Immunohematology

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Author:
ncrook
ID:
213152
Filename:
Immunohematology
Updated:
2013-05-11 01:04:26
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Blood Components
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Blood Components
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  1. What is the term for using blood or blood components to treat a disease in a patient?
    Hemotherapy
  2. What is adenine used in?
    ATP synthesis
  3. What is citrate used for?
    Chelates calcium to prevent coagulation
  4. What does CPD, CP2D, and CPDA-1 stand for?
    • Citrate Phosphate Dextrose
    • Citrate Phosphate 2 Dextrose
    • Citrate Phosphate Dextrose Adenine-1
  5. What is dextrose used for?
    Sugar to support RBC life
  6. What is Sodium biphosphate used for?
    Buffer to prevent decreased pH
  7. What additives:
    Are used to extend the shelf life of RBCs to 42 days 
    Reduce RBC viscosity during transfusion
    How long after collection must it be added?
    • Adsol (AS-1, AS-3, or AS-5)
    • AS-1: contains mannitol
    • AS-3: contains citrate and phosphate
    • AS-5: contains mannitol
    • Must be added within 72 hours of collection
  8. What preservative solution:
    Contains phosphate, inosine, pyruvate, and adenine
    Its purpose is to resotre 2,3-BPG and ATP levels before freezing or transfusing a unit
    May be necessary for autologous or rare units
    Rejuvenation solution
  9. When can RBCs be rejuvenated?
    Up to 3 days past the expiration date and then frozen for future use
  10. What must happen to cells that have been rejuvenated prior to transfusion?
    Cells must be washed to remove the inosine
  11. What is the storage temp and expiration dates of whole blood?
    • 1-6 degrees celcius
    • 21 days with CPD and CP2D
    • 35 days with CPDA-1
    • 42 days with Adsol (AS-1, AS-3, or AS-5)
  12. What is the storage temp and expiration dates of RBCs?
    • 1-6 degrees celcius
    • 21 days with CPD and CP2D
    • 35 days with CPDA-1
    • 42 days with AS-1, AS-3, and AS-5
  13. What is the storage temp and expiration dates of Platelets?
    • 20-24 degrees celcius (RMT) with rotation
    • Expires in 5 days
  14. What is the storage temp and expiration of FFP (frozen and thawed)?
    • Frozen: -18 degrees, expires 1 year
    • Frozen: -65 degrees, expires 7 years
    • Thawed: 1-6 degrees, expires 24 hours 
    • ***If not transfused within 24 hours, it is relabeled as Thawed plasma and expires 4 days after the initial 24 hours***
  15. What is the storage temp and expiration of Cryoprecipate (frozen and pooled)?
    • Frozen: -18 degrees, expires in 1 year
    • Pooled: 20-24 degrees, expires 4 hours after pooling
  16. What is the storage temp and expiration of RBCs (frozen)?
    • -65 degrees
    • Expires 10 years
  17. What is the the storage temp and expiration of deglycerolized/washed RBCs?
    • 1-6 degrees
    • Expires 24 hours after deglycerolization
  18. What is the storage temp and expiration of irradiated RBCs?
    • 1-6 degrees
    • Expires 28 days or original outdate - whichever comes first
  19. What is the storage temp and expiration of plateletpheresis?
    • 20-24 degrees with rotation
    • Expires 5 days
  20. Who defines calibration and maintenance procedures, storage temps, and monitoring parameters for equipment used to store blood products?
    • FDA requirements
    • AABB Standards
  21. What is the required transport temp of RBCs?
    1-10 degrees
  22. What is required when transporting frozen components?
    Shipped on dry ice
  23. What is the transport temp of platelets?
    Room temperature
  24. How long can platelets survive without agitation?
    24 hours
  25. What is the maximum transfusion time allowed for one unit to be transfused?
    • 2-4 hours
    • 4 hours max
  26. What component is used in actibely bleeding patients, patients who have lost at least 25% of their blood volume, or patients requiring exchange transfusions?
    Whole Blood
  27. What component is used in oncology patients undergoing chemotherapy or radiation therapy, trauma patients, surgery patients, dialysis patients, premature infants, and patients with sickle cell anemia?
    RBCs
  28. What is the end result of transfusing 1 unit of RBCs?
    Increases the patients Hgb by 1 g/dL and HCT by 3%
  29. What component is used in chronically transfused patients or patients having known febrile transfusions reactions?
    Leukocyte Reduced RBCs (PCLP)
  30. What is the AABB Standard on the leukocyte reduction for RBCs?
    85% of RBCs must remain and leukocytes must be reduced to <5x106 WBC/unit
  31. How are RBCs frozen and why?
    RBCs are frozen by adding glycerol to prevent cell hydration and the formation of ice crystals that can cause cell lysis
  32. How are RBCs deglycerolized?
    Glycerol is drawn out of the RBCs by washing the RBC with a series of saline solutions with decreasing osmolality
  33. What component with used for patients who have a reaction to plasma proteins (allergic, febrile, and/or anaphylactic) and also used in infant or intrauterine transfusions?
    Washed RBCs
  34. What component is used
    To prevent T cell proliferation (T cells can cause graft-vs-host disease)
    Used for intrauterin transfusions, immunodeficient recipients, premature infants, chemotherapy and radiation patients, and bone marrow or progenitor cells transplant pantients
    Irradiated RBCs
  35. What is the AABB standard for Irradiation of RBCs?
    • Irradiation of cellular components (RBCs and platelets), if a donor is a blood relative of the intended recipient or donor unit is HLA matched for the recipient
    • Recommended minimum dose of gamma radiation is 25 Gy (2500 rads)
  36. What component is used:
    To control or prevent bleeding
    Indicated with patients with chemotherapy, post-bone marrow transplants, or post operative bleeding
    Platelets
  37. What is the life span of transfused platelets?
    3-4 days
  38. What component is:
    Prepared from whole blood unit
    Contains approximately 5.5x1010 plts/unit
    Raises plt count by 5000 micro-L/unit after transfusion
    Platelet concentrates
  39. What is the expiration of pooled platelets after pooling?
    4 hours
  40. How many platelets per unit does plateletpheresis contain?
    3x1011 plts/unit
  41. How many single donor platelets are in plateletpheresis?
    6-8
  42. What component is used to replace coagulation factors in patients?
    FFP
  43. What component is indicated in:
    Bleeding patients who require Factors II, V, VII, IX, and X
    Abnormal coagulation due to massive transfusion
    Patient on anticoagulants who are bleeding or require surgery
    Treatment of TTP and hemolytic uremic syndrome
    Patients with liver disease to prevent or correct bleeding
    Antithrombin III deficiencies
    DIC when fibrinogen is >100 mg/dL
    FFP
  44. What component is used for patients with:
    Factor XIII deficiency
    von Willebrand disease
    Fibrinogen deficiency
    As a fibrin sealant
    Cryoprecipitate
  45. What must each unit of cryoprecipitate contain?
    • 150 mg/dL of fibrinogen
    • 80 IU of factor VIII
  46. What is the expiration of cryoprecipitate after pooling?
    4 hours
  47. What is the formula for figuring factor VIII in cryoprecipitate?
  48. What component is:
    Rare
    Limited to septic infants
    Granulocyte transfusions
  49. What does a bag of granulocyte pheresis contain?
    • >1 x 1010 granulocytes and platelets
    • 20-50 mL of RBCs
  50. What is the storage temp of granulocyte pheresis?
    20-24 degrees celcius with NO agitation until transfused
  51. What must the labeling in Blood Bank conform with?
    • Title 21 of the Code of Federal Regulations (CFR)
    • FDA current thinkings as described in "Guidance for Industry: Recognition and Use of a Standard for Uniform Blood and Blood Component Container Labels"
    • Facilities accredited by AABB must have implemented ISBT 128 labeling systems
  52. What is the term for a replacement of a person's entire blood volume (approximately 10 units) within 24 hours?
    Massive transfusion
  53. If an emergency release of blood is requested, what type should be given to males and females?
    • Males: O Pos
    • Females: O Neg
  54. What clinical condition causes the neonate or infant to develop an anemia that may be severe enought to transfuse?
    Iatrogenic blood loss
  55. What components are preferred for neonatal and pediatric transfusions?
    • Washed or fresh blood because of the liver's inability to metabolize citrate anticoagulants and potassium, which leaks from RBCs in donor units over time
    • Transfusions are given in small volumens in multiple packs taken from a normal size blood unit
    • CMV Negative and/or Leukoreduced blood
  56. Why does liver transplant patients require large amounts of blood products?
    Liver produces many coag factors and cholesterol for RBC membranes
  57. When performing transplants, when is ABO compatibility important?
    ABO compatibility is important in kidney, liver, and heart transplants
  58. What type of transplants are:
    Allogeneic or autologous
    Derived from bone marrow or umbilical cord blood
    Require transfusion support with leukocyte reduced products to prevetn alloimmunization and greater change of rejection
    Progenitor cell transplants
  59. What Transfusion therapy is done when replacement of blood from a patient to improve a patient's health 
    Includes conditions such as Multiple myeloma, Waldenstrom macroglobulinemia, hyperleukocytosis, TTP/HUS, sickle cell, myasthenia gravis, and acute Guillain-Barre syndrome 
    Therapeutic hemapheresis
  60. What type of transfusion reaction
    Destroys the transfused blood cells in vivo
    Has large amount of free hgb released into the blood and can cause systemic damage
    Hemolytic
  61. What type of transfusion reaction is febrile and allergic?
    Nonhemolytic
  62. What type of transfusion reaction are due to RBC or HLA antigens and antigen-antibody reactions?
    Immune-mediated transfusion reactions
  63. What type of transfusion reaction:
    IgM antibodies activate the classical pathway of complement that lyses RBCs intravascularly
    The lysis releases hgb and RBC remnants into the blood
    Excess hgb binds to haptoglobin
    Haptoglobin can only bind so much hgb, so excess hgb is found in the blood and urine
    Intravascular hemolysis hemolytic transfusion reaction
  64. What type of transfusion reaction:
    antibody-coated RBCs are removed from circulation by the liver and spleen
    Cells lyse when sequestered and subsequently, bilirubin is released into the blood
    Antibodies responsible for they type of hemolysis do NOT activate complement cascade or only partially activate it
    Extravascular hemolysis hemolytic transfusion reaction
  65. Whaty type of transfusion reaction causes hypertension by triggering serotonin and histamine release?
    Anaphylatoxins
  66. What type of transfusion reaction:
    Sensitized RBCs are cleared from the blood by phagocytes
    The phagocytes release cytokines that cause fever, hypotension, and activation of T and B cells
    Cytokine activation
  67. What type of transfusion reaction is antigen-antibody complement complexes activate the clotting system and cause DIC?
    Coagulation activation
  68. What is the major result of Acute hemolytic transfusion reactions?
    • DIC
    • Renal failure
    • Irreversible shock
    • Death
  69. What transfusion reaction is an antigen-antibody reaction that activates complement or coats complement?
    Acute hemolytic transfusion reaction
  70. What transfusion reaction has the following labs:
    Increased plasma free hgb
    Increased bilirubin
    Decreased haptoglobin
    Positive DAT
    Acute hemolytic transfusion reaction
  71. What transfusion reaction usually:
    Dependent on the concentration of antibody in the blood rather than the type of antibody
    Occurs 5-7 days posttransfusion
    Caused by alloantibodies to Rh, Duffy, Kidd
    Delayed hemolytic transfusion reaction
  72. What transfusion reaction has the following labs:
    Positive DAT
    Positive posttransfusion antibody screen
    Decreased H&H
    Delayed hemolytic transfusion reaction
  73. What transfusion reaction is caused by:
    HLA antibody in recipient to donor antigens
    Cytokines in blood products containing WBCs and platelets
    Common in patients with multiple pregnancies and transfusions
    Immune Mediated Nonhemolytic Transfusion Reaction
  74. What type of transfusion reaction:
    Clinical signs: Wheals, hives, itching
    Caused when recipient forms antibodies to foreign proteins in donor plasma
    Urticarial reactions
  75. What type of transfusion reaction:
    Clinical signs: rapid onset, severe wheezing and cough, and bronchospasms
    Sequelae: Syncope, shock, death
    Caused by IgA deficiency
    Anaphylactic reaction
  76. What transfusion reaction:
    Occurs 3-30 days posttransfusion
    Clinical signs: Fever, erythematous, maculopapular rash, abnormal liver function
    Caused by transfused T cells react against recipients
    Transfusion Associated Graft-vs-Host disease
  77. What is the most common bacterial contamination in blood products?
    Yersinia enterocolitica
  78. What complication with transfusions:
    Characterized by deposition of the iron containing pigment hemosiderin in organs such as the liver and spleen
    Occurs in chronically transfused patients - especially those with hemolytic anemias
    Hemosiderosis
  79. What complication with transfusions:
    Massive transfusions introduce large amounts of citrate into the body
    Citrate binds ionized calcium but it can be alleviated by calcium chloride or calcium gluconate injections
    Citrate overload
  80. Who is CMV negative used for?
    • Premature infants
    • Intraueterine transfusions
    • Immunocompromised patients
  81. What federal, state, or local safety regulation was made by the FDA and controls:
    Licensing of manufacturers and products
    Labeling
    Facility inspections
    Suspension or revoking license
    Penalties for violation
    Act was expanded in 1944 and implemented under the Public Health Service Act
    Biologics Control Act of 1902
  82. What federal, state, or local safety regulation was made by OSHA and:
    Ensures a sefe and healthy workplace
    Act enforce by OSHA
    Updates to OSHA are published annually in the Code of Federal Regulation (CFR)
    Occupational Safety and Health Act
  83. What federal, state, or local safety regulation was made by the CDC and introduced universal precautions in 1987 to decrease risks of bloodborne pathogens exposure
    In 1991, this regulation required:
    Hazard free workplace
    Provision of education and training to staff
    Evaluation of potential risks
    Evaluation of positions for potential risks
    Posting of signs and use of labels
    Implementation of standard precautions for handling biohazardous substances
    Provision of PPE, at no cost to the employee
    Provision of free Hepatitis B vaccine to at risk staff
    Provision of free Hepatitis B immunoglobulin for any exposures to employees
    Universal precautions in 1987 (referred to as "standard precautions")

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