Donor Screening

What are the types of deferral?

1) Temporary deferral (2 weeks to 12 months)

2) Indefinite deferral (but can donate autologous blood)

3) Permanent deferral (but can donate autologous blood)

What is autologous blood donation?

When you can donate to yourself and only yourself

What kind of vaccine would result in a temporary 2 week deferral?

Attenuated vaccine (aka any alternative-live vaccine)

What are the some reasons for indefinite/permanent deferrals?

• Hx of hepatitis, HCV, HIV, HTLV

• Hx of Babesiosis or Chaga’s diseases

• Family hx of Creutzfeld-Jakob Disease (CJD)

Which medication would cause a permanent deferral?

Tegison

Why is there a 3 day deferral after you take asprin?

Because it interrupts platelets function

What kind of vaccine can result in no deferrals?

• Toxoid vaccines (Flu, Diphteria, Hep A, Pertussis)

• Covid

• Tetracycline

How many time can a person donate RBC? How many time in a year?

1 bag = 8 weeks up to 6x a year

2 bags = 16 weeks up to 3x a year

How many time can a person donate platelets and plasma? HOw many times in a year?

2x in 7 days, no more than 24x a year

double = 1x in 7 days

What is the average time to collect 500ml?

<10 min

What is the ratio of anticoagulant to whole blood?

14:100

What is the minimum weight to donate blood?

110 lbs (or 50 Kg)

What happens when the donor does not meet the minimum weight to donate blood?

They must adjust the ratio of blood to anticoagulants to ensure quality

• Donors weight (lb) / 100 ×450 = the amount of blood to draw

• the amount of blood to draw/100 × 14 = amount of anticoagulant

• 63- amount of anticoagulant needed = amount to be removed from the bag

Why are you dividing by 14 when adjusting for patient weight?

Because of the 14 to 110 ratio

What is the expiration of blood treated with Citrate Phosphate dextrose (CPD)?

21 Days

What is the expiration of CPDA-1 (Adenine)?

35 days

What is the expiration of CDP / Adenine saline 1,3,5)?

42 days

What is the expiration of CDP/Adenine Saline-7?

42-56 days

What is the goal of RBC preservation?

1) Keep RBC and components viable and functional

2) Maintain integrity of the RBC throughout shelf life

What do we add to help with ATP production?

Adenine and Dextrose

What do we add to maintain the pH for 2,3 DPG?

Phosphate

What do we add to prevent clotting?

Citrate

What happens when there is a right shift of the oxygen affinity curve?

• Decrease pH

• Increase DPG = less oxygen in the blood and more in the muscles

• Increase temp

What happens when there is a left shift of the oxygen affinity curve?

• Increase pH

• Decrease DPG = more oxygen in the blood and no oxygen in the tissues

• Decrease temperature

What are some storage lesions that can happen to expired blood?

Biochemical structural and functional changes

• Decrease: Glucose, ATMP, pH and 2,3 DPG

• Increase: Lactic acid, potassium, free hemoglobin

What are some reasons to have an autologous donation?

• To treated surgical blood loss

• Decrease risk of disease transmission, transfusion reaction and alloimmunization

What are some methods for obtaining autologous units?

• Preoperative collection

• Acute normovlemic proceddure

• Intraoperative procedure (cell saver aka in the operating room)

• Post operative collection

What is Directed donation?

When someone donate for a specific recipient

What are some Donor reaction?

• Syncope, nausea, vomiting, anxiety, loss of consciousness, hyperventilation, convulsion

What is Fresh Frozen Plasma?

When you freeze plasma that was separated from RBC within 8 hours of collection

What is frozen plasma?

Plasma that has been separated from RBC AFTER 8 hours of collection or after 24 hours

Which plasma can you make cryoprecipitate from?

Fresh Frozen Plasma

What does the buffy coat have?

platelets and white blood cells

What is apheresis donation?

When the donor is only donating a certain component of the RBC

• Platelets, granulocytes, plasma, RBC and stem cells

• everything else is returned to the donor

What is being donated during Leukapheresis? What are they given in preparation?

Granulocytes; Hydroxyethyl starch (HES) or corticosteroid or growth factors to increase granulocyte collection

What is the hematocrit lvl required by double RBC pheresis?

40%

What is collected in hematopoietic progenitor cells / peripheral blood stem cells?

Collects mononuclear cells (CD34) & requires 2-3 apheresis collections

What is therapeutic apheresis?

When they remove the excess components

What is therapeutic plasma exchange?

• Removes antibodies, toxins, immune complexes and replaces missing coagulation factors

• usually 1 to 1.5 volume exchange

What is Red Blood Cell Exchange?

When they either yonk thine blood out and give u new ones (sickle cell anemia) or toss it out like a salad (polycythemia vera)

What is leukocytapheresis?

Yeeting WBC to save u

• Treats hyperleukocytosis and acute myelogenous leukemia

What does therapeutic plateletpheresis treat?

Thrombocytosis

What is the final hematocrit for RBC for QC?

55-65% to 80%

What is the final apheresis RBC for QC?

60 g. Hgb or 180 m of RBC per unit

95% unit collected: 50 Hgb/150 ml. RBC

What is the QC for platelets?

Platelets count, bacterial testing, pH > 6.2

What is the plasma QC?

Correct volume (within 10% of actual)

What is Cryoprecipitate QC?

80 IU of Factor VIII and 150 mg fibrinogen

What is Leukoreduction QC?

On RBC: residual WBC> 5.0 ×10^6

on PLT: >8.3 ×10 ^5

What % of hematocrit gets raised by 1 unit of blood?

3%

What are the component of blood?

1) RBC

2) Plasma

3) Platelets

4) Cryoprecipitate

5) Granulocytes

What temperature do you store RBC at ?

1 to 6C

What is the FDA requirement of RBC?

75% RBC survival 24-hours post txn and <1% free Hgb

What % of glycerol do you need to prevent RBC from hemolyzing?

40% wt/volume and needs to be frozen within 6 days of collection

What do you thaw and wash deglycerolized RBC with?

12%, 1.6% and .2% dextrose/saline

Why do we wash RBC?

• Remove excess potassium, ABO antibodies and plasma proteins

• expires 24 hours after washing

Why do we do leuko-reduced RBC?

To remove leukocytes on the RBC to prevent febrile non hemolytic transfusion reactions

What is Irradiated RBC? Why do we do it

Using 25 gray to irradiate rbc

• To prevent Graft-versus-host disease (GVHD)

What are the plasma products?

• Fresh Frozen Plasma (FFP)

• FP24

• Cryo poor plasma (CPP)

• Plasma collected by Apheresis “Jumbo” (FFP)

• Liquid Plasma (LP)

• Recovered Plasma

• Plasma derivatives

What does FFP contain?

• 1 IU of stable and labile clotting factors per ml

• 1 unit/ml of factors V and VIII

• Contains 300 mg of Fibrinogen

What are the products of platelets?

• Random-Donor-Platelets (from whole blood)

• Apheresis platelets aka single donor platelets (SDP)

What are the SDP stored in?

Resuspended in plasma or platelet additive solution (PAS)

What is the FDA requirement for platelet pheresis collection?

3.0 × 10^11 count

What is the platelet count for Random-donor-platelets?

5.5×10^10

What temp do you store platelets? What is the risk?

20-24C and high risk for bacterial contamination

What is the pH requirement for platelets?

pH < 6.2

What do you use cryoprecipitate for?

Fibrinogen replacement

What is in Cryoprecipitated AHF?

• Cold precipitated concentration of Factor VIII = 80 IU

• Fibrinogen (150mg), Factor XIII, vWF, cryoglobulin and firbonectin

• Made from FFP

What is in cryo-poor plasma?

Plasma w/o cryoprecipitate

contains residual albumin, F II, V, VII, IX,X,XI and ADAMTS13

When do we use cryo-poor plasma?

Plasma exchange in Thrombotic Thrombocytopenia Purapura (TTP)

How much granulocytes should you have per unit?

>1.10^10 granulocytes per unit

What temperature are granulocytes stored at?

20-24C

How long does whole blood last in a closed system? What temperature?

21 days; 1-6C

How long does PRBC last? What temperature?

42 days; 1-6C

How long does FF/FP 24 last (Frozen); What temp?

1 year; -18C

How long does Sigle Donor platelets / platelet concentrate last? What temp?

5 days; 20-24C

How long does frozen RBC last? What temp?

10 years; -65 or -150C

What are the 6 methods of component modification?

1) Pathogen Inactivation (PRT)

2) Irradiation

3) Leukocyte reduction

4) Pooling

5) Washing

6) Aliquoting

What is Irradiation? What does it prevent?

Cesium 237, Cobalt 60 or X-rays produced by radiation therapy linear acceleration of dosage 25 Gray (Gy)

• Prevents Graft versus Host Disease (GVHD)

• Shortens shelf life of RBC to 28 days

What are characteristics of Leukocyte reduction by filtration?

Removal of leukocytes from RBC and platelets from WB

• FDA requirement: <5.0 ×10^6 residual leukocytes per unit

Which reaction does leukocyte reduction by filtration prevent?

Febrile non-hemolytic transfusion reaction (FNHTR)

How long does thawed/wash RBC last? What temp do you store it in?

24 hours; 1-6C

How long does packed / washed platelets last? What temperature do you store it at?

4 hours; 20-24C

What is pooliing?

Shoving palettes or cryoprecipitate of the same ABO type together

What are indications of washed RBC?

• Remove plasma proteins (allergic reactions)

• remove incompatible plasma and additive solution

• remove excess potassium

What is aliquotes? When it is used?

Small volume tranfusion; used during iatrogenic blood loss often <4 months old

What is iatrogenic blood loss?

When the hospital causes a draws blood and then gives you the same amount back

What is pathogen inactivation?

• Reducing the infectivity of residual pathogen in the blood component (either plasma or platelets)

• reduce transmission of infectious agents for which there are no screening test

What are the DFA approved methods of pathogen inactivation? (For plasma and platelets?)

• Solvent/detergent (SD Plasma)

• Amotosalen (psoralen) / UVA (Intercept)

What is the mechanisms pathogen inactivation method is targeting?

Both target nucleic acid of viruses, bacteria and parasites, preventing replications

What is Intercept effective against?

HIV, HBV, HCV, HTLV, WNV, CMV, ZIKV, Syphillis bacterial contamination, GVHD, reduce FNHTR, prevents white cell induced HLA alloimmunization

What are some limitation of PRT?

• Mild / moderate bleeding frequency is increased

• TRALI (Tranfusion related acute lung injury) has been reported

• RBC functionality impaired near 42 days

Why is important to get HgS units?

For babies with sickle cell anemia

WHat is HgS?

Hemaglobin S —> abnormal hemoglobin that causes sickle cell anemia

What is the marker we’re looking for hepatitis B?

• HBsAg

• IgM and IgG anti-HBc

• HBV DNA

What is the marker we’re looking for Heptatis C?

• IgG anti-HCV

• HCV RNA

What is the marker we’re looking for for HIV?

• IgM and IgG anti-HIV

• HIV RNA

What is the marker we’re looking for for Syphillus?

• Nontreponmal Test (RPR)

• IgM/IgG anti-T. pallidum

What marker are we looking for for West Nile Virus

WNV RNA

What are the 4 things we are testing for in when we get donor blood?

1) Bacteria detection for platelets

2) Malaria

3) Alanine Transaminase (ALT) —> Heptatis A & B

4) Chikunogunya (CHIKV)

What are some special storage requirement for platelets?

• Stored between 2- to 24C

• Maintain pH 6.0 greater

• Requires continuous gentle agitation

• Requires special platelets storage bag

• remove contaminating leukocytes