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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? 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
Created by: 1558803501