Bloodbanking - MEJORADA

• 52% proteins

• 40% lipids

• 8% carbohydrates

The RBC membrane is composed of:

Deformability

Ability of RBC to change it shape and responds to external forces to allows them pass on a narrow vocabulary

RBC viability

This is a measure of in vivo RBC survival following transfusion

Citrate

Responsible for chelating calcium

Monobasic sodium phosphate

Maintains the pH during the storage

Monobasic sodium phosphate

• It acts as a buffer and also a substrate

• It is needed for maintenance of 2,3 DPG

Dextrose

Used as substrate but more on ATP production

Adenine

• Important for production of 2,3 DPG

• Prolongs the shelf-life of RBCs to 35 days instead of 21 days

Acid-citrate dextrose (ACD-A)

Toxic and must be coupled with dextrose to lessen the toxicity

Citrate-phosphate dextrose (CPD)

Which anticoagulant is used for apheresis?

CP2D

Coupled with citrate, dextrose + monobasic sodium phosphate

35 days

What is the shelf life of CPDA-1?

RBC concentrates or for packed red blood cells

RBC additive solutions are used for:

42 days

RBC additive solutions extend the shelf life of RBCs for up to:

Mannitol

MORSE TYPE

Adsol AS-1

Citrate and phosphate

MORSE TYPE

Nutricel AS-3

Mannitol

MORSE TYPE

Optisol AS-5

Cryoprecipitate

Whole blood hard spin is used for which component/s?

2 days

Shelf life of Heparin

1-6 C

What is the storage temp of whole blood and pRBC?

5 x 10^6

How much residual RBCs are in Leukoreduced RBCs?

170 um

1st gen filter size

20-40 um

2nd gen filter size

400 mL collection

Rejuvenated RBCs are only for RBCs with:

Rejuvenated RBCs (Rejuvesol)

Revives the levels of lost ATP and 2,3 DPG levels

Increased HCT up to 1-3%

What is the immediate effect of 1u whole blood?

CPD, CP2D & CPDA1

Rejuvenated RBCs are preserved using:

• Phosphate

• Inosine

• Pyruvate

• Adenine

Rejuvesol contains:

Washed RBCs

• Anemia with history of febrile reactions

• Paroxysmal nocturnal hemoglobinuria

• For patients with plasma proteins antibodies to reduced allergic reactions (for IgA-deficient pxs)

Requires plasma removal

QC requirement of washed RBCs

Washed RBCs

What component is given for IgA-deficient patients and/or febrile reactions?

Autologous

It is the safest method of blood donation

10 years

Shelf life of frozen RBCs

Glycerol

It is the most common cryoprotectant

–65 C

Storage temp for RBC freezing

40% W/V

Which glycerol concentration uses dry ice?

20% W/V

Which glycerol concentration uses liquid nitrogen?

40% W/V

Which glycerol concentration is most commonly used for RBC freezing?

24 hours

Deglycerolized RBCs should be transfused within:

20-24 C

Storage temperature of platelets

Increase platelet count by 30,000-60,000/unit

Immediate effect of single donor platelets

3-5 days with continuous agitation

Shelf life of random donor platelets

5 days

Shelf life of single donor platelets

Fresh Frozen Plasma

Which component should contain 400mg fibrinogen and all coag factors?

1 year

Shelf life of FFP

Depletion of components

Exposing the FFP directly in 37 C can cause:

Single Donor Plasma

Used for treatment of stable clotting factor deficiencies

5 days beyond WB expiration

Shelf life of single donor plasma (liquid)

5 years

Shelf life of single donor plasma (frozen)

Cryoprecipitated AHF

Cold and soluble precipitate prepared from FFP

Used for treating:

• Hemophilia A

• Von Willebrand’s disease

• Fibrinogen deficiency

• Factor XIII deficiency

Granulocyte concentrate

• To correct severe neutropenia

• Fever unresponsive to antibiotic therapy

• Myeloid hypoplasia of the bone marrow

• Equal or greater than 1.0x 10^10 WBC

24 hours

Shelf life of granulocyte concentrate

1 year

Shelf life of frozen cryoprecipitated AHF

6 hours

Shelf life of thawed cryoprecipitated AHF

4 hours

Shelf life of pooled cryoprecipitated AHF

FVIII Concentrate

It is used for treatment of Hemophilia A

FIX Concentrate

It is used for treatment of Hemophilia B

Immune Serum Globulin

• Prophylactic treatment to patients exposed to hepatitis, measles or chickenpox

• Treatment of congenital hypogamma-globulinemia

Normal Serum Albumin (NSA)

Requested there is a decrease in albumin due to trauma burns, surgery in cases where there is hypoalbuminemia

96% of albumin and 4% of globulin

Normal Serum Albumin contents

85% of albumin and 15-20% of globulin

Plasma Protein Fraction contents

28 days of the normal dating period of the blood, whichever comes first

Shelf life of irradiated blood

Irradiated blood

Which blood component is used for BM transplants and GVH reactions?

• Cesium 137

• Cobalt 60 isotopes

Contents of irradiated blood

15 gy

Lowest minimal dose of irradiated blood

Ringer’s Lactate

Most commonly used crystalloid

8 weeks

If a donor donates WB, how many days/weeks must be elapsed before he can donate for pheresis?

150 x10^9/L

If platelet pheresis is to be performed, a donor must have above _____________________ platelet count.

Hydroxyethyl starch (HES)

Sedimenting agent used for granulocyte collection

Neocytapheresis

Transfusion of young RBCs as therapeutic indications for children with hematologic disorders such as Thalassemia in which there is an abnormal Hgb synthesis

Erythrocytapheresis

Considered an exchange procedure predetermined quantity of red cells is removed from the patients and replaced with homologous blood

FFP

Recommended replacement fluid used for plasma exchange

Plasma exchange

To remove the offending agent in the plasma causing clinical symptoms in cases of Paraproteinemia

Clerical error

Most common cause of transfusion reaction

IgM

Which type of antibody is involved in intravascular hemolysis?

AHTR

• Manifestation of signs and symptoms happens within 24 hours

• Deadly type of tranfusion reaction

• The associated hemolysis is Extravascular

FNHTR

• Increase temperature of greater than 1ºC after transfusion

• Most common type of transfusion reactions but easily manageable

Antipyretics (Paracetamol)

It is used for managing or preventing FNHTR

Allergic transfusion reaction

• Second most common type of transfusion reaction

• Immune-type transfusion reaction that involves IgE antibodies

• S/S: Urticaria (Hives), Erythema

  Management/Prevention: Antihistamine (prior to transfusion) and washed RBCs

Fever

The most common sign or symptom of FNHTR

Transfusion of IgA deficient components (No colloid), and washed components

Management and prevention of anaphylactic transfusion reaction

TACO

• Good example of iatrogenic (physician-caused) transfusion reaction

• Common in patients with iron overload / cardiac and pulmonary related conditions

TRALI

Most common cause of transfusion-related deaths (TRD)

Hypotension

It is a nonspecific sign that could be seen in a variety of other transfusion reactions or as part of the patient’s underlying condition.

Hypotensive Transfusion Reaction

In children, it is defined as a 25% drop in baseline systolic BP

Kidd

It is the most related antibody to DHTR

TA-GVHD

Occurs when immunological competent lymphocytes (T-cells) attack an immunocompromised host

Post-transfusion purpura

Characterized by severe thrombocytopenia one week after transfusion due to platelet antibodies to platelet specific antigens

Transfusion-Induced Hemosiderosis

It is also known as iron overload

It is related with citrate toxicity

Deferoxamine

It is the treatment for Transfusion-Induced Hemosiderosis

Immune hemolytic anemia

Defined as shortened RBC survival mediated through the immune response, specifically by a humoral antibody

HTLV-1

Oncogenic retrovirus that causes adult T-cell leukemia

Erythroblastosis Fetalis

HDFN is also known as?

Stressed erythropoiesis

Premature erythropoiesis characterized by increased destruction of neonatal RBCs due to maternal incompatible antibodies

Fetomaternal hemorrhage

It occurs 28 weeks of gestation

Anemia

Most immediate severe complication among fetuses

Hyperbilirubinemia (Jaundice)

Most immediate severe complication among newborns

Hydrops fetalis (Fetal edema)

• Seen 18-20 weeks of gestations

• Demonstrated via Ultrasound

• Common cause of death among fetus due to anemia

ABO HDFN

Most common but less severe form of HDFN

Rh HDFN

Most severe HDFN