Blood Components
Platelet Compatibility High Risk Patients (BMT Pts)
-Avoid ABO incompatibility -literature suggests ABO Incompatible PLTs can increase the rate of alloimmunization and platelet refractoriness, and reduce survival after marrrow transplant (Practical Clinical Pathology 2nd Ed: p92) (Practical Clinical Pathology 2nd Ed: p92)
The four proteins in cryoprecipitate are:
1) fibrinogen 2) coagulation factor VIII 3) coagulation factor XIII 4) von Willebrand's factor
ACD-A
21 days
CP2D
21 days
CPD
21 days
CPDA-1
35 days
Leuko Reduced red cell units typically contain what volume of WBCs left in the unit?
< 5 x 10⁶ WBCs per unit
Cryoprecipitated AHF must be transfused within what period of time following thawing and pooling? A) 4 hours B) 8 hours C) 12 hours D) 24 hours
A) 4 hours Cryoprecipitate must be transfused within 4 hours of pooling in an open system. [AABB /TS Standards 2018, p58]
All of the following statements regarding FFP are true, except: A) FFP must be prepared within 24 hours of collection B) After thawing, FFP must be transfused within 24 hours C) Storage temperature for FFP with a 1 year shelf life is less than or equal to -18°C D) When thawed, FFP must be stored between 1°C-6°C
A) FFP must be prepared within 24 hours of collection FFP must be prepared within 8 hours after collection if the anticoagulant is citrate phosphate dextrose (CPD), citrate phosphate double dextrose (CP2D), or citrate phosphate dextrose adenine (CPDA-1); Or within 6 hours if the anticoagulant is ACD.
Two of 4 units of packed RBCs were used in the OR at 3PM. Can the remaining 2 units be returned to the blood bank at 5PM? A) Yes, if the 2 units have been kept under the proper storage conditions B) Yes, but only if the units are to be used for the same patient C) No, units may have become contaminated outside the blood bank D) No, units have been out of the blood bank for longer than 1 hour
A) Yes, if the 2 units have been kept under the proper storage conditions The unused units may be returned to BB if the OR has a refrigerator maintained at the proper temperature and with the proper monitors and temperature recording devices
Cryoprecipitated AHF: A) is indicated for fibrinogen deficiencies B) should be stored at 4C prior to administration C) will not transmit HBV D) is indicated for the treatment of hemophilia B
A) is indicated for fibrinogen deficiencies Cryoprecipitate is used primarily for fibrinogen replacement. It is stored at room temperature (20-24C) after thawing and must be infused within 6 hours as single units or if pooled using a sterile connecting device. If pooled in an open system, it must be infused within 4 hours. [Harmening 2012, p357]
Four units of packed RBCs were brought to the nurses' station at 10:20 a.m. Two units were transfused immediately, and 1 unit was transfused at 10:40 a.m. The remaining unit was returned to the blood bank at 11:00 a.m. The units were not refrigerated after leaving the blood bank. What problem(s) is (are) present in this situation? A. The only problem is with the returned unit; the 30-minute limit has expired and the unit cannot be used B. The unit should not have been transfused at 10:40 a.m. because the time limit had expired; this unit and the remaining unit should have been returned to the blood bank C. The returned unit may be held for this patient for 48 hours but cannot be used for another patient D. No problems; all actions were performed within the allowable time limits
A. The only problem is with the returned unit; the 30-minute limit has expired and the unit cannot be used There is a 30-minute time limit for a unit of RBCs that is not kept under proper storage conditions (1C-6C)
21 days
ACD-A CPD CP2D
Preservative Solutions
ACD-A CPD CP2D CPDA-1
Apheresis Donor Platelet (APT)
APT platelets are collected from a single donor who provides sufficient platelets for one dosage.
Adsol
AS-1 42 days
Nutricel
AS-3 42 days
Optisol
AS-5 42 days
Additive Solutions
Adsol Nutricel Optisol
Anti-M
Antibodies that can give this pattern include anti-Lewis, anti-I, anti-P, anti-M, and anti-N. These antibodies can interfere with testing done at room temperature (such as ABO testing, leading to an ABO discrepancy in the reverse typing
What is the proper storage temperature for thawed cryoprecipitate? A) 4 - 8 ºC. B) 20 - 24 ºC. C) 35 - 37 ºC. D) -20 ºC or colder
B) 20 - 24 ºC. Once thawed, cryoprecipitate must be kept at room temperature (20 - 24oC) and used within 6 hours after thawing. If pooled using an open system cryoprecipitate must be used within 4 hours of thawing (storage temperature 20 - 24oC). All other temperature listed are outside of the acceptable range.
What is the component of choice for treating von Willebrand's disease? A) FFP B) Cryoprecipitate C) Factor IX concentrate D) Liquid plasma
B) Cryoprecipitate Cryoprecipitate is the component of choice for treating von Willebrand disease because of the consistent level of von Willebrand factor found in cryoprecipitate
Can frozen RBCs thawed and washed at 9AM be transfused at 11AM the next day A) Yes, issue the units B) No, units have now expired C) Yes, wash units again and then issue D) No, return units to the blood supplier
B) No, units have now expired the units have expired past the 24 hour time limit for thawed and washed red cells
How is an individual classified with genotype dCE/dce? A) Rh POS B) Rh NEG C) Rh null D) Rh enhanced
B) Rh NEG This individual lacks D antigen and is classified as Rh NEGative
What course of action should be taken if a medical laboratory scientist inadvertently irradiated a unit of red cells twice? A) issue the unit B) discard the unit C) change the expiration date; then issue the unit D) note on the irradiation sticker that the unit was irradiated twice an issue
B) discard the unit If a technologist mistakenly radiates a unit of red cells more than once, the unit must be discarded due to subsequent potassium accumulation. This does not apply to platelets
Irradiation of a unit of Red blood cells is done to prevent the replication of donor: A) granulocytes B) lymphocytes C) red cells D) platelets
B) lymphocytes Irradiation inhibits proliferation of T lymphocytes. [Harmening 2012, p381]
A unit of whole blood is collected at 10:00 a.m. and stored at 20°C-24°C. What is the last hour platelet concentrates may be made from this unit? A. 4:00 p.m. B. 6:00 p.m. C. 7:00 p.m. D. 8:00 p.m.
B. 6:00 p.m. Platelets preparation from whole blood must be done within 8 hours of collection
FFP can be transfused without regard for: A. ABO type B. Rh type C. Antibody in product D. All of these options
B. Rh type FFP can be transfused without regard for Rh type because FFP is not a cellular product
Sodium citrate
Binds calcium & prevents coagulation
What is the storage requirement for an open system, leukoreduced RBC unit? A) 10-year shelf-life when stored at -65C or less B) 5-day shelf-life when stored at 20C to 24C C) 24-hour shelf life when stored at 1C to 6C D) Expires 28 days from irradiation when stored at 1C to 6C
C
What is the storage temperature and expiration date for granulocytes? A) Storage at -18C; expiration in 35 days B) Storage at 1-6C; expiration in 5 days C) Storage at 20-24C; expiration in 24 hours D) Storage at 37C; expiration in 6 hours
C
After frozen RBC's have been thawed and washed, they must be used within how many hours? A) 6 B) 12 C) 24 D)48
C) 24 Thawed and washed units of red blood cells must be used within 24 hours. Frozen red blood cells must be washed to remove the glycerol that is added to protect the cells during the freezing process. This process requires that the unit becomes an open system and therefore it has a 24 hour expiration.
Which component(s) provide(s) a concentrated source of fibrinogen? A) Fresh or frozen RBCs and FFP B) FFP and cryoprecipitate C) Cryoprecipitate D) Random-donor platelets and plasma
C) Cryoprecipitate Cryoprecipitate is the only component containing concentrated fibrinogen
Which component has the longest expiration date? A) Cryoprecipitate B) FFP C) Frozen RBCs D) Platelet concentrate
C) Frozen RBCs Frozen RBCs can be kept for up to 10years. FFP and cryoprecipitate expire in 1 year. Platelet concentrates expire in 5 days.
During storage, the concentration of 2, 3-diphosphoglycerate (2,3-DPG) decreases in a unit of: A) Platelets B) Fresh Frozen Plasma C) Red Blood Cells D) Cryoprecipitated AHF
C) Red Blood Cells 2,3-DPG declines during storage of Red Blood Cells, causing a "shift-to-the-Left" on the oxygen dissociation curve and an impaired ability to deliver oxygen to the tissues. [Harmening 2012, p6-7]
What component(s) is/are indicated for patients who have anti-IgA antibodies? A) Whole blood B) Packed RBCs C) Washed, leukocyte-poor, or frozen deglycerolized RBCs D) Granulocyte preparations
C) Washed, leukocyte-poor, or frozen deglycerolized RBCs Patients with anti-IgA antibodies should not receive components containing plasma. Washed or deglycerolized red cells can be issued
Which of the following is true regarding granulocyte concentrates? A) the product must contain a maximum of 1.0 X 10^10 granulocytes B) the pH must be 6.0 C) the product must be cross matched D) the product must be irradiated
C) the product must be cross matched Granulocyte concentrates contain a large amount of red cells and must be cross matched with the recipient's serum.
A male cancer patient with a hemoglobin of 6 g/dL was admitted to the hospital with acute abdominal pain. Small bowel resection was indicated, but the attending physician wanted to raise the patient's hemoglobin to 12 g/dL before surgery. How many units of RBCs would most likely be required to accomplish this? A. 2 B. 3 C. 6 D. 8
C. 6 One unit of RBCs will raise the hemoglobin level by approximately 1 to 1.5g/dL, and the hematocrit by 3%-4%. Results vary depending upon the age of the blood, and the patient's blood volume and hydration status. Six units will raise the hemoglobin to at least 12g/dL.
Citric acid
Creates acidic environment to slow down glycolysis
What should be done with a unit of cryoprecipitate that will not be used for at least 3 months? A) Thaw the unit immediately and freeze at -5C B) Refrigerate the unit immediately at 5C C) Pool the unit and store at 20C to 24C D) Freeze the unit immediately at -18C
D
The proper storage requirements for granulocyte concentrates is: A) 1 - 6 degrees Celsius, 12 hours B) - 20 degrees Celsius, 48 hours C) 1 - 6 degrees Celsius, 24 hours D) 20 - 24 degrees Celsius, 24 hours
D) 20 - 24 degrees Celsius, 24 hours Granulocytes are used as treatment for patients that are severely neutropenic (neutrophil count less than 500/µL) who have the following: Documented infection (24-48 hours) that is nonresponsive to antibiotic or antifungal treatment, myeloid hyperplasia demonstrated by bone marrow biopsy, and a chance of bone marrow recovery. Granulocytes are most often collected by apheresis to achieve a higher yield than those collected from whole blood. Storage is 20-24 degrees Celsius for up to 24 hours, but should be transfused as soon as possible. The other storage conditions above all have temperatures lower than what is optimal for granulocytes.
Apheresis Platelets must be stored at: A) 1-6°C B) 1-10°C C) 18-20°C D) 20-24°C
D) 20-24°C Apheresis Platelets are stored at 20-24°C. [AABB BB/TS Standards 2018, Reference Standard 5.1.8.8, p 56]
Which unit contains the proper number of platelets (RANDOM donor)? A) 3.5 X 10^8 B) 5.0 X 10^9 C) 4.5 X 10^10 D) 5.8 X 10^10
D) 5.8 X 10^10 At least 75% of all platelet concentrates (random donor) should contain a minimum of 5.5 X 10^10 platelets
What may be used if frozen RBCs, fresh frozen plasma (FFP), and platelets were shipped on dry ice? A) All components B) No components C) Frozen RBCs and platelets only D) FFP and frozen RBCs only
D) FFP and frozen RBCs only Only FFP and frozen RBCs may be shipped on dry ice. Platelets require shipment at 20-24C
All of the following are acceptable preparation methods for leukocyte reduced RBCs EXCEPT: A) Filtering B) Centrifugation C) Washing D) Irradiation
D) Irradiation Irradiation prevents blast transformation of leukocytes, but does not actually remove the cells. Filtering, centrifugation, and washing can remove the white cells.
Select the patients below for which transfusion of buffy coats is BEST indicated: A) Immunocompromised leukemia patients B) Patients with low WBC counts C) Patients with bone marrow failure D) Newborns with severe infections
D) Newborns with severe infections Buffy coats are low-volume white cell concentrates prepared from random-donor units and are indicated primarily to control severe infections in newborns
Derivative Factor VIII
Description and Indication Prepared for treatment of hemophilia A; ____________can be purified from pooled human plasma and treated to remove and inactivate infectious agents; recombinant ___________ products are available; some plasma-derived preparations contain significant amounts of von Willebrand factor and are suitable for treatment of this disease as well
Derivative Albumin
Description and Indication Prepared from pooled donor plasma as a 5% or a 25% solution in a manner that removes infectious agents; albumin is used as replacement fluid for plasmapheresis, for hypoalbuminemic patients with acute lung injury, in conjunction with large-volume paracentesis, for diuresis in patients with ascites unresponsive to diuretics, in selected patients with subarachnoid hemorrhage to prevent vasospasm, and in selected burn patients; it should not be used routinely for volume expansion when crystalloid or synthetic colloid volume expanders such as dextran and hydroxyethyl starch are available
Derivative Intravenous immunoglobulin (IV Ig)
Description and Indication The IgG fraction prepared from pooled donor plasma is processed to minimize IgG dimerization and remove or inactivate infectious agents; used as antibody replacement therapy in humoral immunodeficiency states and in the treatment of selected autoimmune disorders such as idiopathic or immune thrombocytopenic purpura (ITP)
Derivative Rh immune globulin
Description and Indication The IgG fraction prepared from pooled plasma from donors with high-titer anti-D treated to remove or inactivate infectious agents; administered by intramuscular injection to Rh-negative women to prevent their alloimmunization during pregnancy and childbirth; Rh-negative women should receive this product at 28 weeks of gestation and again within 72 h of the birth of an Rh-positive baby, or at the time of abortion, miscarriage, vaginal hemorrhage, ectopic pregnancy, abdominal trauma, or invasive procedure such as amniocentesis or chorionic villus sampling; an intravenous formulation of this product is used for treatment of ITP
RBCs, leukoreduced
Description of Product Packed RBCs may be modified by removal of leukocytes by filtration or washing; washing RBCs is less effective at removing leukocytes than filtration Major Indications ; leukoreduced RBCs are used for individuals who have experienced febrile reactions due to passenger WBCs in a blood component; they are also used to prevent alloimmunization in a patient who may require multiple platelet transfusions, or to prevent cytomegalovirus infection in a susceptible patient Actions Precautions
Fresh frozen plasma (FFP)
Description of Product Plasma that is separated from the cellular components and frozen within 8 h of collection of whole blood is known as FFP; it may also be prepared from plasma collected by apheresis Major Indications Because FFP contains significant levels of all the plasma coagulation factors, including Factors V and VIII that are labile, it is useful to control bleeding in patients who have multiple coagulation factor deficiencies; FFP should not be used to correct a deficit of blood volume; other volume expanders that are less potentially infectious should be used Actions FFP restores plasma proteins, particularly coagulation factors, and this may result in control of a bleeding episode Precautions This component should be ABO-compatible with the recipient's RBCs, but crossmatching is not performed prior to transfusion; Rh type is not a consideration
Packed RBCs
Description of Product the product of a centrifugal separation of red cells from plasma; this component has a hematocrit of 55-80% Major Indications used for treatment of a symptomatic anemia; this component may also be used for exchange transfusion when treating sickle cell crisis or hemolytic disease of the newborn Actions Packed RBCs provide RBC mass and increase oxygen-carrying capacity in the blood Precautions RBCs must be ABO- and Rh-compatible, and crossmatched
Cryoprecipitate
Description of the Product generated by thawing FFP at 1-6°C; the precipitate is collected and refrozen; a typical unit of cryoprecipitate contains at least 80 units of Factor VIII and at least 150 mg of fibrinogen in a volume of less than 25 mL Major Indications This component is used for patients with a deficiency of fibrinogen (often from disseminated intravascular coagulation), or deficiency of Factor XIII Actions Transfusion of cryoprecipitate to raise fibrinogen levels to 100 mg/dL may be useful to provide hemostasis for fibrinogen deficiency Precautions Crossmatch testing is unnecessary; although ABO-compatible cryoprecipitate is preferred, it is not necessary; the Rh type is not a consideration
Fill in The Blank Plasma must be centrifuged from whole blood (collected into a preservative known as CPD) and frozen within 8 hours of collection if it is to be called _______ _______ _______
FRESH frozen plasma
To prevent GVHD, blood components can be?
Gamma Irradiated to prevent T cell proliferation 25 Grays?
Random Donor Platelet Pool (PLTF)
Platelets are separated from the plasma. Typically, a dosage of platelets consists of six random units
Platelet Compatibility
Platelets carry AB antigens and are potentially targeted by the recipient's isoagglutinins, which may result in a poor rise in PLT count after transfusion (Practical Clinical Pathology 2nd Ed: p92)
a. Maintain the pH so the platelets will be alive before transfusion Platelets must be gently agitated during storage by the use of a rotator to prevent the pH from decreasing below 6.2.
Platelets must be kept in constant motion for which of the following reasons? a. Maintain the pH so the platelets will be alive before transfusion b. Keep the platelets in suspension and prevent clumping of the platelets c. Mimic what is going on in the blood vessels d. Preserve the coagulation factors and platelet viability
True/False An adult human has about 4-6 liters of blood circulating in the body
True
What microorganisms are most commonly implicated in bacterial contamination of blood components?
Yersinia enterocolitica
Which of the following is acceptable according to the AABB standards? a) Rejuvenated RBCs may be made within 3 days of outdate and transfused or frozen within 24 hours or rejuvenation b) Frozen RBCs must be prepared within 30 minutes of collection and may be used within 10 years c) Irradiated RBCs must be treated within 8 hrs of collection and transfused within 6 hrs d) Leukocyte-reduced RBCs must be prepared within 6 hours of collection and transfused within 6 hours of preparation
a) Rejuvenated RBCs may be made within 3 days of outdate and transfused or frozen within 24 hours or rejuvenation Rejuvenated RBCs may be prepared within 3 days of the outdate of the unit and washed and transfused or frozen within 24 hours A unit of RBCs may be frozen within 6 days of collection An RBC unit can be irradiated any time prior to expiration date; once irradiated, the unit must be transfused within 28 days of irradiation or the original outdate, whichever comes first
What is the expiration of cryoprecipitate once pooled? a. 4 hours b. 6 hours c. 8 hours d. 24 hours
a. 4 hours When individual Cryo units are pooled in an open system, the expiration time is 4 hours. If Cryo is pooled using a sterile connecting device, the expiration time is 6 hours
A unit of packed RBCs is split using the open system. One of the half units is used. What may be done with the second half unit? a. Must be issued within 24hrs b. Must be isued within 48hrs c. Must be irradiated d. Must retain the original expiration date
a. Must be issued within 24hrs The other half unit must be issued within 24hrs, if an open system is used to split the unit
What is the number of white blood cells permitted in a unit of leukoreduced red cells? a. <5 X 10^10 b. <5 X 10^6 c. <8.3 X 10^5 d. <8.3 X 10^6
b. <5 X 10^6 Red cells that have been leukoreduced must have fewer than 5 X 10^6 white cells per unit
Concerning the component and the required quality control results, which of the following is a true statement? a. FFP must have 80 international units of fibrinogen in 7 units tested b. Cryoprecipitate must have 80 international units of factor VIII c. Leukocyte-reduced red blood cells must have fewer than 3.3 × 1011 WBCs in each unit d. Platelets must have no red blood cells
b. Cryoprecipitate must have 80 international units of factor VIII FFP has no quality control or minimum requirements. Cryo must have ≥ 80 IU of Factor VIII and ≥ 150 mg of fibrinogen. Leukocyte reduced red cells must have < 5 × 106 residual leukocytes and 85% of original red cells retained. There are no quality control or minimum requirements for the number of red cells in platelets.
WHat is the component of choice for a patient with Chronic Granulomatous Disease? a. FFP b. Granulocytes c. Cryoprecipitate d. RBCs
b. Granulocytes Patients with CGD cannot fight bacterial infections due to dysfunctional phagocytic enzymes; granulocyte concentrates are the product of choice for these patients.
FFP is appropriate replacement therapy for all of the following conditions EXCEPT: a. Antithrombin III deficiency b. Liver Disease c. Hypofibrinogenemia d. Factor IX deficiency
c
What component(s) can be stored at room temperature, 20-24C? a. Rejuvenated RBCs b. Thawed FFP and cryoprecipitate c. Platelets and granulocytes d. No components can be stored at room temperature 20-24C
c
What may be done to RBCs before transfusion to a patient with cold agglutinin disease? a. Irradiate to prevent GVHD b. Wash with 0.9% saline c. Warm to 37C with a blood warmer d. Transport so that temperature is maintained at 20-24C
c
What percentage of red cells must be retained in leukocyte-reduced red cells? a. 75% b. 80% c. 85% d. 100%
c. 85% A red cell unit that has been leukocyte reduced must retain 85% of original red cells
Which component has the longest expiration date? a. Cryoprecipitate b. FFP c. Frozen RBCs d. Platelet concentrates
c. Frozen RBCs Frozen RBCs may be kept for up to 10 years. FFP and Cryo stored at -18C or lower expire in 1 year. If FFP is kept at -65C or lower, the expiration time is 7 years. Platelet concentrates expire in 5 days.
Cryoprecipiate may be used to treat all of the following, EXCEPT: a. von Willebrand's disease b. Hypofibrinogenemia c. Idiopathic thrombocytopenic purpura (ITP) d. Factor XIII deficiency
c. Idiopathic thrombocytopenic purpura (ITP) Cryoprecipitate may be used to treat von Willebrand's disease, hypofibrinogenemia, and factor XIII deficiency, but is not indicated in ITP. IVIG is the product of choice for ITP
All of the following are true regarding washed RBCs, EXCEPT: a. RBCs are washed with 1-2L of normal saline b. Volume is 180mL c. Shelf life is extended d. Leukocytes are removed
c. Shelf life is extended Washed RBCs renders the system "open" and shortens the expiration time to 24 hours
Which of the following is true regarding apheresis platelets? a. The minimum platelet count must be 3.0 X 10^11, pH must be >6.0 b. The minimum platelet count must be 3.0 X 10^10, pH must be <6.2 c. The minimum platelet count must be 3.0 X 10^11, pH must be >6.2 d. The minimum platelet count must be 5.5 X 10^10, pH must be <6.0
c. The minimum platelet count must be 3.0 X 10^11, pH must be >6.2 Single-donor platelets prepared by apheresis must contain a minimum of 3.0 X 10^11 platelets and the pH must be 6.2 or higher throughout the shelf life of the product
Typical Indications for IRRAdiated Blood Components
certain groups of immunocompromised patients at particular risk of TA-GvHD: ---pts with Hematologic malignancies ---transplant recipients ---patients with congenital or T-cell immunodeficiency, eg, Wiskott-Aldrich ---recipients of granulocyte concentrates ---patients receiving nucleoside analogs: (flucytosine, Ribavarin,tenofovir, abacavir,Fludarabine,etc) --- treatment with purine analogue drugs: -Allopurinol -Nelarabine a purine analog used for T-cell acute lymphoblastic leukemia -pentostatin(Hairy cell Leukemia), -cladribine (2-chlorodeoxyadenosine) -Thioguanine -Fludarabine -Mercaptopurine --- patients with Hodgkin lymphoma ---recipients of donations from related donors ----HSCT pts ---fetuses and neonates who have received an intrauterine transfusion. ---infants with prematurity, low birth weight, or HDFN (Source: Practical Clinical Pathology, 2nd Ed, Mais, p104)
What is the expiration date for a unit of packed red cells preserved with ADSOL? a. 6 hours b. 24 hours c. 35 days d. 42 days
d
Which condition is proper for platelet storage? a. -18C b. 1-6C with agitation c. 20-24C d. 20-24C with agitation
d
How is Cryoprecipitate used?
is used primarily to administer a high fibrinogen dose in a small volume (approximately 15 cc/unit).
1 unit of packed RBCs should increase:
- Hct by 3% - Hgb by ~ 1 g/dL
2,3-DPG storage lesion:
- Levels will decrease with age - Required for effective release of oxygen in tissues - Neonates (<28‐days‐old) require blood *less than 7 days old* for this reason
Fresh Frozen Plasma [FFP]:
- Must be frozen within 8 hours of collection - Contains all coagulation factors - Can also be separated into other components
List the circumstances that would call for the transfusion of Irradiated RBCs to prevent GVHD:
- Siblings [HLA halpotypes very similar] - Severely Immunocompromised [Neonates, bone marrow transplants, cancer patients]
