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79 Cards in this Set

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Medical terminology & units of measure to report test results *review*

*review*

Laboratory safety practices & appropriate responses to any unsafe situation in accordance with established policies to minimize harm and danger to self and others *review*

*review*

Blood banking and transfusion medicine practices (protocols), basic lab skills, and values that can be applied *case studies*

*case studies*

Patient ID

Donor phlebotomy



Sample collection

Preanalytic/analytic/postanalytic errors


Whole blood - Indications & anticipated therapeutic effects of transfusion



Indications:


-actively bleeding pts & those who have lost greater than 25% blood

RBCs - Indications & anticipated therapeutic effects of transfusion


PLTs - Indications & anticipated therapeutic effects of transfusion

 


Plasma - Indications & anticipated therapeutic effects of transfusion


Cyroprecipitate - Indications & anticipated therapeutic effects of transfusion


Defend the rational for pre-donation screening

enhance safety for the blood recipient and the blood donor

PRBC prep

-leuko-reduction


-washed


-pooled

FFP prep

plasma that is removed from a donor, separated, and placed in freezer w/in 8 h of collection (or 6 h, ifACD is the anticoagulant/preservative)

PLT prep

-leuko-reduction


-washed


-pooled

Cryoprecipitate prep

-thawed FFP @ refrigerated T


--if pooled using closed system, once thawed, use w/in 6 h


--if pooled using open system, once thawed, use w/in 4 h

Use of leuko-reduction (LR) of both RBCs & PLTs



-neonates


-transplant recipients


-pts w/ history of FNHTRs

Use of irradiation

To prevent Transfusion Associated Graft vs Host Disease (TV-GVHD) (gamma irradiation prevents T cell proliferation)


-fetal & neonatal recipients


-immunocomp pts


-recipients of blood components from blood relative


-marrow, stem cell transplant recipient


-recipients receiving HLA-matched donor components

Use of cryoprecipitate

*cold insoluble ppt containing FI, FVIII, FXIII, vWF & fibronectin


-bleeding associated w/ FI deficiency (<100 mg/dL) &/or FXIII deficiency, & volume issues prevent use of FFP


-2nd line therapy for severe vWD & hemophilia A



Use of RBC & platelet washing

RBCs:


-IgA deficient pts


-neonates


-fetus (intrauterine transfusion)


PLTs:


-IgA deficient pts


-pts w/ severe life threatening plasma allergies uncontrollable w/ meds

Use of red cell rejuvenation

*soln containing phosphate, pyruvate, inosine & adenine


-to restore 2,3-DPG and ATP levels in RBCs collected in CPD or CPDA-1 during storage or w/in 3 days after expiration, extends freezing exp date (longer than a yr), extends transfusion date

Blood typing



-classification of blood based on presence or absence of Ags on surface of RBCs

Detection and ID of antibodies

-Screen: detects Ab to Ag resulting from exposure to red cells through transfusion & pregnancy


-ID: determines Ab specificity for Ab or Abs detected in Ab screen

Compatibility testing

-detect unexpected Abs in the pt/ prevent transfusion rxn (2nd check of Ab screen)


-establish ABO comp between pt & blood products/ maximize in vivo RBC survival (2nd check of ABO errors)

Quality control in BB

-to determine whether analytical phase of testing is working properly

Rationalize additional testing of samples in cases of incomplete antibody workups




Anti-A,B (non-routine) use



used for O donor units

Antiglobulin (AHG) mechanism & use

cross-links IgG sensitized RBCs

Bovine serum albumin (BSA) mechanism & use

reduces zeta potential & membrane hydration

Low ionic strength saline (LISS) mechanism & use

lowers ionic strength, incr rate of Ab uptake

Polyethylene glycol (PEG) mechanism & use

lowers ionic strength, enhance Ab uptake, concentrates Ab

Proteolytic enzymes: papain, ficin & bromealin mechanism & use

reduces RBC zeta potential by removing neg charges; destroys some RBC Ag

Dolichos biflorusmechanism

binds A1 Ag

Ulex europaeus

binds H Ag

Vicia graminea

binds N Ag

Iberis amara

binds M Ag

Massive transfusion - need for and/or type of compatibility testing req & recommend steps



-T&S


-XM (O, Rh neg when XM not done)

Autologous blood transfusion - need for and/or type of compatibility testing req & recommend steps

-ABO & Rh only


-Infectious disease testing ONLY IF transfused outside collection facility (may transfuse viral positive blood w/ permissions)

Red cell transfusion of infant less than 4 mo - need for and/or type of compatibility testing req & recommend steps

-ABO (no reverse type-no production of Ab) & Rh only


-Ab screen: if pos=give Ag neg blood or IAT XM-compatible blood; if neg=NO XM as long as O RBCs are transfused


-If a non-group O neonate is to receive non-group O RBCs NOT comp w/ maternal ABO group, neonate's serum/plasma is tested for anti-A or anti-B

Non-red cell products - need for and/or type of compatibility testing req & recommend steps

-Plasma: not usually XM (unless sig RBCs in plasma/PLTs)


-PLTs: not usually XM

ABO compatibilities for WB, RBCs & Plasma/PLT transfusions



-PRBCs: same ABO/Rh type otherwise compatible 
-Rh-neg to Rh-neg (exceptions, not clin sig: anti-A1, anti-P1, anti-Lu^a, anti-M or anti-N)

-PRBCs: same ABO/Rh type otherwise compatible


-Rh-neg to Rh-neg (exceptions, not clin sig: anti-A1, anti-P1, anti-Lu^a, anti-M or anti-N)

Priority of blood products in a massive transfusion & in cases of limited blood and blood product supplies


Analyze topic-related case studies and propose valid solutions (Look @ examples)

(Look @ examples)

Dosage blood group systems

-Duffy


-Kidd


-Rh


-MNS

Incr w/ enzymes

"Lewis P is a Rhotten Kidd"


-Le, P, Rh, Kidd





Decr w/ enzymes

-Duffy


-MNSs (S & s variable)

Unaffected or variable w/ enzymes

-Kell


-Lutheran

Cold-reacting (IgM) Abs

"LIPMaN"


-Le, I/i, P1, M, N

Warm-reacting (IgG) Abs

-S, s, U, K, k, Jk^a, Jk^b, Fy^a, Fy^b, P, PP1Pk, Lu^b, D, C, c, E, e




(ABO, Rh, Kell, Kidd, Duffy, S, s, U, Lu^b)

Low prevalence Ags

Exceptions to homozygous rule K, Kp^a, Js^a, Lu^a, also F, V, Cw, Wr^a, Co^b, Xg^a unlikely Ab

ABO discrepancy - sample problem: Red cell testing (forward grouping)

-extra Ags (polyagglut, rouleaux, Whorton's jelly)


-missing weak Ags


-M-F rxns

ABO discrepancy - sample problem: plasma/serum testing

-extra Abs


-missing/weak Abs


-M-F rxns

ABO discrepancy - extra Ags: acquired B phenomenon

ABO discrepancy - extra Ags: science of acquired B Phenomenon



ABO discrepancy - extra Ags: resolving acquired B Phenomenon

ABO discrepancy - extra Ags: B(A) phenomenon

ABO discrepancy - extra Ags: science of B(A) Phenomenon

ABO discrepancy - extra Ags: resolving B(A) Phenomenon

ABO discrepancy - extra Ags: other reasons

ABO discrepancy - missing/weak Ag

ABO discrepancy - extra Ags: science of subgroups of A or B

ABO discrepancy - resolving missing/weak Ag subgroups

ABO discrepancy - MF rxns



ABO discrepancy - science of MF rxns

ABO discrepancy - resolving MF rxns

ABO discrepancy - extra Abs

ABO discrepancy - Anti-A1in A2 or A2BPerson



ABO discrepancy - science of Anti-A1

ABO discrepancy - resolving Anti-A1

ABO discrepancy - cold Abs



ABO discrepancy - science of cold Abs



ABO discrepancy - resolving cold allo/auto-Abs



ABO discrepancy - rouleaux



ABO discrepancy - science of rouleaux



ABO discrepancy - resolving rouleaux



ABO discrepancy - missing or weak Abs



ABO discrepancy - science of missing or weak Abs



ABO discrepancy - resolving missing or weak Abs