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Flashcards in Blood Bank Osler 4-5 Deck (26)
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1
Q

Inital marker of Hep B infection?
What shows up 4-6 weeks later?
Window period?

A

HBsAG; Surface antigen!; HBsAb indicates vaccination

HBcAb

38 days!; Period when HbSAg not present and HBcAb not present

2
Q

Are Hep C carriers defered?
What about people with contact with Hep C individuals?

Antibodies tested for and window period?

A

Yes

No

Anti-HCV (EIA) or HCV RNA window period 7.4 days!!

3
Q

Tests for HIV?

Confirmatory tests (if NAT negative)?

Ancillary test?

A

Anti-HIV 1/2 and HIV-NAT
Immunoflourescence or Western Blot

Anti-HIV-2 if Anti-HIV 1 is negative; VERY RARE IN US

4
Q

Testing for HTLV I/II?

Confirmatory?

Type 1 vs 2?

Transmission routes

A

HTLVI/II screen; EIA or ChLIA

Confirm with IFA or line immunoblot; No nucleic acid test

Type 1: Caribean, Asian populations: Adult T-cell lymphoma/leukemia

Type 2: Native Americans, IV drug use
HTLV-myelopathy types I and II

Transmissions: Breast milk, sexual contact, blood exposure, mother to baby

5
Q

What transmits West NIle Virus?

Symptoms?

Testing?

Deferal?

A

Culix mosquito and birds are natural resvervor

80% asymptomatic: 20% mild few like symptoms

1-150 get severe disease: Encephalitis, meningitis, meningoenchphalitis, flacid paralysis; Death in older patients who are transfused

NAT: Virmeia 1-3 weeks detects RNA

120 days after Reactive NAT

6
Q

What causes Chagas’s disease?

Process?

What seen in blood?

Symptoms?

Chronic phase?

A

Reduvidae; Triatoma infestans

Bug bites, deficates, host scratches, contraminated feces enters wound

C-shapped triple mastagote in PB

Romana’s sign; SWELLING OF EYE, tiredness, fever, raish, loss of appetite, severe and fatal in young nad old

Chronic: 10-20 yrs after infection; enlarged heart with heart failure, and megacolon (RARE TO TRANSMIT IN BLOOD TRANSFUSION)

7
Q

Chagas testing?

Confirmatory test?
How often to test donors?

Deferal?

A

ChLIA, or EIA

Confirmatorry test; T. Cruzi E. Coli recombinant antigen

Only once but if postive permenant deferal

8
Q

Is Zika required to be tested for in donors?

What transmits?
Symptoms?

Has it been transmitted by transfusion?

Testing?

A

Yes
Aedes aegypti and albopictus

Trivial to dengue like

No documented cases in US

Minipoor or individual donor by NAT; Convert to individual donor test for 14 days from last reactive case

9
Q

Is Babesisois required to test for?

How many transfusion transmitted cases?

Is FDA guidence prescent?

A

No; only in certain area

~200

Just a draft; no licensed tests

10
Q

Are blood warmers needed routinely?

How many patient identifiers?

A

No; only in trauma or surgery

Cold products can cause hypothermia and cardiac issues

2; Not room number, also ABO and Rh an donor ABO and Rh type

11
Q

Can blood be stored on patient floor?

Storage temp?

How long to transfuse blood on floor?

Can spiked unit be retransfused?

A

NO: must be in transfusion service fridges

1-6 degree C and 1-10 degree C during transport

4 hours or put into aliquots

Nope must be discarded

12
Q

Needle size for transfusion Adult vs infant/toddler?

How to spike unit?

Start transfusion fast or slow?

A

20-18 G for adults; 24-25 for infants/toddlers (constant flow infusion device needed)

Aseptic technique; nurses need training records to show they know what they are doing

Slow 2mL/min for 15 min; test vitals after 15 min

13
Q

Can emergency release be signed after the fact?

Massive transfusion definitions?

Avoid what in massive transfusion?

What ratio to transfuse?

A

Yes; no specific time window; must be signed by MD/DO/MBBS

Loss of 1 BV in 24 hours, 10+ units in 24 hours, 50% BV in 3 hours

Blood failure/lethal triad (hypothermia, acidosis, coagulopathy)
1:1:1 vs 1:1:2 RBC:Plasma:Platelets

14
Q

Benefits of whole blood for Massive transfusion?

AABB allows what blood?

How often to titer donors?

A

Provides rapid treatment of oxygen debt and coagulopathy; contains Plts that have equivalent or better hemostatic effect

Simplification of resuscitation and balance fluid in 1 bag

Type O or low titer O (facility defined) and must be monitored
Commonly: Up to 256

Anti-A and B doesn’t change but no recommendation

15
Q

Who makes donor regulations?

A

Federal Government–laws

FDA-guidance as standard of care; NOT LAWS

AABB Standards: need for accredidation

AABB Association Bulletins

16
Q

What regulation deals wtih Donor Eligibility and Reinstatment?

Do donors need to be notified of positive test results?

A

FDA 21 CFR 610.41; and includes reentry

THen the specifics are in FDA guidance documents and AABB Association Bulletins
YES! and important implications for thier health

17
Q

Donor reinstatment steps; must follow?

What is a look back?

What are REQUIRED look backs?

A

Set amount of time, then retests must be negative; MUST FOLLOW FDA DEFINED ALGORITHMS EXPLICITLY

FDA and AABB discuss how to do it: Previously collected blood component from donors or who current donation is NAT reactive

Need to look at and pull prior donors materials and notify recepients

HIV and HEP C by LAW; even if recepient dead must notify realitives

18
Q

For component retrieval which 3 agents are based on FDA Guidance and AABB recomendations and NOT FDA Code of Federal Regulations?

A

WNV, Zika, T. Cruzi

19
Q

What is alloantibody mitigation?

Common practice is to test for?

If positive for antibody extend to?

A

Transfuse phenotypically matced common antigens.

C, E, and K

Others like Fy, Jk, and S

20
Q

Warm autoimmune hemolytic anemia has what in DAT?

Cold agglutinin disease, association?

Mixed type autoimmune hemolytic anemia?

Paroxysmal cold hemoglobinuria, associated with?

A

IgG, IgG+C3, and C3

Cold: C3 only, a/w Anti-I

Mixed: IgG+ C3 and C3

PCH: C3 only, associated with Anti-P

21
Q

What causes warm auto antibodies?

Tx?

Cold agglutinin disease assoc?

A

Idiopathic (50%), malignancies, drugs, autoimmune disease
Compatible blood is usually impossible

Tx: Steroids, immonosuppressants

CAD:Acute- Mycoplasma pneumonia and Anti-I

Chronic: Waldenstroms, Lymphoma, CLL

22
Q

PCH associated with?

Lab test?

Causes?

A

Auto Anti-P
Biphasic IgG hemolysin–collect 37 and no hemolysis hemolysis once it cools and warms up (Donner-Landsteiner test)

Syphilis and viral infections in kids

23
Q

What is cause of plt refractoryness?

How long should plts survive?

Ways to tx?

A

20% immune (lab evaluate), 80% non-immune (clinical evaluate)

~3 days after transfusion; if count goes down in 24 hours then non-immune

Try ABO matching, and HLA antibody screening test and then HLA Avoidence

Can cross match plts

24
Q

HLA match grades?
Perfect?

B1U, X
B2U, UX, X

C

D

A

Perfect: 4 antigen match

B1U: 3 antigens detected in donor, all match, X: 3 donor antigens match 1 cross-reactive

B2U: 2 antigens in donor, both match; UX 3 antigens in donor, 2 match, 1 cross reactive, X: 2 donor antigens match, 2 cross reactive

C: 1 antigen in donor not present in recipient and not cross reactive

D: 2 antigens in donor not present in recipient and not cross-reactive

25
Q

HLA matching limitations?

If plt count is refractors at 10 min to 1 hour think?

Do irradiated platelts affect refractoriness?

A

Difficult to make database (15-20% donor attrition)
HLA matching doesn’t address non-immune refractoriness

HLA antibodies/immune ( Most comm Claa I HLA antigens on A and B loci); Non immune is a drop over ~24 hours

Nope; just as refractory. Consider HLA matching

26
Q
A