Whole blood expires based on anticoagulant?
How to store?
21 days for CPD and CP2D and 35 days CPDA1
Store: 1-6 degrees C
Transport: 1-10 degrees C
What protects from hemolysis?
Additive solution increases shelf life to, Hct needed?
CPD CP2D; Hct 65-85%
Additive: 42 day shelf life, HCt 55-65%: Bade from 21 day old whole blood and remove plasma and add solution
Apheresis RBCs need how much Hemoglobin?
FDA and AABB BB/TS standards address (3 things)?
at least 60 g hemoglobin (or 180 mL red cell volume)
Donor selection and monitoring, Maximal RBC loss and QC and record requirements
Tranfusion guidelines in adults?
Can you transfuse blood at any age?
1. No indicated if Hgb >7 g/dL in hospitalized adult patients who are hemodynamically stable
-Does not apply in ACS or severe thrombocytopenia or chornic transfusion
2. Subgroups: Orthopedic, CV surgery, and preexisiting CV disease can transfuse at Hgb 8 g/dL
Yes should receive any blood in licesned period
1 U of RBCs expected to raise Hct and Hgb?
When to test Hct and Hgb if you want to give a second unit?
3% and 1 g/dL
15 min after transfusion can do H and H
Frozen red cell are good for?
Washed RBC shelf life?
Storage ant transport?
Irradiated shelf life?
Washed: 24 hrs, Store 1-6 degree C, Transport 1-6 degree C
Irrad: Original expiration of 28 days form radiation, which ever is shorter
What fluids can you not use with a transfusion?
What fluids can you use?
Lactated Ringers (Ca caust ppt); 0.45% Normal saline (hemolysis), Sterile water, and other meds
Use: Normal Saline, ABO compatible plasma, 5% albumin
Plt transfusion guidelines?
Count <10k overall
Prophylatic transfusion for central venous catheter if count less than 20k
Lumbar puncture if elective <50k
Prophylactic transfusion if major elective non neuro surgery: <50k
Cardiopulmonary bypass: Perioperative bleeding with thrombocytopenia or plt dysfunction
Can't recommend agaqinst in patient on antiplatelet therapy for intracranial hemorrhage
Plt count should increase after 1 unit apheresis plts?
Plt shelf life (apheresis and Prestorage pooled)?
Amount of plts needed in each unit?
5 days (7 with release testing)
Storage: 20-24 C with gentle agitation
Transport: as close to 20-24 without agitation: 30 hours max time
Apher: 3e11 and whole blood (5.5e10)/unit
How long to incubate plt culture, is it required?
Leukocyte reduced definition for RBCs?
Leukocyte reduced definition for Whole blood plts?
24 hours; BacT/ALERT, eBDS; YES!!; cannot swirl or gram stain to check for bacteria
RBC: <5e6 WBCs (95%)
WBCs: <8.3e5 (95%)
Why leukocyte reduce?
Leukocyte reduction contraindications?
Decreased ebrile rxns, decreased HLA immunization, decreased CMV
Contraindications: To prevent GVHD (irradiate), Frozen products, Granulocytes
25Gy to center portion of container and 15Gyto any point
What won't irradiation not prevent?
How long are irradiated RBCs good for?
Irradiated plt expiration?
28 days or shorter
Not changed from 5 days
Frozen RBCs what is the storage media?
Indications for Forzen RBCs
When should hte be frozen?
40% glycerol (20% can be used); remove before transfusion
Rare units, autologous donations
Withitn 6 days of collection; frozen before expiration if Rare; 10 years at -65C
Closed (or FDA approved)
Open 24 hrs at 1-6 C, 24 hrs 1-10 C
Closed: 14 days 1-6 C and 14 days 1-10 C
Why wash blood components?
Storage of washed plts?
Severe allergic reaciton
Neonatal alloimmune thrombocytopenia (Maternal anti-HPA-1a)
Stoarge plts: 4 hrs 20-24 C continuous agitation
When to use plasma?
Risks of plasma?
Massive transfusion also for INR >2
Reversal of Warfain in pts with intracranial hemorrhage; just use K-Centra
Lung injury; TRALI; TACO; etc.
When to give plasma?
When to measure coagulation labs?
Right before surgery, (same with RBCs and Plts)
10-20 mL/kg; can give multiple units
Before and 5 hours after (VII has 5 hr half life)
Plasma universal donor?
Plasma universal recepient?
What coag factors does plasma have?
AB (no Anti-A or B)
O (No target for Anti-A or Anti-B)
All of them including AT3 AND ADAMTS13
Thawed plasma and Frozen within 24 hours have decreases in what 2 factors?
FFP and PF24 shelf life?
Thawed plasma shelf life?
Liquid plasma shelf life, missing what, used for?
VIII, V (Labile factors); other than that FFP, PF24, and thawed are equal
FFP and PF24: -18 for 12 months, -65 C 7 years for FFP but thawed 1-5 C for 24 hours
Thawed: 1-6C for 5 days
Liquid: 1-6C 5 days AFTER expiration of whole blood: lacks Vit K dependent factors; USED MASSIVE TRANSFUSION ONLY
What is cryoprecipitate reduced plasma used for?
What is recovered plasma?
Recovered: Convert plasma and liquid plasma form whole blood; unlicensed, made into derivatives such as albumin and immune globulin
Also pooled solvent/detergent treated, virus inactivated
What factors does Cryoprecipitate have?
Does it need QC?
How long does Frozen last, thawed single unit, thawed pool?
Fibrinogen (>150 mg), Factor 8 (>80 IU), also VWF, F8, F13, Fibronectin
Yes, see above
Frozen: -18 C for 1 2 months
Thawed single: 20-24 C for 6 hrs
Thawed pool: 20-24 C 4 hours or sterile connection 6 hrs
Indications: Fibrinogen deficiency (Factor XIII deficency)
Do granulocytes need to be ABO compatible?
What requirements do they need?
CMV negative, H LA compatible, Irradiated
1.0e10 in 75% of units; MD sets requirements for neonates|
Store: 20-24 C with no agitation; USE ASAP and <24 hrs
No specific indications; clinician discretion
Plt and granulocytes?
Plasma and cryo?
RBC: Store 1-6 C; transport 1-10 C
Plt and grandulocyte store and transport: 20-24 C
Plasma and cryo store: -18 or colder
Transfusion reaction that causes death the most?
How long to report death to FDA?
Acute Hemolytic Transfusion reaction; is it common?
TRALI, then TACO, then Hemolytic due to non ABO
1 days prelim; 7 days final
Not really 1:76,000
Symptoms of acute hemolytic transfusion?
Mild back pain to severe hypotension, dyspnea and shock with DIC
Hemoglobinemia and Hemoglobinurea; Positive DAT, increased hyperbilirubinemia, RBCs with schistocytes and sphereocytes
Tx: Supportive, keep BP up; keep urine at 1 mL/Kg/hr and look for DIC
Febrile nonhemolytic transfusion reactons and definition?
No specific one; 1 degree C above 37 without explanation
Diagnosis of exclusion
Symptoms may occurs during or 1 hr after: Shaking chills, up respiratory rate
Tx: Stop and give acetaminophen or antipyretic
Prevent: Leukocyte reduce and give tylenol/benadryl
Bacterial contamination is most commonly, prevention?
Staphylococcus: Leading cause of blood transfusion sepsis, divert 10-40 mL
Temp >38 C (100.4 F) with rise 1 C (1.8 F) PLUS any rigors, hypotension, shock, tachycardia, dyspnea, N/V
Show up within 1 hr and may occur up to 24 hours
Labs: Culture IV and blood and patient, Negative DAT +, confirmed positive if patient and unit match
What cause TRALI?
Leading cause of fatality: HLA antibodies degranulate lungs
Onset of symptoms within 6 hours; see white out appearence in lungs
Oxygen, pressors, diuretics ARE NOT indicated, steroids show no improvement
Prevent: by using Male donors, female never pregnant or antibody negative (Whole blood plts and plasma, NOT RBCs)
Allergic transfusion symptoms?
Can you resume the unit?
Most common rxn (1-3%); Localized urticaria and type 1 hypersensitivity
Only reaction where you can RESUME the unit
Administer antihistamine and once symptoms improve resume
Prevent by giving antihistamines before (oral 30 min; IV 10 min)
Anaphylactic transfusion reaction symptoms?
VERY EARLY (few mL): hypotension, lower airway obstruction, abdominal distress shock
Associated with IgA deficiency and/or Anti-IgA antibodies
Prevention: wash cellular products, and use IgA deficient plasma