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BII > L18: Blood and blood products > Flashcards

L18: Blood and blood products Flashcards

1
Q

Definitions: blood product, blood component, blood derivative

A

Blood product = any product derived from blood
Blood component = blood product manufactured in local blood centre, derived from single donation or small pool (4-6) including RBCs, platelets, FFP
Blood derivative = blood product manufactured from large pool of plasma donations (1000s) using industrial-type system

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2
Q

Priorities for National Blood Service

A
  • Minimise risk of recipients of blood products
  • Responsiveness to emergencies or potential infection risks
  • Protection of gift status of blood
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3
Q

Maintaining safe blood supply

A
  1. Use of voluntary non-remunerated donors
  2. Exclusion of people whose behaviour/lifestyle puts them at increased risk of blood borne infection
  3. Testing of all blood donations for evidence of major blood borne viruses
  4. Use of physical and chemical methods to destroy pathogens that may be present
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4
Q

Voluntary non-remunerated donation

A

i. e. no incentive
- Paid donation associated with blood born virus transmission (influences honesty)
- Exploitation of poor/disadvantaged
- In 1974 World Health Assembly resolution encouraged national blood services to be voluntary non-remunerated donor based

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5
Q

National self-sufficiency

A
  • Country taking active steps to meet requirements for blood and blood products from its own resources
  • Concerns around liability and infection transmission
  • NZ is self-sufficient in blood components and largely self-sufficient for main types of plasma
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6
Q

Precautionary principle

A
  • Safety implies absence of risk and risk is inherent with use of blood or blood products so cannot say their use is perfectly safe
  • Preventative action should be taken when evidence of potential disease causing agent being blood borne even if no evidence that recipients affected
  • If harm can occur, assume it will occur
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7
Q

Selection of donors

A
  • Age 16-70
  • Good general health
  • Able to donate every 12 weeks
  • Selection process involves: health questionnaire, interview with RN, Hb check

Aims to protect:

  • Recipient (medical/lifestyle factors that might increase risk to recipient)
  • Donor (health problems that might increase risk of complications from donation)
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8
Q

Exclusion of homosexual men

A
  • Excluded of men who have had sex with other men (for 12 months after last episode of oral or anal sex)
  • Testing of blood is imperfect
  • Window period between virus load and production of antibodies (detectable in blood) = possibility of transmission
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9
Q

UK donor exclusion

A

People who lived in the UK for at least 6 months between 1980-1996

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10
Q

Testing of donated blood

A
  • ABO, Rh(D) type and antibody screen
  • Hep B surface antigen and nucleic acid test for HPV DNA
  • Hep C antibody and nucleic acid test for HCV RNA
  • HIV 1/2 antibody and nucleic acid test for HIV-1 RNA
  • HTLC antibody (1st time donors)
  • Serological test for syphilis
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11
Q

Informed consent for transfusion

A

Health and disability code requires:

  • Patients to receive information concerning their treatment
  • Specific informed consent must be provided before treatment commences
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12
Q

Prescribing checklist

A
  1. What improvements in patients condition am I trying to achieve?
  2. Can blood loss be minimised to reduce need for transfusion?
  3. Any other treatments before transfusion?
  4. What is specific clinical or lab indication for transfusion for patient?
  5. Do benefits outweigh risks for patient?
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13
Q

Blood components

A
  • Manufactured from single donation or small pool for direct transfusion to patient
  • Leucodepletion (removal of WBCs by filtration)
  • Selection of blood components requires: blood group of patient to be known, may involve specific compatibility testing

Blood processing starts with unit of whole blood –> resuspended red cell + platelet concentrate + FPP

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14
Q

Specific blood components

A

Red cell: stored at 2-6C, 35 day shelf life
–> given to improve O2 delivery to tissues in anaemia or blood loss

Platelet concentrates: 20-24C, 7 days
–> management or prevention of bleeding in patients with low platelet count

FFP: minus 25C, 2 years (5 days once thawed)
–> correction of abnormal coagulation in bleeding patients

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15
Q

Red cell transfusion

A
  • Patient Hb should not be sole deciding factor
  • Aim to increase tissue oxygenation
  • Need to consider: signs/symptoms of hypoxia, ongoing blood loss, risk of anaemia to patient, risk of transfusion
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16
Q

Red cell transfusion - specific factors to consider

A
  • Patients cardiopulmonary reserve: if not normal may need to transfuse at higher threshold
  • Volume of blood loss
  • Oxygen consumption (affected by fever, anaesthesia, shivering): if increased, need for transfusion could be higher
  • Atherosclerotic disease
17
Q

Red cell transfusion - Hb levels

A

< 70g/L: lower thresholds may be acceptable in patients without symptoms
70-100g/L: likely appropriate with major blood loss or signs of hypoxia
>100g/L: not likely appropriate unless specific indications

18
Q

Platelet concentrates

A
  • Provided as adult therapeutic dose
  • Specific component manufactured for neonatal use
  • Only manufactured from group O and group A donors
19
Q

Prophylactic use of platelet concentrates

A
  • Bone marrow failure (when <10x10^9g/L or <20 when fever/other risk factors)
  • Surgery/invasive procedure (<50 for normal surgery, <100 for high risk)
  • Platelet function disorder (platelet count unlikely to be helpful
20
Q

Patient bleeding use of platelet concentrates

A
  • Bleeding (when platelet count below trigger level and sig bleeding)
  • Massive haemorrhage
21
Q

Fresh frozen plasma

A
  • From single donation, frozen within 6hrs of collection (to -25C)
  • Volume ~200mL
  • Initial dosage 12-15ml/kg
  • All FFP from male donors (female increased risk of HLA antibodies e.g. pregnancy)
  • Evidence indicates significant overuse
22
Q

Blood groups and FFP

A
  • Select FFP to avoid passive antibody leading to haemolysis of recipient red cells
  • Different to selection of red cells
  • NZBS no longer provide group O FFP

O recipient: O, AB, A, B
A recipient: A, AB
B recipient: B, AB
AB recipient: AB

23
Q

Indications for FPP

A
  • Treatment of multiple coagulation deficiencies associated with acute DIC
  • In bleeding patients with abnormal coagulation parameters
  • Immediate reversal of warfarin effect in potentially life-threatening bleed (prothrombinex now preferred)
24
Q

Plasma derivatives used in NZ

A 
IV immunoglobulin = Intragam P
Subcutaneous immunoglobulin = Evogram
Human albumen solution = Albumex
Factor VIII = Biostate
Factor IX = MonoFIX, Prothrombinex

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