Blood Bank and Transfusion Medicine Review

Comprehensive vocabulary flashcards covering ABO/Rh typing discrepancies, pretransfusion testing, quality control standards, transfusion reactions, and Canadian transfusion safety protocols.

Cold-Reactive Autoantibody ABO Discrepancy Resolution

A procedure to resolve weak forward Anti-A reactivity caused by cold autoantibodies by warm-washing the patient's red blood cells three times with warm ($37^\circ\text{C}$) saline prior to repeating forward grouping.

Incompatible IAT Crossmatch Protocol

The protocol required when an IAT crossmatch is incompatible ($3+$ positive) despite a negative antibody screen: withhold the unit, repeat the antibody screen on the same sample, perform antibody identification if positive, contact the blood bank physician, and select a new unit.

Expired Red Blood Cell Protocol

The required action when expired PRBC units are discovered: immediately quarantine in a separate labelled area marked 'DO NOT TRANSFUSE - EXPIRED', remove from active inventory, notify the supervisor, document discovery details, and complete a product discrepancy report.

Wrong-Blood-In-Tube (WBIT) Primary Cause

The failure to label a blood collection tube at the patient's bedside with two unique identifiers, such as labelling after leaving the room or using another patient's pre-printed label.

Pretransfusion Sample Rejection Criteria

Mandatory rejection of any pretransfusion sample missing required tube label identifiers (such as date of birth or MRN), requiring rejection documentation and a fresh sample collected and labelled at the bedside with two unique identifiers.

96-Hour Pretransfusion Sample Validity Rule

The standard requiring a fresh pretransfusion sample to be collected within 96 hours of scheduled transfusion if the patient has been transfused or pregnant within the preceding 3 months.

Group A ABO Typing Profile

ABO testing results demonstrating Anti-A $4+$ and Anti-B $0$ in forward grouping, with $A_1$ cells $0$ and B cells $4+$ in reverse grouping.

Multiple Myeloma ABO Discrepancy

False-positive weak reactions in reverse grouping with both $A_1$ and B cells caused by rouleaux formation from abnormal plasma paraproteins; resolved using the saline replacement technique.

Equivocal Rh(D) Typing Workup

An initial weak ($1+$) Anti-D reaction requiring weak D testing via indirect antiglobulin test (IAT) to distinguish weak D from partial D; the patient is managed as Rh(D)-negative while testing is in progress.

Weak D Recipient Transfusion Classification

The classification of a transfusion recipient presenting with a serologically weak D phenotype as Rh(D)-negative per Canadian standards to prevent alloimmunisation in potential partial D individuals.

Group B Plasma Compatibility

The rule stating that Group B plasma or Group AB plasma (universal donor plasma lacking anti-B) are the only ABO-compatible plasma options for a Group B recipient.

Historical ABO/Rh Typing Discrepancy Protocol

The mandatory action when current ABO/Rh typing conflicts with historical records: investigate source samples and records, repeat typing on a fresh sample, and withhold blood issuance until resolved.

Canadian Transfusion Record Requirements

The required legal elements on a transfusion record: patient name, donor unit number, component type, ABO/Rh of patient and unit, compatibility test result, expiry date, transfusionist name, and start/stop times.

Emergency Uncrossmatched RBC Release Protocol

Protocol to issue group O, Rh(D)-negative uncrossmatched red cells during emergency release; requires documenting emergency indication, issue time, unit numbers, physician authorisation, and switching to group-specific product once sample testing is available.

RBC Storage Temperature Excursion Protocol

Action required when red cell storage exceeds the $6^\circ\text{C}$ limit: quarantine all affected units, notify supervisor, document event, investigate cause, evaluate viability per institutional SOP, and report to Canadian Blood Services if compromised.

Leaking Blood Unit Disposal Protocol

Safety requirement to place a punctured or leaking blood unit in a sealed biohazard bag, label as contaminated/unfit for transfusion, discard in biohazard waste, complete a product loss report, and notify the supervisor.

Purpose of the Antibody Screen

An indirect antiglobulin test designed to detect clinically significant unexpected red cell alloantibodies in patient plasma prior to compatibility testing.

Gel Card Antibody Screen Interpretation

Evaluation of gel column agglutination where a clear cell pellet at the bottom of the control column confirms validity, and agglutination in test columns indicates a positive antibody screen requiring identification.

Positive Control Quality Control Failure Protocol

Procedure following positive control failure (e.g. $1+$ instead of $4+$): halt patient testing, investigate causes such as AHG degradation or pipetting error, repeat control before resuming, and do not report patient results from the failed run.

Anti-$Jk^a$ (Kidd System) Clinical Persistence

The characteristic of Kidd system antibodies to drop below detectable laboratory limits over time while retaining the capacity to mount a rapid anamnestic response; historically documented anti-$Jk^a$ requires antigen-negative units regardless of current screen results.

Anti-c Laboratory Report Requirements

A complete antibody identification report detailing antibody specificity (anti-c), IgG class, clinical significance (severe HTR and HDFN risk), c-negative unit selection criteria, and recommendation for extended Rh phenotyping (C, c, E, e).

Automated Gel Card Analyzer Daily Quality Control

Daily QC steps requiring positive control (IgG-sensitised cells, expected $3\text{--}4+$), negative control (unsensitised cells, expected $0$), and incubator temperature verification ($37^\circ\text{C} \pm 1^\circ\text{C}$); any failure mandates halting patient testing.

Jehovah's Witness Blood Refusal Management

Protocol upon reconfirmed refusal of blood products: document refusal in blood bank records and LIS, inform the blood bank physician, notify the surgeon that blood cannot be held without consent, and recommend bloodless medicine protocols.

Restrictive PRBC Transfusion Thresholds

Evidence-based thresholds for red cell transfusion: Hgb $< 70\,\text{g/L}$ for stable non-cardiac inpatients/ICU patients, and Hgb $< 80\,\text{g/L}$ for cardiac surgery patients or patients with symptomatic cardiac disease.

Massive Transfusion Protocol (MTP) Resuscitation Ratio

Canadian damage control resuscitation guidelines recommending a balanced 1:1:1 ratio of PRBCs, FFP, and apheresis platelet units during massive transfusion.

Expected Post-Transfusion Platelet Count Increment

The anticipated rise in platelet count of $30\text{--}50 \times 10^9/\text{L}$ measured at 1 hour following transfusion of one adult apheresis platelet unit (containing $\ge 3 \times 10^{11}$ platelets) in a non-refractory patient.

FFP Misuse in Hypoalbuminaemia

The rule that FFP is not indicated for hypoalbuminaemia in the absence of coagulopathy (normal INR); albumin solution is the appropriate therapy.

Blood Component Label Elements

Mandatory attributes required on a blood component label prior to release: ABO/Rh, component type, donation number, expiry date/time, approximate volume, and special processing attributes (e.g., irradiated, leukoreduced).

Cellular Blood Component Irradiation Standards

Gamma irradiation applied to cellular components (PRBCs, platelets) to inactivate donor T-lymphocytes and prevent transfusion-associated graft-versus-host disease (TA-GvHD); standard Canadian dose is $25\,\text{Gy}$ central, minimum $15\,\text{Gy}$ at any point.

CSTM Leukoreduction Quality Control Threshold

The maximum permitted threshold of fewer than $5 \times 10^6$ residual white blood cells per unit in leukoreduced components; exceeding this value mandates unit failure, lot quarantine, process investigation, and supplier notification.

Positive Bacterial Culture Flag in Platelet Units

Action required when automated culture flags positive: immediately quarantine the unit, investigate if transfused, notify the blood supplier, and submit a haemovigilance report.

Family-Directed Blood Donation Requirements

Requirements for directed donations from first-degree relatives, which carry an elevated TA-GvHD risk due to shared HLA haplotypes and require mandatory irradiation, full compatibility testing, and extended processing time.

Transfusion Reaction Workup Specimens

Required specimens submitted for investigation: post-transfusion EDTA tube (ABO/Rh repeat + DAT), clotted serum tube (haemolysis markers: bilirubin, LDH, haptoglobin, plasma inspection), implicated blood bag with tubing, and first post-transfusion urine if haemoglobinuria is suspected.

Transfusion Vital Signs Monitoring Protocol

Assessment of vital signs required before starting transfusion, 15 minutes post-initiation, and at completion; transfusion must be stopped if temperature increases $\ge 1^\circ\text{C}$ from baseline or if clinical deterioration occurs.

Initial Acute Haemolytic Transfusion Reaction (AHTR) Step

The mandatory first step in an AHTR workup: performing a clerical check to verify that patient identification on the compatibility label matches the patient's wristband and paperwork.

Positive Post-Transfusion DAT Management

Action required when post-transfusion DAT becomes positive ($3+$ IgG) with pink plasma: perform an eluate study on the post-transfusion EDTA sample to identify antibody specificity and withhold blood release until antigen-negative units are found.

Febrile Non-Haemolytic Transfusion Reaction (FNHTR)

A reaction presenting with temperature rise ($\ge 1^\circ\text{C}$), rigors, clear plasma, and negative DAT; caused by accumulated cytokines in stored cellular components or recipient HLA antibodies reacting with donor leukocytes.

TRALI vs. TACO Distinction

Diagnostic differentiation where TRALI presents with normal BNP levels (e.g. $95\,\text{pg/mL}$), absence of cardiomegaly, non-responsiveness to diuretics, and association with multiparous donor plasma, distinguishing it from volume overload in TACO.

Delayed Haemolytic Transfusion Reaction (DHTR)

A reaction occurring days post-transfusion (e.g., 10 days) presenting with falling haemoglobin, mild jaundice, positive DAT, and initial negative antibody screen; caused by an anamnestic immune response to transfused red cell antigens.

Mild Allergic Transfusion Reaction Management

Management of isolated urticaria/pruritus without systemic symptoms: stop transfusion, administer diphenhydramine, monitor patient, and cautiously restart transfusion at a slower rate with physician authorization once symptoms resolve.

AHTR Haemovigilance Reporting

The requirement that serious adverse reactions, such as ABO-incompatible acute haemolytic transfusion reactions, must be reported externally to Canadian Blood Services or Hma-Qubec and logged in national tracking systems.

Preliminary AHTR Physician Communication

Immediate findings that an MLT must report to the ordering physician during an AHTR workup: clerical check results, plasma colour (clear vs haemoglobinaemic), DAT result, repeat ABO/Rh concordance, and preliminary haemolysis likelihood.

Post-Transfusion Alloantibody Workflow

Required steps upon detecting a new alloantibody post-transfusion: update LIS with antibody specificity and clinical significance, notify the attending physician, and issue an alloantibody alert card to the patient.

CSTM Near-Miss Event Reporting Requirements

Mandatory reporting under CSTM for near-miss events (e.g., wrong unit quarantined prior to issue): document in LIS, report to institutional risk management/QA, include in haemovigilance tracking, and perform root cause analysis.

Blood Bank Spill Decontamination Procedure

Standard procedure for blood/plasma spills: wear PPE (gloves and eye protection), absorb bulk spill with paper towels, apply 0.5% sodium hypochlorite (1:10 dilution household bleach) for at least 10 minutes contact time, wipe clean, and discard in biohazard waste.

Withdrawal of Transfusion Consent Protocol

Action required when a patient withdraws consent prior to infusion: halt the issuance process immediately, document consent withdrawal in the LIS transfusion record, and notify ordering physician and nursing staff.

External Quality Assurance (EQA) Failure Protocol

Action required following unacceptable EQA performance: perform root cause analysis on failed samples, implement corrective actions, retest using internal challenge samples to confirm resolution, document findings, and notify the accreditation body within required timeframes.