UAMS BLOOD BANK EXAM 5

TO GIVE BLOOD PRODUCTS WHICH ARE SAFE, EFFECTIVE AND PURE.

BLOOD BANK

WHO REGULATES BLOOD BANK

AABB, JCAHO,CAP,FDA,CMS

WHAT SCORE MUST YOU GET ON PROFICIENCY TEST IN BLOOD BANK

100

HOW LONG DO YOU KEEP RECORDS OF QA

5 YEARS

HOW LONG DO YOU KEEP PATIENT RECORDS

10 YEARS

WHO REGULATES PROCEDURE MANUAL

CLSI

WHO REVIEWS CROSSMATCH:TRANSFUSION RATIO, WASTED PRODUCTS, EMERGENCY USE OR ANY SERIOUS ADVERSE EFFECTS?

TRANSFUSION COMMITTEE

HOW OFTEN DO YOU QC REAGENTS

DAILY

WHAT DO YOU RECORD ON REAGENTS AND SUPPLIES

DATE OF RECEIPT, MANUFACTURER, LOT # AND OUTDATE

WHO REGULATES EQUIPMENT PERFORMANCE MONITORING AND REQUIREMENTS

FDA

WHAT DO YOU CHECK DAILY IN BLOOD BANK

TEMPERATURE, REFRIGERATED CENTRIFUGE SPEED AND TEMP,
AUTOMATED BLOOD TYPING INSTRUMENT FOR CORRECT RESULTS,
SCALE,
WATER BATH/HEAT BLOCK TEMP,
Rh VIEW BOX FOR TEMPERATURE

WHAT DO YOU CHECK MONTHLY IN BLOOD BANK

ELECTRONIC THERMOMETERS ...CALIBRATE

WHAT DO YOU CHECK EVERY 6 MONTHS IN BLOOD BANK

CENTRIFUGE W/ TACHOMETER

WHO REVIEWS ALL LOGS IN BLOOD BANK

SUPERVISOR AND DIRECTOR

HOW DO YOU CHECK THE COMPONENTS IN BLOOD BANK

RANDOMLY SELECT 3-4 UNITS EACH MONTH

WHAT DO YOU CHECK PLATELET COMPONENT FOR

NUMBER OF CELLS (5.5 X 10(10))

WHAT DO YOU CHECK pH FOR IN BLOOD BANK

>6

HOW MANY TIMES DO YOU PERFORM PROFICIENCY TEST IN BLOOD BANK

4 TIMES A YEAR

WHAT DOES PROFICIENCY TEST DO

EVALUATE TECH AS WELL AS REAGENTS AND EQUIPMENT

WHAT DOES A QA PROGRAM DO

DETERMINE HOW THINGS SHOULD BE DONE CORRECTLY, IDENTIFY WHEN NOT CORRECT AND FIX

WHAT IS JCAHO 10 STEP PROCESS

1. ASSIGN RESPONSIBILITY
2. DELINATE THE SCOPE OF CARE
3. ID THE MOST IMPORTANT ASPECT OF CARE
4. ID INDICATORS
5. ESTABLISH THRESHOLDS
6. COLLECT AND ORGANIZE DATE
7. EVALUATE THE DATA
8. TAKE CORRECTIVE ACTION
9. ASSESS ACTIONS AND DOCUMENT IMPROVEMENT
10. COMMUNICATE

WHAT ARE INDICATORS FOR QA

RECRUITMENT GOALS
WAIT TIME FOR DONORS
LABELING ERRORS
AUTOLOGOUS TRANSF. %
CORRECT USE OF RhIG
WRIST BANDS
TAT

WHAT DOES QA MONITOR:

1. DONOR COLLECTION
2. COMPONENT PROCESSING
3. TRANSFUSION SERVICE LABORATORY MONITORS
4. UTILIZATION

WHAT IS INCLUDED IN DONOR COLLECTION

PREPERATION
HISTORY/PHYSICAL
# SHORT DRAWS
REACTIONS

WHAT IS INCLUDED IN TRANSFUSION SERVICE LABORATORY MONITORS

MISLABELED SPECIMENS
VOLUME OF SAMPLES
CORRECTED REPORTS
COMPLAINTS
TAT

WHO MONITORS IF PRODUCTS GIVEN WITH HCT > 24, HGB >8, PLATELET >20,000, FFP GIVEN <60 AND PT <16

UTILIZATION REVIEW

WHAT SHOULD CROSSMATCH/TRANSFUSION RATIO BE

2.5:1 AND NO GREATER THAN 3:1

WHAT SHOULD SINGLE UNIT OF TRANSFUSION NOT EXCEED

5% OF TOTAL NUMBER OF TRANSFUSION

WAHT SHOULD COMPLICATIONS NOT EXCEED

1-2% OF TOTAL NUMBER UNITS TRANSFUSED

SEPERATION O0F BLOOD COMPONENTS ON LINE FROM WHOLE BLOOD WITH SUBSEQUENT REMOVAL OF ONE COMPONENTS AND THE RETURN OF REMAINING COMPONENTS

APHERESIS

WHAT % IF TOTAL BLOOD IS PLASMA

55%

WHAT % OF TOTAL BLOOD IS BUFFY COAT

<1%

WHAT % OF TOTAL BLOOD IS RBC

45%

WHAT IS IN THE BUFFY COAT

WBC AND PLATELETS

WHERE ARE NEOCYTES LOCATED IN TOTAL BLOOD

RIGHT BELOW BUFFY COAT AND ARE LIGHTER COLOR THAN OLDER RBC

USE 1 NEEDLE, MAKES 6-8 PASSES
ADVANTAGE IS SMALLER AND MOBILE

INTERMITTENT FLOW

USES 2 NEEDLES, TAKES LESS VOLUME OUT OF PATIENT
ADVANTAGE IS QUICKER

CONTINOUS FLOW

BLOOD PASSES OVER MEMBRANES W/ SPECIFIC PORE SIZES FOR COLLECTION

FILTRATION

WHAT DOES FILTRATION DO

ALLOWS PLASMA THROUGH BUT NOT CELLS
CAN REMOVE SPECIFIC PARTS OF PLASMA

WHY DO COMPONENT COLLECTION

MATCH HLA
REDUCE ALLOIMMUNIZATION
DECREASE RISK OF DISEASE

HOW OFTEN CAN YOU DONATE WITH APHERESIS

EVERY 48 HOURS
NO MORE THAN 24 TIMES A YEAR
CANNOT LOSE MORE THAN 25 ML RBC/ WEEK

WHAT IS MAXIMUM % IF BLOOD VOLUME CAN YOU EXTRACT

15%

WHAT DO YOU GIVE TO PATIENTS W/ PLATELET REFRACTORY

LEUKOCEPLETED PLATELETS

HOW LONG IS DEFERRMENT IF TAKEN ASPIRIN

48 HOURS

WHAT IS REQUIREMENT FOR PLATELET DONATION

PLATELETS >150,000

WHAT CAN YOU ADD TO DONOR ANTICOAGULANT TO HELP SEPERATE WBC FROM RBC

HES

WHAT ARE DISADVANTAGES TO HES

CAN BE TOXIC TO DONOR AND CAUSE ROULEAUX

WHY WOULD YOU GIVE STEROIDS IN LEUKAPHERESIS

TO INCREASE DEMARGINATION OF CELLS

WFHY DO WE IRRADIATE BLOOD PRODUCTS

TO KILL LYMPHOCYTES AND PREVENT GVHD

WHY WOULD YOU GIVE NEOCYTAPHERESIS AND WHAT IS ADVANTAGE

TO SICKLE CELL OR THALASSEMIA PATIENTS WHO NEED CONSTANT BLOOD PRODUCTS AND DEVELOP IRON OVERLOAD
NEOCYTES LIVE LONGER = LESS TRANSFUSION

WHY DO WE DO PLASMAPHERESIS

FOR RARE BLOOD TYPE ... AB
AND RARE ANTIBODIES

WHAT IS MAXIMUM AMOUNT OF PLASMA YOU CAN REMOVE

500 ML

PLASMA EXCHANGE CONSISTS OF

REMOVING SEVERAL LITERS OVER 14 DAYS AND REPLACING WITH COLLOIDS .( ALBUMIN) OR CRYSTALLOIDS (STEROIDS)

IF YOU REMOVE LARGE AMOUNT OF PLASMA WHAT MUST YOU DO

REPLACE COAG FACTORS W/ FFP

WHAT IS PROBLEM WITH GIVING FFP

INFECTIOUS DISEASE RISK

SELECTIVE REMOVAL OF CERTAIN PLASMA COMPONENTS CAN BE OBTAINED BY

FILTRATION OR ADSORPTION

HOW IS SELECTIVE REMOVAL OBTAINED

LIGAND BOUND TO A MATRIX THROUGH WHICH PLASMA IS PASSED

WHO WOULD BE IN CATEGORY 1 FOR THERAPEUTIC HEMAPHERESIS

CRYOGLOBULINEMIA,
HYPERVISCOSITY SYNDROME (EX. WALDENSTROMS),
TTP PATIENTS

WHO WOULD BE IN CATEGORY 3 FOR THERAPEUTIC HEMAPHERESIS

ABO INCOMPATIBLE OR B.M TRANSPLANT
MATERNAL TREATMENT OF MATERNAL FETAL INCOMPAT.
TRANSF. REFRACTORINESS FROM ALLO AB. (RBC, PLAT. HLA)
WAIHA

WHO WOULD BE IN CATEGORY 2 FOR THERAPEUTIC HEMAPHERESIS

COLD AB.
DRUG OVERDOSE/POISONING
HUS
SYSTEMIC VASCULITIS

WHO WOULD BE IN CATEGORY 4 FOR THERAPEUTIC HEMAPHERESIS

AIDS
APLASTIC ANEMIA
ITP (CHRONIC)

WHAT IS HEMAPHERESIS

REMOVAL OF RBC

WHAT IS CYTAPHERESIS

REMOVAL OF WBC AND/OR PLATELETS

WHEN WOULD YOU DO RBC EXCHANGE

SICKLE CELL TO LOWER % OF HGB S BEFORE SURGERY OR DURING PREGNANCY

WHAT IS GOAL WITH RBC EXCHANGE

TO GET HGB A > 50%

RBC EXCHANGE ALSO BEEN USED TO TREAT

MALARIA AND BABESIOSIS

WHAT DOES CITRATE IN APHERESIS DO AND HOW CAN WE TREAT

LOWERS IONIZED CA = TETANY, PARESTHESIS AND ABDOMINAL DISCOMFORT
TREAT W/ TUMS AND SLOW RATE DOWN

WHAT IS HYPOVOLEMIA

LOW BP W/ INCREASE HEART RATE

WHAT CAUSES VASOVAGAL

NEEDLE

WHAT IS DISADVANTAGE TO APHERESIS

CAN ALTER THERAPEUTIC DRUG LEVELS IN BLOOD

WHAT IS PHOTOPHERESIS USED FOR

TREATMENT OF CUTANEOUS T CELL LYMPHOMA

HOW IS LDL REMOVED

BY REMOVING BUFFY COAT

PSORALEN IS THE DRUG USED IN PHOTOPHERESIS, HOW DOES IT WORK

DNA OF WBC ABSORB IT

HOW DOES PHOTOPHERESIS WORK

DRUG PSORALEN IS GIVEN
DNA OF WBC TAKES UP THE DRUG
BUFFY COAT IS REMOVED
UV LIGHT ACTIVATES DRUG, CROSSLINKS DNA AND PREVENTS REPLICATION
REINFUSED

WHAT DO THE REINFUSED CELLS INITATE IN PHOTOPHERESIS

IMMUNE RESPONSE TOWARD THE MALIGNANT CIRCULATING SEZARY CELLS

WHAT IS THE REMOVAL OF IMMUNOGLOBULINS USED FOR

AUTGMENT IMMUNE RESPONSE FOLLOWING A BONE MARROW TRANSPLANT
TREAT TTP

WHERE ARE STEM AND PROGENITOR CELLS LOCATED

IN PERIPHERAL BLOOD

HOW DO WE REMOVE STEM CELLS

GIVE CYTOKINES TO STIMULATE PRODUCTION
COLLECT DAILY FOR 2-5 HRS
REMOVE PLASMA OR RBC AND FREEZE

WHEN ARE PERIPHERAL BLOOD STEM CELLS REINFUSED

POST CHEMO/RADIATION

WHAT IS GOAL OF PERIPHERAL BLOOD STEM CELLS

TO REPLENISH BONE MARROW

WHAT IS PERIPHERAL BLOOD STEM CELLS MOST COMMONLY USED FOR

AML
CML
LYMPHOMA
SELECTIVE USE FOR SOLID TUMORS (BREAST CANCER)

WHY IS MODIFIED HGB CROSSLINKED

TO PREVENT TETRAMERS FROM DIVIDING INTO DIMERS
DIMERS ARE EXCRETED BY KIDNEY AND CAN BECOME TOXIC

WHAT DOES CROSSLINKING DO IN MODIFIED HGB

PYRIDOXAL PHOSPHATE (2,3 DPG) ALLOWS BETTER OFFLOADING OF OXYGEN
REMAINS IN CIRCULATION 25-30 HOURS

WHAT ARE ADVANTAGES OF MODIFIED HGB

NO TYPE AND SCREEN SINCE CONTAINS NO BLOOD GROUP ANTIGENS

CAN BE LYPHOLIZED AND STORED AS STABLE DRY POWDER

WHAT IS ENCAPSULATED HGB MORE LIKE

ARTFICIAL RBC

WHAT IS BIGGEST DRAWBACK TO ENCAPSULATED HGB

QUICK REMOVAL BY RE SYSTEM

WHAT IS CONJUGATED HGB

MOLECULES LINKED TO FORM POLYMERS

GENETIC ENGINEERING OF E. COLI TO MANUFACTURE HUMAN HGB

RECOMBINANT HGB

WHAT DOES BLOCKING NITRIC OXIDE IN RECOMBINANT HGB DO

STOPS VASOCONSTRICTION WHEN INFUSED INTO EXPERIMENT ANIMALS

ASSUMING THEY CAN FIX SHORT HALF LIFE WHAT IS MOST PROMISING NEW DEVELOPEMENT

ENCAPSULATED HGB

WHAT DOES PERFLUOROCARBONS DO

CARRIES OXYGEN WHICH WILL INCREASE OXYGEN AFTER THROMBOSIS, STROKE

WHAT IS OXYGENT USED FOR

PATIENTS BREATHING 100 % OXYGEN

HOW MUCH COULD PERFLUOROCARBONS REDUCE HOMOLOGOUS BLOOD BY IF APPROVED

2 UNITS WHEN USED WITH AUTOLOGOUS PREDEPOSITION AND CELL SAVER DURING SURGERY

WHAT ARE DISADVANTAGES OF PERFLUOROCARBON

PATIENT MUST BE ON 70-90%
RAPIDSLY REMOVED BY RE SYSTEM
MUST BE KEPT FROZEN

WHAT IS ADVANTAGE TO PERFLUOROCARBONS

LARGE QUANTITITIES

WHAT IS TRANSGENIC HGB MADE FROM

PIGS

CAN STEM CELLS MAKE HGB

YES

WHAT ARE CYPLEX

VIRUS KILLED., INFUSABLE PLATELET MEMBRANES W/ LONGER SHELF LIFE THAN DONOR PLATELETS

NON IMMUNOGENIC PLATELET W/ NO HLA ANTIBODIES AND CAN BE USED ON PATIENT W/ PLATELET REFRACTORY

ARTIFICIAL PLATELETS

WHAT ARE ARTIFICAL PLATELETS MADE FROM

EXPIRED PLATELETS