Blood Bank BOC review

BOC study

Two key criteria for donor selection are the safety of:

The DONOR and the RECIPIENT , as well as the quality of the BLOOD collected.

What is the criteria a blood donor must meet?

Age: at least 17 years old

Weight: minimum 110lbs

Temp: must be below 99.5°F(37.5 C)

Pulse: 50-100 bpm

Blood pressure: 180/100

Hemoglobin: Womenat least 12.5 g/dL; Men at least 13.0 g/dL

Hematocrit: Women at least 38%; Men at least 39%

Systolic/Diastolic

Sky is above Dirt

ACD/CPD/CPD2

• Anticoagulants used in blood collection and storage

• Expiration: 21 days

CPDA-1

Anticoagulant/additive solution used in blood preservation that extends shelf life up to 35 days and includes citrate, phosphate, dextrose, and adenine.

Additive solutions

used to enhance the preservation of red blood cells in stored blood products, often containing nutrients and anticoagulants.

Expiration: 42 days

Rejuvenating solutions

• solutions added to stored red blood cells to restore 2,3-DPG and ATP levels, improving oxygen delivery and function.

• Unit can be frozen or; if used in 24 hrs can be stored at 1-6C

• Must wash cells before transfusion to remove solution

Autologous Donation

• Self-donation; no age limit

• Hct: 33%

• Hgb: 11 g/dL

• No bacteria present

• Preop collection must be labeled” for autologous use only” .

• Must be separated from other units

Low volume autologous collection

• A technique to collect smaller amounts of blood from a patient before surgery for their own use, minimizing risk and maximizing safety.

• Use regular blood bags

• Volume should be less than 10.5 mL/kg of body weight.

• If 300-404 mL drawn label as RBC low volume

• If < 300 mL drawn, use less anticoagulant

Inoperative collections

“Salvaged” blood collected during surgery, washed on-site and returned to patient during procedure to minimize blood loss and improve patient outcomes.

Cytapheresis

Separates platelets, granulocytes, and leukocytes

Donations at least 2 days apart and no more than 2 in any 7 days

If RBC can’t be returned, must wait 7 weeks

Plasmapheresis

A procedure that separates plasma from blood cells using apheresis

Plateletpheresis

A specific type of apheresis that concentrates and collects platelets from the blood while returning other components to the donor.

Leuka/Granulocytapheresis

A type of apheresis that selectively collects leukocytes or granulocytes from the blood while returning other blood components to the donor.

Hematopoietic progenitor and stem cells

• Used to reconstitute bone marrow post-chemo/irradiation or to replace abnormal marrow cells with normal marrow cells

• Obtained from bone marrow, umbilical cord blood, or peripheral blood.

• Allogenic marrow- HLA-identical match lowers GVHD risk; ABO compatibility not required

What test should be performed on donor blood?

• ABO

• Rh

• Antibody screen

• Syphillis

• Viral Diseases

Whole Blood

• Given in cases of severe shock needing rbc’s for oxygen and plasma for volume

• Rarely used due to increased use and availability of components such as red blood cells and plasma for transfusion.

RBC- Packed RBC

• Red cells with plasma removed

• Provides same oxygen carrying capacity as whole blood with less volume

• <80% Hct inidcates sufficient plasma removal; 55-65% Hct if an additive solution is used

• 1 unit raises Hgb 1g or the Hct by 3%

Washed Red Cell

• Plasma removed by successive saline washes

• Prevents allergic responses to plasma proteins and anaphylactic shock in IgA deficient patients with known IgA antibodies.

• Expires 24 hours after seal of original unit is broken

Leukocyte Reduced Red cells

• 85% of red cells retained

• Final WBC ,<5 x 10^6 to prevent febrile non-hemolytic rxn and to prevent CMV

• Preparaton by filtration preferred; washing will remove leukocytes also

• Used primarily for patients with repeated febrile nonhemolytic rxns; usually due to presence of cytokines released from white cells or alloimmunization to HLA or leukocyte antigens

Frozen Cells/ Deglycerolyzed

• Cells protected from ultra low temps by cryoprotective agent (40% glycerol)

• Must be thawed at 37C and glycerol removed prior to transfusion

• 80% of original RBCs must be recovered

• Used for storage of autologous units and “rare” units; expires in 10yrs

• Stored at < -65C; 1-6C for 24hrs after declycerolizing

Fresh Frozen Plasma(FFP)

• Prepared by seperating cells and plasma by centrifugation and freezing plasma within 8 hours of collection

• Expires 1 year from date of collection when stored at < -18C or 7 years stored at < -65C

• Once thawed( between 30-37C) expires in 24 hrs (EAMC: 5days)

• Must be ABO compatible

• Used for multiple coagulation deficiencies, Factor 11 deficiencies, and other congenital deficiencies where no other concentrate is available.

Cryoprecipitate

• When FFP frozen within 8 hrs of whole blood collection is thawed at 6 °C, a cold insoluble portion of plasma forms- CRYO

• CRYO is separated from thawed FFP and refrozen within one hour

• Must contain > 150 mg of fibrinogen and > 80 IU/bag of factor 8

• Also contains vWF, factor 13, and fibronectin

• Store at < -18 °C for 1 year from date of phelbotomy; room temperature after thawing

• Transfuse within 6 hrs of thawing; 4 hrs after pooling

What is cryoprecipitate used for?

• Fibrinogen and Factor 13 deficiencies

• Severe von Willebrand disease

• Topical fibrin sealant

• Ocassionally used for hemophilia because of Factor 8 concentrates which have little or no risk of viral infection transmission

Which retrovirus is associated with adult T-cell lymphoma/leukemia and is endemic in the Carribbean basin?

Human T-cell lymphotropic virus type I (HTLV-I)

A₁ Lectin is known as:

Dolichos biflorus

What product should be transfused to a patient who has polyagglutinable cells?

Washed RBC are given because washing the RBCs prior to transfusion removes plasma proteins; plasma from all or most adults causes agglutination of patient’s RBCs who demonstrate polyagglutinability due to specific antigen exposure.

Describe first-order exclusion in parentage testing

The presence of an antigen in a child that is not present in the mother and alleged father constitutes a first-order exclusion; a first-order exclusion exists when the child possesses a marker that is not present in either the mother or alleged father.

Why are antibodies to high frequency antigens rarely seen in patient samples?

The vast majority of population (i.e., > 98%) expresses high-frequency antigens on their RBCs. Therefore, only a small percentage of the population (i.e., individuals negative for the high-frequency antigen) can produce an antibody to a high-frequency antigen.

What is given to Rh-negative patients that have been given Rh-positive RBCs?

Rh immunoglobulin (RhIg) is administered to Rh-negative patients who have been exposed to Rh-positive RBCs to prevent the development of antibodies against Rh-positive antigens.

People who are Fy(a-b-) are resistant to infection by what organism?

The organism Plasmodium vivax, which causes malaria, as Fy(a-b-) individuals lack the receptor for the parasite on their red blood cells.

What is the criteria for mothers to be considered for Rh-immune globulin?

Mothers must be Rh-negative and have delivered an Rh-positive infant or have experienced any event that may cause fetal blood to enter the mother's circulation. Additionally, they should not have pre-existing anti-Rh antibodies.

In the drug-dependent mechanism where the antibody is reactive with drug-treated red cells, what causes the positive DAT?

IgG antibodies bind to the drug-modified red blood cell surface, causing agglutination and a positive direct antiglobulin test (DAT).

When is additive solution(AS) added to RBCs?

After plasma has been removed

Anti-D is what type of antibody?

IgG antibody that reacts with the D antigen on red blood cells.

Term used to describe an antibody reaction that is stronger with homozygous cells than heterozygous cells?

Dosage effect

Universal plasma donor

is a person with type AB plasma, which can be given to any patient regardless of their blood type.

Test that are required for pretransfusion testing?

Includes ABO/Rh typing, antibody screening, and crossmatching.

Which test detects in vivo sensitization of RBCs

This test is known as the Direct Antiglobulin Test (DAT).

Anti-H reacts best with which blood group?

The Anti-H antibody reacts best with the O blood group as it expresses the most H antigen