Blood Bank 3

Front 1

Storage time and temp for pRBC's/whole blood using CPD?

Back 1

21 days at 1-6C (i.e. fridge)

Front 2

Storage time and temp for pRBC's /whole blood using CPDA-1?

Back 2

35 days at 1-6C

Front 3

Storage time and temp for pRBC's/whole blood using additives?

Back 3

42 days at 1-6C

Front 4

Storage time and temp for frozen rbc's? How soon must you use them after thawing?

Back 4

10 years at -65C.
Must use em within 24 hours after thawing.

Front 5

How soon must you use washed rbc's? What temp must they be kept at until you use them?

Back 5

Within 24 hours
Must be kept at 1-6C

vs. within 4 hrs and rm temp for washed plts

Front 6

How soon must you use washed platelets? What temp must they be kept at until you use them?

Back 6

Within 4 hours
Must be kept at 20-24C (rm temp)

vs. within 24 hrs and 1-6C (i.e. in the fridge) for rbc's

Front 7

Storage time and temp for platelets?

Back 7

5 days at 20-24C (gentle agitation)

Front 8

Storage time and temp for WBC?

Back 8

24 hours at 20-24C (no agitation)

Front 9

Storage time and temp for FFP?

Back 9

1 year at -18C or 7 years at -65C or 24 hours (b/c coag factors decrease after thawing; esp. factors 5&8) at 1-6C after thawing at 30-37C. If don't want to keep in fridge (1-6C), them must use within 4 hours

Front 10

Storage time and temp for cryo?

Back 10

1 year at -18C; 6 hours at 20-24C after thawing at 30-37C or 4 hours if pooled (b/c broken sterility)

Note that you dont put cryo or platelets in the fridge?

Front 11

QC HCT for rbc's?

Back 11

<80% in all tested

Front 12

QC WBC for leukoreduced rbc's?

Back 12

</=5x10^6 wbcs in 95% tested and must retain 85% of the rbc's

Front 13

QC platelets?

Back 13

>/=5.5x10^10 and pH>/=6.2 in 90% tested

Front 14

QC platelets leukoreduced?

Back 14

>/=5.5x10^10 in 75% tested; pH>/=6.2 in 90% tested AND </=8.3x10^5 WBCs in 95% tested

Front 15

QC apheresis platelets?

Back 15

>/=3x10^11 and pH>/=6.2 in 90% tested

Front 16

QC apheresis platelets leukoreduced?

Back 16

Same as apheresis platelets plus </=5x10^6 residual WBCs in 95% tested

Note that the leukoreduction # is the same as for rbc's. Note also, when it comes to leukoreduction, it's always in 95% tested.

Front 17

QC cryo?

Back 17

Factor VIII>/=80IU (all)
Fibrinogen >/=150 mg (all)

Front 18

QC Granulocyte concentrate

Back 18

>/=1x10^10 WBCs in 75% tested

Front 19

Whole blood components by volume?

Back 19

Vol=450-500 mls
RBCs=200 mls
Plasma=250 mls
WBCs=10^9 and platelets
Anticoagulant (63 or 70 mls)

Front 20

Red blood cell components by volume?

Back 20

Vol=250 mls (350 mls with additive soln)
RBCs=200 mls
HCT</=80%
Plasma=50 mls with CPDA-1
WBCs=10^9 and platelets
Anticoagulant
Additive soln (if applicable)=100 mls
Iron=200 mg (ie 1 mg per ml of rbcs)

Front 21

Platelet concentrate components by volume?

Back 21

Vol=40-60 mls
Platelets>/=5.5x10^10 in 90%
Plasma (incl. 80 ml fibrinogen)-Is why ABO status matters in FFP and plts.
WBCs=10^7
pH>/=6.2 in 90% tested

Front 22

What is the expected increase in H&H after transfusion of 1 unit of rbc's?

Back 22

Hgb increases by 1 g/dL; hct increases by 3%.

Front 23

Apheresis platelets components by volume?

Back 23

Vol=100 mls (~2x that of PC)
Platelets>/=3x10^11 in 90%
Plasma (incl. ~150 mls fibrinogen)
WBCs=10^6-10^8

Front 24

Name 2 indications (besides those given for platelet concentrates) for apheresis platelets

Back 24

1. Limiting exposure
2. Platelet refractoriness

Front 25

Name 6 indications for leukocyte reduced products (e.g. red cells and platelets)

Back 25

1. Prevent FNHTRs
2. Prevent HLA immunization
3. Prevent CMV transmission
4. Prevent immunosuppressive effects of transfusion
5. Reduction of bac. contamination (esp. Y. enterocolitica)
6. Reduction of prion dz risk (NOTE: 3 OF THE 6 DEAL WITH INFECTION)

Front 26

Name 3 indications for the washing of rbc's or platelets.

Back 26

1. Removal of plasma proteins (esp. imp. for IgA def. folks b/c they could have an anaphylactic rxn if they make anti-IgA).
2.Prevent neonatal alloimmune thrombocytopenic purpura (NAIT).
3.Repeated FNHTRs (removes cytokines AND wbc's (vs. just wbc's with leukoreduction))

Front 27

What is the name of the platelet Ag that is the problem in NAIT?

Back 27

PL-A1 (aka HPA-1A). The mom makes an Ab to this Ag secondary to either pregnancy or transfusion.

Front 28

What is the radiation dose and location re: bag that is needed to irradiate a blood product?

Back 28

2500 cGy (rad) to center of bag with at least 1500 cGy in all parts of bag.

Note: cGy=rad

Front 29

What 4 types of patients are especially at risk for TA-GVHD and therefore need irradiated blood products?

Back 29

1. Immunosuppressed (including pts taking Fludarabine- a chemo drug for CLL)
2. Intrauterine and premature neonates who need transfusion
3. Hodgkin dz pts (and usu. other heme malignancies)
4. Pts getting bld from 1st degree relative or receiving HLA "matched" units.

Front 30

After irradiation, how long can you store that product before usage?

Back 30

28 days after irradiation or regular expiration date, whichever one comes first.

Front 31

Components by volume of FFP (in general)?

Back 31

Vol=200-250 mls
All coag factors
-400 mg fibrinogen
-1 IU/ml of all others
Almost no viable cells
Anticoagulant

Front 32

What % levels of your coag factors do you need in order to clot?

Back 32

~20-30% of all your coag factors across the board

Front 33

What is the in vivo t1/2 of factor VII?

Back 33

About 4 hours (so don't give FFP the night before surgery and expect the PT to still be nml in the morning)

Front 34

What factors have the shortest in vitro (i.e. in the bag) t1/2?

Back 34

Factors 5 and 8

Front 35

Name 6 indications for FFP.

Back 35

1. Coagulopathy d/t multiple factor deficiencies (e.g. liver dz-F VII will be gone 1st b/c of shortest t1/2)
2. Urgent reversal of vit K defic. from dietary factors or warfarin OD.
3. Dilutional coagulopathy.
4. Transfusion or plasma x-change for TTP/HUS
5. Other factor-specific coagulopathies that do not have a factor concentrate available.
6. Rare circumstances such as Pro C or S defic if no factor concentrate available, a C1 esterase inhibitor defic. or factor XIII defic.

Front 36

When making FFP, how soon after phlebotomy must you freeze it and why?

Back 36

Must freeze it w/in 8 hours because if take longer, the labile factors (factors 5&8) will be markedly decreased or gone.

Front 37

What is PF24?

Back 37

It is plasma frozen within 24 hours-basically FFP that takes longer than 8 hours before freezing it in the making process.

Front 38

What is the dosage of FFP for neonates?

Back 38

10-15 ml/Kg

Front 39

What is the expected effect on factor levels after a 2 unit dose of FFP?

Back 39

Each 2 unit dose increases factor levels by about 20-30% in a 70 Kg person.

Front 40

Can you give FFP w/o regard to recipient/donor Rh status? ABO status?

Back 40

Yes for Rh status.
No for ABO status (the ABO status matters with FFP).

Front 41

For how long and at what temp is THAWED plasma good?

Back 41

5 days at 1-6C

Note: Thawed plasma is not the same as FFP that has been thawed. The latter must be used within 24 hrs (b/c of lability of factors 5 and 8) and kept in fridge. If not kept in fridge, must use within 4 hrs.

Front 42

Components by volume of cryoprecipitate?

Back 42

Vol=15 mls
>/=150 mg fibrinogen (us. ~250 mg)
>/=80 IU factor VIII
80-120 IU vWF
40-60 IU factor XIII
Fibronectin

Front 43

Name 6 Indications for cryoprecipitate.

Back 43

1. Fibrinogen deficiency
2. Rx of von wilibrand's dz (2nd line therapy-use only if factor VIII concs not available). Cryo can be used for severe VWD. DDAVP is used for milder forms.
3. Rx of uremic thrombocytopathy (2nd line tx-after DDAVP, dialysis)
4. Factor XIII defic.
5. Topical glue.
6. Rx of hemophilia A (Absolutely 2nd line therapy-use only if emergency and no F VIII available).

Front 44

What is the general target % for F VIII level in hemarthrosis?

Back 44

50% F VIII levels

Front 45

What is the general target % for F VIII levels in surgery?

Back 45

100% F VIII levels

Front 46

Components by volume of granulocyte concentrate.

Back 46

Vol=Usu. 200-300 mls
WBCs>/=1x10^10 in 75% tested
Platelets>3x10^11 (same as apheresis)
RBCs>2 mls
Plasma
Anticoagulant

Front 47

Name 5 indications within a clinical situation for granulocyte concentrate.

Back 47

1. Fever 24-48 hrs
2. Cx proven bac or fungal inf.
3. No response to abx tx.
4. Neutropenia <500/uL
5. Reversible BM hypoplasia

Front 48

Is it o.k. to irradiate granulocyte concentrate?

Back 48

Yes. Irradiation harms lymphs but doesn't really bother granulocytes.

BQ

Front 49

Must granulocyte concentrate be ABO and/or Rh compatible?

Back 49

Yes, It must be both ABO and Rh compatible b/c the product contains abundant red cells. A crossmatch is also required before transfusion!

Front 50

How does DDAVP work?

Back 50

It is synthetic ADH which as a fortunate side effect, causes release of VWF from endothelial cells and seems to ftnally increase factor VIII as well.

Front 51

Name 4 indications for DDAVP.

Back 51

1. Uremic thrombocytopathy (use it before plts or cryo)
2. Mild hemophilia A
3. Mild to mod VWD (don't use in type IIB (may cause clotting) or III (ineffective).
4. Liver failure (for improved plt ftn)