bb guy section 3 notes:storage temps, QC and such
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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
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| Storage time for pRBCs in CPDA-1 | Allows 35 days of RBC/Whole Blood storage
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| 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)
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| Storage temperature for pRBCs | 1-6 degrees C
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| Storage temperature for frozen pRBCs | 10 years @ –65 C; 24 hours @ 1-6 C after thaw
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| Storage temperature for washed pRBCs | 24 hours @ 1-6 C
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| Storage requirements for platelets | 5 days @ 20-24 C (gentle agitation); 4 hours if pooled in open system
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| Storage requirements for granulocytes | 24 hours at 20-24 C (no agitation);
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| Storage requirements for FFP | 1 year @ –18 C; 7 years @ –65 C; 24 hours at 1-6 C after thaw
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| Storage requirements for cryo | 1 year @ –18 C; 6 hours @ 20-24 C after thaw (4 hrs if pooled in open system)
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| QC requirements for Hematocrit in pRBCs | HCT < 80% (all); > 50 g HGB in 95% (apheresis RBCs)
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| QC requirements for leukoreduced pRBCs | ≤ 5 x 10(6) WBCs in 95%, retain 85% of RBCs
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| QC requirements for random donor platelet | ≥ 5.5 x 10(10) and pH ≥ 6.2 in 90%
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| 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%
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| QC requirement for apheresis platelets | ≥ 3.0 x 10(11) and pH ≥ 6.2 in 90%
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| 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%
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| QC requirement for cryo | Factor VIII ≥ 80 IU (all); Fibrinogen ≥ 150 mg (all)
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| QC requirement for granulocytes | ≥ 1.0 x 10(10) in 75%
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| Most commonly used blood component | packed RBCs
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| 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)
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| Shipping temperature for RBC units | Shipping temperature 1-10 C
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| 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
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| 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)
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| 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
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| 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
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| Advantages of AD-PLTs over WBD-PLTs? | Limiting exposure for infectious disease transmission;
Platelet refractoriness
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| Things that improve platelet function in renal failure patients | dialysis, DDAVP, CRYO, conjugated estrogens
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| Describe specificity of antibody in HIT (heparin induced thrombocytopenia) | Antibody vs. heparin/platelet factor 4 complex
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| Describe specificity of auto-antibody in TTP (thrombotic thrombocytopenic purpura) | auto-anti-ADAMTS-13
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| Do platelets require pretransfusion crossmatches? | PLTs do not require pretransfusion crossmatches
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| Are ABO Rh antigens present on platelets? | ABO antigens are present on platelets. RhD antigens are NOT present on platelets
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| 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
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| 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
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| What is the purpose of irradiating blood products? | Prevention of transfusion-associated GVHD
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| 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+)
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| 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;
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| 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)
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| Most common cryopreservative agent for RBCs | Glycerol at 40% concentration
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| Reasons for storing frozen RBCs | 1.Storage of rare, autologous, or O-negative units
2.Plasma hypersensitivities (IgA defeiciency)
3.Repeated febrile reactions
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| 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
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| 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
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| 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
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| List the required QC tests for FFP | None
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| How do you reverse warfarin in a non-bleeding patient | For non-bleeding patients, correct without FFP administration (hold dose and give vitamin K)
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| Storage requirements for FFP | Stored at -18C up to 1 year (or -65C for 7 yrs)
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| How is FFP thawed? | Thawed at 30-37C (water bath/approved device)
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| 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
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| What is "source plasma"? | Source plasma:1) Apheresis collection, usually paid donors 2) Used for manufacture, not transfusion 3) Licensed product
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| 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
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| QC requirements for cryoprecipitate | 1) > 80 IU FVIII per bag 2) > 150 mg fibrinogen per bag
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| 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%
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| Blood product used in treatment of Fibrinogen deficiency | cryoprecipitate
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| Treatment for Factor XIII deficiency if concentrate unavailable | cryoprecipitate
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| 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
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| 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
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| Storage requirements for cryoprecipitate | -18 C for 1 year
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| 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
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| Are compatibility tests required for cryo? | No compatibility testing required; Can give without regard to Rh status
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| Used to treat moderate to severe hemophilia A | Factor VIII concentrate
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| 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
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| 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
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| This must be done prior to a granulocyte transfusion | irradiate to prevent TA-GVHD. Irradiation deactivates T-lymphs but not PMNs
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| Pretransfusion testing requirements for granulocyte transfusion | Must be ABO, Rh, and crossmatch compatible
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| Product used to treat Hemophiliacs (A or B) with inhibitors (bleeding prevention and bleeding treatment) | Recombinant activated factor VII (NovoSeven)
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| 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
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