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Adv. BB Exam 1
Advanced Bloodbank Exam 1, Dr. Smith
|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?
|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?
|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?
|The West Nile Virus test looks at which type of genetic material?
|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?
|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?
|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?
|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 _____?
|CPD and CP2D give whole blood a shelf life of _____?
|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?
|How long is a pooled unit of CRYO good for post thaw?
|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?
|FFP contains which coag factors?
|Stabile and labile
|Are there any non-culture based methods of detecting bacterial contamination in platelets?
|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?
|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?
|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?
|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?
|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?
|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?
|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?
|How long does CPDA-1 preserved RBCs last?
|How long do additive solutions extend the shelf life of RBCs?
|To 42 days
|How much preservative solution is inside teh bag?
|What nutrients are contained in the preservative solution?
|Dextrose and sodium bisphosphate
|What anticoagulant is contained in the preservative solution?
|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