Blood Bank Rotation Week 4

State the acceptable limits for blood donation.

Weight:

Blood pessure:

Temperature:

Hematocrit:

Pulse:

Interval between donations:

Weight: 110 lbs

Blood pessure: <180/100 mmHg

Temperature: <37.5C or <99.5F

Hematocrit: 38%

Pulse: 50-100 bpm

Interval between donations: 8 weeks

What is the acceptable Hematocrit limit for an autologous blood donor?

33%

NAT testing on donor units is done for which viruses?

HIV, WNV, HCV

A directed donor unit going to a relative must be irradiated. Why?

To prevent Graft vs Host Disease (GVHD).

What is the deferral time for live vaccination of smallpox, measles, mumps, yellow fever, and influenza?

2 weeks

What is the deferral time for attenuated vaccination of German measles (rubella) and chickenpox?

4 weeks

What is the deferral time for STS syphilis?

12 months after therapy completion

What is the deferral time for an individual treated for malaria?

3 years

What is the deferral time for an individual with a history of hepatitis or confirmed HBsAg after their 11th birthday?

Permanent

What is the deferral time for tattoos?

12 months

List the testing done for donor units.

-ABO/Rh, weak D, Ab screen

-HBsAg and Anti-HBc

-Anti-HCV and HCV RNA

-Anti-HIV-1 and -2; NAT for HIV

-WNV RNA

-Anti-HTLV-1 and -2

-Serological test for Syphilis

1 unit of packed red blood cells will raise Hemoglobin by _____ g/dL following transfusion.

1 g/dL

What are the storage requirements and indications for transfusion for:

Packed red blood cells

Store 35 days at 1-6C

With ADSOL, store 42 days at 1-6C

Use for volume expansion and to increase O2.

What are the storage requirements and indications for transfusion for:

Irradiated red blood cells

Store 28 days at 1-6C

Use to prevent GVHD, increase O2, volume expansion.

What are the storage requirements and indications for transfusion for:

Fresh frozen plasma

Store 1 year at -18C

Use for coagulation deficiency, liver disease, DIC, or massive transfusion.

What are the storage requirements and indications for transfusion for:

Cryoprecipitate

Store 1 year at -18C

Thawed: 6 hours, Pooled: 4 hours

Use for Hemophilia A, VWD, Factor XIII deficiency, and as a fibrin sealant.

What are the storage requirements and indications for transfusion for:

Platelets

Store 5 days at 20-24C

Use for bleeding, thrombocytopenia, and DIC.

What are the storage requirements and indications for transfusion for:

Albumin (NSA)

Store 5 years at 2-10C

Use for hypovolemia and hypoproteinemia.

What are the storage requirements and indications for transfusion for:

Factor VIII concentrate

Store at 1-6C

Use for Hemophilia A.

When RBCs are stored, what happen to 2,3-DPG and potassium levels?

2,3-DPG decreases; Potassium increases

Indicate 2 conditions in which the patient needs washed RBCs for transfusion.

1) IgA deficiency

2) Paroxysmal Nocturnal Hemoglobinuria

When would transfusion of whole blood be beneficial?

When would it be contraindicated?

Beneficial for massive transfusion (patient needs both RBCs and plasma).

Contraindicated for chronic anemia. Patient compensates low RBC count with plasma, therefore additional plasma is not needed.

At what hemoglobin "trigger" level is a transfusion needed in a patient without known disease?

What is the trigger level for a patient with heart, lung, or cerebral vascular disease?

Patient without disease: Hb <6 g/dL

Patient with disease: Hb 7-8 g/dL

List 3 conditions that are prevented by the use of leuko-depleted RBCs.

1) Febrile nonhemolytic transfusion reaction

2) Transfusion associated GVHD

3) Transfusion related immune suppression

What is the blood component of choice for treating a patient with multiple coagulation factor deficiencies?

Fresh frozen plasma

When a patient's 1 hour post-platelet transfusion count is corrected to his body surface area and yields a result less than _______ platelets/uL, it indicates refractoriness to platelet transfusion.

<5000/uL

Define massive transfusion.

Massive transfusion:

The replacement of one or more blood volumes within 24 hours, OR approximately 10 units of blood in an adult.

Leukocyte reduced RBCs are the component of choice for a patient who repeatedly experiences which type of transfusion reaction?

Febrile Nonhemolytic

Why should blood used in a neonatal transfusion be <7 days old?

To prevent hyperkalemia and maximize levels of 2,3-DPG (which the baby is unable to replenish).

What is the component of choice for transfusion to treat a patient with Factor I deficiency?

Cryoprecipitate

(Factor I = Fibrinogen)

A premature baby weighing 1100g needs transfusion to treat anemia and hypoxia. What specifications need to be considered when choosing blood units?

- <7 days old

- CMV negative

- HbS negative

- Irradiated

- Compatible with maternal Abs

Name 3 things Cryoprecipitate is used to treat.

1) Hemophilia A

2) VWD

3) Factor XIII deficiency

Donor units are screened for which virus via ELISA and Western Blot?

West Nile Virus

Test via ELISA x2. Confirm with Western Blot.

List 3 transfusion associated Protozoan parasites in which blood donors may be asymptomatic.

1) Babesia microti

2) Trypanosoma cruzi

3) Plasmodium spp.

What test is currently used to reduce the window period in HIV infection by detecting the virus earlier than other available tests?

HIV-RNA by NAT

List 4 types of patients that should receive CMV-negative blood.

1) Pregnant women who are CMV-neg

2) Premature infants weighing <1200g

3) Immunocompromised CMV-neg patients

4) Allogeneic CMV-neg bone marrow and hematopoietic progenitor cell transplant recipients

What test are routinely performed on donor blood to prevent transmission of transfusion-associated Hepatitis?

Hepatitis B:

HBsAg & Anti-HBc

Hepatitis C:

Anti-HCV & HCV-RNA

ALT was formerly a blood donor test, but it has been discontinued. What did it test for?

Previously used to test for non-A and non-B Hepatitis.

What is the time interval required between whole blood donations?

8 weeks

What are the minimum levels of Hemoglobin and Hematocrit acceptable for autologous blood donation?

Hemoglobin: 11 g/dL

Hematocrit: 33%

What is the shelf life of a washed RBC unit?

24 hours

What is the shelf life of platelets after pooling (open system)? in a closed system?

4 hours; in a closed system it would be 5-7 days

What is the time interval schedule that must be followed for preoperative autologous donation of blood?

Time between donations doesn't matter, BUT the last donation must be made at least 72 hours prior to surgery.

What are the minimum acceptable levels of Hemoglobin and Hematocrit for an allogeneic blood donor?

Hemoglobin: 12.5 g/dL

Hematocrit: 38%

Which methods are used for measurement of hemoglobin in blood donors?

Copper sulfate or POCT instruments using spectrophotometric methods

Why are individuals who have received injections of human pituitary growth hormone permanently deferred from blood donation?

Some individuals who took this hormone developed Creutzfeldt-Jakob Disease (CJD).

What actions should be taken when a blood donor faints upon initiation of blood collection?

Remove tourniquet and needle, put a cold compress on their head, raise legs above their head, loosen any tight garments, and monitor vital signs.

For preparation of platelet concentrate, blood donors should refrain from taking aspirin _____ hours before donation. Why is this?

48 hours.

Aspirin interferes with platelet adhesion.

FFP from which ABO group can be transfused into any individual?

AB

What is the shelf life of RBCs prepared in CPDA-1?

Is Adsol is added?

CPDA-1 = 35 days

Adsol = 42 days

In the preparation of RBCs from donor blood, the resulting hematocrit value of the RBC unit must be between what percentage?

70-80%

When preparing platelet concentrates, the platelets must be separated from the donor blood within ___ hours of blood collection.

4 hours

What is the minimum platelet count per bag for a:

Random donor concentrate?

Single donor concentrate?

Random donor = 5.5 x 10^10

Single donor = 3 x 10^11

What minimum pH is required for platelet concentrate?

>6.2

Blood collected via intra-operative salvage device and stored between 1-6C must be used within ___ hours.

24 hours

Blood collected via intra-operative salvage device and stored at room temperature must be used within ___ hours.

6 hours

Plasma to be used for FFP must be separated from RBCs and frozen within ___ hours from the time of phlebotomy.

8 hours

FFP can be stored for ___ years at -65C.

7 years

Plasma to be prepared for Cryoprecipitate is frozen at a temperature of ___ and then allowed to thaw at a temperature of ___ for 18-24 hours.

frozen at -18C

thawed at 1-6C

Differentiate liquid plasma from FFP.

Liquid plasma has poorly characterized coagulation factors and is mainly used for volume supplementation with RBCs.

Leuko-reduced RBC products have an absolute WBC count below _______ per unit and must have ____% original RBC mass.

< 5 million WBCs

85% original RBC mass

What is the major advantage of pre-storage leuko-reduction over post-storage leuko-reduction?

Post-storage lueko-reduction will not prevent reactions caused by BRMs that originate from leukocytes present in the component during storage (such as complement and cytokines).

List 5 possible adverse effects that are associated with leukocytes in transfused blood.

1) Febrile nonhemolytic transfusion reaction

2) TRALI

3) EBV transmission

4) CMV transmission

5) T-cell lymphotrophic virus transmission

A plateletpheresis donor should refrain from taking aspirin for ___ hours.

48 hours.

Frozen, deglycerolized and washed RBCs may be the choice product in certain patient conditions. Name 3.

1) Rare phenotype

2) IgA deficiency

3) PNH

Frozen, deglycerolized RBCs have a shelf life of ____.

10 years.

What is the storage temperature for granulocytes?

20-24C (RT)

What does SAGM stand for?

Saline, adenine, glucose, mannitol

Prior to use, cryoprecipitate should be thawed at what temperature? It should then be stored at what temp?

thaw at 37C, then store at RT

State the shelf life of:

Frozen cryo

Thawed cryo

Pooled cryo

Frozen cryo: 1 year at -18C

Thawed cryo: 6 hours

Pooled cryo: 4 hours

Cyroprecipitate contains how many units of Factor VIII?

80 units

What is meant by a "shift to the left" in the oxygen dissociation curve of hemoglobin?

Hemoglobin has an increased O2 affinity (doesn't want to release oxygen) due to decreased 2,3-DPG.