Donor Collection Flashcards
Once ports have been opened on a unit of blood, it must be used within?
4 hrs
system at 1 - 6 degree celcius has a shelf life of ?
24 hrs
6 anticoagulant additive solutions?
- Sodium Citrate
- Citric Acid
- Dextrose
- Adenine
- Mannitol
- Monobasic sodium phosphate
Preservative solutions are based on what?
FDA requirement that 70% of red cells (RBC) must survive 24 hours post transfusion.
Additive solutions must ensure what?
75% of RBCs survive 24 hrs post transfusion
Red Cell Products with Citrate Phosphate Dextrose (CPD or CP2D) Shelf Life ?
21 Days @ 1-6 °C
Red Cell Products with Citrate Phosphate Dextrose Adenine (CPDA-1 ) shelf life?
35 days @ 1 - 6 °C
Red Cell Products with
Additive systems: AS-1, AS-3, AS-5 shelf life ?
42 days @ 1 - 6 °C
pH blood storage lesion?
- Increase in [H+] as the RBC metabolize glucose
- pH drops over time
2,3 DPG blood storage lesion?
- ↓ in 2,3 DPG as pH decreases
- Release of O2 to tissues will decrease
Within 3-8 hours after transfusion previously stored RBC will regenerate what?
50% of normal 2,3 DPG levels
Does K+ decrease or increase in the unit as the red cells lyse over time?
Increase
Na/K+ blood storage lesion ?
Na/K pump will not function in the cold temperatures so K will not be pumped into the RBC
ATP storage lesion ?
Gradually decreases as RBC use for glycolysis
Donor Unit (BAG A) is centrifuged at a low speed (soft spin) Produces what?
packed cells and platelet rich plasma (PRP)
PRP is expressed into the first satellite bag
Bag B
The platelets are placed on a rotator or rocker bed to become ‘unpacked’
Platelets are stored at ?
- (25C) and under constant agitation
- These are good for 5 days
The platelet poor plasma (PPP) is placed in the freezer and is FRESH FROZEN PLASMA.
- Good for 1 year at (-18C)
- Once thawed for transfusion, stored at 1-6C and good for 5 days.
Bag C
- Fresh frozen plasma (FFP)
- Stored at -18C
Making CRYOPRECIPITATE
-Thaw FFP at 4C for
24 hours
-Hardspin of slushy product
Cryo AHF is stored at ?
(-18C) for 1 year
Leave the cryoprecipitate button in the original FFP bag and add what ?
10 mL of plasma
Plasma (Frozen)
outdate and storage temp?
1 year @ -18°C
Plasma (Thawed) outdate and storage temps?
5 days @ 1 - 6 °C
Platelets outdate and storage temps?
5 days @ 25 °C
Cryoprecipitate (Thawed) outdate and storage temps?
6 hours @ 25 °C
Cryoprecipitate (Frozen)
outdate and storage temps ?
1 year @ (-18 °C)
PRBC will be good for
4 hours unrefrigerated or 24 hours in proper refrigeration
Units of platelets or cryoprecipitate that have been pooled to achieve an adult dose will be good for
4 hours only.
HBsAG Test detects
the outer envelope of the virus; Detects infection; Test becomes negative a few months after illness; May become chronic carrier
Anti-HBc detects
antibody to virus; permanent deferral despite no active illness; Not made in response to HepB vaccination
Anti-HCV detects
- Detects antibody (ab) to virus
- Inflammation of the liver
- 80% develop chronic infection
- 20% develop cirrhosis and other liver diseases
- Asymptomatic individuals may be carriers
Anti- HIV 1 AND 2detects
- Test for ab to virus
- HIV-1 is more common in US
- HIV-2 more common in
Western Africa - Both viruses cause acquired immunodeficiency syndrome (AIDS)
Anti-HTLV I AND IIdetects
- Test for ab to viruses
- Uncommon in US
- HTLV-I common in Japan
and Caribbean - HTLV-II infections usually associated with I.V. drug users
- Causes leukemia or lymphoma and neurological disease
SYPHILLISdetects
- spirochete that causes syphilis - Testing began after WWII when risk of infection much higher - Spirochete is fragile and unlikely to survive the 1-6C temp of blood storage
West Nile Virus
- Incubation from 2-14 days
- 80% of those infected not
symtomatic - 20%: fever, headache, GI
complaints - Donor questionaire about
fever and headache - NAT testing (nucleic acid
amplification)
Directly detects genetic material of viruses.
Reduces “window period” during which an infecting agent is undetectable by traditional tests
Used for WNV, HIV-1 and HCV
Reduced “window period”
for HCV from 70-80 days to 10-30 days
For HIV from 45 days to 10 days
NAT
CMV detects
- Cytomegalovirus
- Rarely transmitted by blood
transfusion - According to CDC 50-85% of adults in US are infected by age 40
Red cell and platelet products can be CMV-negative by test, or can be
CMV-safe by leukoreduction.
Donor Questionaire to eliminate infections for which there is no screen
- Babesiosis
- Malaria
- Chagas Disease
Babesiosis
- Most common in US
- Bite from infected Deer tick
- Fever 1-4 weeks after
- hemolytic anemia
- renal failure
- Asymtomatic for months
while infectious - Parasite survives in blood for
35 days
Malaria
- Rare in US
- Parasite survives for week at 4C
- Donors can be asymptomatic and infectious
- Exclude donor for 1 year if travel to endemic area
- Exclude for 3 years if have had disease or lived in endemic area
Chagas’ Disease
- Protozoan parasite
- Typanosoma cruzi carried by kissing bug
- Often asymtomatic. Can get fever, enlarged liver/spleen.
- Children get myocarditis.
- Chronically infected get cardiac and GI symptoms
Creutzfeldt-Jakob Disease (CJD)
- Rare degenerative and fatal nervous system disorder
- Currently no screening test
- Blood transfusions do not
transmit the disease - FDA prohibits potential donors who have received injections of human-derived pituitary hormone, family history, or those with transplanted dura mater
SARS
- Severe Acute Respiratory Syndrome
- Most cases identified in Asia
- No evidence this infection is transmitted from blood donors to transfusion recipients
- Deferral through questionaire
Pretransfusion testing?
- ABO typing
- Rh Typing
- Antibody Screens / Compatibility testing
Type A has what antingen(s) and antibodies present in the RBC’s?
A antigen / Anti-B Antibodies
Type B has what antingen(s) and antibodies present in the RBC’s?
B antigen / Anti-A Antibodies
Type O has what antingen(s)and antibodies present in the RBC’s ?
Neither A nor B / BOTH Anti-A & Anti-B Antibodies
Type AB has what antingen(s) present in the RBC’s?
A antigen & B antigen / NEITHER A or B Antibodies
Rh positive individuals have the
D antigen on their RBC
Rh negative individuals do not have
D antigen on their RBC
Screening for unusual antibodies that may be present
- Incubate pt serum with RBC
- Look for hemolysis or agglutination
- Add anti-IgG to look for those antibodies (ab) that do not cause DIRECT agglutination
Positive (agglutination or hemolysis) indicates
an existing ab to red cell antigens which may cause transfusion reaction
Lack of agglutination or hemolysis indicates what ?
No Antibodies
When screening for unusual antibodies, what is a big concern?
- weak antibodies may not be detected.
Crossmatched
- ) Choose ABO and Rh compatible donor units
- ) Test pt serum against donor cells and look for agglutination or hemolysis
- ) incubate this test at 37C (like ab screen) and add anti-IgG to detect ab that do not agglutinate directly.
During a crossmatch, agglutination or hemolysis indicates what ?
incompatible donor unit for that patient
During a crossmatch, NO agglutination or hemolysis indicates what ?
compatible unit
A positive antibody screen indicates the need for further testing to determine what?
the specificity of the patient’s antibody
Once Antibody is identified…Test donor units for those that
LACK the antigen to the ab present in your patient
Ease of finding antigen compatible units depends on what ?
The frequency of the antigen in the donor units
Kell antigen frequency in the population ?
10%
Lub Antigen frequency in the population ?
99.8 %
c, E, Fy^a Antigen frequency in the population ?
80%, 30%, and 66% resp.
- About 5 units out of 100 will be compatible for an individual with this combination of antibodies
Non-specific cold agglutinins can have life threatening consequences in the OR when the patient’s body temperature is
lowered
