Exam 3 Cram

What is whole blood usually used for?

Trauma

● Maximum degrees blood can be stored

6c

● How long can blood be stored when preserved with CPDA-1?

35 days

● How long can blood be stored when preserved with CPD?

21 days

● What is CPDA?

Citrate phosphate dextrose adenine

● What qualifies frozen plasma as being fresh?

○ Frozen within 8 hours (We have 24 hours until disposal)

● How long is FFP good for after being thawed?

○ 24 hours

● How many donor samples for pooled cryoprecipitate?

○ 5 donor samples

● How long does cryo remain good once thawed?

○ 4-6 hours

● How many donor samples have to be pooled to make a whole unit of PLTs?

○ 6 donor units

● How many doses can we get from apheresis?

○ 3 doses

● How long can PLTs be stored for at room temperature

○ 5 days

● What does irradiation do?

○ Inactivate WBCs

● What is the purpose of irradiation? (2)

Preventing donor WBCs from attacking patient cells

○ Prevent GVHD

● How can pathogens be reduced (PLT sample) (3)

○ Photosensitizer

○ Amotosalen

○ UV light

● What is the purpose of pathogen-reduced PLTs?

○ Inactivate bacteria and viruses

● When should PLTs be pathogen-reduced? (2)

Prevent GVHD

○ Prevent CMV transmission

● Patients at risk for CMV (4)

○ Underweight newborns

○ Intrauterine transfusions

○ Transplant recipients

○ Immune-compromised patient

Whole blood good for trauma

Low titer whole blood

Plasma good for trauma

Group A thawed

● What is low-titer whole blood?

○ Whole blood with a titer of anti-A and anti-B below 200

● When are cold stored PLTs used?

○ Actively bleeding patient

● What are some diseases that can’t be tested for that we ask about? (3)

○ Ebola

○ Malaria

○ CJD

● What are the two kinds of tests we do for donor testing? (2)

○ Antibody tests

○ Nucleic acid testing

● What are the diseases we look for in antibody donor testing? (4)

○ HIV

○ Hep C

○ HTLV

○ Hep B

● What are the diseases we look for in nucleic acid testing? (5)

○ Hep B virus

○ HCV

○ HIV-1

○ West nile virus

○ Zika virus

● What are the two things every unit is test for? (2)

○ Hep B surface antigen

○ Serologic testing for syphilis

● 3 most common causes of death from blood transfusion (3)

○ TRALI

○ TACO

○ ABO incompatibility

● Acute reactions with fever (4)

○ Acute hemolytic reaction

○ Febrile nonhemolytic

○ Transfusion-related sepsis

○ TRALI

● What is the cause of an acute hemolytic TR usually?

○ ABO incompatible blood due to a clerical error

● What is a symptom of acute hemolytic TR?

○ Hemoglobinuria

● How common is a febrile nonhemolytic reaction?

○ The most common cause of acute reaction that results in fever

● What is the cause of febrile nonhemolytic reactions? (2)

○ HLA antibody in the donor

○ Accumulated cytokines in the bag

● How can we prevent febrile nonhemolytic reactions?

○ Leukocyte reduction of blood products

● Acute reactions without fever (3)

○ Allergic response

○ Hypotensive

○ TACO

● TACO vs TRALI

TACO - Elevated BNP, hypertensive, no fever, less severe

TRALI - Normal BNP, hypotensive, fever, more severe

● When does anaphylactic transfusion reactions happen?

○ When a patient has very little IgA and produces Ab to IgA

● Delayed reactions with fever (3)

○ Delayed hemolytic reaction

○ Delayed serologic

○ TA-GVHD

● What causes delayed hemolytic reactions?

○ Antibody in the blood that was missed during the antibody detection test

● How soon do delayed hemolytic reactions take place?

○ 5-7 days after the transfusion

● How does GVHD work?

○ WBC from donor attack the recipient

● Delayed reactions without fever (3)

○ Delayed serologic

○ Post transfusion purpura

○ Iron overload

● What is post transfusion purpura?

○ PLT antibody destroys a patient's PLTs, leading to severe thrombocytopenia 5-10 days after transfusion

● How does iron overload happen?

○ When someone is chronically transfused

● How many units is equivalent to a patients blood volume?

○ 10 units

● AIHA DAT

○ Pos or neg

● What are the two kinds of alloantibody-induced hemolytic anemias? (2)

○ HTR

○ HDFN

● What are the kinds of autoimmune hemolytic anemias? (4)

○ WAIHA

○ Cold agglutinin syndrome (CHD)

○ PCH

○ Atypical

● Primary cause of WAIHA

○ Ideopathic

● Treatment for WAIHA (4)

○ Avoid transfusion

○ Steroids

○ Splenectomy

○ Rituximab

● CHD predisposing factors (3)

○ Lymphoproliferative disorder

○ Mycoplasma pneumoniae infection

○ Infectious mononucleosis

● Mycoplasma pneumoniae is associated with this Ab

○ Big I

● Infectious mononucleosis is associated with this Ab

○ Little i

● What antibody is most associated with CHD?

○ Anti-I

● CHD is associated with this type of hemolysis

○ Intravascular

● What DAT is positive in PCH

○ C3d only

● Mechanism of PCH (2)

○ Binds at <37

○ RBC lyse at 37

● How do we differ DAIHA from other kinds of AIHA

○ Eluate is negative

● How does DAIHA function

○ Drug binds and creates and epitope that is seen as foreign by the body

● What happens in NIPA

○ Drug cause the RBC to become sticky

● When do we need to release blood products immediately? (3)

○ Trauma

○ GI bleeding

○ Obstetrical hemorrhage

● Definition of MTP

○ An algorithm of release of large volumes of blood products for patients who are actively bleeding out

● First sequence for MTP (2)

○ 2 units RBC

○ 2 units plasma

● Second sequence for MTP (2)

○ 3 units RBC

○ 3 units plasma

● Third sequence for MTP (4)

○ 3 units RBC

○ 3 units plasma

○ 1 unit PLT

○ 1 pool of 5 donors of cryoprecipitate

● If someone continues massive bleeding what do we do?

○ Continue second and third steps of MTP until it is stopped

● What do we do if someone is going through the third sequence multiple times

○ Test every other sequence until MTP is deactivated

● What is moder/ new way of prescribing whole blood?

○ Low titer group O whole blood

● What is the max we can give of group O whole blood without having ABO typed?

○ 2-4 units

○ How does the cold temp PLT function?

■ Faster normalization of bleeding time

○ How does room temp affect platelet function?

■ Slow return to normal function

○ What does post transfusion survival of the PLT look like in the body when cold?

■ 1-2 day half life

○ What does post transfusion survival of the PLT look like in the body when room temp?

■ 7-9 day half life

○ What is the risk for large volume incompatible plasma transfusions?

■ Passive anti-B may cause positive DAT, ABO discrepancies, and slight hemolysis

● How many mL of blood can we use per one kg that a person weighs

○ 10.5 mL/kg

● Required female hct and hgb

○ >38%

○ 12.5 g/dl

● Required male hct and hgb

○ >39%

○ 13 g/dl

● Required systolic BP

○ 90-180 mmHg

● Required diastolic BP

○ 50-100 mmHg

● Max temp

○ 99.5 F

○ 37.5 C

● Donation interval for whole blood

○ 8 weeks

● Donation interval for 2 units of red cells

○ 16 weeks

● Donation interval for plasma, single PLT, and leukapheresis

○ >2 days

● Donation interval for double or triple PLT pheresis

○ >7 days

● How long after pregnancy can someone donate?

○ 6 weeks

● How long after transfusion or transplant can someone donate?

○ 12 months

● Which vaccinations are 2 weeks (5)

○ Measles

○ Mumps

○ Polio

○ Typhoid

○ Yellow fever

● Which vaccinations wait 4 weeks? (3)

○ German measles

○ Chickenpox/ shingles

○ Chikungunya

● Deferal for someone who has had sexual relations with someone with hepatitis

○ 12 months

● Deferal for incarceration >72 hours

○ 12 months

● Deferal babesia

2 years

● Deferal of multiple sex partners and anal

○ 3 months

● Tests I forget when testing donors (5)

○ West nile

○ T. cruzi

○ Babesia

○ CMV

○ HTLV

● How often do we test T. cruzi?

○ Only once

● How often is CMV tested for?

○ Only some donors

● How do we make something safe from CMV

○ Leukocyte reduction