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Storage time for pRBCs in CPD Citrate-phosphate-dextrose (CPD) and citratephosphate-dextrose-dextrose (CP2D) 1) Allow 21 days of RBC/whole blood storage
Storage time for pRBCs in CPDA-1 Allows 35 days of RBC/Whole Blood storage
Storage time for pRBCs in AS-3 Additive solutions (“Adenine Saline” additives) a. Increases shelf life of RBCs to 42 days b. Most common types 1) AS-1 (Adsol) 2) AS-3 (Nutricel) 3) AS-5 (Optisol) 4) AS-7 (SOLX)
Storage temperature for pRBCs 1-6 degrees C
Storage temperature for frozen pRBCs 10 years @ –65 C; 24 hours @ 1-6 C after thaw
Storage temperature for washed pRBCs 24 hours @ 1-6 C
Storage requirements for platelets 5 days @ 20-24 C (gentle agitation); 4 hours if pooled in open system
Storage requirements for granulocytes 24 hours at 20-24 C (no agitation);
Storage requirements for FFP 1 year @ –18 C; 7 years @ –65 C; 24 hours at 1-6 C after thaw
Storage requirements for cryo 1 year @ –18 C; 6 hours @ 20-24 C after thaw (4 hrs if pooled in open system)
QC requirements for Hematocrit in pRBCs HCT < 80% (all); > 50 g HGB in 95% (apheresis RBCs)
QC requirements for leukoreduced pRBCs ≤ 5 x 10(6) WBCs in 95%, retain 85% of RBCs
QC requirements for random donor platelet ≥ 5.5 x 10(10) and pH ≥ 6.2 in 90%
QC requirement for leukoreduced random donor platelets ≥ 5.5 x 10(10) in 75%, pH ≥ 6.2 in 90%, AND < 8.3 x 10(5) WBCs in 95%
QC requirement for apheresis platelets ≥ 3.0 x 10(11) and pH ≥ 6.2 in 90%
QC requirement for Apheresis platelets leukoreduced ≥ 3.0 x 10(11) and pH ≥ 6.2 in 90%; < 5.0 x 10(6)residual WBCs in 95%
QC requirement for cryo Factor VIII ≥ 80 IU (all); Fibrinogen ≥ 150 mg (all)
QC requirement for granulocytes ≥ 1.0 x 10(10) in 75%
Most commonly used blood component packed RBCs
Expected increase in hemoglobin and hematocrit after a unit of pRBC is transfused HCT increases 3%, HGB 1 g/dL (without acute bleeding or hemolysis)
Shipping temperature for RBC units Shipping temperature 1-10 C
Fluids that may be infused with RBCs Compatible fluids: Normal saline (0.9%, not 0.45%),; ABO-compatible plasma; 5% albumin; Normosol-R pH 7.4 and Plasma-Lyte 148 and -A
Why Red cells should not contact lactated Ringer’s LR has enough calcium to counteract the citrate anticoagulant in blood (LR has 3 mEq Ca2+/L)
Why Red cells should not contact D5W, 0.45% NS, antibiotics/other drugs, or TPN Hypotonic solutions - red cells swell and burst; hypertonic solutions - red cell shrinkage
Explain how whole blood derived platelets are made Prepared via centrifugation from one whole blood unit 1) The initial “soft” spin leaves “platelet-rich plasma” on top, so the method is known as the PRP method
Advantages of AD-PLTs over WBD-PLTs? Limiting exposure for infectious disease transmission; Platelet refractoriness
Things that improve platelet function in renal failure patients dialysis, DDAVP, CRYO, conjugated estrogens
Describe specificity of antibody in HIT (heparin induced thrombocytopenia) Antibody vs. heparin/platelet factor 4 complex
Describe specificity of auto-antibody in TTP (thrombotic thrombocytopenic purpura) auto-anti-ADAMTS-13
Do platelets require pretransfusion crossmatches? PLTs do not require pretransfusion crossmatches
Are ABO Rh antigens present on platelets? ABO antigens are present on platelets. RhD antigens are NOT present on platelets
True or False: “Universal” Leukoreduction is mandated in the US “Universal” LR is NOT mandated in the US, but vast majority of cellular components are leukoreduced
What are the Established benefits of leukoreduced blood products? Prevention of febrile nonhemolytic transfusion reactions; Prevention of HLA immunization; Prevention of CMV transmission; Reduction of reperfusion injury post cardiac bypass
What is the purpose of irradiating blood products? Prevention of transfusion-associated GVHD
What is the purpose of washing RBCs? Removal of plasma proteins for hypersensitivity (RBCs and platelets); : IgA deficiency;Haptoglobin deficiency(Asians); Removal of unwanted antibodies- ABO antibodies (neonatal transfusions); T-activation (polyagglutination) removal of electrolytes (K+)
Describe pathophysiology of Neonatal alloimmune thrombocytopenia Severe thrombocytopenia in neonate/fetus usually due to maternal anti-HPA-1A (80%);IgG crosses placenta, attacks platelets;25% 1st pregnancy; 20% get intracranial hemorrhage;
Describe treatment of Neonatal alloimmune thrombocytopenia Maternal IVIG used before birth (+/- intrauterine platelet transfusion); Platelet choices: • HPA-1A negative platelets given after birth; Washed, irradiated maternal platelets may also be used (lack antigen and antibody)
Most common cryopreservative agent Glycerol at 40% concentration
Reasons for storing frozen RBCs 1.Storage of rare, autologous, or O-negative units 2.Plasma hypersensitivities 3.Repeated febrile reactions
Radiation dose for blood products 2500 cGy (“rad”) dose required targeted to center of bag, with at least 1500 cGy in all parts of the bag
Indications for irradiation of blood products Immunosuppression; Intrauterine transfusions/premature neonatal transfusions; Hematologic malignancies (esp. Hodgkin’s); Granulocyte transfusions; Receiving blood from a first-degree relative donor or receiving HLA-matched unit
Maximum storage after irradiation of RBC unit 28 days after irradiation or regular expiration date, whichever comes first; K+ triples and free hemoglobin increases in plasma, indicative of mild RBC membrane damage
List the required QC tests for FFP None
How do you reverse warfarin in a non-bleeding patient For non-bleeding patients, correct without FFP administration (hold dose and give vitamin K)
Storage requirements for FFP Stored at -18C up to 1 year (or -65C for 7 yrs)
How is FFP thawed? Thawed at 30-37C (water bath/approved device)
How long can FFP be stored after thawing? Stored after thawing at 1-6 C for 24 hours; May extend beyond 24 hours per AABB-may be relabeled as “Thawed Plasma” and kept at 1-6 C for up to 5 day
What is "source plasma"? Source plasma:1) Apheresis collection, usually paid donors 2) Used for manufacture, not transfusion 3) Licensed product
What is "recovered plasma"? Recovered plasma: 1) Plasma from volunteer whole blood donation 2) Unused units may be relabeled and sold for further manufacture under short supply agreement 3) Unlicensed product, blood center revenue source
QC requirements for cryoprecipitate 1) > 80 IU FVIII per bag 2) > 150 mg fibrinogen per bag
Blood product used in treatment of uremic thrombocytopathy cryoprecipitate; Acquired adhesion defect (probably) which may respond to vWF supplementation; seen with creatinine levels > 3 mg/dL;after DDAVP, dialysis; Conjugated. estrogens; increase HCT to ~30%
Blood product used in treatment of Fibrinogen deficiency cryoprecipitate
Treatment for Factor XIII deficiency if concentrate unavailable cryoprecipitate
Treatment of von Willebrand’s disease Use cryo only if FVIII concentrates are not available; Some FVIII concentrates (e.g., “Humate-P”) contain vWF; Cryo may be used for severe forms; DDAVP can be used for milder forms
How is cryoprecipitate manufactured? Made from a single unit of whole blood-derived FFP (not PF24 or PF24RT24 or via apheresis); Thaw FFP at 1-6 C, spin and remove liquid, refreeze slushy precipitate within 24 hours
Storage requirements for cryoprecipitate -18 C for 1 year
How is cryo thawed and what are the requirements after thawing? After thawing (at 30-37 C, like FFP), store up to 6 hours at 20-24 C (unlike FFP). Pre-pooled CRYO has a 6 hour shelf life after thawing
Are compatibility tests required for cryo? No compatibility testing required; Can give without regard to Rh status
Used to treat moderate to severe hemophilia A Factor VIII concentrate
Used to treat moderate to severe hemophilia B Factor IX concentrate; Prothrombin Complex Concentrate (PCC) Or, “Factor IX Complex Concentrate”; Approved only for bleeding hemophilia B patients
Indications for granulocyte transfusions premature neonates with sepsis/infxns, t-plant patients with infxns, patients with CGD; or 1) Fever for 24-48 hours, 2) Proven bacterial or fungal infxn 3) No response to ABX 4) Neutropenia 5) Reversible bone marrow hypoplasia
This must be done prior to a granulocyte transfusion irradiate to prevent TA-GVHD. Irradiation deactivates T-lymphs but not PMNs
Pretransfusion testing requirements for granulocyte transfusion Must be ABO, Rh, and crossmatch compatible
Product used to treat Hemophiliacs (A or B) with inhibitors (bleeding prevention and bleeding treatment) Recombinant activated factor VII (NovoSeven)
Used to treat hemophilia B Factor IX concentrate; Prothrombin Complex Concentrate (PCC) 1) Or, “Factor IX Complex Concentrate” 2) Approved only for bleeding hemophilia B patients
Indications for granulocyte transfusions premature neonates with sepsis/infxns, transplant pts with infxns, chronic granulomatous dz; Fever 24-48 hours; bacterial or fungal infxn; No response to antibiotics; Neutropenia (<500/uL; <3000/uL in neonates) 5) Reversible bone marrow hypoplasia
Created by: jfshikle