TransfusionMedicine Flashcards
- A patient had a transfusion reaction to packed red blood cells. The medical laboratory scientist began the laboratory investigation of the transfusion reaction by assembling pre- and post-transfusion specimens and all paperwork and computer printouts.
What should he do next?
A. Perform a DAT on the post-transfusion sample
B. Check for a clerical error(s)
C. Repeat ABO and Rh typing of patient and
donor unit
D. Perform an antibody screen on the posttransfusion sample
B
Criteria for the acceptability of blood donors, performance of
pretransfusion testing, manufacture of blood components,
donor infectious disease testing, and evaluation and reporting
of adverse events associated with transfusion are all defined
by the ______
FDA
Donor Screening
■ ________ requirements for the donor
■ Mini physical examination
■ _______ testing of the donor blood
Medical history
Serologic
Types of Deferral
Prospective donor is unable to donate blood for a limited period of time.
Temporary Deferral
Types of Deferral
Prospective donor is unable to donate blood for someone else for an unspecified period of time. This donor would not be able to donate blood until the current requirement changes. These donors may be eligible to donate autologous blood
Indefinite Deferral
Types of Deferral
Prospective donor will never be eligible to donate blood for someone else. These donor may be eligible to donate autologous blood
Permanent Deferral
■ a unit collected under the same requirements as those for
allogeneic donors, except that the unit collected is directed toward a specific patient.
Directed Donation
■ collecting a specific blood component while returning the remaining whole blood components back to the patient
■ used to collect platelets, plasma, white cells (leukocytes), red cells, and stem cells.
Apheresis Donation
_______ is the process of removing normal (donor) or abnormal (patient) blood constituents from circulating blood.
Hemapheresis
______ – erythrocytapheresis, plateletapheresis, leukocytapheresis
Cytapheresis
Types of Apheresis Machine:
1. by centrifugation - based on density.
It is performed in cycles or passes
One cycle in includes withdrawing of blood through a pump, addition of anticoagulant and separation processes, which is then followed by reinfusion back into the donor
Equipment used is smaller and mobile compared to continuous flow centrifugation
Intermittent flow centrifugation (IFC)
Types of Apheresis Machine:
1. by centrifugation - based on density.
Involves withdrawal, processing and reinfusing of blood to the individual simultaneously
Does not involve cycle and passes
Blood is drawn and returned continuously and would require two arms for the procedure
Continuous flow centrifugation (CFC)
Plateletpheresis
A pheresis platelet unit is equivalent to six to eight random donor platelets, so a single product is a typical therapeutic
dose for most adult patients.
The interval between donations is at least ______, not to exceed more than twice a week or more than 24 times a year.
Each pheresis platelet unit is required to contain at least _____
Donor reactions to platelet pheresis collection are most commonly a reaction to the citrate or ______used in
the procedure.
2 days
3 × 10^11 platelets.
anticoagulant
Plateletpheresis
Test requirements:
- ABO group/Rh type
- antibody screen
- infectious disease markers
______ if donation is repeatedly done
FDA guidelines require that the donation records of regular platelet pheresis donors be reviewed by a physician at least
every ______.
30 days
4 months
Classification:
Infrequent/occasional
Serial
The red cell loss must not exceed 25 mL/week or 200 mL in an 8-week period.
if the donor’s red cells cannot be returned, the donor must be deferred for 8 weeks before returning to a plasma pheresis
program.
The donor must be tested for total serum/plasma protein levels and quantitative immunoglobulin levels, and protein
electrophoresis must be performed.
Plasmapheresis
A typical therapeutic dose is at least 1 × 1011 granulocytes each day for 5 consecutive days.
donor must be given certain drugs or sedimenting agents, and specific informed consent must be obtained from the
donor prior to administering these drugs.
AABB Standards states that any of these drugs or agents used to facilitate leukapheresis will not be used on donors
whose medical history suggests that such a drug will exacerbate previous disease.
Leukopheresis
_______ – common sedimenting agent
hydroxyethyl starch (HES)
used to collect either allogeneic or autologous units
Donors must meet with the requirements for whole blood donation.
Donors participating in double red cell pheresis programs are deferred for 16 weeks following successful completion of the
donation procedures.
Double RBC Pheresis
numeric or alpha numeric system – donor record, pilot tubes, blood container, and all components made from the original collection.
AABB Standards require that the trained phlebotomist must identify the donor record and ensure that the donor name and
identification numbers match.
Donor should state or spell his or her name
Whole Blood Collection – Donor ID
syncope or fainting, nausea or vomiting, hyperventilation,
twitching, and muscle spasm
The donor may show signs of sweating, dizziness, pallor, or convulsions.
Instructions for donor who has fainted:
Remove the tourniquet and withdraw needle
Place cold compresses on the donor’s forehead
Raise the donor’s legs above the level of the head
Loosen tight clothing and secure airway
Monitor vital signs
Donor Reactions – Mild Reactions
Donors who are extremely _____ may exhibit sudden twitching or muscle spasms. If this happens, try to disengage the hyperventilation sequence by conversing with the donor
and having the donor breathe into a paper bag, if necessary. It is _____ to give oxygen to these donors.
nervous
not advised
If the donor starts to feel nauseated or vomits, the following instructions apply:
- Instruct the donor to breathe slowly
- Apply ___ compresses to the forehead
- Turn the donor’s head to one side and provide an appropriate receptacle
- The donor may be given water after vomiting has ceased
cold
Include all the mild reactions, plus loss of consciousness
The donor may have a decreased pulse rate, may hyperventilate, and may exhibit a fall in systolic pressure to 60 mm Hg.
The following instructions apply:
- Check vital signs frequently
- Administer 95% oxygen and 5% carbon dioxide
Donor Reactions – Moderate Reactions
If the donor experiencing convulsions
Convulsions can be caused by cerebral ischemia, marked hyperventilation, or epilepsy.
The following should be followed by the donor room personnel:
- Call for help immediately; notify blood bank physician
- Try and restrain the donor to prevent injury to self or others
- Ensure an adequate airway
Donor Reactions – Severe Reactions
caused by the needle going through the vein, with subsequent leakage of blood into the tissue
Hematomas
If a hematoma develops, the following instructions apply:
- Remove the tourniquet and needle from donor’s arm
- Apply pressure with sterile gauze pads for 7 to 10 minutes, with the donor raising his or her arm above the heart
- Apply ice to the area for 5 minutes
Donor Records
The minimum retention time for donor records varies from ______ to indefinitely.
5 to 10 years
Component Preparation – Whole Blood
platelets, white cells, and labile clotting factors _______ in stored whole blood, so whole blood is rarely used for transfusion today with the exception of autologous units in
some transfusion facilities.
do not survive
If the donation remains as whole blood, it must be stored at ______, and the shelf-life is dependent on the preservative used. If collected in ACD or CPD, shelf-life is _____ and CPDA-1 is _____
1°C to 6°C
21 days
35 days.
most often transfused during the neonatal period or in infants younger than 4 months of age.
RBC Aliquots
Blood drawn from infants for laboratory testing (iatrogenic anemia) also may warrant a neonatal transfusion if more than
____ of the blood volume has been removed.
10%
The aliquoted blood has an expiration time of ____and should be stored at 1°C to 6°C until issued.
24 hours
AABB Standards states that repeat ABO and Rh typing may be omitted for the remainder of the neonate’s hospital admission; in the event the initial screen for RBC antibodies is
_____, it is not necessary to crossmatch donor RBCs for the initial or subsequent transfusions.
negative
If the antibody screen is ____ for clinically significant RBC antibodies, the neonate must receive blood that does not contain the corresponding antigen or is compatible by the
antiglobulin crossmatch.
positive
The anticoagulant most often used for neonate transfusions is _____
CPDA-1.
A transfusion of 10 mL/kg in a unit with a hematocrit level of 80% should raise the hemoglobin by __`g/dL.
3
Patients that must receive \_\_\_\_\_\_: Immunocompromised Receiving a bone marrow Stem cell transplant Fetuses undergoing an intrauterine transfusion Recipients of blood from relatives
_______ inhibits the proliferation of T cells and subsequent transfusion-associated graft-versus-host disease.
irradiated RBCs
RBCs, platelets, and granulocyte concentrates contain viable_______ that can become engrafted when transfused if the host’s immune system is not capable of identifying or
defending against the foreign cells.
T lymphocytes
Both the FDA and AABB recommend a minimum dose of gamma irradiation of __ Gy to the central portion of the blood unit, with no less than 15 Gy delivered to any part of the blood unit.2 Irradiation is generally performed using _____ or cobalt-60.
25
cesium-137
To confirm a product was irradiated, a _______label is affixed to the component before it is placed into the metal canister of the irradiator.
radiochromic film
______ of the film confirms irradiation requirements.
Darkening
According to AABB Standards, ________ is a product in which the absolute WBC count in the unit is reduced to less than 5 × 106 and contains at least 85% of the original RBC mass.
Two major categories of _____:
Prestorage
Poststorage
leukoreduced red cells
RBCs that have been frozen, thawed, deglycerolized, and washed also produce a _______ product.
leukoreduced
_______ have been useful in trying to avoid the following reactions associated with products containing
leukocytes:
febrile nonhemolytic transfusion reactions
transfusion-related acute lung injury; and
transmission of Epstein-Barr virus, CMV, and human T-cell
lymphotrophic virus
