TM / path

Question 1

PRBC: preparation, storage temp, storage duration

Answer 1

centrifuge whole blood and filter (leukoreduction, remove plt)

2-6C storage

35 d

Question 2

plt: preparation, storage temp, storage duration

Answer 2

apheresis
pooled: 4 donors; whole blood buffy coat + filter leukoreduction

20-24C (room temp) w constant gentle agitation

5-7d

Question 3

FFP : preparation, storage temp, storage duration

Answer 3

apheresis
whole blood centrifugation
- FFP means frozen <8h from collection

< -18C, 2-6C once thawed

1y
5d thawed
28d never frozen

Question 4

Cryo: preparation, storage temp, storage duration

Answer 4

insoluble precipitate on centrifugation of FFP

< -18C

1y

Question 5

plasma derived product preparation

Answer 5

pooled samples from cold ethanol fractionation

Question 6

Cryo includes:

Answer 6

Fibrinogen, VIII, XIII, VWF

Question 7

examples of plasma derived products

Answer 7

IVIG
albumin
PCC
rhogam
coagulation factors

Question 8

IVIG indications

Answer 8

ITP, NAIT, HDNF
primary immunodeficiency
secondary immunodeficiency (hypogamm, post ritux, post BMT)
Kawasaki
HIV
neuro: GBS, chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, myasthenia gravis

Question 9

IVIG S/E

Answer 9

common: rash, h/a, flushing, arthralgia, mild temp increase, tachypnea/tachycardia
severe: hypotension, fever/chill/rigor, bronchospasm, allergy/anaphylaxis, rare aseptic meningitis

Post: neutropenia, hemolytic anemia (10%), h/a, fluid overload, thrombus (1%)

Question 10

Dose and expected rise with PRBC, plt, FFP, cryo

Answer 10

PRBC: 15 cc/kg - 20 point rise
plt: 10 cc/kg - 30-50 point rise
FFP: 10-20 cc/kg - increase of 30-50%
cryo: 1 U/10kg to max 10 U - fibrinogen increase by 0.5 g/L

Question 11

FFP indications

Answer 11

TTP
INR >1.8, PTT > 1.5x ULN
MTP
PLEX replacement fluid

factor deficiency replacement (no specific product available)
warfarin reversal (if PCC unavailable)

Question 12

Cryo indications

Answer 12

Riastap preferred!

APL
DIC
MTP
hypofibrinogenemia

Question 13

leukoreduction benefits

Answer 13

reduced TA-GVHD
reduced FNHTR
reduced HLA alloimmunization
reduced CMV

Question 14

PRBC irradiation pro/con, indications

Answer 14

Pro: reduces TA-GVHD risk (by removing T cells)
Con: shortens shelf life, may increase K

IUT
immunocompromised
directed donation
post BMT/some chemo, malignancy (HL)
neonates <1yo

Question 15

when/how to cryopreserve PRBC

Answer 15

rare blood donor program
< -65C in glycerol
lasts 10y

Question 15

which viruses not destroyed by viral inactivation

Answer 15

parvovirus
hepatitis A

Question 16

development of RBC Ag/Ab

Answer 16

Glycotransferases add A or B Ag to H Ag (fucose) base chain
lack of H = Bombay

anti-A and -B Ab are formed early in life from exposure to similar appearing Ag

Question 17

Bombay phenotype is

Answer 17

lack of H (fucose) base chain

Question 18

Describe forward vs reverse typing

Answer 18

forward: pt RBC + anti_ reagant (testing for pt Ag)
reverse: pt plasma + test RBCs (testing for pt Ab)

Question 18

blood group incidence (including Rh)

Answer 18

O 45%
A 40%
B 10%
AB 5%

Rh+ 85%

Question 19

forward/reverse typing inconsistency reasons

Answer 19

lab error
immunosuppression
young infants
ABO-mismatch HSCT
chimerism

extra reverse typing: recent non-matched transfusion, autoAb, Rouleaux
missing reverse: infant, immunosuppression

Question 20

standard vs extended vs full phenotype matching

Answer 20

Standard: Rh (DCE), K
Extended: Rh, K, Jka, Jkb, Fya, Fyb
Full: Ss

Question 21

Most immunogenic RBC Ag

Answer 21

D (50%) > K (5%) > c > E > k > e …

Question 22

risk with directed donations

Answer 22

increased:
- TA-TMA
- infection
- cost/waste

Question 23

plt refractoriness assessment

Answer 23

CCI = [ (plt increment/u] x BSA ] / #plt transfused x10^11
(use 3x10^11 for standard transfusion)

refractory is CCI <5000 x2

Question 24

Transfusion infectious risks

Answer 24

HIV 1/ 21.4 M
HCV 1/ 12.6 M
HBV 1/ 7.5 M
HTLV 1/ 7.6 M

plt bacteria 1:10k - death 1:200k

Question 25

Common transfusion risks

Answer 25

mild allergic 1/100
FNHTR 1/200
TACO 1/700
TRALI 1/5000
DHTR 1/7000
anaphylaxis 1/40k
death 1/1M

Question 26

transfusion fever DDx

Answer 26

FNHTR
hemolysis
sepsis
TRALI
non-transfusion related

Question 27

Transfusion reaction mgt

Answer 27

stop transfusion
vitals
symptom mgt
check product
report
investigations
return blood to lab

Question 28

transfusion major vs minor ABO incompatability

Answer 28

major: recipient anti-donor
minor: donor anti-recipient

Question 29

when can you do electronic over serologic crossmatch

Answer 29

if 2 previous ABO, no Ab hx, negative Ab screen

Question 30

review Ab screening (:

Answer 30

(‘:
(See TM/HP Answers document @ bottom)

Question 31

Fridge-thriving bacteria (PRBC)

Answer 31

yersinia
listeria
serratia
CONS

Question 32

TRIPICU study results

Answer 32

PRBC threshold of 70 vs 95 had 50% decrease in transfusions, no clinic differences

Question 33

plasmapheresis indications

Answer 33

TTP
neuro: myasthenia gravis, GBS, transverse myelitis
autoimmune: ANCA vasculitis, FSGS
CAPS
Ab mediated solid organ transplant rejection

Question 34

Extracorporeal photopheresis method and indications

Answer 34

apheresis with UV light crosslinks DNA to prevent T cell proliferation

GVHD steroid refractory
cellular solid organ transplant rejection
cutaneous T cell leuk/loma

Question 35

Small round blue cell tumors

Answer 35

LEARN NMR

lymphoma
Ewing
ALL
RMS
NBl
neuroepithelioma
Medullo
Retinoblastoma