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Adv. BB Exam 1
Advanced Bloodbank Exam 1, Dr. Smith
| Question | Answer |
|---|---|
| A donor comes in with a positive syphilis test. What happens? | Deferral for one year following the end of treatment. |
| A donor comes in with a positive HIV test. What happens? | Indefinite deferral. |
| A donor comes in who recieved the flu vaccine one week ago. What happens? | As long as they are afebrile and feeling well, they are accepted. |
| A donor comes in with a history of traveling to Great Britain before 1985. What happens? | Indefinite deferral due to the risk of that donor having contracted CJD |
| A 32-year old male donor comes in with a history of having sex with other men. What happens? | Indefinite deferral. |
| A 25 year old woman comes in to donate blood and received a butterfly tattoo six months ago. What happens? | They are deferred for one year from recieving the tattoo, so this donor won't be eligible to donate for another six months. |
| How often can someone donate whole blood? | Every 4 weeks |
| A donor has recieved Hepatitis C IG one month ago. What happens? | Deferred for one year. |
| How much should one unit of pRBC's raise a patient's hemoglobin/hematocrit? | 1 gm/dl hemoglobin, or 3% hematocrit |
| A donor comes in with a history of recieving growth hormone from pituitary glands. What happens? | Permanent deferral due to the risk of transmitting CJD. |
| A donor comes in with a history of taking Tegison (etretinate), a drug used for severe psoriasis. What happens? | Permanent deferral due to the risk of birth defects associated with the drug. |
| A donor comes in who has a history of recieving bovine insulin. What happens? | Indefinite deferral due to the risk of transmitting CJD. |
| A donor comes in with a history of travelling to malaria-infested swamps in Africa. What happens? | Indefinite deferral, since there is no specific/sensitive test for malaria. |
| What is the test method for the Human Cytolomegalovirus? | NAT |
| The West Nile Virus test looks at which type of genetic material? | RNA |
| If a donor tests "repeatedly reactive" yet negative on confirmatory testing, what happens in terms of transfusion possibilities? | That donor's blood cannot be used for allogenic transfusions |
| If an NAT is reactive, does it have to be repeated? | No. |
| How are donors infected with Babesia screened? | Based on history of travel/living in endemic areas. There is no definitive test. |
| The test for T. cruzi is based on what methodology? | EIA, RIPA as supplemental |
| What is a massive transfusion? (units/time) | >10 units pRBCs in 24 hours |
| Name some complications of massive transfusions. | Complications include: Hypovolemia, Shock, Hypothermia, Hyperkalemia, Citrate toxicity, Acidosis, Hemostatic abnormalities, DIC |
| What is a crystalloid? | An electrolyte solution. |
| What is a colloid? (in terms of transfusion medicine) | Plasma fractions, albumin |
| Why do coagulation problems often happen during massive transfusions? | Dilutional coagulopathy and dilutional thrombocytopenia; the result of massive infusions of pRBCs without any coagulation factors or platelets. |
| Name some key laboratory results for DIC. | Increased PT & APTT, decreased PLTs, decreased fibrinogen, elevated FDP's, elevated D-Dimer |
| What are perflourocarbons? | Chemical hemoglobin substitutes, that only carry hemoglobin. Not available for use in North America. |
| When is granulocyte therapy indicated? | When patients have extremely low granulocyte counts and are vulnerable to infections, but also have the capacity to recover (i.e neonates) |
| What is special about granulocyte donors? | They recieve colony-growth stimulating factor before donation, putting them at risk for complications |
| What is IVIg? | Antibodies of all types from pooled plasma (from different donors), used in passive antibody therapy |
| Name some adverse reactions to IVIg. | Nausea, vomiting, fever, chills, headache, anaphylactic response |
| What is WinRho? | A type of IVIg; it is anti-D. It is used in severe RH HDFN and ITP treatment. |
| When is IVIg indicated? | Various immunologic-mediated diseases, and primary and secondary immunodeficiencies |
| Standard collection bags are composed of what? | PVC |
| What biochemical changes occur while storing whole blood? | pH decreases, ATP decreases, 2,3-DPG decreases, Plasma K+ increases, Plasma HgB increases |
| What is the storage temp for the BB refrigerator and how often does it have to be monitored? | 1-6 degrees C, monitored at least every 4 hrs |
| What percentage of RBCs must be found in recipient’s circulation 24 hours after transfusion per shelf life criteria? | 75% |
| What is the point of sodium bisphospate in the preservative solution for storing whole blood? | Acts as a buffer and maintains 2,3 DPG |
| Whole blood presevered with CPDA-1 has a shelf life of _____? | 35 days |
| CPD and CP2D give whole blood a shelf life of _____? | 21 days |
| What is the effect of radiation on RBC's in terms of expiration date? | The RBC's expire 28 days after irradiation OR their original expiration date, WHICHEVER IS SOONER. |
| What is the point of irradiating RBCs? | To reduce the risk of graft vs host disease |
| How long are granulocytes good for? | 24 hours after collection by apheresis |
| How long is a single unit of CRYO good for post thaw? | 6 hours |
| How long is a pooled unit of CRYO good for post thaw? | 4 hours |
| What is the primary use of cryoprecipitate? | Patients with hypofibrinogenemia |
| What is the QC for cryoprecipitate? | All bags tested must have at least 80 IU/bag of Factor 8, AND at least 150 mg of fibrinogen |
| What are some indications for using FFP? | Isolated factor deficiencies, warfarin/Coumadin overdose, massive transfusion (1 FFP per 5 RBCs), thrombocytopenic purpura |
| When is FFP frozen? | Within 24 hours of phlebotomy |
| How long can FFP be stored? | One year at -18C |
| After thawing, how long is FFP good for? | 24 hrs |
| FFP contains which coag factors? | Stabile and labile |
| Are there any non-culture based methods of detecting bacterial contamination in platelets? | No. |
| Why is bacterial contamination a major problem with platelets? | They are stored at room temperature, platelets are usually cloudy so it's hard to detect growth, and normal flora contaminants grow quickly |
| What is the ph for plasma at expiration for apheresis PLT QC? | >6.2 |
| How many WBC's are allowed to stay inside leukocyte-reduced platelets-pheresis? | <5.0 x 10^6 residual WBCs |
| How often can someone donate platelets via plateletpheresis? | Every 2 days in a 7 day period, for a max of 24x in a year |
| Name some causes (non-immune and immune)of refractoriness. | Non-immune: fever, sepsis, DIC Immune: production of HLA or plt-specific antibodies |
| What is refractoriness? | When platelets no longer give expected increase at 1 hour post-transfusion |
| What is the expected raise in platelet count per unit of platelets transfused? | 5,000-10,000 |
| When is platelet transfusion warranted (plt count)? | Surgical: <50,000 Non-surgical: <20,000 |
| How many platelets must be in a luekoreduced unit? | 5.5 x 10^10 platelets in >75% of units tested |
| How does irradiating platelet units affect their expiration date? | It doesn't. |
| When would volume-reduced platelet units be indicated? | To prevent TACO, in neonates and intrauterine transfusions |
| How long can a single PLT unit be stored and at what temp is it stored at? | 5 days at RT |
| How long can pooled platelets be stored and at what temperature? | 4 hours at RT after pooling |
| How much plasma does a unit of platelets contain? | 40-70 mls |
| What are some indications for platelet transfusion? | To prevent spontaneous bleeding, and to stop established bleeding in patients with hypoplastic anemia, marrow failure, malignancies, chemotherapy-induced marrow suppression |
| What is the QC for frozen RBC recovery? | at least 80% recovery of original RBCs and 70% viability of D-RBCs 24 hours after transfusion |
| What is the QC for thawed frozen RBCs? | HCT 80-85%, expiration 24 hours post thaw (2 weeks if closed system is used) |
| How quickly must frozen red cells be thawed in order to prevent RBC destruction? | 20-25 mins, max 40 mins |
| How quickly must red cells be deglycerolized in order to prevent RBC destruction? | within 2 hours |
| When must RBCs be glycerolized? | Within 6 days of collection (rejuventated RBCs must be frozen within 3 days) |
| What is the glycerolization principle? | RBCs are fozen when acqueous content is replaced with cryoprotective agent |
| What is the principle of deglycerolization? | Eqilibration of thawed RBCs with a hypertonic solution of saline then normalized in isotonic saline |
| What is the outdate of washed RBCs? | 24 hours |
| What is the value of using washed RBC's? | Used mainly in IgA deficient patients |
| How many WBC's are allowed to be inside leukocyte-reduced pRBC units? | <5 x 10^6 (filters must removed at least 99.9% of leukocytes) |
| How many RBC's must remain in a leukocyte-reduced pRBC unit? | >85% RBCs |
| What are some indications for the use of leukoreduced RBCs? | To reduce the risk of CMV transmission, HLA immunization, and FNHTR |
| What is a rejuvenation solution and what does it do? | Contains pyruvate, inosine, adenine, and phospate, and restores depleted 2,3 DPG and ATP. It is toxic |
| When can a rejuvenation solution be added? | Up to 72 hrs post expiration (CPD or CPDA-1 RBCS) |
| When do rejuvenated RBCs expire? | 24 hours after rejuvenation unless frozen |
| How much HCT does a pRBC unit contain? | <80% HCT, unless additive is used, in which case it may be around 65% |
| What bacteria infect pRBCs? Is this a major problem? | psychotrophilic bacteria, such as Yersinia enterocolitica. It is not a major problem |
| How long can PRBCs go without being refrigerated? | Up to 8 hours |
| What are pRBCs used for? | To treat symptomatic anemia (>30% blood loss, anemia with HgB <8 g/dL) |
| How much does one unit of PRBC in a 70KG adult increase the hemoglobin? The hematocrit? | Hemoglobin: 1 gm/dL Hematocrit: 3% |
| What are two methods used to seperate whole blood? | Differential centrifugation and gravitational settling |
| What are some ways to prevent a collection lesion? | single venipuncture, minimal trauma to tissues, frequent and gentle mixing of blood |
| What time interval should blood be collected and why? | Preferably 4-10 minutes to prevent activation of the coagulation cascade |
| When is additive added to RBC's? | After the removal of plasma, and up to 72 hours post-collection. |
| What is the volume of additive added? What is the final hematocrit? | 100 ml of solution, with a final hematocrit of 55-66% |
| How long do CPD and CP2D preserved RBCs last? | 21 days |
| How long does CPDA-1 preserved RBCs last? | 35 days |
| How long do additive solutions extend the shelf life of RBCs? | To 42 days |
| How much preservative solution is inside teh bag? | 63 ml |
| What nutrients are contained in the preservative solution? | Dextrose and sodium bisphosphate |
| What anticoagulant is contained in the preservative solution? | Citrate |
| What is the effect of 2,3-DPG levels on oxygen release to the tissues? | Directly proportional - high 2,3 DPG levels mean higher oxygen release, low 2,3 DPG levels mean lower oxygen release |
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