Test 6: Donor Selection and Testing Flashcards by Sarah King

the process of separating blood into its different components: Platelets, red blood cells (RBCs) and plasma.

apheresis

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Whole blood is collected in a ratio of _____ mL anticoagulant per _____ mL whole blood.

14, 100

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Collection ratios:

-450 mL whole blood with ____ mL anticoagulant-preservative
-500 mL whole blood with ___ mL anticoagulant-preservative

63, 70

*remember basic info, but do not need to calculate for exam.

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Packed RBCs:

-AS (additive solution) = Hematocrit of _____ %

No AS = Hematocrit of ____ %

55-65

65-80

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Based on a 70 kg adult, one unit of packed RBCs will raise Hgb by how much?

1 gram (3% Hct)

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What anticoagulant-preservative can be used for babies?

Citrate-phosphate-dextrose-adenine (CPDA-1)

-longer shelf life of 35 days (all others are 21 days)

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What is the only Red blood cells additive solution that can be used for babies? Why?

AS-3 ((Nutricel)

-only one that does not contain mannitol (it harms babies brains)

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What are the substances that help support red cell membrane?

SAGM

-saline
-adenine
-glucose
-mannitol

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Why are additives used for Red blood cells?

they double the shelf life, good for 42 days

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Plasma:

FFP must be frozen within ____ hours.

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Plasma:

FFP can be frozen for up to _______.
Once thawed, ______ expiration.

1 year

24 hour

*same for PF24

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FFP has maximum levels of…

both stable and labile clotting factors, about 1 international unit (IU) per milliliter

-factors 5 and 8

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PF24 must be frozen within 24 hours. What is the disadvantage?

Slightly reduced levels of F VIII, then FFP

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PF24RT24 – kept at room temp up to 24 hours, then frozen
 Frozen for up to 1 year
 Once thawed, _____ exp

5 day

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LP (liquid plasma) – plasma from whole blood maintained at ____ C, ___ day exp

1-6

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Thawed Plasma (TP) – Passed 24 hour thaw expiration, stored
for an additional ___ days (___ days total)

4, 5

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What is the disadvantage of Thawed Plasma (TP)?

Can not maintain therapeutic levels of labile factors V and VIII

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What is liquid plasma used for?

trauma cases, don’t need to wait to give to the patient.

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LP (liquid plasma) can become what after expiration so it can still be used?

Thawed plasma (5 day exp)

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What are the two different platelet product types?

-From whole blood = “Random Donor” = RDP (from 5-6 people to = one apheresis donor)

-Apheresis = “single Donor” = SDP (less risk of a reaction)

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Around 6 RDP = 1 SDP to raise platelet count by ___________

30—60,000

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Cryoprecipitated
Antihemophilic Factor aka…

Cryoprecipitated AHF, or Cryo

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Cryo concentration of….

-factor VIII (AHF)
-fibrinogen
-factor XIII
-vWF (along
with ADAMTS13)
-cryoglobulin
-fibronectin

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Preparation cryo : FFP thawed at 1-6oC, centrifuged cold hard spin, supernatant expressed, cryo refrozen within 1 hr

-Supernatant = _________
-Button = Cryoprecipitate

Cryo-poor plasma (CPP) —-> Plasma Cryoprecipitate
Reduced

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1 unit Plasma yields 1 unit cryo (adult dose = 10 units cryo)  ____ mg fibrinogen  ____ units of AHF

150 80

Cryo: -Pre-storage pool – once thawed, expire in ____hours at 20-24 C -Post-storage pool – thawed then pooled, expire in ___ hours at 20-24 C

6 4

Leukoreduction: Less than ________ WBC per whole blood, red blood cells, apheresis platelets Less than _______ WBC per whole blood derived platelets

5.0 x 10^6 8.3 x 10^5 ***must know these numbers!

Leukoreduction: less than ____% recovery

85 The amount of blood that remains after reduction

Leukoreduction: prestorage should be within ___ hours.

Leukoreduction: Do all units have WBC counts performed?

_______ and ________ must go in the fridge after thawing.

red cells and plasma

True or false? Apheresis blood and blood components do not need to be run through a LR filter.

true

Leukocyte Reduction: -At patient bedside by inexperienced personnel  Filter must be perfectly _________  Blood cannot be forced through (no pumps)  Cannot flush filter

vertical

Leukocyte Reduction: What are the types of additional manufacturing?

-Irradiation (cesium, cobalt, x-ray) -Washing (allergic reactions, removal of antibody or other substances) -Aliquots (can do in a closed system) -pooling (cyro, plasma, platelets) -Reconstituted Whole Blood -Frozen, Deglycerolized RBCs

What are the types of Frozen, Deglycerolized RBCs?

- High Glycerol - Low Glycerol - QC – 80% recovery and less than 1% residual glycerol

What is the goal of leukoreduction? effect on exp?

less than 5 million WBC per unit none

What is the goal of washing? affect on exp?

-IgA Deficiency -Severe Anaphylactic Rxn -Rejuvenation -Removal of Glycerol 24 hours (open system)

What is the goal of Irradiation? Effect on exp?

Inactivate residual donor lymphocytes = prevent GVHD 28 days post irradiation, or original expiration, whichever is sooner

What is the affect on exp with freezing?

good for 10 years from collection

What is the blood components travelling temp?

1-10 degrees up to 24 hours at this temp

The Food and Drug Administration (FDA) establishes donor criteria through the Code of....

Federal regulations -Guidelines are written in the Standards for Blood Banks and Transfusion Services (AABB)

_________ developed the donor history questionnaire * Questionnaire meets FDA requirements

AABB

permanent deferral? history of viral hepatitis after 11th birthday?

yes

permanent deferral? positive for hep B surface antigen

yes

permanent deferral? -reactive to antibodies to hep B core on more than one occasion

yes

permanent deferral? past or present infection of hep C, Human T-cell lymphotropic virus, or HIV

yes

permanent deferral? History of babesiosis or Chagas disease

yes

permanent deferral? Family history of CJD

yes

permanent deferral? Recipient of dura mater or human pituitary growth hormone

yes

permanent deferral? Risk of vCJD

yes

permanent deferral? Use of a needle to administer nonprescription drugs

yes

How many months must someone wait to donate if they get a tattoo, piecing, or pregnant.

3 months

Deferral for hep B vaccine?

NO!!!!****

What does the donor physical examination include?

-General appearance * Weight * Temperature * Pulse * Blood pressure * Hemoglobin * Skin lesions

What must hemoglobin be for donors?*

≥12.5 g/dL (125 g/L) Females 13.0 g/dL (130 g/L) Males

What must Hematocrit be for donors?*

≥38% Females ≥39% Males

What must blood pressure be for donors?*

Systolic 90–180 mm Diastolic: 50–100 mm

What must temp be for donors?*

≤37.5° C (99.5° F)

What must the pulse be for donors?*

50–100 beats/minute

What is the min weight for donors?*

Minimum 110 lb (50 kg

What is the age requirement for donors?*

Conform to applicable state law or >16 years

What needle is used on donors?

16-gauge needle

Most autologous blood is used to treat...

surgical blood loss in very specific situations where there is a reasonable opportunity to avoid homologous transfusions and/or when compatible allogeneic blood is not available.

How long is autologous blood kept for?

*must be kept till it expires!

Disadvantages of autologous donation/transfusion beyond the usual risks...

-Bacterial contamination * Circulatory overload * Cytokine mediated reactions and product/recipient misidentification

What are the 3 types of autologous donations?

-preoperative -normovolemic -blood recovery

Types of Autologous Donations: Blood is drawn and stored before the anticipated date * Certain criteria must be met

preoperative

Types of Autologous Donations: Removing units at the beginning of surgery and reinfusing them at the end of surgery

normovolemic -blood volume stays the same (replaced with saline)

Types of Autologous Donations: A medical device is used to wash, filter, and concentrate blood during an operation

blood recovery aka blood salvage

Preoperative Donation Criteria: can donate up to ____ hours prior to surgery.

How is the Preoperative Donation Criteria different?

-High-risk questions do not apply * No age restriction * If weight is less than 110 pounds, the volume is adjusted * Hemoglobin is 11 g/dL or higher * Hematocrit is 33% or higher

With directed donations, the 56-day interval may be waived with...

a medical director’s approval

Components are separated, and the remaining blood is returned to the donor

Apheresis

Platelet count must be at least _______ for plateletpheresis.

150,000/μL

Plateletpheresis: Donations are made at least ____ hours apart, no more than ___________ (or 24 times a year)

48 twice a week

How often can Plasmapheresis be done?

Infrequent: No more than once every 4 weeks Frequent: Immunoglobulin G and M (IgG and IgM) levels are monitored every 4 months if donations are more than once every 4 weeks

How often can Red cell apheresis be done?

Two units of RBCs may be donated if weight and height requirements are met Deferral is 16 weeks following double RBC donation

What are the requirements for donor records?

Donor records must be retained by the blood collection facility as mandated by the FDA and AABB. * There must be a system to ensure that confidentiality of the donor is not compromised, and that donor records are not altered.

What is the likelihood of a transfusiontransmitted disease (TTD)?

very small, Blood components undergo rigorous testing that makes them extremely safe However, bacterial, viral, parasitic, and prion pathogens constantly evolve, and if not detected in the testing process, can cause harm and even death

Donor tests can be divided into what 2 categories?

-Immunohematologic testing (ABO and D testing and antibody screen) -Infectious disease screening

What are the required hepatitis tests? ***

HBsAg HBV DNA (NAT) Anti-HBc Anti-HCV HCV NAT

What are disease tests that must be done on donor blood besides hepatitis tests?

HIV-1/2* HTLV-I/II* Syphilis* WNV T. cruzi (Chagas disease)

What immunohematlogic tests are done one donor blood?

-ABO (forward and reverse) -D -Weak D on all negative donors -antibody screen

If significant antibodies are present in donor blood, what cannot be used?

plasma and platelets -RBCs can be used, but the antibody interpretation should be on the label

Required serologic testing is performed on all donor units, that include...

-Hepatitis B surface antigen (HBsAg) * Antibody to Hepatitis B core antigen (antiHBc) * Antibody to Hepatitis C virus (anti-HCV) * Antibodies to HIV (anti-HIV 1/2) * Antibodies to HTLV (anti-HTLV-I/II * Syphilis * HCV RNA * WNV RNA * HIV-1 RNA

Confirmatory tests are used to detect false-positives. Tests vary be the disease but could include....

* Polymerase Chain Reaction (PCR) * Western Blot (WB) * Radioimmunoprecipitin Assay (RIPA) * Recombinant Immunoblot Assay (RIBA)

Syphilis is caused by...

Treponema pallidum

Syphilis testing: Screening test that detects reagin in serum

Rapid plasma reagin (RPR)

Syphilis testing: Fixed chicken RBCs sensitized with the organism react with patient antibodies to T. pallidum

Hemagglutination for T. pallidum

What is the confirmatory testing for Syphilis?

-Tests for specific antibody if the RPR or hemagglutination test is positive * Fluorescent treponemal antibody adsorption

-This testing technique can detect very low numbers of viral copies in plasma before antibodies appear -amplifies nucleic acids of infectious agents and identifies viral RNA

Nucleic Acid Testing (NAT)

RNA and DNA viruses routinely tested using NAT:

-HIV * HCV * West Nile virus (WNV) * HBV

What are the advantages of chemiluminescence?

Stable Less reagent is needed Relatively nontoxic Quick reagents Very sensitive Fast turnaround time

Ability of assay to identify samples from infected individuals as positive

Sensitivity

Ability of assay to identify samples from noninfected individuals as negative

Specificity

Hepatitis ___ and Hepatitis ___ are tested for on donors.

B, C

Hepatitis testing: indicates that the individual is infectious***

Hepatitis B surface antigen (HBsAg

Antibody appears after HBsAG but before symptoms***

Antibody to hepatitis B core antibody (anti-HBc)

_______ antibody is detectable 10 weeks after infection*

Anti-HCV

NAT to detect _____of HCV NAT to detect ____ of HBV*

RNA DNA

A retrovirus contains ________________, which allows the virus to convert RNA to DNA and then integrate the DNA into the cell.

reverse transcriptase

What are two Human Retroviruses subfamilies?

− Lentivirus (HIV types 1 and 2) − Oncornavirus (human T-cell lymphotropic virus [HTLV] types I, II, and V)

Donor testing for HIV types 1 and 2 require what donor testing?

-Antibody to HIV 1 and 2 develops 22 to 25 days after infection -HIV-1 NAT

HIV infects what type of cells?

Infects CD4+ T lymphocytes (helper T cells)

HIV types 1 and 2 cause...

acquired immunodeficiency syndrome (AIDS)

HTLV-I is associated with?

adult T-cell leukemia

HTLV-II is associated with...

large granular lymphocyte leukemia

True or false? It is a requirement that all donor blood be tested for antibody to HTLV types I and II

true

-Mosquito-borne flavivirus -Clinical manifestations range from mild fever to encephalitis, coma, and death -Individual donors are screened for West Nile virus using NAT

West Nile Virus

True or false? Leukoreduction does not get rid of CMV

false, it does (the reason it dose not need to be tested for)

What products must be tested for bacterial contamination?

Apheresis platelets and platelet concentrates

Additional tests: -Mononucleosis-like virus that is found in white blood cells * negative blood is given to infants or anyone who is immunocompromised

Cytomegalovirus

Additional tests: * Caused by Trypanosoma cruzi; transmitted by reduviid bug * Blood collection facilities in areas with many Latino immigrants perform an EIA test * In 2010, the FDA recommended one-time donor screening

Chagas disease

__________ have been the most frequent source of septic transfusion reactions.

platelets

What organisms may be transfusion -transmitted but are not routinely tested for?

Hepatitis A, E, D, G CMV EBV Human B19 Parvovirus Human Herpesvirus 6 and 8 Babesia microti Trypanosoma cruzi Malaria (Plasmodium species) Creutzfeldt-Jakob Disease (CJD)

The lipid-enveloped viruses, HIV, HBV, HCV, HTLV, EBV, CMV, HHV-6, and HHV-8, are all inactivated by use of...

organic solvents and detergents

Why is the risk of enveloped virus transmission very low?

-the combination of treatments such as heat treatment, solvent/detergent treatment, and nanofiltration. -This process is not effective with nonlipid-enveloped viruses such as HAV and parvovirus B-19.

* A __________ investigation involves actions taken when donor test results are positive for the hepatitis virus, HIV, HTLV, or WNV

look-back

What actions are taken during a look-back investigation?

-Quarantine prior to donations from the donor − Notify facilities that received products − Donor is further tested − Destroy (or relabel) prior collections − Notify transfusion recipients

If it is noted that a patient developed HBV, HCV, HIV, or HTLV after receiving a single unit from one donor, that donor is...

permanently deferred.

True or false? Autologous donations positive for HBV, HCV, HIV, HTLV, or syphilis can be used

true, they already have the disease so there is no additional harm

Any fatalities due to a TTD must be reported to the director of the Center for Biologics Evaluation and Research within ___ working day, followed by a written report within 7 days.