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J Sarge BB test 5
Blood Bank Test 5
| Question | Answer |
|---|---|
| When are samples drawn for donor testing? | At the same time as donor units |
| What tests are done on donor samples? | ABO/Rh, Ab screen/Ab ID if necessary |
| Why are group O individuals considered Universal Donors? | No antigens on RBCs |
| Why are group AB individuals are considered Universal Recipients? | No antibodies in serum. |
| What alternative packed RBCs can be given to a type O patient? | None |
| What alternative packed RBCs can be given to a type A patient? | Type O |
| What alternative packed RBCs can be given to a type B patient? | Type O |
| What alternative packed RBCs can be given to a type AB patient? | Type A, B, O |
| Should Rh negative blood be given to Rh+ patients? | It can be safely given, not the best use of this limited resource. Should be kept for Rh negative patients |
| Name three areas of RBC biology crucial for normal survival and function: | 1. Normal chemical composition/structure of RBC membrane 2. RBC metabolism 3. Hgb structure and function |
| Describe two important characteristics of the RBC membrane and how they impact RBC survival: | Deformability (flexibility of membrane) spherocytes/bite cells = destruction. Permeability (controls cell volume) rigid = destruction |
| Name three items necessary for hemoglobin synthesis: | Adequate iron supply; Adequate synthesis of protoporphyrins; Adequate globin synthesis |
| Describe three pathways involved in RBC metabolism and how a defect in them can affect RBC survival: (1) | (1) Pentose phosphate pathway-10% of ATP production. Deficiency = formation of Heinz bodies (RBC less deformable=increased destruction) |
| Describe three pathways involved in RBC metabolism and how a defect in them can affect RBC survival: (2) | (2) Methemoglobin reductase pathway-Maintains the heme iron of Hgb in the 2+ (ferrus) state so it can bind oxygen |
| Describe three pathways involved in RBC metabolism and how a defect in them can affect RBC survival: (3) | (3) Luebering-Rapaport shunt-Permits accumulation of 2,3-diphosphoglycerate [2,3,-DPG] = significant effect on affinity of Hgb for oxygen |
| Describe the five major changes in blood upon storage: | Decrease in pH; Buildup of lactic acid; Decrease in glucose consumption; Decrease in ATP levels; Loss of RBC function |
| Describe the purpose of ATP and 2,3-DPG in blood storage: | ATP=energy and deformability; 2,3-DPG=hemoglobin's affinity for oxygen |
| Name the four anticoagulants used in the collection of a unit of blood and describe the advantages and disadvantages of each: (1) | (1) ACD-Acid Citrate Dextrose; 21 days; Disadvantage-Low pH; Most of 2,3,-DPG is lost in the 1st week of storage |
| Name the four anticoagulants used in the collection of a unit of blood and describe the advantages and disadvantages of each: (2) | (2) CPD-Citrate Phosphate Dextrose; 21 days; Disadvantage-Low 2,3-DPG by 2nd week of storage |
| Name the four anticoagulants used in the collection of a unit of blood and describe the advantages and disadvantages of each: (3) | (3) CPDA-1-Citrate Phosphate Dextrose Adenine; Adenine plus 25% more glucose than CPD; 35 days; Advantage-Longer shelf life; Disadvantage-Low 2,3-DPG by 2nd week of storage |
| Name the four anticoagulants used in the collection of a unit of blood and describe the advantages and disadvantages of each: (4) | (4) CP2D-Citrate Phosphate Double Dextrose; Contains 100% more glucose than CPD; 21 days; Advantage-More glucose; Disadvantage-Low 2,3-DPG by 2nd week of storage; Less shelf-life |
| Define shelf-life: | The amount of time blood or blood components may be stored upon collection |
| Describe how the shelf-life of a blood component is determined: | Based on preservatives and viability requirements |
| What are the two questions blood donor selection is designed to answer? | Will a donation of approximately 500mL of whole blood be harmful to the donor? Could blood drawn from this donor at this time potentially transmit a disease to the recipient? |
| Explain the importance of clear, unique identification of the donor: | Each donor must be clearly and uniquely identified in order to be traced through the entire procedure, and if necessary, recalled |
| Describe the age limits on a donor and the exception to this rule: | Minimum of 17 years of age(Becky said 16 now); no upper age limit; no minimum age for autologous |
| Name the seven items required when registering a blood donor and describe why each item is necessary: | ID and tracing for recall-Donor's name, address, phone number, gender, DOB (also for acceptance); Date of donation-deferral; Donor's consent-written, informed consent (all risks must be explained and opportunity given for donor's questions) |
| Describe the seven areas covered by a physical examination of the donor. (1) What should their general appearance be? | In good health, no signs of alcoholism, drug abuse, cold or disease |
| Describe the seven areas covered by a physical examination of the donor. (2) What is the weight requirement? | Greater than or equal to 110lbs; Donation of unit of blood should not exceed 10% of donor's blood volume |
| Describe the seven areas covered by a physical examination of the donor. (3) What should the donor's temperature not exceed? | 99.5°F/37.5°C |
| Describe the seven areas covered by a physical examination of the donor. (4) What should the donor's pulse be? | 50 to 100 beats per minute |
| Describe the seven areas covered by a physical examination of the donor. (5) What should the donor's blood pressure be? | Systolic 90-180 mm Hg; Diastolic 50-100 mm Hg |
| Describe the seven areas covered by a physical examination of the donor. (6) What should the donor's Hct and/or Hgb be? | Hct-38%; Hgb-12.5g Venipuncture or fingerstick |
| Describe the seven areas covered by a physical examination of the donor. (7) What should be looked for relating to the donor's skin? | Skin lesions, arm check; Inspection of anticubital area of both arms for drug use, skin eruptions like poison ivy, rash or psoriasis |
| Describe the main areas of questioning on the donor questionnaire to ascertain disease status: | Disease history; Receipt of blood/blood products, transplants; Tattoo, piercings; Contact with anyone with hepatitis or HIV; Drug use; Surgery/dental work; Donation within the past 8 week; Pregnant; Risk behavior/STDs |
| Describe the copper sulfate method of measuring hemoglobin: | A drop of blood into a solution of copper sulfate with a SG of 1.053. Hgb too low, the drop floats. Hgb too high, drop sinks too quickly; Should drop within 15 seconds |
| What is an autologous donor? | Donor is donating blood for his or her own future use. Safest blood for transfusion. |
| Describe what is needed in a predeposit donation: | Written statement form Dr.; Pt signed consent; No age limit; No weight requirement (<110 proportional amount drawn); Hgb not <11g/dL Hct not <33%; Every 3 days (most stop 3 day before surgery; Much less medical history |
| Describe intraoperative autologous transfusion: | Blood collected during surgery and reinfused immediately; Aspirated from surgical site; Centrifuged, washed filtered and returned to Pt during surgery |
| Describe immediate preoperative hemodilution: | In the OR, 1 to 3 units of WB collected (replaced with volume expanders) Blood remains in the OR and is infused during surgical procedure |
| When and why is immediate preoperative hemodilution useful? | Heart surgery; Pt Hct is lowered to 28%; Bleeding occurs at a lower Hct (amount of RBC mass lost is less) Reinfused blood is fresh, viable plts, clotting factors, protein; Blood flow though microcirculation is improved due to lower Hct |
| Describe the care of the donor after collection is finished: | Bandage site; Cookies/crackers and juice; Rest if light headed; Advise of need for fluid replacement and limited lifting |
| Describe a random donor unit and the time required for the donation: | Unit of whole blood to be divided into components; 20 to 30 minutes; minimum physical components |
| Describe a pheresis donor unit and the time required for the donation: | Giving particular components; 2 hours; Special medical history; Must meet minimum physical requirements of random donor PLUS additional test on the component being pheresed |
| Describe a MILD donor reaction to donation: | Most frequently encountered; Signs of shock, no loss of consciousness |
| Describe the signs and symptoms of a mild donation reaction: | Nervousness, anxiety; Complaints of feeling warm; Pallor, sweating; Increased or thready pulse; Increased respirations leading to hyperventilation; Decreased BP; Nausea and possibly vomiting |
| Describe the treatment of a mild donation reaction: | Stop donation, remove needle;Breath into a paper bag; Loosen tight clothing;Ensure clear airway;Pull knees up/raise feet; Apply a cold towel to forehead and neck; Spirits of ammonia; Reassure donor; If no response, summon medical help; Do not leave donor |
| Describe a moderate donation reaction: | Same as mild but donor loses consciousness |
| Describe the signs and symptoms of a moderate donation reaction: | Periods of unconsciousness; Decreased pulse rate; Rapid, shallow respirations and hyperventilation; Continued decrease BP |
| Describe the treatment of a moderate donation reaction: | Same as mild; Check BP, pulse, and respirations frequently; Administer 95% O2, 5% CO2; Separate the donor from the general donor area |
| Describe a severe donation reaction: | All mild and moderate plus convulsions; |
| Describe the signs and symptoms of a severe donation reaction: Hyperventilation tetany | Donor still conscious, complains of stiffness and/or tingling fingers, spasms of fingers, progresses to more pronounced convulsions |
| Describe the treatment of hyperventilation tetany: | Remain calm; have donor breathe form a paper bag; do not leave the donor; summon additional help |
| Describe the signs and symptoms of a severe donation reaction: Mild Convulsion | Short lapse of consciousness; voice fadeout; slight involuntary movement of arms and legs |
| Describe the signs and symptoms of a severe donation reaction: Severe Convulsion | Rigid body and tightly clenched teeth; temporary loss of breathing followed by rasping breathing; slight involuntary movement of arms and legs |
| Describe the treatment of mild and severe convulsions: | Gently restrain donor to prevent injury; summon help immediately; remain calm and stay with donor; ensure and adequate airway; may administer 95% O2 and 5% CO2; maintain observation of donor until fully recovered |
| Describe how to respond to a cardiac or respiratory problem during a donation reaction: | Call for medical help immediately; If cardiac arrest start CPR |
| Define a hematoma: | A swelling or a mass of blood confined to an organ, tissue, or space and caused by a break in blood vessel. |
| Describe how a hematoma should be treated: | Remove the needle; Apply pressure to the site and raise the arm for 5 to 10 minutes; Make sure bleeding has stopped and apply bandage; An ice pack can be used |
| Name the blood bank tests performed on the donor samples: | ABO Grouping/Rh Typing; Ab Screen/Ab ID if necessary; Infectious Disease tests |
| If clinically significant antibodies are detected, what part of the patient's unit of blood can be used and why? | Washed RBCs only may be used; Plasma will have Abs; no FFP, no plts, no cryo |
| Name six diseases donor units are tested for: | Syphilis (RPR); Hep B surface Ag; Hep B core Ab; Hep C Ab (EIA & NAT); HIV-1/2/O (EIA & NAT) Human T-cell lymphotropic Virus Type 1 & 2; West Nile Virus |
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