DENISE Key Concepts in Blood Banking and Immunology

Maximum blood volume from donor

525 mL from a 110-lb donor.

Shift to the left in RBCs

Increased hemoglobin affinity due to decreased 2,3-DPG.

Loss of ATP in RBCs

Decreased spectrin phosphorylation, reduced membrane deformability.

CPDA-1

Anticoagulant for 35 days storage at 1-6°C.

Role of platelets

Maintain vascular integrity and initial bleeding arrest.

Platelet storage time

5 days at 20-24°C with continuous agitation.

Total platelet count requirement

Minimum 5.5 x 10^10 in platelet concentrate.

Platelet storage without agitation

Up to 24 hours during 5-day storage.

Frozen platelets storage duration

Up to 2 years for autologous transfusions.

Minimum platelets in apheresis

3 x 10^11 in apheresis component.

RBC storage temperature

1-6°C for whole blood and RBC units.

Additive solutions for RBCs

Allow 42 days storage for red blood cells.

FDA RBC survival criterion

Average 24-hour post-transfusion survival over 75%.

Lowest allowable pH for platelets

pH 6.2 at outdate.

Frozen RBCs storage in open system

Stored for 24 hours after thawing.

Disadvantage of stroma-free hemoglobin

High oxygen affinity limits effectiveness.

Hemoglobin sources for carriers

Bovine and human hemoglobins in clinical testing.

Bacterial contamination cause in platelets

Skin plugs entering the collection bag.

B lymphocytes function

Characterized by presence of immunoglobulins.

Plasma cells role

Involved in antibody production.

T lymphocytes function

Recognize antigens post-phagocytosis.

Cytokines

Regulate and duration of immune response.

Macrophage function

Primarily processes and presents antigens.

IgM

Immunoglobulin produced in primary immune response.

IgG

Immunoglobulins produced in secondary immune response.

IgG1

IgG subclass most efficient at crossing placenta.

IgG3

IgG subclass most efficient at complement activation.

MHC Class II

MHC class found on antigen presenting cells.

MHC Class III

MHC class encodes complement components.

Fc region

Heavy chain constant region with complement binding sites.

Classical pathway

Complement pathway activated by Ag-Ab complexes.

Recognition unit

Key component in classical complement pathway.

Membrane attack complex

C5b, C6, C7, C8, C9 in complement pathway.

HDFN

Hemolytic disease of fetus and newborn caused by IgG.

TED antibodies

Antibodies formed to blood group antigens.

Postzone

Excess antigen present in a test system.

Prozone

Excess antibody present in a test system.

Zone of equivalence

State of equilibrium in antigen-antibody reactions.

Isotype

Ability to cross placenta, varies by class.

Opsonins

Molecules promoting uptake of bacteria for phagocytosis.

Epitope

Unique confirmation of antigen recognized by antibody.

Zeta potential

Net negative charge surrounding red blood cells.

AHG reagent

Crosslinks sensitized red cells with antibody or complement.

Monoclonal antibodies

Develop from single B cell clone targeting one epitope.

Type IV reaction

Graft-versus-host reaction in immunocompromised patients.

Autoantibodies

Interfere with detection of clinically significant antibodies.

Cryoprecipitate

Prepared from controlled thawing of FFP.

AHF concentrates

Used to treat Hemophilia A.

Prothrombin complex

Contains factors II, VII, IX, and X deficiencies.

Leukoreduced RBCs

Must contain less than 5x10^6 WBCs.

Platelet concentrates

Prepared by apheresis, should contain 3x10^11 platelets.

RDP leukocyte limit

Must contain < 8.3x10^5 leukocytes.

Pooled RDP leukocyte count

Final product must have < 5x10^6 leukocytes.

Leukoreduced SDP limit

Must contain < 5x10^6 leukocytes in 95% units.

FFP volume

Single unit contains 150 to 250 mL of plasma.

Cryoprecipitate transfusion time

Must be transfused within 4 hours.

Blood processing time

Must occur within 6 to 8 hours.

Leukocyte-reduced filters

Reduce risk of CMV infection and HLA alloimmunization.

Leukocyte-reduced filters exception

Do not prevent TA-GVHD.

Albumin use

Indicated for burns and shock treatment.

Albumin contraindication

Not for nutritional purposes.

Blood type for emergencies

Group O is used when matching is delayed.

RBC transfusion time

Should be administered within 4 hours.

Irradiation requirement

Bone marrow transplant requires irradiated blood components.

Anemia treatment for transplant patients

Irradiated RBCs are appropriate for anemia.

Vitamin K deficiency treatment

Plasma is selected for treatment.

RBC dilution fluid

Use only isotonic saline or 5% albumin.

Common apheresis anticoagulant

ACD (citrate) is most frequently used.

Therapeutic cytapheresis role

Primary treatment for sickle cell chest syndrome.

Plateletpheresis interval

Minimum interval is 2 days between collections.

Plasma exchange effectiveness

Greatest with the first plasma volume removed.

Replacement fluid for TTP

Fresh Frozen Plasma (FFP) is indicated.

Adverse effect of plateletpheresis

Citrate effect is most common.

Apheresis anticoagulant function

Binds calcium ions during blood removal.

Peripheral blood stem cells

Pluripotential hematopoietic precursors in circulation.

Granulocyte increase for donors

G-CSF can be administered to increase granulocytes.

Macrophage collection limitation

Apheresis cannot collect macrophages.

Continuous-flow centrifugation advantage

Lower extracorporeal volume compared to IFC.

Platelet shelf-life

Platelets in apheresis have a 5-day shelf-life.

Transfusion-associated sepsis component

Platelets are most frequently involved.

Fatal transfusion reactions cause

Mostly caused by clerical errors.

Acute hemolytic reaction confusion

Can be confused with febrile nonhemolytic reaction.

Acute hemolytic reaction symptoms

Pain at infusion site and hypotension observed.

Irradiation purpose

Prevents transfusion-associated graft-versus-host disease.

Delayed hemolytic reaction sign

Unexplained decrease in hemoglobin is common.

Transfusion-associated GVHD symptoms

Presents with fever, rash, diarrhea, and pancytopenia.

Nonimmune hemolysis causes

Can occur from infusion pump or blood warmer.

Transfusion reaction classification

Based on signs or symptoms during or after transfusion.

Mild allergic reaction treatment

Stop transfusion, administer antihistamines, then restart.

Iron overload characteristic

Delayed complication requiring chelating agents.

Immediate allergic reaction symptoms

Erythema, itching, and hives after plasma transfusion.

Urticaria etiology

Most likely due to plasma proteins.

RBC alloimmunization triggers

Results from pregnancy and transfusions.

TACO risk patients

Children, elderly, and chronic anemia patients.

Anaphylactic reaction association

Most common in patients lacking IgA.

Rapid transfusion reaction

Termed 'warm', may cause fever or shock.

Bacterial contamination sources

Can occur during phlebotomy or component preparation.

Hemolytic Reaction

Stop transfusion but keep IV line open.

Febrile Nonhemolytic Reaction

Temperature rise of 1°C during transfusion.

Leukoagglutinins

Cause of febrile nonhemolytic transfusion reactions.