BB_SEM

Blood Component Therapy

• Involves transfusing specific blood components instead of whole blood

• Ensures patients receive only what they need

Red Blood Cells (RBCs)

Platelets

Plasma

Cryoprecipitate

Blood Component Therapy

• Blood Components Include:

  • _ – for oxygen transport

  • _ – for blood clotting

  • _ – contains clotting factors

  • _ – rich in fibrinogen

450

Whole Blood

• Start: Whole blood (_ mL)

  • From this single bag, we create 4-5 components using centrifugation and freezing

red cells

hemoglobin

1-6

Whole Blood

• How to Make Packed RBCs

  • Goal: Get the _ _

  • Whole blood → hard spin; RBCs settle at the bottom → remove plasma → packed RBCs

  • Packed RBCs

    • Used to increase _

    • Stored at _°C

Whole blood → hard spin; RBCs settle at the bottom → remove plasma → packed RBCs

Whole Blood

• How to Make Packed RBCs

  • Goal: Get the red cells

  • (process)

  • Packed RBCs

    • Used to increase hemoglobin

    • Stored at 1-6°C

platelets

RDPs

20-24, agitation

Whole Blood

• How to Make Platelets (RDPs)

  • Goal: Get the _

  • Two spins: Whole blood → light spin → platelet-rich plasma (PRP) → hard spin → platelets form a pellet → random donor platelets (RDPs)

• _

  • Stored at room temp _°C WITH ?

    • Platelets need movement and oxygen to stay alive

  • Used when platelets are low

Whole blood → light spin → platelet-rich plasma (PRP) → hard spin → platelets form a pellet → random donor platelets (RDPs)

Whole Blood

• How to Make Platelets (RDPs)

  • Goal: Get the platelets

  • Two spins: (process)

• RDPs

  • Stored at room temp 20-24°C WITH agitation

    • Platelets need movement and oxygen to stay alive

  • Used when platelets are low

plasma, clotting factors

-18

Whole Blood

• How to Make Fresh Frozen Plasma (FFP)

  • Goal: Get _ with full ?

  • Whole blood → hard spin → separate plasma → freeze within 8 hours → FFP

  • FFP

    • Stored at _°C or colder

      • To keep clotting factors alive

    • Used for coagulopathy, DIC, liver failure

Whole blood → hard spin → separate plasma → freeze within 8 hours → FFP

Whole Blood

• How to Make Fresh Frozen Plasma (FFP)

  • Goal: Get plasma with full clotting factors

  • (process)

  • FFP

    • Stored at -18°C or colder

      • To keep clotting factors alive

    • Used for coagulopathy, DIC, liver failure

fibrinogen-rich product

fibrinogen, factor VIII, XIII, vWF

Whole Blood

• How to Make Cryoprecipitate 

  • Goal: Get ?

  • FFP (frozen) → thaw at 1-6C → cold “precipitate forms → collect the precipitate → this is cryoprecipitate

  • Cryoprecipitate

    • Contains (4)

    • Used for low fibrinogen

  • Slow thawing maximizes the recovery and concentration of key clotting factors

FFP (frozen) → thaw at 1-6C → cold “precipitate” forms → collect the precipitate → this is cryoprecipitate

Whole Blood

• How to Make Cryoprecipitate 

  • Goal: Get fibrinogen-rich product

  • (process)

  • Cryoprecipitate

    • Contains fibrinogen, factor VIII, XIII, vWF

    • Used for low fibrinogen

  • Slow thawing maximizes the recovery and concentration of key clotting factors

white cells

Granulocyte product

Whole Blood

• How to Make Granulocytes

  • Goal: Collect ? for severe infections

  • Donor → apheresis machine → granulocyte product

  • ?

    • Used only for severe neutropenia infections

    • Must be TRANSFUSED ASAP and IRRADIATED

Donor → apheresis machine → granulocyte product

Whole Blood

• How to Make Granulocytes

  • Goal: Collect white cells for severe infections

  • (process)

  • Granulocyte product

    • Used only for severe neutropenia infections

    • Must be TRANSFUSED ASAP and IRRADIATED

1-6, 42

hemoglobin, oxygen

Blood Component	Starting Material	Key Preparation Steps	Storage Requirement	Major Clinical Use / Importance
Packed Red Blood Cells (PRBCs)	Whole blood	Collect whole blood with anticoagulant Centrifuge (heavy spin) Remove plasma	? °C up to ? days (with additive solution)	Increases ? and ? delivery without excess volume

leukocyte

1-6

febrile, CMV, HLA alloimmunization

Blood Component	Starting Material	Key Preparation Steps	Storage Requirement	Major Clinical Use / Importance
Leukocyte- Reduced PRBCs (LR-PRBCs)	PRBCs	Pass PRBCs through ? filter	? °C	Reduces ? reactions, ? transmission, and ?

20-24, 5

thrombocytopenia

Blood Component	Starting Material	Key Preparation Steps	Storage Requirement	Major Clinical Use / Importance
Random Donor Platelets (RDPs)	Whole blood	Light spin → platelet rich plasma (PRP) Heavy spin of PRP Remove excess plasma	? °C with agitation ? days	Prevents or controls bleeding in ?

-18, 1

clotting factors

Blood Component	Starting Material	Key Preparation Steps	Storage Requirement	Major Clinical Use / Importance
Fresh Frozen Plasma (FFP)	Whole blood	Centrifuge whole blood Separate plasma Freeze within 8 hours	≤ ? °C up to ? year	Replaces ? in bleeding disorders

-18, 1

fibrinogen

Blood Component	Starting Material	Key Preparation Steps	Storage Requirement	Major Clinical Use / Importance
Cryoprecipitate (CRYO)	Fresh frozen plasma	Thaw FFP at 1-6 °C Collect precipitate Remove plasma Refreeze	≤ ? °C up to ? year	Provides ? for severe bleeding

20-24, 24

neutropenia

Blood Component	Starting Material	Key Preparation Steps	Storage Requirement	Major Clinical Use / Importance
Granulocytes	Donor blood	Donor stimulation (GCSF/steroids)  Apheresis collection	? °C use within ? hours	Used in severe infection with ?

Acute massive blood loss

Hypovolemic shock with anemia

Exchange transfusion

Patients requiring CPB (Cardiopulmonary bypass) if whole blood protocol is used

Whole Blood Transfusion

Instances where whole blood is used: (4)

25

Whole Blood Transfusion

1. Acute massive blood loss

   • Loss of >?% of total blood volume

   • In trauma, battlefield injuries, or major surgery

   • When the patient needs oxygen-carrying capacity + volume expansion simultaneously

crystalloids/colloids

Whole Blood Transfusion

1. Hypovolemic shock with anemia

   • When ? alone cannot stabilize the patient

anemia, sepsis, or hyperbilirubinemia

Whole Blood Transfusion

1. Exchange transfusion

   • Neonatal exchange transfusion for severe (3) (though reconstituted whole blood is more common now)

coagulopathy

Whole Blood Transfusion

1. Patients requiring CPB (Cardiopulmonary bypass) if whole blood protocol is used

   • Some cardiac surgery centers use fresh whole blood to reduce ?

massive hemorrhage

Whole Blood Transfusion

1. Not recommended when:

• You only need RBCs → use packed RBCs

• You only need plasma → use FFP

• You need platelets → use platelet concentrates

• Whole blood is not a substitute for component therapy except in ?

1-6

35

Whole Blood Transfusion

Storage Requirements

• Whole Blood (CPDA-1)

  • ?°C

  • Shelf life: ? days

1-6

21

Whole Blood Transfusion

Storage Requirements

• Whole Blood (CPD)

  • ?°C

  • Shelf life: ? days

Platelets

V & VIII

Whole Blood Transfusion

Storage Requirements

• Storage considerations:

  • ? in whole blood are nonfunctional when stored at 1-6°C

  • Coagulation factors degrade (Factor ? and ? drop quickly)

  • Therefore, whole blood is NOT used as a source of platelets or labile coag factors

1-10

Whole Blood Transfusion

Transport Requirements

• Temperature requirement

  • Must be transported at ?°C

  • Use insulated containers with ice packs or validated cold boxes

30

reused

discard

Whole Blood Transfusion

Transport Requirements

• If temperature exceeds 10°C

  • Unit must be discarded unless:

    • It can be proven that temp excursion was brief AND still within allowable limits (per AABB/DOH guidelines)

  • Once issued from the blood bank

    • Must be transfused within ? minutes (“-minute rule”)

  • If returned within 30 minutes AND still 1-10°C → can be ?

  • If warm or above temperature → ?

1-6

42

Packed Red Blood Cells (PRBCs)

• PRBCs are whole blood with most plasma removed, leaving concentrated red cells

• Storage

  • ?°C

  • Shelf life: Up to ? days (depending on preservative; CPDA-1, AS-1, AS-3, AS-5)

1-10

hemolysis

Packed Red Blood Cells (PRBCs)

• Transportation

  • Must be maintained at ?°C

  • Transported inside validated cold containers

  • Any deviation may cause ? → unit is discarded

Acute blood loss

Anemia

Surgical bleeding

Trauma

Packed Red Blood Cells (PRBCs)

• Indications

• (4)

• When the goal is oxygen-carrying capacity, not volume expansion

1

3

Packed Red Blood Cells (PRBCs)

• Expected Increase

  • ↑ Hemoglobin by ~? g/dL per unit

  • ↑ Hematocrit by ~?% per unit

Normal Saline

Packed Red Blood Cells (PRBCs)

• Special Considerations

• Use only ? (0.9% NaCl) for Infusion

• No LR, D5W, or medications – they cause hemolysis or RBC clumping

  • Must be ABO compatible

  • Irradiation or leukoreduction applied based on patient risk (e.g., immunocompromised)

Random Donor Platelets (RDPs)

Apheresis Platelets (SDPs)

Platelet Concentrates

• These may be:

  • ? – pooled from whole blood

  • ? – collected from one donor

20-24

agitation

5-7

Platelet Concentrates

• Storage

  • _°C (room temp)

  • With continuous _

  • Shelf life: _ days (risk of bacterial growth is highest among all components)

20-24

Platelet Concentrates

• Transportation

• Must be maintained at _°C, with agitation

• Should never be refrigerated – platelets lose function

Active bleeding

Thrombocytopenia

Platelet dysfunction (e.g., uremia, aspirin therapy)

Massive transfusion

Platelet Concentrates

• Indications

  • (4)

5,000–10,000/μL

30,000–60,000/μL

Platelet Concentrates

• Expected Increase

• 1 unit RDP → ↑ ?

• 1 unit SDP → ↑ ?

Room temperature

ABO

Platelet Concentrates

• Special Considerations

• ? is required to preserve platelet function

• Must be ? compatible if possible, but not strictly needed

• Cannot use a filter or refrigerate

Fresh Frozen Plasma (FFP)

Plasma frozen within 8 hours of collection

-18

1

Fresh Frozen Plasma (FFP)

• Storage

  • _°C or colder

  • Shelf life: Up to _ year

-18

Fresh Frozen Plasma (FFP)

• Transportation

  • Transported frozen, kept at _°C or below

  • Must be thawed before transfusion

Coagulopathy

Liver disease

DIC

Warfarin reversal

Massive transfusion protocol (MTP)

Fresh Frozen Plasma (FFP)

• Indications

  • (5)

INR

V and VIII

Fresh Frozen Plasma (FFP)

• Expected Therapeutic Effect

  • ↓ ?

  • Replaces all clotting factors (including (2))

ABO

antibodies

Fresh Frozen Plasma (FFP)

• Special Considerations

  • ? compatibility required

  • Plasma contains ?

  • Not for volume expansion

Fibrinogen

Factor VIII

vWF

Factor XIII

Fibronectin

Cryoprecipitate

• Cryo contains:

  • (5)

-18, 1

-18

Cryoprecipitate

• Storage

  • ?°C or colder, up to ? year

• Transportation

  • Transported frozen, kept below ?°C

  • Thawed right before use

DIC

Hypofibrinogenemia

Factor XIII deficiency

Massive transfusion with low fibrinogen

Uremic bleeding (vWF)

Cryoprecipitate

• Indications

  • (5)

5-10

Cryoprecipitate

• Expected Increase

  • 1 unit increases fibrinogen by _ mg/dL

10-15

Cryoprecipitate

• Special Considerations

  • ABO compatibility not strictly required

  • Small volume (~_ mL), so used for fibrinogen replacement, not volume expansion

20-24

24

Granulocytes

• Granulocytes

  • This is very rarely used and reserved for desperate cases

  • Storage

    • _°C

    • Must be transfused ASAP (within _ hours)

    • Granulocytes lose function rapidly

20-24

Granulocytes

• Transportation

  • _°C

  • Should not be cooled or agitated excessively

bacterial/fungal

Neutropenia

immunocompromised

Granulocytes

• Indications

  • Severe ? infection

  • ? unresponsive to antibiotics

  • Used in ? patients (e.g., post-chemotherapy)

WBC

Granulocytes

• Expected Increase

  • Provides a temporary ? boost, not sustained

  • Counts fall again within hours

irradiated

ABO

febrile, alloimmunization

Granulocytes

• Special Considerations

  • MUST be ?

    • Prevents transfusion-associated GVHD

  • ? compatibility is ideal

  • High risk of reactions ((2))

Whole Blood

Blood Components

Combined red cells and volume deficit, e.g., massive hemorrhage; exchange transfusion

Red blood cells

Blood Components

Red cell deficit

Leukocyte reduced red blood cells

Blood Components

Prevention of febrile reaction/alloimmunization

Washed red cells

Blood Components

Prevention of allergic reaction

Frozen red cells

Blood Components

Autologous storage for postponed surgery

Whole Blood

1-6

1-10

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Massive hemorrhage, trauma, cardiac surgery with volume loss	Collected directly from donor; contains RBCs, plasma, and platelets if not separated

Packed Red Blood Cells (PRBCs)

1-6

1-10

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Anemia, hemorrhage, surgical blood loss, low Hb	Whole blood is centrifuged and plasma is removed; additives may be added (e.g., SAGM)

Leukocyte- Reduced RBCs

1-6

1-10

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Prevent febrile non-hemolytic reactions, CMV transmission	PRBCs are filtered to remove WBCs either during collection or before storage

Irradiated RBCs

1-6

1-10

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Prevent TA-GvHD (e.g., in immunocompromised patients)	PRBCs are exposed to gamma or X-ray radiation to inactivate lymphocytes

Washed RBCs

1-6

1-10

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Severe allergic reactions, IgA deficiency	RBCs are washed with sterile saline to remove plasma proteins and WBCs

Platelet Concentrate (Random Donor)

20-24 with continuous agitation

20-24

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Thrombocytopenia, platelet dysfunction, bleeding	Centrifugation of whole blood; platelet-rich plasma is separated and concentrated

Single Donor Platelets (Apheresis)

20-24 with continuous agitation

20-24

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Same as above; preferred when matching HLA types or reducing exposure to multiple donors	Collected via apheresis using a cell separator machine

Fresh Frozen Plasma (FFP)

≤-18 °C (or ≤-25 °C for 1 year storage)

Maintain frozen

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Coagulation factor deficiencies, liver disease, DIC, warfarin reversal	Plasma is separated and frozen within 8 hours of collection to preserve labile clotting factors

Thawed Plasma

1-6 °C (for up to 5 days after thawing)

1-10 °C

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Same as FFP; used when FFP not available	FFP is thawed and stored in 1-6 °C refrigerator

Cryoprecipitate

≤-18 °C

Maintain frozen

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Fibrinogen deficiency, DIC, factor XIII deficiency, hemophilia A (if factor VIII not available)	FFP is slowly thawed at 1-6 °C; the cold-insoluble portion is collected and refrozen

Granulocyte Concentrate

20-24 °C (no agitation)

20-24 °C

Blood Component	Storage Temp	Transport Temp	Indications	How It Is Prepared
?	? °C	? °C	Neutropenia with severe infection unresponsive to antibiotics	Collected by apheresis; often requires donor stimulation (e.g., G-CSF or steroids)

Blood Donor Screening

• Is done to assess the condition of the donor and the quality of the blood 

• Ensures the safety of the donor during and after the blood donation

• Ensures that the blood donated is safe for transfusion

• This procedure includes physical examination, interview, and screening of the donor’s blood

110 lb (50 kg)

Blood Donor Screening

General Appearance and Weight Determination

• The donor’s general appearance is first assessed to determine overall health and fitness to donate

• The donor should appear alert, well-nourished, and free from signs of illness such as pallor, weakness, intoxication, or distress

• Weight is then measured to ensure donor safety

• According to Harmening, the donor must weigh at least ? to safely tolerate blood collection and to reduce the risk of adverse donor reactions

17

65

Blood Donor Screening

• Age Requirement for Blood Donors

  • Minimum age: ? years old (or 16 years old with parental consent, depending on local regulations)

  • Maximum age: ? years old (donors older than 65 may be accepted if they are in good health and allowed by institutional policy)

90-180

50-100

Blood Donor Screening

• Blood Pressure Determination

  • Blood pressure is measured to assess cardiovascular stability

  • Acceptable blood pressure values are generally ? mmHg systolic and ? mmHg diastolic, ensuring that blood donation will not place undue stress on the donor’s circulatory system

50-100

Blood Donor Screening

• Pulse Rate Determination

  • Pulse rate evaluation helps determine heart rate and rhythm

  • A normal, regular pulse between ? beats per minute is considered acceptable

  • An irregular or abnormal pulse may indicate underlying medical conditions and is a basis for donor deferral

37.5°C (99.5°F)

Blood Donor Screening

• Temperature Determination

  • Body temperature is taken to screen for fever or infection

  • According to Harmening, the donor’s temperature must not exceed ?

  • Elevated temperature may indicate infection and poses a risk to both the donor and the blood recipient

12.5 g/dL

38

Blood Donor Screening

• Hemoglobin and Hematocrit Determination

  • Hemoglobin or hematocrit testing is performed to ensure the donor is not anemic

  • The minimum acceptable hemoglobin is ≥? (or hematocrit ≥?%)

  • This protects the donor from post-donation anemia and ensures adequate red cell quality

acute hemolytic transfusion reactions

Blood Donor Screening

• Blood Type Determination (ABO and Rh)

  • ABO and Rh typing are required for proper identification and labeling of donated blood units

  • This step is critical in preventing ? caused by blood group incompatibility

HIV, Hepatitis B, Hepatitis C, and Syphilis

Malaria

Blood Donor Screening

• Tests for Blood-Transmissible Diseases

  • All donated blood is tested for transfusion-transmitted infections 

  • Mandatory testing includes ?, with additional tests such as ? depending on local epidemiology and regulations

  • This ensures the safety of the blood supply

Donor’s weight in kg / 50 × 450 mL

Volume to collect ÷ 450 × 63 mL

63 - anticoagulant needed

Blood Donor Screening

• Computing Blood Volume and Anticoagulant Adjustment

  • Formula

Donor Interview

?

• Blood donor interview data sheet

  • This form is usually given to the donor to let him/her fill in necessary information (full name, address, type of donor: volunteer, replacement, directed, autologous)

• The second part is the interview form wherein the donor is asked a series of questions about medical and travel history, blood donation history, contact with infectious individuals, and use of substances of abuse

• The interviewer must be respectful and professional when asking questions and recording the results

Donor Consent

?

• The donor is asked to fill out a form indicating that the donor is willing to have his/her blood taken and screened for different parameters

• This also ensures the confidentiality of the results

• Verbal or written consent may be given although a written consent is lawful and formal

450

470

Donor Bleeding

• A standard blood bag used for whole blood donation contains:

  • About 1 pint of blood

  • Volume: Approximately ? mL (±10%)

    • This is equal to 1 pint

• 450 mL → actual blood collected from the donor

• ~20 mL → anticoagulant solution already inside the bag

  • Total volume ≈ ? mL

• The anticoagulant is needed to prevent clotting and preserve blood cells during storage. That is why the labeled volume of a filled blood bag is often 470 mL, not just 450 mL

Aseptic Technique

PVP-iodine

chlorhexidine gluconate, isopropyl alcohol

?

• ? is used to prevent infection and contamination

• The venipuncture site is cleaned properly, allowed to dry, and must not be touched again before needle insertion

• Most blood banks use iodine complex compounds such as ? as an antiseptic for the venipuncture site

• Donors who are allergic or sensitive to iodine compounds may use ? and ?

antecubital vein

8-10

Collection Procedure

• Blood is collected from a suitable vein, usually the ?, using a sterile needle. The blood flows into the bag and is gently mixed with anticoagulant

• The usual collection time is ? minutes, and about 450 mL of blood is collected

median cubital

median cubital

Aspect	Routine Venipuncture	Blood Donation (Donor Bleeding)
Vein Used	Antecubital veins (? most common)	Antecubital veins (? preferred; cephalic or basilic as alternatives)

21–22

16

Aspect	Routine Venipuncture	Blood Donation (Donor Bleeding)
Needle Size	Smaller needle (usually ? gauge)	Larger bore needle (usually ? gauge)

15-30

15-30

Aspect	Routine Venipuncture	Blood Donation (Donor Bleeding)
Needle Angle	? degrees	? degrees

Blood collection bag

Blood collection needle (16G)

Tubing and clamp

Antiseptic solution

Tourniquet

Material/Instrument	Purpose
?	Collects whole blood and contains anticoagulant to prevent clotting
?	Allows safe and fast blood flow from vein
?	Guides blood into the bag and controls flow
?	Cleans skin to prevent infection
?	Makes vein visible and easier to puncture

Gloves

Blood mixer / weighing scale

Gauze / cotton

Pressure bandage

Donor chair / bed

Material/Instrument	Purpose
?	Protects donor and phlebotomist from infection
?	Measures blood volume and mixes blood with anticoagulant
?	Stops bleeding after needle removal
?	Protects puncture site and prevents bleeding
?	Keeps donor comfortable and safe

Blood Pressure Monitor

Donor couch/chair

Blood bag with needle

Blood bag tube clip/sealer

Blood bag transportation box

EDTA tube

Other Materials and Instruments in Donor Bleeding
?	Used to monitor the donor’s blood pressure during the collection
?	To ensure the donor is in supine position during blood collection
?	Collected blood will be stored here
?	Used to stop the flow of blood from the donor to the blood bag
?	Container used to store blood bags
?	For collection of donor’s sample whole blood for analysis

Non-additive tube

PVP-iodine

Blood bag refrigerator

Other Materials and Instruments in Donor Bleeding
?	For collection of donor’s serum for antibody analysis
?	Used as an antiseptic in the venipuncture site of donor bleeding
?	Used for long-term storage of collected blood

16g

17g

• What is the appropriate needle gauge used in blood bag collection?

  • _ – most common

  • _ – occasional

12.5, 38, 39

56, 14

Breastfeeding

Temporary Deferral
Low hemoglobin/hematocrit	<? g/dL; <?% for females, <?% for males
Fever or active infection
Antibiotic use
Minor surgery
Blood donation	Whole blood – ? days
	Platelets – ? days
Pregnancy or up to 6 weeks postpartum
?	If iron levels adequate

3-12 months

1 year

2 to 4 weeks

1 month

1 month

6 months

Temporary Deferral
Recent dental procedures
Tattoo/body piercing	?
Recent travel to malaria-endemic areas	?
Immunization	Live virus – ?
	Inactivated – usually no deferral
Taking isotretinoin	?
Taking finasteride	?
Taking dutasteride	?

48 hours

3-12 months

3-12 months

24 hours

12 months

1 year

Temporary Deferral
Taking aspirin	For platelets – ?
Recent blood transfusion	?
Sexual contact with high-risk individuals	?
After alcohol intake	?
Menstruation with symptoms
Exposure to hepatitis or HIV-positive person	?
Recent rabies vaccination	If no exposure: ?

3 years

skin/BCC

recent

1-5 years

Definite Deferral
Malaria	Past history; ? after treatment
Cancer history	Except ?, cervical in situ*
Heart disease	Depends on severity
History of seizures	If ?
Blood disorders	Evaluated individually
Certain cancers in remission	After ?