BB Exam 5 Review

How long is the blood donor deferral for someone with or with a history of Chagas’ Disease?

Indefinite deferral

How long is someone deferred from donating blood if they have CJD, have a blood relative with CJD, had a dura matter transplant, or pituitary-derived growth hormone?

Indefinite deferral

How long is someone deferred from blood donation if they have Zika? Or is it if they travelled to somewhere with a zika endemic?

4 week deferral

How long is a blood donor deferred if they have Hep B IgG?

12 months

How long is a blood donor deferred if they have a new tattoo/piercing?

12 months

How long is a blood donor deferred if they have been exposed to someone else’s blood?

12 months

How long is a blood donor deferred if they have had sexual contact with a person at high risk for HIV?

12 months

How long is a blood donor deferred if they have been imprisoned for more than 72 hours?

12 months

How long is a blood donor deferred after they have returned from a malarial endemic area?

12 months

How long is a blood donor deferred after a post-blood transfusion?

12 months

How long is a blood donor deferred after they have used acutane?

1 month

How long is a blood donor deferred after they have used propecia use?

1 month

How long is a blood donor deferred after a malarial infection?

3 years after becoming asymptomatic

How long is a blood donor deferred if they have taken aspirin and aspirin-containing drugs?

48 hours (2 days)

List some conditions that would meet the criteria for a **permanent deferral**

1. Human pituitary growth hormone injection
2. Taken clotting factors
3. Sexual contact with anyone who used a needle to take illegal drugs
4. AIDS or HIV pos.
5. Males having sex w/ other males $(update: 3 mo. from last sexual contact)$
6. Had viral hepatitis
7. Positive HBsAg
8. Positive HBc
9. Positive HTLV
10. History of CJD
11. History of Chagas’ or babesiosis

What is the minimum Hgb requirement to donate blood?

12\.5 g/dl

What is the minimum Hct requirement to donate blood?

38%

What is the minimal age *without* parental consent to donate blood?

17

What age must you at least be in order to donate blood *with* parental consent?

16 or older

What is the ideal body temperature to donate blood?

What is the ideal blood pressure you must have to donate blood?

< 180/100

What is the pulse range for blood donation?

50-100 bpm

What is the minimum body weight required for blood donation?

110 lbs

If you decide to take blood from someone who is less than 110 lbs, what must you do first?

Reduce the amount of anticoagulant

What is the standard volume of anticoagulant? (hint: looking for a # not a definition)

63 mL

What is the volume of a standard unit?

450 mL plus or minus 45 mL

How would you calculate the amount of anticoagulant needed, anticoagulant removed, and amount of blood collected for an “underweight” donor?

1. __Reduce Volume Factor (__@@__**A**__@@__)__ = weight (lbs)/ 110 lbs
2. @@**A**@@ x 63 = amount of anticoagulant needed (^^**B**^^)
3. 63 mL - ^^**B**^^ = amount of anticoagulant removed
4. @@**A**@@ x 450 mL = amount of blood collected

How often can you donate **RBCs**?

8 weeks

How often can you donate **Platelets**/**Granulocytes**?

* 48 hours between donations
* No more than 2x a week or 24x per year

What is the minimum amount of platelets that you need to have in order to donate?

150,000/uL

How often can you donate **plasma**?

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

Blood expires in ___ days with the addition of the anticoagulant CPD.

21

Blood expires in ___ days with the addition of the anticoagulant CP2D.

21

Blood expires in ___ days with the addition of the coagulant CPDA-1.

35

Blood expires in ___ days with the addition of AS-1, AS-3, or AS-5.

42

What is the function of the preservative: Dextrose

Supports RBC life by providing energy

What is the function of the preservative: Adenine

Used in ATP synthesis; restores ATP

What is the function of the preservative: Citrate

Chelates calcium to prevent coagulation

What is the function of the preservative: Sodium biphosphate

Buffer to prevent decrease in pH

During storage of **RBC** units, what **increases**?

1. $Potassium (K+)$
2. Lactic Acid
3. Plasma Hemoglobin

During the storage of **RBC** units, what **decreases**?

1. ATP
2. 2,3 DPG
3. pH

What temperature do you store **PRBCs**?

1-6 C

What temperature do you store **frozen RBCs** and when do they expire?

* ≤ -65 C
* 10 years

What temperature do you store **deglycerolized RBCs** and when do they expire?

* 1-6 C
* 24 hours

What temperature do you store **irradiated RBCs** and when do they expire?

* 1-6 C
* 28 days *or* originally assigned expiration date (whichever comes first)

What temperature do you store **platelets** and when do they expire?

* 20-24 C (room temp.), agitated
* 5 days

What temperature do you store ***pooled*** **platelets** and when do they expire?

* 20-24 C (room temp.), agitated
* 4 hours

What temperature do you store **apheresis platelets** and when do they expire?

* 20-24 C (room temp.), agitated
* 24-48 hours

What temperature do you store **fresh frozen plasma (FFP)** and when does it expire?

* ≤ -18 C
* 1 year

What temperature do you store **thawed FFP** and when does it expire?

* 1-6 C
* 24 hours

What temperature do you store **cryoprecipitate** and when does it expire?

* ≤ -18 C
* 12 months

What temperature do you store **granulocytes** and when do they expire?

* 20-24 C (room temp.)
* 24 hours

What is the guideline in order for a patient to be refractory?

If 10 minute platelet count is less than 50% of that expected on *two* occasions

What is the equation to determine platelet refractoriness?

\

If CCI is less than 7500 after 1 hour, the patient is considered ________.

Refractory

If the CCI is greater than 10,000/uL per m^2 after 10 minutes to an hour, the patient is considered _______.

normal

List the most common FDA approved methods for bacterial contamination testing.

1. BacT/ALERT culture system (bioMerieux)
2. Pall eBDS system (Pall Corp)
3. ScanSystem (Hemosystem)

What temperature should **PBRCs** be ***transported*** at?

1-10 C with ice in plastic bags

How should **frozen components** be transported?

With dry ice

Define **Apheresis**

The separation of blood components; removal of desired components and return of remainder of the blood to donor

The **buffy coat** consists of ______ & _______.

leukocytes & platelets

What are the donor requirements for **plateletpheresis**?

* same as whole blood, no aspirin within 3 days
* Pre-platelet count: 150 x 10^9/L

What quality control factors do you need to consider with plateletpheresis?

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

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What is plateletpheresis used for?

1. Increase platelet counts
2. Prevent HLA alloimmunization

What are the requirements for leukapheresis?

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

What quality control factors do you need to consider with leukapheresis?

WBC > 1.0 x 10^10

What is leukapheresis used for?

1. Sepsis
2. Removal of blasts from leukemic patients
3. Neutropenia in cancer patients

What is the purpose of plasmapheresis?

Removal of plasma and returning cellular components to patient

What are the donor requirements for plasmapheresis?

Same as platelet donors

What is plasmapheresis used for?

1. @@**Multiple myeloma**@@ (remove abnormal protein)
2. Lupus (immune complexes)
3. Autoantibodies
4. Toxins (barbiturate poisoning)

What happens in **Intermittent Flow Centrifugation**

1. Blood drawn from donor is anticoagulated with **ACD**
2. Blood pumped into bowl which separates components by specific gravity
3. Desired component is removed into a separate bag and the remaining is returned to donor

What does the list below describe?

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

Intermittent Flow Centrifugation

What does the list below describe?

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

Continuous Flow Centrifugation

What is a major “pro” of Continuous Flow Centrifugation (CFC)?

Reinfuses **simultaneously** (IFC does one cycle before starting the next one) - so it’s a lot faster

If a patient is experiencing tingly/ numb lips during an apheresis treatment, what might be the cause?

Transient systemic hypocalcemia (citrate toxicity) presenting with numbness, tingly lips, cramping, EKC changes, etc… from **ACD** (Acid Citrate Dextrose)

What is **HES** and what is it used for?

* Hydroxyethyl starch
* “Sedimenting agent”
* Promotes rouleaux

What is the minimum acceptable platelet count for platelets apheresis?

3 x 10^11

What might donors be given in order to increase the number of granulocytes that can be collected for granulocytes apheresis?

1. corticosteroids
2. growth factors (G-CSF)
3. Precipitating agents (e.g., **HES**)

What is the minimum number of granulocytes per component for granulocytes apheresis?

1 x 10^10

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

15 minutes

When should FFP be separated/frozen?

Within 7 (or 8) hours of collection

When should platelets be separated?

Within 8 hours of collection

You’re gonna ace these finals, pass the BOC with flying colors, and get a job starting off at 70K.

periodt

Quality Control:

In **leukocyte-reduced components**, what is the amount of leukocytes that you must have and what percentage of the original RBC mass should be maintained?

* 5.5 x 10^6 (leukocytes)
* 85% of original RBC mass should be maintained

Quality Control:

How many **platelets** per unit in 75% of units tested? How many platelets per unit in an **apheresis unit**?

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

Do leukapheresis and granulocyte products need to be crossmatched with the patient?

YES! These products still contain a small amount of RBCs that are still in it.

Quality Control:

How much fibrinogen and Factor VIII (8) is needed in order to be considered **cryoprecipitate**?

* 150 mg/dL of fibrinogen
* 80 IU Factor VIII (8)

Quality Control:

Granulocytes need to be greater than _____.

greater than 1 x 10^10

In general, what is the function of all RBC components?

Carrying oxygen

Why do we give leukocyte-reduced RBCs?

To reduce **febrile transfusion reactions**

Why do we give irradiated RBCs?

To reduce the chance of **graft-vs-host**

Why do we give washed RBCs?

Given for someone who has an anaphylactic reaction

Why do we use FFP (fresh frozen plasma)?

Replace coag factors

What are platelets used for?

* Used to control bleeding

Contraindications:

You __**DO NOT**__ want to give platelets to patients with which disorders?

1. Uremic patients (HUS)
2. Autoimmune disorders


1. Idiopathic thrombocytopenia (ITP)
2. TTP

What do we use granulocytes for?

1. Septic patients
2. Immunodeficient patients

What do we use cryo for?

1. **Fibrinogen deficiency**
2. Factor XIII deficiency
3. Fibrin sealant (mixed with thrombin)

Contraindications:

When should you __**NOT**__ give a patient RBCs?

1. Compensated/nutritional anemias
2. General fatigue
3. Enhance a patient’s well-being
4. Wound healing

MHC 1 is responsible for which HLA’s?

HLA-…

* A
* B
* C

MHC 2 is responsible for which HLA’s?

HLA-…

* DR
* DP
* DQ