IMH Exam 5 Review

Donor Selection - Malaria

* Deferrals:
* History of Malaria: 3 years
* Lived in endemic country: 3 years
* Travel to endemic area: 12 months
* ==(Update 3 months)==

Donor Selection - Babesiosis

* Deferrals:
* History of Babesiosis- indefinite deferral
* ==Update: 2 year==

Donor Selection - Chagas Disease

History of Chagas’ disease - indefinite deferral

Donor Selection - vCJD

Geographic deferrals ==removed (update)==

Donor Selection - CJD

* Deferrals:
* Pituitary-derived growth hormone, dura mater transplant, blood relatives with CJD - indefinite deferral

Donor Selection - Zika

* 4 week deferral

Donor Selection - Babesiosis

* Deferral: 2 years

12 month deferral

* Hepatitis B IgG
* Tattoo/piercing
* Exposure to blood
* Sexual contact with a person at high risk for HIV
* Imprisonment >72 hours
* Return from a malarial endemic area
* Post-blood transfusion

1 month deferral

* Accutane use
* Propecia use

3 year deferral

* Malarial infection

48 hour deferral

* Aspirin and aspirin-containing drugs

Permanent deferral - Positive HBsAg

Human pituitary growth hormone injection

Permanent deferral - Positive HBc

Taken clotting factors

Permanent deferral - Positive HTLV

Sexual contact with anyone who used a needle to take illegal drugs

Permanent deferral - History of CJD

AIDS/ or HIV positive

Permanent deferral - History of Chagas’ or babesiosis

Males having sex with other males ==(Update: 3 months from last sexual contact)==

Permanent deferral

Had viral hepatitis

Donor criteria - minimum Hgb requirement

12\.5 g/dL

Donor criteria - minimum Hct requirement

38%

Donor criteria - Age

≥ 16 years of age

Donor criteria - Temperature

Donor criteria - Blood pressure

< 180/100

Donor criteria - Pulse

50-100 bpm

Donor criteria - Weight

110 lbs

Weight Exception - Autologous Donation

* Reduce amount of anticoagulant
* Reduce Volume Factor (A) = weight (lbs.)/ 110 lbs
* A x 63 mL = amount of anticoagulant needed (B)
* 63 mL – B = amount of anticoagulant removed
* A x 450 mL = amount of blood collected
* Example: 90 lb donor
* 90 lbs/110 lbs = 0.81 = A
* 0.81 x 63 mL = 51.5 mL (amount of anticoagulant needed)
* 63 mL – 51.5 mL = 11.5 (12) mL of anticoagulant removed
* 0.81 x 450 mL = 365 mL of blood collected

Weight Exception - Autologous Donation

* Standard unit: 450 mL ± 45 mL
* Standard volume of anticoagulant: 63 mL

How often can you donate RBC’s?

8 weeks

How often can you donate Platelets/Granulocytes?

* 48 hours between donations
* No more than 2x a week or 24x/year
* 150,000/µL

How often can you donate Plasma?

* Every 4 weeks
* Total protein-must be within normal limits (>6.0g/dL)

Anticoagulants - CPD and CP2D

Expiration: 21 days

Anticoagulants - CPDA-1

Expiration: 35 days

Anticoagulants - AS-I and AS-3

Expiration: 42 days

Preservatives - Dextrose

Supports RBC life

Preservatives - Adenine

Used in ATP synthesis; restores ATP

Preservatives - Citrate

Chelates calcium to prevent coagulation

Preservatives - Sodium biphosphate

Buffer to prevent decrease in pH

Storage Effects - Increases

Metabolic end products (K+, H+)

Storage Effects - Decreases

* ATP
* 2,3 DPG
* pH

PRBC

* Storage: 1-6°C
* Expires: 42 days

Frozen RBC

* Storage: ≤ -65°C
* Expires: 10 years

RBC deglycerolized

* Storage: 1-6°C
* Expires: 24 hours

RBC irradiated

* Storage: 1-6°C
* Expires: 28 days or originally assigned expiration date - whichever comes first

Platelets

* Storage: 20-24°C, agitated
* Expires: 5 days

Platelets (pooled)

* Storage: 20-24°C, agitated
* Expires: 4 hours

Plateletpheresis

* Storage: 20-24°C, agitated
* Expires: 24-48 hours

fresh frozen plasma (FFP)

* Storage: ≤ -18°C
* Expires: 1 year

thawed FFP

* Storage: 1-6°C
* Expires: 24 hours

Cryoprecipitate

* Storage: ≤ -18°C
* Expires: 12 months

Granulocytes

* Storage: 20-24°C
* Expires: 24 hours

Irradiated unit

* Unit drawn today: 4/21/2023
* Adsol: 6/2/2023
* Irradiate: 5/19/2023

Platelet Refractoriness

* CCI = (Post transfusion - Pretransfusion plt count) x 10^11 x BSA / # of plts transfused (multiples of 10^11)
* ==CCI < 7500 after 1 hour = Refractory==
* ==CCI > 10,000/µL per m^2  10 min- 1 hour = Normal==

Refractoriness

* Patient BSA = 1.5 M^2
* Precount: 2000/μL
* Postcount: 29000/μL
* Platelets transfused: 4.5 x 10^11
* CCI = (29000 - 2000) x 10^11 x 1.5 / 4.5 x 10^11 = 9000

\

Refractoriness

* Patient BSA = 1.5 M^2
* Precount: 2000/μL
* Postcount: 29000/μL
* 6 random donor units transfused
* CCI = (29000 - 2000) x 10^11 x 1.5 / 6 x (0.55 x 10^11) = 12,272
* RDP = 5.5 x 10^10 = 0.55 x 10^11

Refractoriness

* Patient BSA = 1.5 M^2
* Precount: 2000/μL
* Postcount: 29000/μL
* Apheresis platelet
* CCI = (29000 - 2000) x 10^11 x 1.5 / 3 x 10^11 = 13,500

Bacterial Contamination Testing

* None of the methods listed are sensitive enough to detect bacteria directly after donation
* Most common methods (FDA approved methods)
* BacT/ALERT culture system (bioMerieux)
* Pall eBDS system (Pall Corp)
* ScanSystem (Hemosystem)

Transport Temperatures

* PRBC: 1-10°C with ice in plastic bags
* Frozen components: transported with dry ice

Apheresis - Centrifugation

* separation of blood components; removal of desired components and return of remainder of the blood to donor
* Plasma: 55% of total blood
* Buffy coat: leukocytes and platelets;

Plateletpheresis - donor requirements

* Same as whole blood, no aspirin w/in 3 days;
* Pre-platelet count: 150 x 10^9/L

Plateletpheresis - quality control

* 3 x 10^11 in 75% of units tested
* pH > 6.0

Plateletpheresis - uses

* Increase platelet counts
* Prevent HLA alloimmunization

Plateletpheresis

Includes: green teas, ginseng, energy drinks

Leukapheresis - donor requirements

* Same as whole blood donations
* Absolute granulocyte count : 4.0 x 10^9/L

Leukapheresis - quality control

* WBC > 1.0 x 10^10

Leukapheresis - uses

* Sepsis
* Removal of blasts from leukemic patients
* Neutropenia in cancer patients

Plasmapheresis

* Removal of plasma and returning cellular components to patient

Plasmapheresis - donor requirements

* same as platelet donors

Plasmapheresis - uses

* Multiple myeloma (remove abnormal protein)
* Lupus (immune complexes)
* Autoantibodies
* Toxins (barbiturate poisoning)

Plasmapheresis

* Have to replace with another fluid to maintain intravascular compartment
* Antibodies- removes IgM antibody better b/c mostly in intravascular space and produced slowly; IgG evenly distrubuted in intravascular and extravascular spaces and body makes IgG quickly.

Intermittent Flow Centrifugation (IFC)

* Blood drawn out and put back in “batches”
* One venipuncture site
* Repeats 6-8 cycle to obtain therapeutic dose
* Takes longer but more mobile

Continuous Flow Centrifugation (CFC)

* Blood is spun, separated continuously with desired product being removed, and remaining product returned uninterrupted
* 2 venipuncture sites
* Faster

Anticoagulant

* Citrate
* Citrate Toxicity

Acid Citrate Dextrose (ACD)

* Most common
* Citrate ions chelate free calcium (Ca2+) and blocks calcium-dependent coagulation cascade
* Ensures extracorporeal blood remains in fluid state

Acid Citrate Dextrose (ACD) pros

* Found in all human cells, not foreign
* Metabolized quickly by liver to bicarbonate, little systemic effect

Acid Citrate Dextrose (ACD) cons

* Can cause transient systemic hypocalcemia (citrate toxicity), presenting with numbness, tingly lips, cramping, EKC changes

HES

* Hydroxyethyl starch
* “Sedimenting agent”
* Promotes rouleaux

Plasma apheresis

* Volumes vary based on weight of donor, max 600 mL
* Plasma may be used as FFP or as plasma for manufacture
* May be collected together with an apheresis platelet donation

Platelets apheresis

* ==Minimum acceptable platelet count 3 x 10^11 platelets per component==
* Volume can vary from 100 to 500 mL
* One platelet apheresis is equivalent to one adult dose of platelets
* A high-yield apheresis platelet collection can be divided to 2 or more platelet apheresis components as long as each contains a minimum of 3 x 10^11 platelets

RBC apheresis

* Very similar to rbc components prepared from whole blood
* Normally contain about 60 g of hemoglobin per component
* May be collected together with an apheresis platelet or an apheresis plasma
* 2 rbc apheresis components can be collected from one donor if the donor meets eligibility requirements and no other apheresis components are collected during the same donation

Granulocytes apheresis

* ==Donors may be given drugs such as corticosteroids or growth factors (G-CSF) or precipitating agents, such as hydroxyethyl starch (HES), to increase the  number of granulocytes that can be collected==
* ==Minimum number of granulocytes per component is 1 x 10^10==

Component Preparation

* Whole blood unit is given a “soft-spin”
* PRBC + platelet-rich plasma
* Add adsol
* Separate RBC bag
* Hard-spin platelet-rich plasma
* Platelet concentrate (leave \~ 50 ml of plasma) + plasma
* Express off the plasma into separate bag; seal and freeze
* Platelets should “rest” prior to agitation

How long should it take to collect a whole blood unit?

15 min

When should FFP be separated/frozen?

Within 7 hours of collection

When should Platelets be separated?

Within 8 hours of collection

QC - Leukocyte-reduced Components

* 5.5 x 10^6
* 85% of original RBC mass

QC - Platelets

* 5.5 x 10^10 platelets/unit in 75% of units tested
* Apheresis unit: 3 x 10^11 platelets/unit

QC - Cryoprecipitate

* 150 mg/dL of fibrinogen
* 80 IU Factor VIII

QC - Granulocyte

1 x 10^10

Component Utilization - PRBC, whole blood, Leukocyte-reduced RBC, Irradiated RBC, Deglycerolized RBC, Washed RBC

* Oxygen carrying capacity
* Raise Hgb 1-1.5 g/dL; 3% increase in HCT

Component Utilization - FFP

* Replace coag factors

Component Utilization - Platelets

* Used to control bleeding
* Not indicated for patients with ITP

Component Utilization - Granulocytes

* Sepsis, immunodeficient patients

Component Utilization - Cryoprecipitate

* Used for patients with Factor XIII deficiency, fibrinogen deficiency, and as a fibrin sealant (mixed with thrombin)

Component Utilization - Leukocyte-reduced

chronically transfused, 5 x 10^6

Contraindications - RBC

* Compensated/nutritional anemias
* General fatigue
* Enhance a patient’s well-being
* Wound healing

Contraindications - Platelets

* Autoimmune disorders
* TTP
* Hemolytic Uremic Syndrome

A donor with a rare blood type weighs less than 110 pounds. The blood bank technologist calculates that less than 300 mL of blood can be drawn. What must be done prior drawing the unit.

The volume of anticoagulant in the bag must be reduced in proportion to the volume of  blood drawn.

How often can person donate a unit of blood?

8 weeks

A donor reports that he just complete a 12 hour shift at work and was so busy that he had not eaten all day. What should he do before donating?

Eat a snack. This will decrease his chances of an adverse reaction.

A phlebotomist visits the blood mobile while it is at the hospital for a blood drive. During the donor history she relates that she had a needle-stick injury six months ago and was given HBIG. If she meets all other criteria, can she be accepted for donation?

No. She must be deferred for 12 months because of the needle stick.

How long must a prospective donor with a history of malaria be deferred?

3 years after becoming asymptomatic.