Blood Bank Sect 1: Components & Preparation

Front 1

Donor selection--Age?

Back 1

Donor selection age = 17 yrs minimum; no maximum age

Front 2

Donor selection--Temp?

Back 2

Donor temp = <37.5*C or 99.5*F

Front 3

Donor selection--BP?

Back 3

Donor selection BP =
Systolic <180
Diastolic <100

Front 4

Donor selection--Hgb?

Back 4

Donor selection Hgb = >/=12.5 g/dL

Front 5

Donor selection--Hematocrit?

Back 5

Donor selection Hematocrit = >/=38%

Front 6

Donor selection--Pulse?

Back 6

Donor selection Pulse = Between 50-100 beats/min

Front 7

Donor selection--Wt?

Back 7

Donor selection Wt = >/=110 lbs (50 kg)

Front 8

Donor selection--Interval between whole blood donations?

Back 8

Interval between whole blood donations = 8 weeks

Front 9

Deferment time:
Surgery: did NOT receive blood products?

Back 9

Deferment for surgery (did NOT receive blood products) = Until healing is complete & donor has resumed full range of activity

Front 10

Deferment time:
Surgery: DID receive blood products?

Back 10

Deferment time for surgery (DID receive blood products) = 12 months

Front 11

Deferment time:
Conclusion of pregnancy?

Back 11

Deferment post pregnancy = 6 weeks

Front 12

Deferment time:
Tattoo?

Back 12

Deferment time for tattoo = 12 months

Front 13

Deferment time:
Visited malaria endemic area?

Back 13

Deferment time post visiting malaria area = 12 months

Front 14

Deferment time:
Recipient of human pituitary growth hormone between 1958-1986?

Back 14

Deferment time for receiving growth hormone (1958-1986) = Permanently deferred

Front 15

Deferment time:
Sexual contact with HIV high-risk?

Back 15

Deferment time for sex with HIV high-risk partner = 12 months

Front 16

Deferment time:
Chicken pox (varicella-zoster) vaccine?

Back 16

Deferment time post chicken pox = 4 weeks

Front 17

Deferment time:
Incarceration for more than 72 hours?

Back 17

Deferment time, incarceration for >72 hours = 12 months

Front 18

Deferment time:
MMR vaccine?

Back 18

Deferment time post MMR vaccine = 4 weeks

Front 19

Deferment time:
IV drug user?

Back 19

Deferment time, IV drug use =
Permenantly deferred

Front 20

What are the symptoms & first aid requirements for MILD donor reactions?

Back 20

MILD donor reactions.
Symptoms: Pallor, sweating, hyperventilation, decreased BP, nausea.

Treatment: Stop donation, loosen tight clothing, elevate feet, apply cold towel to forehead & neck. If donor does not respond quickly, call for help.

Front 21

Symptoms & first aid for MODERATE donor reactions?

Back 21

MODERATE donor reactions.
Symptoms: periods of unconsciousness, decreased pulse, decreased BP, hyperventilation

Treatment: apply smelling salts, check BP, pulse & temp until normal again. Administer Oxygen.

Front 22

Symptoms & first aid for SEVERE donor reactions?

Back 22

SEVERE donor reaction.
Symptoms: convulsions or seizures, hyperventilation, tetany (muscle spasms)

Treatment: get help, ensure adequate airway, give 95% oxygen, observe until release by BB physician.

Front 23

What processing tests must be performed on a donor unit? (Include type & disease screen)

Back 23

Tests for donor unit (+type & screen):
ABO & Rh type (including weak D)
Antibody screen & ID
Syphilis (ie RPR)
Viral testing for hepatitis, HIV, CMV & HTLV
(HB sAG, HIV-1 Ag, anti-HBc, anti-HCV, anti-HIV-1, anti-HIV-2, anti-HTLV-I/II)
Chagas' disease

Front 24

One unit of whole blood can be processed into 1-4 components. Name the components & discuss the procedure for this separation.

Back 24

Components of whole blood.
Packed RBC
FFP
Cryoprecipitate
Platelets

Front 25

Whole blood separation procedure?

Back 25

Whole blood + anticoagulant (500 mL) --> soft spin (2-3 min/3,200 rpm) = packed RBC with small amount of plasma (250 mL) & plasma/platelets.
Plasma/platelets --> hard spin (5 min/3,600 rpm) = plasma for FFP & Cryoprecipitate (200 mL) & Platelets in 50-70 mL of plasma.

Front 26

What is the maximum/minimum amount of blood drawn from a donor for collection of a whole blood unit?

Back 26

Amount of donated blood =
450 +/- 45 mL

Front 27

What is the hermetic seal? What must be done if it is broken?

Back 27

Hermetic seal.
Completely enclosed system reducing exposure to m icrobes/contaminants. If broken, the unit mmust be used within 24 hours.

Front 28

What is the expiration of blood/components when the seal is broken if :
Stored at 1-6*C?
Stored at 20-24*C?

Back 28

Expiration blood/components (broken seal)
Stored @ 1-6*C = 24 hours
Stored @ 20-24*C = 4 hours

Front 29

What are the indications for using washed RBCs?

Back 29

Washed RBC:
Febrile or allergic reaction; history of plasma protein antibodies or PNH.

Front 30

Indications for using FFP?

Back 30

FFP:
Multiple coagulation factor deficiencies or unidentified deficiency.

Front 31

Indications for using single donor plasma?

Back 31

Single donor plasma:
To treat stable clotting factor deficiencies

Front 32

Indications for using platelet concentrates-random donor & single donor?

Back 32

Platelet concentrates (random & single donor):
Thrombocytopenia

Front 33

Indications for using cryoprecipitated anti-hemophiliac factor & fibrinogen (fibrin glue)?

Back 33

Cryoprecipitated anti-hemophiliac factor & fibrinogen (fibrin glue):
Factor VIII, XIII, &/or fibrinogen deficiency

Front 34

Indications for using WBC concentrates?

Back 34

WBC concentrates:
correct severe neutropenia (<500 PMN/mL)

Front 35

Indications for using packed RBCs?

Back 35

Packed RBCs:
Restore oxygen-carrying capacity.

Front 36

Indications for using whole blood?

Back 36

Whole blood:
Major blood loss (>25% of blood volume lost); treat cardiopulmonary bypass patients intra-operatively or up to 6 hours post-surgery.

Front 37

Indications for using leukocyte poor RBC?

Back 37

Leukocyte poor RBC:
Avoid febrile reactions (reduced exposure to MHC antigens on WBC).

Front 38

Indications for using granulocyte concentrate?

Back 38

Granulocyte concentrate:
Correct severe neutropenia.

Front 39

Indications for using Factor VIII concentrate?

Back 39

Factor VIII:
Treat hemophilia A.

Front 40

Indications for using Factor IX concentrate?

Back 40

Factor IX:
Treat hemophilia B/Christmas disease

Front 41

Indications for using blood substitutes?

Back 41

Blood substitutes:
Patient's personal beliefs; examples include hgb encapsulation, SF"hS (stroma free hgb solution), PFS (perfluoro chemicals); all carry oxygen w/o using intact RBCs.

Front 42

Indications for using plasma protein fraction?

Back 42

Plasma protein fraction:
Plasma volume expansion (80-85% albumin & 15-29% globulin).

Front 43

Indications for using synthetic volume expanders?

Back 43

Synthetic volume expanders:
Plasma volume expansion (ex. normal saline, ringer's, electrolyte solution, dextran)

Front 44

Indications for using frozen RBCs?

Back 44

Frozen RBCs:
Rare blood type.

Front 45

Indications for using irradiated RBCs?

Back 45

Irradiated RBCs:
for immunocompromised patients; prevent GVHD (Graft vs. host disease).

Front 46

Shelf life & storage temp?
Washed RBC
FFP
Platelet concentrates
Cryoprecipitated anti-hemophiliac factor

Back 46

Shelf life & storage temp:
Washed RBC: 24 hrs, 1-6*C
FFP: 1 yr, frz at -18*C
24 hrs thawed at 1-6*C
Platelet concentrates: 5 days at 20-24*C w/aggitation
Cryoprecipitated anti-hemophiliac factor:
1 yr frozen, -18*C
6 hrs thawed, 20-24*C (closed system)
4 hrs poooled, 20-24*C (open system)

Front 47

Shelf life & storage temp?
WBC concentrates
Packed RBCs
Frozen, thawed & deglycerolized RBCs
Irradiated RBCs

Back 47

Shelf life & storage temp:
WBC concentrates: 24 hrs, room temp
Packed RBCs:
CPD--21 days, 1-6*C
CPDA-1---35 days, 1-6*C
CPD-AS---42 days, 1-6*C
Frozen, thawed & deglycerolized RBCs:
10 yrs frozen, -65 to -150*C
24 hrs deglycerolized, 1-6*C
Irradiated RBCs:
28 days from irradiation or original outdate, whichever is 1st, 1-6*C

Front 48

What is the cryoprotective agent for frozen RBCs?

Back 48

Cryoprotective agent for RBCs:
High amounts of glycerol (40% w/v), at -65*C
Low amounts of glycerol (14% w/v), at -15*C

Front 49

How are frozen RBC prepared for transfusion? What % of original RBCs must be recovered?

Back 49

RBC preparation for transfusion; % original RBC recovered.
Wash with decreasing concentrations of NaCl (12% NaCl, 1.6% NaCl, final wash with 0.9% NaCl & 0.2% dextrose)
80% RBCs must be recovered

Front 50

What is the optimum temp for shipping blood?

Back 50

Optimum temp for shipping blood: 1*-10*C

Front 51

What does 2,3 DPG stand for & what RBC function does it affect?

Back 51

2,3 DPG.
2,3 diphosphoglycerate
Important in the release of oxygen from Hgb.

Front 52

ATP is important for what RBC parameters?

Back 52

ATP.
Important for RBC viability & membrane integrity.

Front 53

As the donor unit ages, what changes occur:
Levels of 2,3 DPG
pH
Plasma K
Plasma Na
Cytokine levels
Changes in the oxygen disasssociation curve to compensate?

Back 53

Aging unit reactions:
2,3 DPG = Decreases
pH = Decreases
Plasma K = Increases
Plasma Na = Decreases
Cytokine levels = Increases
Changes in Oxygen disassociation curve = Shifts to right if Hgb has decreased affinity to oxygen (ex. high 2,3 DPG levels); Oxygen gets released to tissues
Shifts to left if Hgb has increased affinity to oxygen (ex. low 2,3 DPG levels); Oxygen is not released to tissues.

Front 54

When inspecting blood each day, what do you look for? What do changes suggest?

Back 54

Inspecting blood.
Check color, clots, expiration dates, leaks
May suggest bacterial contamination or tampering

Front 55

How if refrigerator temp monitored?

Back 55

Temperature monitored with
continuous recorder with an alarm system

Front 56

How can RBCs be rejuvenated after expiration date? For how long?

Back 56

Rejuvenate RBC.
PIPA (phosphate, inosine, pyruvate, adenine) can be added.
Rejuvenates RBCs for 24 hours.

Front 57

What is the average # of platelets in each bag of platelet concentrate? In an apheresis unit?

Back 57

Avg # of platelets.
In platelet concentrate = 5.5 x 10*10
In apheresis unit = 3 x 10*11

Front 58

What is the pH requirement for a unit of platelets?

Back 58

pH for platelets:
>/= 6.2

Front 59

What is an autologous unit & why would it be donated?

Back 59

Autologous.
A donation of blood reserved for the donor's own use at a later time. donated when patients will undergo a planned surgery. Requirements for autologous donors are significantly different from allogenic donors.

Front 60

Why are units irradiated?

Back 60

Irradiated.
Gamma irradiation prevents proliferation of T lymphocytes thereby preventing GVHD.

Front 61

Which coagulation factors are stable?

Back 61

Stable coag factors:
Fibrinogen (I)
Prothrombin (II)
VII
IX, X, XI, XII, XIII

Front 62

Which coagulation factors are labile?

Back 62

Labile factors:
V
VIII
von Willebrand's

Front 63

T or F
FFP is used to replace both labile & stabile coagulation factors.

Back 63

True: FFP is used to replace both labile & stable coag factors.

Front 64

How many units of Factor VIII shpould be in each bag of cryoprecipitate?

Back 64

Units of Factor VIII in each bag of cryoprecipitate:
80-150 IU

Front 65

What is the expected effect in the recipient after receiving:
1 unit of packed RBCs?
1 unit of platelets (random donor)?
1 unit of platelets (single donor by apheresis)?
1 unit of whole blood?

Back 65

Expected effect.
1 U packed RBC = Increase Hct 2-3%; Increase Hgb 1-1.5 g/dL
1 U platelets (random)=Increase count by 5,000-10,000 for each unit given
1 U platelets (single donor/apheresis)=Increase count by 30,000-60,000/unit
1 U whole blood=Increase Hct 3% & Hgb 1 g/dL

Front 66

List 4 factors removed by plasmapheresis.

Back 66

4 factors removed by plasmapheresis:
Immune complexes
Auto or alloantibodies
Inflammatory mediators
Protein-bound toxins

Front 67

What is Rh immune globulin (Rhogam, RhIgG)? How is it prepared? Why is it given to patients?

Back 67

Rh immune globulin (Rhogam, RhIgG).
Anti-D prepared from human plasma. Little to no risk of viral transmissioin. Given to a Rh neg unsensitized mother of a Rh pos baby within 72 hrs post partum or about 28 wks antenatal.

Front 68

How long do RBCs survive normally? What % of RBCs in a unit of blood should be viable in the patient 24 hrs after transfusion?

Back 68

RBC survive; % in unit viable 24 hrs after transfusion.
Life of RBC=120 days.
75% RBC survival 24 hrs after transfusion

Front 69

How fast should blood products be infused?

Back 69

Rate of infusion.
Slowly for the first 10-15 min;
the unit must be transfused w/n 4 hours

Front 70

When should blood be warmed?

Back 70

Warm blood.
Rapid or exchange transfusion
Patients with PCH or cold agglutinins reactive at 37*C

Front 71

What is a transfusion reaction?

Back 71

Transfusion reaction.
An unfavorable/adverse reaction to a transfusion.

Front 72

What causes the following transfusion complications:
Circulatory overload?
Febrile non-hemolytic reaction?
Allergic reaction?

Back 72

What causes the following transfusion complications:
Hemolytic transfusion reaction?
Anaphylactic reaction?

Front 73

Circulatory overload: excess volume
Febrile non-hemolytic reaction: Antibodies to MHC antigens located on WBCs
Allergic reactions: IgE mediated reaction

Back 73

Hemolytic transfusion reaction:
Intravascular: interaction of antibody with antigen on RBC membrane resulting in complement activation that leads to hemolysis. Seen with ABO and Kidd antibodies.
Extravascular: Incomplete complement binding or RBCs sensitized with antibodies. Cells removed by macrophages in the spleen
Anaphylactic reactions: Immediate hypersensitivity; usually anti-IgA in patient

Front 74

What other undersirable effects may transfusions have?

Back 74

Other undersirable effects:
Infections
GVHD
Pulmonary edema
Iron overload

Front 75

How long must blood samples be kept for both the donor unit & recipient past transfusion? How long must the records be kept?

Back 75

Blood samples/records kept.
Blood: at least 14 days
Records: indefinitely

Front 76

What solutions may be infused/used to dilute blood components?

Back 76

Dilute solutions.
0.9% saline or 5% albumin