Red Cell Components Flashcards
How are Red blood cell products packed
what are the two systems they are filtered by
What is the anticoagulant
-Ordered as packed cells or PRBC
-Whole blood filtration or buffy coat production
-RBC are LR and then the additive is added
-Anticoagulant if citrate, phosphate dextrose with additive SAGM (Saline, adenine, glucose, and mannitol)
-480 ml of WB in 70 ml CPD
-unit raises HGB by 10 g/L in non bleeding patient
What is a closed system
When contents of WB are moved between bags without air exposure
-42 days shelf life at 1-6 C if it stays in original bag
-287 ml
What is breaching a bag and what happens to the shelf life once you do
- attaching a 2ndary bag to the original via a spike
-can be done to remove an aliquot
-once breached
there is increased risk of bacterial contamination
the expiry date needs to be adjusted
use within 24 hours if storage at 1-6 or in 4 if storage above 6
-if transfusing blood through an infuser needs to be done in 4 hours
Where would you spike the bag
aseptically in a fume hood
use alcohol wipes to clean everything
What is each bag of Red Cell Products tested with
-ABO group, Rh type, and unexpected Antibodies.
before transfusion tested for:
1) Antibodies to HIV-1 and HIV-2, HCV, HTLV and HBcore
2) HBsAg
3) Viral RNA HIV-1 and HCV
4) DNA HBV
5) Syphilis (Treponema pallidum)
6) WNV and Chagas are performed on at-risk donors
7) CMV results will be indicated on the label if tested
west Nile and chygas disease on only high risk donors
how are RBCs stored
in fridge 1-6C
-expiry date is dependent on the anticoagulant and additive used
-WB and RBC processed in closed sterile system
-shelf life 42 days
-changes will change the expiry date (neonatal irradiated unti)
After a packed cell is issued and NOT used, it can be
returned within 60 mins; after 60 mins, it is discarded.
* IF issued in a cooler, the unit can be returned within 3 hours.
-CBS processes blood in closed system - no contamination with air
What is hypovalemia
- volume depletion -loss of salt and water
-if you dont have significant RedCell deficit then manage with colloid solutions such as albumin,10% Pentastarch, and crystalloid solutions.
Why is RBC LR SAGM PC not suitable for clinical areas with limited O2 carrying capacity
before transfusing a patient what should be done first
oxygen carrying capacity of blood is increased by increasing the mass of circulating RBC
-transfusion alternatives should be considered before transfusing
-treat Anemias with NON blood derived therapies like Iron, b12, folic acid and recombinant EPO
What do you have to be careful with when treating pts with Chronic anemia
risk of iron overload , pts may need chelation therapy
what does choosing wisely say about not transfusing
do not transfuse if pt is asymptomatic
if pt is not bleeding with HGB of 70 g/L
-decision to transfuse cannot be based on hgb value alone
Warnings about transfusion
RBC need to be ABO complatible
-pretransfusion testing is required unless its an emergency request
-RH neg pts need to get RH neg blood
-DEHP plastic leaches into RBC
-for babies use the freshest sample
-fetus needs irradiated CMV neg blood
-less than 7-10 days old for larger transfusions for neonates
-alloimmunization can be a consequences
-TACO- too much all at once
-transmission of infectious disease
Adverse events
-severe to minor
-report to Transfusion bbk department and CBS
-RN monitor at initial or intervals
dose and Administration
-each unit should raised HGB in non bleeding adult 10 g/L
-ped dosing 10-15 ml per Kg
-hgb/hct must be at a certain amount based on pt condition
-rate of transfusion dependent on pt condition and what is being transfused
-if the pt is risk of circulatory overload then the transfusion must be done slowly
-blood administration set approved by health canada
-blood warm can be used at discretion of physician
-can give 0.9 NaCl injection, ABO compatible plasma or 5% albumin as per DR
-all transfusion need to be done in 4 hours
-pts observed in first 15 mins and intervals
What is the purpose or indication of modifications
deglycerolized red cells
-frozen in glycerol
-can be stored for 10 years
-new expiry date storage temp, storage, or suspension like saline
-used for transfusion pts who need specific phenotypes
-for ppl who need regular transfusions with many Abs
-like Bombay pts
What is the purpose or indication of modifications
irradiated units
-cells exposed to ionzing radiation - gamma or xray
-recipients are immunocompromised pt, HLA matched
-chemo pts with CLL, lymphoma, BM transplants
-reduces white cells
-expires 14 days post irradiation or 28 post collection which ever comes first
-reduced GVHD
-donor lymps are eliminated
Who needs irradiated units
NBs
Congential T cell immunodeficiency
Acquired deficiency
Cell transplant /BM
Gamma Rays destroy the lymphocytes’ ability to divide and used in recipients who are not capable of eliminating these cells.
Divided packs
modification of RBC packs
-original RBC unit is collected and stored in quad pack
-a blood bag with smaller attached bags
-so one bag canbe used for smaller transfusions without a port being entered
-used for neonates so there is reduced donor exposure
-done at CBS
-STERILE - so no change in expiry
cmv NEGATIVE
Modification of RBC packs
-Contracted through body fluids, blood transfusions, and transplants
-healthy people are asymp with non specific illness like mono
-virus is dormant (latent) in monocytes of WBC and can react later, but it is never cleared from the system.
-Immune response is to develop CMV IgG antibody within 6-8 weeks
-Immunocompromised can develop CMV disease
-LR blood helps to remove alot fo CMV containing cells
–best practice give CMV negative units for intrauterine transfusion because it is hard to monitor a fetus with infection and there is no utero therapy
Washed cells
Modification
-reduces residuals like AB, IgA, Additive, K, cytokines
-needs be washed in first 2 weeks of storages and has to be used in 7 days of expiry - automated washing
-label as RBC-LR washed or RBC LR extra washed for IgA def patients
-if manually washed you have to use in 24 hours because you can get an increase of bacterial contamination
-RBC washed with 1-2L of saline and resuspended with SAGM
Extra Washed cells
Modification
-for IgA deficiency because of increased risk of anaphylactic reaction with standard
RBC products
-IgA deficient individuals can produce Anti-IgA
* Platelets can be washed but can lose up to 20% of
platelets
neonate exchange transfusion
-unit needs to be less than or equal to 5 days old
-Group O, Rh negative, CMV negative, Kell negative, and antigen negative to maternal antibody
-HGB S negative
-SAGM volume reduced
What are the differences between neonatal vs ped vs adult transfusions
- no reverse typing on babies
-hgb at birth is 165 g/L and at 24 hours its 184
-at birthday the concentration of Vitamin K dependent factors and inhibitors is lower than an adult - slow increase at 6 months
Neonatal trans
-neonate is baby upto 4 months
-no reverse typing on babies because the ABO AB are of maternal origin
-given Group O Rh negative unit - IRRADIATED
-if mom has AB the PRBC needs to be phenotyped for AG before the transfusion
-transfusion is different because the volume is smaller, anemia of infancy, low EPO and unable to tolerate stress
-hard to determine HbF and HbA levels
-transfuse if blood loss if >10%, hgb <80 g/l with anemia, or hgb <120 with respiratory distress or heart disease
-tranfusion dose of 15 ml/kg raises baby hgb 20g/;
-transfuse neonates with FRESH RBC
-increase K in stored RBC
-too much blood given too quick is lethal
-fresh PRBC is given - aliquot 2 units to limit exposure
-directed donation with satellite packs
