
What is HBIG and when is it used?
Hepatitis B immunoglobulin. It is used when there is exposure to hepatitis B with no immunity
How can RBCs be rejuvenated after expiration date and for how long?
Within 3 days after expiration, add PIPA - shelf life then becomes 24 hours
Why are units irradiated?
To make T cells nonviable to eliminate GVHD caused by transfused WBCs
What is the range of radiated in Gy’s for inactivation of WBC’s in prevention of GVHD?
25-35 gy’s
How long are records maintained for both the donor and recipient?
10 years
Describe what bacterial contamination may look like in a packed unit of cells
Purplish, white flecks throughout when mixed
What is the expiration time and storage temp for PPF and NSA?
5 years at 2-10 degrees C
How long can fresh frozen plasma be thawed before the labile coagulation factors are nonviable?
24 hours
How many mL of plasma is in a unit of fresh frozen plasma?
150-250 mL
What is the difference between FFP and single donor plasma (SDP)?
FFP still has labile coagulation factors that are viable (< 1 yr) and SDP does not (1-5 yrs)
What are the labile coagulation factors that are non-viable in single donor plasma?
Factors V and VIII
How fast should RBCs be infused?
Within 4 hours
When should blood be warmed?
Rapid or exchange transfusion
Patients with PCH or cold agglutinins reactive at 37 degree C
What is a transfusion reaction?
Adverse response to a transfusion
Advantages of autologous transfusion
Reduced risk of transfusion reaction
Reduced risk of transmission of infectious disease
What diseases are routinely tested by molecular methods on donor units?
West Nile, HIV, HBV, St. Louis Encephalitis, Zika
Purpose of solutions infused
Only 0.9% saline or 5% albumin should be used to dilute blood components
Purpose of warmers
Blood warmer with automatic temp control set for 37 degree C with an alarm if temp is exceeded
Speed of transfusion
Within 4 hours
How long must blood samples be kept for both the donor unit and recipient past transfusion?
At least 7 days
Symptoms of mild donor reactions
Pallor, sweating, hyperventilation, decreased blood pressure, nausea.
Treatment: stop donation, loosen tight clothing and elevate feet. Apply cold towel to forehead, neck
Symptoms of moderate donor reactions
Periods of unconsciousness, decreased pulse, decreased blood pressure, hyperventilation.
Treatment: check blood pressure, pulse and temp until normal again. Administer O2
Symptoms of sever donor reactions
Convolutions or seizure, hyperventilation, tetany
Treatment: summon help immediately, ensure adequate airway, give 95% O2
What is intraoperative blood salvage?
Blood is collected by drainage tubes at surgical site. Used most frequently in cardiopulmonary bypass surgery and total knee replacements
How long before intraoperative blood salvage must be re-infused or discarded?
Must be used within 6 hours
What is preoperative hemodilution?
Usually used in cardiopulmonary bypass surgery where 1-3 units of blood are removed from the patient before surgery and re-infused back post surgery. The blood can be store at 1-6 degrees C for 24 hours or at room temp for four hours
What are the coagulation factors in cryoprecipitate?
FVIII
VWF
FXIII
Fibrinogen
When preparing cryoprecipitate, how long do you have before the plasma needs to be frozen?
8 hours
When preparing cryoprecipitate for freezing, what is the maximum amount of time allowed between the initiation of the freeing to being frozen solid?
1 hour
If cryoprecipitate is being pooled, how many hours is the maximum allowed between pooling and transfusion?
4 hours