Blood bank rotation 2 week 3 questions
Baby Girl Martin is eight days old and is going to heart surgery tomorrow. The doctor ordered 4 units of RBCs. State what you need to do to get blood ready for this baby and what you would order from Lifeserve.
4 units O pos or O neg (depending of the Rh of baby) Split units, Leukoreduce, Fresh, and Adsol removed or AS-3
List the antibodies that may cause HDN?
ABO, Rh, S, s, Jka, Jkb, K, Fya, Fyb M, N (rare)
Why don't we crossmatch blood with an infant under four months old?
Baby does not have an immune system or it owns plasma (antibodies).
Now Baby Boy Smith needs 25 ml of RBCs. State all the steps needed in order to get blood ready for him.
Check that a TS NB has been completed. Select a community unit and write baby's information on the sheet. Modify the unit is the computer and reserve and dispense an aliquot on the baby. Make a label for the aliquot and fill out all paperwork. Pull the blood into an aliquot bag and then into the syringe. Label and tag the syringe and call the floor to let them know the specimen in ready.
What is rouleaux?
Coin-like stacking of RBCs in the presence of plasma expanders or abnormal plasma proteins.
What is the purpose of an elution?
Elution is use to remove antibody coating the red cells. Usually performed in following situations: • Cord Blood with Positive DAT • An elution should be done if the patient has been transfused in the last 3 months, has a positive auto-control and positive DAT due to IgG.
Jane Smith is a 21 year old trauma that types as a A neg. She has used 4 units of RBCs and now the doctor wants to give her 4 units of FFP and 10 platelets (pooled and concentrated). Below is our inventory and TBC's inventory, state what FFP and platelets you would give. FFP TBC (platelets) 4 O neg1 B neg10 A pos 15 O pos 15 O pos10 AB pos 5 A neg 9 O neg 6 A neg2 AB neg5 AB neg 6 AB Pos 13 A pos
FFP Platelets 4 A neg 5 A neg, 5 AB neg
Define and describe HTLA?
High Titer Low Avidity These antibodies generally react weakly at AHG and show no specificity. They are usually not clinically significant. To identify a HTLA antibody, make a 1:10 dilution of patient plasma with saline. Test against reactive cells. If the reactions are still weakly positive or the same strength this indicates an HTLA antibody is present.
Define and describe HLA?
Human Leukocyte Antigen HLA antibodies react weakly with several panel cells at AHG but show no specificity. HLA antibodies are generally seen in patients who have had multiple transfusions and multiple pregnancies.
What is HPC and when is it useful?
Human Platelet Concentrate is used to identify HLA antibodies. HPC has platelet antigens that will absorb out the HLA antibody. After treatment with HPC, most HLA antibodies will have weakened or disappeared.
If you have a unit of RBCs that has a positive DAT, is the unit acceptable?
No, anytime you take this unit thru coombs, it will be positive.
Baby Boy Smith is two days old and needs a type and crossmatch. What tests do you need to perform and what do you order in the computer?
Order TS NB Testing on baby: Forward type, DAT, and antibody screen Testing on mom: Type and antibody screen (if mom's specimen is available) Footnote in PTC: TS NB (includes original name of baby and when the baby will be 4 months old.)
Explain panagglutination vs. polyagglutination.
Panagglutination is when an antibody is capable of agglutinating all RBCs tested, including the patient's own cells. Polyagglutination is when an individual's red cells are agglutinated by all sera, regardless of blood type.
What are the steps you take when you find an ABO type discrepancy?
Recheck history and type of the patient. Look in ORV for a specimen drawn at another time to recheck the type. Call the nurse and have her check that is arm band is on the patient. Redraw the specimen if necessary.
ER notified you of a Code 1 Trauma coming and requested 4 O negs ASAP. List all your steps you would take to get blood ready.
Tag 4 O neg units with uncrossmatch stickers. The transporter will bring the emergency release form for uncrossmatch blood signed by the doctor. On the tags, write the patient's blood band number and any patient info (ie. name, age, or type of trauma.) Check out the units to the transporter and pack the units under melting ice in a cooler. Set up tubes or prepare the Echo for the trauma specimen.
You received a shipment from TBC and one of the units of blood has dark spots in it. What do you do?
The dark spot could be blood clots. The unit must be quarantined and returned to the blood center.
Why would we want to adsol reduce a unit that was going to be given to a two week old infant?
The infant may not be able to metabolize the mannitol adequately. Mannitol infusion may cause renal toxicity and a diuretic effect, which may cause harmful fluctuations in cerebral blood flow.
If your patient is an A negative and you give him an O positive platelet pheresis, what will happen and why?
The patient may get a positive DAT because the Anti-A from the platelet will attach to the patient's A cells.
What is your first step when you have a positive auto control?
a. Perform DAT with polyspecific AHG • If poly is positive, perform DAT with monospecific IgG and complement b.See if the patient has been transfused in the last 3 months c.Get a drug history d.Possibly do an elution if the patient has been transfused in the last 3 months and DAT was positive due to IgG
