Advanced Bloodbank Exam 1, Dr. Smith
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| A donor comes in with a positive syphilis test. What happens? | Deferral for one year following the end of treatment.
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| A donor comes in with a positive HIV test. What happens? | Indefinite deferral.
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| 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.
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| 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
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| A 32-year old male donor comes in with a history of having sex with other men. What happens? | Indefinite deferral.
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| 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.
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| How often can someone donate whole blood? | Every 4 weeks
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| A donor has recieved Hepatitis C IG one month ago. What happens? | Deferred for one year.
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| How much should one unit of pRBC's raise a patient's hemoglobin/hematocrit? | 1 gm/dl hemoglobin, or 3% hematocrit
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| 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.
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| 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.
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| A donor comes in who has a history of recieving bovine insulin. What happens? | Indefinite deferral due to the risk of transmitting CJD.
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| 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.
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| What is the test method for the Human Cytolomegalovirus? | NAT
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| The West Nile Virus test looks at which type of genetic material? | RNA
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| 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
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| If an NAT is reactive, does it have to be repeated? | No.
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| How are donors infected with Babesia screened? | Based on history of travel/living in endemic areas. There is no definitive test.
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| The test for T. cruzi is based on what methodology? | EIA, RIPA as supplemental
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| What is a massive transfusion? (units/time) | >10 units pRBCs in 24 hours
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| Name some complications of massive transfusions. | Complications include: Hypovolemia, Shock, Hypothermia, Hyperkalemia, Citrate toxicity, Acidosis, Hemostatic abnormalities, DIC
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| What is a crystalloid? | An electrolyte solution.
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| What is a colloid? (in terms of transfusion medicine) | Plasma fractions, albumin
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| 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.
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| Name some key laboratory results for DIC. | Increased PT & APTT, decreased PLTs, decreased fibrinogen, elevated FDP's, elevated D-Dimer
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| What are perflourocarbons? | Chemical hemoglobin substitutes, that only carry hemoglobin. Not available for use in North America.
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| 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)
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| What is special about granulocyte donors? | They recieve colony-growth stimulating factor before donation, putting them at risk for complications
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| What is IVIg? | Antibodies of all types from pooled plasma (from different donors), used in passive antibody therapy
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| Name some adverse reactions to IVIg. | Nausea, vomiting, fever, chills, headache, anaphylactic response
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| What is WinRho? | A type of IVIg; it is anti-D. It is used in severe RH HDFN and ITP treatment.
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| When is IVIg indicated? | Various immunologic-mediated diseases, and primary and secondary immunodeficiencies
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| Standard collection bags are composed of what? | PVC
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| What biochemical changes occur while storing whole blood? | pH decreases, ATP decreases, 2,3-DPG decreases, Plasma K+ increases, Plasma HgB increases
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| 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
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| What percentage of RBCs must be found in recipient’s circulation 24 hours after transfusion per shelf life criteria? | 75%
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| What is the point of sodium bisphospate in the preservative solution for storing whole blood? | Acts as a buffer and maintains 2,3 DPG
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| Whole blood presevered with CPDA-1 has a shelf life of _____? | 35 days
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| CPD and CP2D give whole blood a shelf life of _____? | 21 days
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| 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.
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| What is the point of irradiating RBCs? | To reduce the risk of graft vs host disease
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| How long are granulocytes good for? | 24 hours after collection by apheresis
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| How long is a single unit of CRYO good for post thaw? | 6 hours
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| How long is a pooled unit of CRYO good for post thaw? | 4 hours
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| What is the primary use of cryoprecipitate? | Patients with hypofibrinogenemia
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| 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
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| What are some indications for using FFP? | Isolated factor deficiencies, warfarin/Coumadin overdose, massive transfusion (1 FFP per 5 RBCs), thrombocytopenic purpura
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| When is FFP frozen? | Within 24 hours of phlebotomy
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| How long can FFP be stored? | One year at -18C
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| After thawing, how long is FFP good for? | 24 hrs
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| FFP contains which coag factors? | Stabile and labile
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| Are there any non-culture based methods of detecting bacterial contamination in platelets? | No.
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| 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
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| What is the ph for plasma at expiration for apheresis PLT QC? | >6.2
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| How many WBC's are allowed to stay inside leukocyte-reduced platelets-pheresis? | <5.0 x 10^6 residual WBCs
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| How often can someone donate platelets via plateletpheresis? | Every 2 days in a 7 day period, for a max of 24x in a year
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| Name some causes (non-immune and immune)of refractoriness. | Non-immune: fever, sepsis, DIC
Immune: production of HLA or plt-specific antibodies
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| What is refractoriness? | When platelets no longer give expected increase at 1 hour post-transfusion
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| What is the expected raise in platelet count per unit of platelets transfused? | 5,000-10,000
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| When is platelet transfusion warranted (plt count)? | Surgical: <50,000
Non-surgical: <20,000
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| How many platelets must be in a luekoreduced unit? | 5.5 x 10^10 platelets in >75% of units tested
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| How does irradiating platelet units affect their expiration date? | It doesn't.
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| When would volume-reduced platelet units be indicated? | To prevent TACO, in neonates and intrauterine transfusions
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| How long can a single PLT unit be stored and at what temp is it stored at? | 5 days at RT
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| How long can pooled platelets be stored and at what temperature? | 4 hours at RT after pooling
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| How much plasma does a unit of platelets contain? | 40-70 mls
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| 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
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| 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
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| What is the QC for thawed frozen RBCs? | HCT 80-85%, expiration 24 hours post thaw (2 weeks if closed system is used)
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| How quickly must frozen red cells be thawed in order to prevent RBC destruction? | 20-25 mins, max 40 mins
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| How quickly must red cells be deglycerolized in order to prevent RBC destruction? | within 2 hours
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| When must RBCs be glycerolized? | Within 6 days of collection (rejuventated RBCs must be frozen within 3 days)
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| What is the glycerolization principle? | RBCs are fozen when acqueous content is replaced with cryoprotective agent
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| What is the principle of deglycerolization? | Eqilibration of thawed RBCs with a hypertonic solution of saline then normalized in isotonic saline
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| What is the outdate of washed RBCs? | 24 hours
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| What is the value of using washed RBC's? | Used mainly in IgA deficient patients
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| 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)
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| How many RBC's must remain in a leukocyte-reduced pRBC unit? | >85% RBCs
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| What are some indications for the use of leukoreduced RBCs? | To reduce the risk of CMV transmission, HLA immunization, and FNHTR
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| 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
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| When can a rejuvenation solution be added? | Up to 72 hrs post expiration (CPD or CPDA-1 RBCS)
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| When do rejuvenated RBCs expire? | 24 hours after rejuvenation unless frozen
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| How much HCT does a pRBC unit contain? | <80% HCT, unless additive is used, in which case it may be around 65%
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| What bacteria infect pRBCs? Is this a major problem? | psychotrophilic bacteria, such as Yersinia enterocolitica. It is not a major problem
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| How long can PRBCs go without being refrigerated? | Up to 8 hours
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| What are pRBCs used for? | To treat symptomatic anemia (>30% blood loss, anemia with HgB <8 g/dL)
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| How much does one unit of PRBC in a 70KG adult increase the hemoglobin? The hematocrit? | Hemoglobin: 1 gm/dL
Hematocrit: 3%
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| What are two methods used to seperate whole blood? | Differential centrifugation and gravitational settling
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| What are some ways to prevent a collection lesion? | single venipuncture, minimal trauma to tissues, frequent and gentle mixing of blood
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| What time interval should blood be collected and why? | Preferably 4-10 minutes to prevent activation of the coagulation cascade
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| When is additive added to RBC's? | After the removal of plasma, and up to 72 hours post-collection.
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| What is the volume of additive added? What is the final hematocrit? | 100 ml of solution, with a final hematocrit of 55-66%
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| How long do CPD and CP2D preserved RBCs last? | 21 days
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| How long does CPDA-1 preserved RBCs last? | 35 days
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| How long do additive solutions extend the shelf life of RBCs? | To 42 days
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| How much preservative solution is inside teh bag? | 63 ml
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| What nutrients are contained in the preservative solution? | Dextrose and sodium bisphosphate
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| What anticoagulant is contained in the preservative solution? | Citrate
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| 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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