Blood Component Preparation and Storage

Question 1

After collection, a unit of WB intended for platelet production should be stored so that

a. the temperature cools towards 20-24C
b. the temperature cools towards 1-6C
c. the temperature cools towards 1-10C
d. there is no temperature requirement for storing WB prior to component production

Answer 1

Correct: the temperature cools towards 20-24C

Recall that platelets are optimally stored at 20-24C. If you intend to make platelets from the whole blood collected, then you should store the collected whole blood in a manner that will cool the blood towards 20-24C. It would be preferable to put the whole blood units in shipping containers that are NOT refrigerated, but are closer to a 20-24C range. The units will take some time to cool from body temperature (37.5C) to 20-24C

Question 2

A unit of CP2D RBCs has a HCT of________, while a unit of AS-3 RBCs has a HCT of ____.

a. 90%, 55-65%
b. 80%, 55-65%
c. 55%, 80-90%
d. 50%, 75-85%

Answer 2

Correct: 80%, 55-65%

This question is written to mimic a question from the SBB exam. The correct answer is not an entire answer. The technical manual states that a unit of CP2D RBCs has a HCT of 65%-85% and a unit of AS-3 RBCs has a HCT of 55%-65%. None of the responses here match the Technical Manual exactly. When you take the SBB exam, you will quite often be in a position to choose the BEST response. Of the choices given, B is the best response.

To review the components, CP2D RBCs are red blood cells that are collected into a blood bag that contains CP2D anticoagulant. AS-3 RBC’s are Red Blood Cells to which the additive solution AS-3 is added to extend the life of the component.

Question 3

A unit of whole blood collected from a volunteer whole blood donor is expected to yield how many units of factor VIII?

a. 40 IU
b. 80 IU
c. 150mg
d. 250mg

Answer 3

Correct: 80 IU

A unit of whole blood will produce one unit of Cryoprecipitate. The average unit of Cryoprecipitate has 80 IU of Factor VIII

Question 4

Citrate-Phosphate-Dextorse-Dextrose (CP2D) is a common anticoagulant added to whole blood at the time of collection. The purpose of the DEXTROSE in this solution is:

a. to keep the blood from clotting
b. to extended the shelf life of the RBC to 42 days
c. to act as a buffer to control decrease of pH
d. to support ATP generation in RBC metabolism

Answer 4

Correct: to support ATP generation in RBC metabolism

Anticoagulant solutions typically contain Dextrose. The purpose of Dextrose is to support RBC metabolism which produces ATP for energy to maintain the RBC integrity

Question 5

Quality Control is performed on Cryoprecipitated AHF. To perform the QC, 10 units of CRYO are pooled, and the fibrinogen and Factor VIII are assayed. The results are as follows:Total Factor VIII Activity = 910 IU Total Fibrinogen =2000 mg total. According to AABB, is this QC acceptable?

a. Yes. All values meet requirements
b. No. CRYO units may not be pooled when performing QC
c. NO. QC fails for Fibrinogen
d. NO. QC fails for Factor VIII activity

Answer 5

Correct: Yes. All values meet requirements

The AABB requires that Cryoprecipitate units are prepared in such a manner so that the final units of CRYO have a minimum of 80 IU and 150mg Fibrinogen. If you are testing a pool of 10 units, you would divide the assay result by 10 and compare it to the minimum standard. 910/10 = 91 IU Factor VIII and 2000/10 = 200mg Fibrinogen. Both results exceed the minimum QC requirements

Question 6

Cryoprecipitated AHF contains all of the following EXCEPT:

a. Factor VIII
b. von Willebrand factor
c. Fibrinogen
d. Factor VII

Answer 6

Correct: Factor VII

CRYO does not contain Factor VII. That thaws into the plasma during component production of CRYO

Question 7

Cryoprecipitated AHF should be stored at a temperature of ______ and has a shelf life of _____.

a. -18C or below; 1 year
b. -18C or below, 5 years
c. -65C or below, 1 year
d. -65C or below, 5 years

Answer 7

Correct: -18C or below; 1 year

This is straight out of the AABB standards. It is important that you know the storage temperatures and expiration dates for ALL components

Question 8

Thawed Cryoprecipitated AHF has a shelf life of ______ if stored at _______.

(note: we are taking about CRYO that is prepared for transfusion-NOT during the initial component production)
a. 24 hours, 1-6C
b. 6 hours, 20-24C
c. 6 hours, 1-6C
d. 24 hours, 20-24C

Answer 8

Correct: 6 hours, 20-24C

When preparing CRYO for transfusion, the thawed product should be stored at room temperature and used within 6 hours. It is stored at room temperature to keep the cryo reconsituted. It has an expiration time of 6 hours. One thing to note is that we are talking about a CLOSED system here. If units of cryo are pooled in an open system, then the expiration time is lowered to 4 hours to limit the risk of bacterial contamination

Question 9

The maximum shelf life of irradiated RBCs is:
a. 24 hours
b. 21 days
c. 28 days
d .No change from original expiration date

Answer 9

Correct: 28 days

Irradiation can accelerate the lesion of storage in RBCs, therefore the expiration date is shortened to 28 days or the date of the original expiration, whichever is shorter. That is to say that you can not exceed the original expiration date. So if you irradiate a unit of RBCs that is expiring in 5 days, the expiration date remains 5 days and is NOT extended to 28 days. Again, this question is a typical SBB type question. You might be tempted to select the option of “original expiration date” but choosing the maximum of 28 days is the more correct response.

Question 10

RBC storage varies with the anticoagulant/preservative used. All of the following are properly paired items EXCEPT:

a. CPD: 21 days
b. AS: 42 days
c. CPDA1: 35 days
d. CP2D: 35 days

Answer 10

Correct: CP2D: 35 days

CP2D anticoagulant is 21 day expiration

Question 11

If stored at 1-6C, thawed Fresh Frozen Plasma should be transfused within:

a. 4 hours
b. 6 hours
c. 24 hours
d. 5 days

Answer 11

Correct: 24 hours

You may have been tempted to select “5 days”. The reason that is not a correct answer is one of labeling. After the unit is thawed for 24 hours, it is no longer considered “Fresh Frozen Plasma”. It is now “Thawed Plasma”. While it may seem a minor issue of semantics, labeling confers a sense of what the component indications and uses are. “Fresh Frozen Plasma” is a product that is capabale of providing optimal levels of labile and stabile coagulation factors. Once it becomes “Thawed Plasma”, it is capable of providing only optimal amounts of STABILE coagulation factors.

Question 12

Irradiated platelets have an expiration time of:

a. 4 hours from time of irradiation
b. 24 hours from time of irradiation
c. 3 days from date of irradiation
d. no shortened expiration time due to irradiation

Answer 12

Correct: no shortened expiration time due to irradiation

Because Platelets last only 5 days, there is no need to shorten the expiration date due to irradiation

Question 13

he correct temperature for shipping Red Blood Cells (RBCs) is:

a. 1-6C
b. 1-10C
c. 20-24C
d. There is no specific temperature range for shipping RBCs

Answer 13

Correct: 1-10C

Shipping guidelines are more lenient than storage guidelines.

Question 14

A unit of RBCs was returned to the blood bank at 10:45am from the oncology unit. The technologist who receives it inspects the unit, and determines that the container has not been penetrated, and 5 sealed segments remain attached to the RBC unit. She notes that the unit was issued from the blood bank at 7:45am. The technologist logs the unit back into the blood bank computer system, with a comment that the unit was issued and returned. She then places the RBC back in the available inventory. (note: the oncology unit does NOT have a monitored RBC storage refrigerator)The actions taken by this technologist can best be described by which statement below?

a. Actions are acceptable
b. Actions are unacceptable, since RBCs can never be returned once issued to the floor.
c. Actions are unacceptable, since RBC was out of a monitored refrigerator for too long a period
d. Actions are unacceptable, as the RBC should have had its labeling altered to reflect its return status.

Answer 14

Correct: Actions are unacceptable, since RBC was out of a monitored refrigerator for too long a period

Question 15

Which of the following statements is TRUE?

a. To prepare Fresh Frozen Plasma (FFP), plasma must be separated from red blood cells within 24 hours
b. If an additive solution is used, the expiration date for RBCs stored at 1-6C is 42 days after phlebotomy
c. To prepare cryoprecipitated AHF, FFP is thawed at 20-24C.
d. The expiration date for RBCs that are frozen and stored at -65C or below is 5 years from date of freezing.

Answer 15

Correct: If an additive solution is used, the expiration date for RBCs stored at 1-6C is 42 days after phlebotomy

FFP must be prepared by separating the plasma from whole blood and placing into the freezer within 8 hours of collection (or less depending on the type of anticoagulant used-check the manufacturer;s product insert)

When preparing Cryoprecipitated AHF, the plasma is separated from the whole blood, frozen, then thawed at 1-6C and the residual plasma removed.

Frozen RBCs are stored at -65C or below and have an expiration date of 10 years

Question 16

The preferred method for providing leukocyte reduced RBC components is:

a. use of cytomegalovirus CMV-negative units
b. use of a leukocyte reduction filter that leaves a residual of < 5.0 X 106 leukocytes
c. washing
d. irradiation

Answer 16

Correct: use of a leukocyte reduction filter that leaves a residual of < 5.0 X 106 leukocytes

Washing is not validated to remove adequate amounts of WBCs. Irradiation affects the WBCs so they can’t respond to the host, but does not actually remove them. CMV negative units are not necessarily WBC free. The units may be seronegative for CMV but still contain significant amounts of WBCs

Question 17

To prepare a unit of platelets from whole blood, which method below is best?

a. two light spins
b. a hard spin followed by a light spin
c. a light spin followed by a hard spin
d. two hard spins.

Answer 17

Correct: a light spin followed by a hard spin

To prepare platelets from whole blood, first the whole blood unit is spun using a slower RPM (a “light” spin). This separates the whole blood into three layers: RBC layer, buffy coat, and platelet rich plasma. The blood bag is designed to allow the platelet rich plasma to be transferred in a closed system to another bag which has a satellite bag. The two bags are then heat sealed and separated. The two bags together are spun with a longer, faster spin (a “hard spin”) to pack the platelets into the lower portion of the bag. After the second centrifugation, most of the plasma is removed to the satellite bag, leaving the platelets suspended in enough plasma to maintain the component for 5 days.

Question 18

Washed Red Blood Cells are ideal for a patient who requires:

a. RBCs free of leukocytes
b. RBCs that will not alloimmunize the patient
c. RBCs free of IgA proteins in the plasma
d. RBCs that are CMV negative

Answer 18

Correct: RBCs free of IgA proteins in the plasma

The other indications are not valid. Washing removes the plasma, but is not validated to remove WBCs, CMV or RBC antigens

Question 19

What is the purpose of irradiating blood components?

a. To prevent CMV transmission
b. to prevent proliferation of transfused T lymphocytes
c. to remove lymphocytes from the components
d. To prevent HLA alloimmunization

Answer 19

Correct: to prevent proliferation of transfused T lymphocytes

The lymphocytes are still present, but they are inactivated

Question 20

Which of the following RBC units would NOT be suitable for freezing using a high glycerol method?

a. RBCs from a donor who ingested aspirin 48 hours before phlebotomy.
b. RBCs from a donor who has sickle cell trait
c. RBCs from a donor who is CMV+
d. RBCs from a donor who had a HCT of 40% at time of phlebotomy

Answer 20

Correct: RBCs from a donor who has sickle cell trait

I marked this as an extra credit question, because I was not sure how well this would be conveyed in the readings. The statement is implied, but not stated directly in the Technical Manual. I included it to be sure that you would think about the suitability of RBCs for freezing, and to make sure that you learn this. The presence of the Hemoglobin S, even in a heterozygous state, means that the RBCS in a lowered concentration of oxygen can collapse on themselves and form “sickle” shapes. Adding glycerol to the RBCs for freezing maintains the integrity of normal RBC membranes, but the lowered oxygen can result in HbS RBCs to sickle

Question 21

How many autologous units can one person donate before they lose 1 gram of iron?

a. 1 unit
b. 4 units
c. 10 units
d. 6 units

Answer 21

an average unit of RBCs contains approx 200-250mg of iron.

1000mg=1g

200-250mg iron content in one unit of RBCs = 0.20-0.25g iron content in one unit of RBCs

to reach 1g you’ll need 5-4 units

Question 22

The rationale for deglycerolizing frozen RBCs with extensive washing is:

a. Glycerol is not approved by the Food and Drug Administration (FDA)
b. Glycerol is toxic to kidneys
c. Glycerol can cause anaphylaxis
d. Glycerol can cause hemolysis

Answer 22

Inadequately removed glycerol can cause in-vivo or in-vitro hemolysis. The presence of glycerol in the red cells renders them hypertonic relative to the solutions with physiologic osmolalities. If the cells are placed in these solutions, there is movement of water into the cells, resulting in their rupture. During the process of deglycerolization, solutions of prgressively lower osmolality are used to wash the red cells. This allows for the removal of the glycerol from the cells without excess hemolysis. Gloverol is approved by the FDA. It is unknown whether glycerol may cause renal toxicity, anaphylaxis or thrombocytopenia.

Question 23

24 units of whole blood are collected at a mobile blood drive. They are placed into an igloo cooler, and transported to the component production laboratory for RBC production. When the units arrive, the igloo temperature is 18C. Which statement below represents the BEST course of action for these components?

a. make RBCs
b. quarantine all blood products and contact the supervisor
c. make platelets
d. discard all the whole blood units

Answer 23

Correct: Make RBCs.

AABB standards require a validated method to cool blood continuously toward 1-10C if transported from collection site. While there is no mandated temperature with which the components should be deemed acceptable upon arrival, an inspector of a blood collection facility would be more concerned with asking questions such as

How is blood stored and transported to ensure the integrity of the components to be manufactured?

What components does your facility make from whole blood units?

What is the process for qualifying the containers in use?

Take note that there are also requirements in place to cool products to a certain temperature within a particular time frame (for example, RBCs must be refrigerated between 1-6C within 8 hrs of collection) Thus, the above scenario, assuming all approved standard operating procedures of the facility are met, would allow for the production of RBCs. There is no evidence to suggest the whole blood was handled or processed inappropriately.

Question 24

Which of the coagulation factors below will not be viable in a thawed unit of plasma frozen within 24 hours of phlebotomy?

a. V, VII, X
b. II, V, VIII, XI
c. I, V, VII, X
d. V, VIII

Answer 24

Correct: V, VIII

Remember that the labile clotting factors will remain active and at therapeutic levels only 24 hours after thawing. After that time period we can no longer use the component as FFP. We must now call it “plasma” and remove the words “Fresh Frozen”. Fresh Frozen Plasma is expected to have all coagulation factors viable and in the expected amounts present in a normal individual.

Question 25

A unit of CPDA-1 RBC expiring in 35 days is split into 5 small aliquots using a sterile pediatric quad set and prepared in a closed system. Each aliquot must be labeled as expiring in: a. 6 hours b. 24 hours c. 4 hours d. 35 days

Answer 25

Correct: 35 days Because the bags are aliquoted into a closed system, the expiration date does not change. Had you used an open system the expiration date would have been changed to 24 hours from the time the unit was spiked with the pedi-bags. It may be that you will not use the unit for babies after the 7 days have passed if your SOP requires that you use fresh RBCs. However, this does not affect the expiration date of the RBC units themselves.

Question 26

The Code of Federal Regulations established by the FDA stresses the importance of ensuring blood products are safe, pure, and potent. An important QC test to assess platelet concentrate potency/viability is: a. plasma potassium concentration b. plasma pH c. prothrombin time d. bleeding time

Answer 26

Correct: Plasma pH The pH value is established as a quality parameter for stored platelet concentrates. pH values below 6.2 are associated with significant reduction of in vivo survival of the stored platelets. During storage, platelets generate metabolites, especially lactate which acidify the platelet concentrate. Plasma pH of platelets has to be maintained at 6.2 or greater during storage. While the other choices are factors that can shed light on the function and viability of platelets, only pH is included in the component QC testing on blood components. AABB Stds 32nd ed. 5.7.4.18 Validation and quality control of Platelets prepared from Whole Blood shall demonstrate that at least 90% of units sampled contain ≥5.5 × 1010 platelets and have a pH ≥6.2 at the end of allowable storage. FDA criteria apply

Question 27

A unit of CP2D whole blood was collected for production of AS-3 LRBC. Due to a plastic shortage there is no more AS-3 available. The technologist has already separated plasma and RBC. What should be done with the final RBC (all testing acceptable)? a. Discard the RBC because the AS-3 could not be added b. Label the RBC with a 21 day expiration date c. Label the RBC with a 42 day expiration date d. Discard the units and consult MD

Answer 27

Correct: Label the RBC with a 21 day expiration date If the AS-3 cannot be added, the RBC is still acceptable but the expiration date is based on the original CP2D anticoagulant, so it should be labeled with a 21 day expiration date. There is no need to quarantine or discard the units if they can become a different type of product. This is the beauty of allowing for different variables in component production (ex thawing cryo in a cold water bath vs fridge)

Question 28

A regular donor has been recruited to start giving double RBC donations because he is Yta(-). His last donation was an apheresis platelet donation on 04-05-22. The donor is schedule to donate the RBC pheresis on 04-13-22. On 04-05-22, his post-donation blood work gave the following results: Platelet count = 135,000/uL HCT = 38% Hgb = 13.0 Which statement below represents the correct way to handle this donor? a. The post-donation results qualify him to donate on 4/13/22. b. The platelet count must be retested and found acceptable prior to donating on 4/13/22. c. The HCT must be retested and found acceptable prior to donating on 4/13/22. d. The donor must be deferred for 16 weeks after the previous donation and is not qualified to donate on 4/13/22.

Answer 28

Correct: The HCT must be retested and found acceptable prior to donating on 4/13/22. Remember that RBC pheresis requires donors to have a minimum HCT of 40% The platelet count is not relevant to erythropheresis, and the deferral period is 48 hours. After he gives the erythropheresis, he will be deferred for 16 weeks.

Question 29

A donor has given platelets pheresis 4 times in 2021, and the most recent donation was 12/30/21. He has been recruited to donate a unit of granlulocytes by apheresis on 04/08/22. His previous donor suitability questions were acceptable and his previous viral marker tests were all nonreactive. He donates on 04/08/22 and is found to be O Positive, with a negative antibody screen. What should be done concerning the viral marker testing for this donation? a. Viral marker testing is required before the unit is released to the patient b. Viral marker testing is not required because he has negative results within the past 6 months. c. Viral marker testing is not required for granulocyte pheresis collections. d. The unit may be emergency released to the patient before viral marker testing is performed.

Answer 29

Correct: The unit may be emergency released to the patient before viral marker testing is performed. Granulocyte pheresis have an outdate of 24 hours, which necessitates that units be emergency released before all testing is completed. We still must perform the testing, however, even if the unit is already released and transfused. The only exception to this is if the donor gave blood within the past 30 days. If the previous viral marker tests were nonreactive, then we could note that on the label that it was testing within the past 30 days.

Question 30

A patient (born female) is scheduled to donate an autologous WB component. They are evaluated and the following information is noted: Hgb = 12.0 g/dL Oral Temperature 37.0F Medications: Accutane, Tegison, Plavix, Cephalosporin Donor questions: Donor mentions that they had a GI infection and is taking a 7-day course of antibiotics. They had two days of medications but is now asymptomatic. What action should be taken with this donor? a. Accept the donor because their oral temperature is normal and they are asymptomatic b. Defer the donor until they have finished the medication c. Defer the donor because their Hgb is too low d. Accept the donor and irradiate the unit as a precaution

Answer 30

Correct: Defer the donor until they have finished the medication We cannot draw a donor with an active infection currently taking antibiotics even if their symptoms have resolved and the oral temperature is normal. Irradiating the unit will not prevent bacterial contamination. The Hgb is acceptable, so that is not deferring.

Question 31

Which of the following is proper procedure for preparation of platelet concentrates? a. One light spin followed by one hard spin b. One light spin followed by two hard spins c. two light spins d. two hard spins

Answer 31

a. One light spin followed by one hard spin Whole blood derived platelets are prepared by a light spin to separate the red blood cells from the platelet-rich plasma (PRP), followed by a hard spin of the PRP to concentrate platlets. Platelets are prepared by first centrifuging the whole blood with a light spin which pack the RBCs, but leave the platelets suspended in the plasma above as platelet rich plasma (PRP). The PRP is then separated, and centrifuged with a hard spin which will pack the platelets against the side of the bag, and then the excess plasma may be removed.

Question 32

Irradiation of donor blood is intended to prevent which type of adverse transfusion reaction? a. Febrile Nonhemolytic (FNHTR) b. Transfusion Related Acute Lung Injury (TRALI) c. Transfusion Associated Graft vs Host Disease ( TA GVHD) d. Transfusion Associated Sepsis

Answer 32

Transfusion Associated Graft vs Host Disease ( TA GVHD) This disease occurs due ot the co-transfusion of viable lymphocytes in cellular blood products, such as whole blood, red blood cells, platelets, granulocytes, and fresh plasma. If the immune system of the recipient cannot recognize and destroy the co-transfused lymphocytes, they can engraft and mount an immunologic response against the host. A number of technologies can abrogate the risk of TA-GVHD in these include irradiation of the product and pathogen-reduction and both of these methods render the DNA in the co-transfused lymphocytes incapable of participating in cell division. Be aware of those products which would benefit from irradiation (cellular, rbc, platelet) vs those which would not (non-cellular, plasma, cryo)

Question 33

A unit of whole blood collected should yield a minimum of..... a. 25 IU of Factor IX and 150 mg of Fibrinogen b. 80 IU of Factor VIII and 150 mg of Fibrinogen c. 80 IU of Factor VIII and 100 mg of Fibrinogen

Answer 33

b. 80 IU of Factor VIII and 150 mg of Fibrinogen AABB Standard 5.7.4.17 CRYOPRECIPITATED AHF Cryoprecipitated AHF shall be prepared by a method known to separate the cold insoluble portion from Fresh Frozen Plasma and result in a minimum of 150 mg of fibrinogen and and minimum of 80 IU of coagulation factor VIII per container or unit. In tests performed on pre-storage pooled components, the pool shall contain a minimum of 150 mg of fibrinogen and 80 IU of coagulation factor VIII times the number of components in the pool. On the SBB exam, you might see a varation of this question asking about a platelet yield. If you can remember the QC requirements for platelets and cryo derived from whole blood, then you can use recall abilities to answer this type of question.

Question 34

What is the shelf life of pooled cryoprecipitate after thawing at 37 C if Cryo was pooled using a sterile connecting device. a. 4 hours b. 6 hours c. 12 hours d. 24 hours

Answer 34

b. 6 hours

Question 35

What is the shelf life of liquid plasma recovered from an allogeneic whole blood unit? a. 5 days after expiration of whole blood unit b. It is the same as expiration of whole blood unit c. 10 days after expiration of whole blood unit d. 56 days after expiration of whole blood unit

Answer 35

a. 5 days after expiration of whole blood unit

Question 36

At what temperature must packed red blood cells be shipped? a. 1-6 C b. 20-24 C c. 1-10 C d. 1-4 C

Answer 36

c. 1-10 C

Question 37

A unit of apheresis platelets was irradiated for a transplant patient. How does the expiration deate change from the original outdate? a. There is no change. b. Expires 24 hours form date of irradiation c. Expires 8 hours from date of irradiation d. Expires in 3 days from date of irradiation

Answer 37

a. There is no change.

Question 38

What is the expiration date of washed red blood cells? a. 48 hours b. 24 hours c. 8 hours d. 72 hours

Answer 38

b. 24 hours

Question 39

Apheresis platelets were leukoreduced in the blood bank after they were collected from the donor. What is the expiration date? a. 5 days b. 24 hours c. 4 hours d. 6 hours

Answer 39

c. 4 hours

Question 40

A whole blood unit was collected in CP2D. Packed red blood cells are made. What would be an acceptable hematocrit for the packed red blood cells? a. 85% b. 95% c. 75% d. 100%

Answer 40

c. 75%

Question 41

What of the following blood products contain the most FVIII? a. Platelets b. Granulocytes c. Cryoprecipitate d. PF24

Answer 41

c. Cryoprecipitate

Question 42

An apheresis unit has a pH of 6.0. Using a sterile connecting device additional compatible plasma was added to increase the pH. Is this an acceptable practice? a. No, volume should be decreased to increase the pH b. Yes c. No, apheresis platelets should be not be manipulated d. No, manipulation may only occur with random donor platelets

Answer 42

b. Yes

Question 43

10 units of packed red blood cells are received by the transfusion service. 5 units were Rh positive and 5 units were Rh negative. Only the Rh negative units are confirmed with Anti-D reagent. What is the reason for this? a. The Rh-positive units will be given to Rh positive and Rh negative patients b.The Rh-negative units will only be given to Rh negative patients c. Rh negative units will be given to both Rh negative and Rh positive patients d. If there was a mistake in donor testing regarding Rh factor any adverse event would be limited to Rh negative units as Rh positive patients can receive either Rh negative or Rh positive blood

Answer 43

d. If there was a mistake in donor testing regarding Rh factor any adverse event would be limited to Rh negative units as Rh positive patients can receive either Rh negative or Rh positive blood

Question 44

Quality control records regarding reagents must be kept for a minimum of: a. 10 years b. 5 years c. Indefinitely d. Permanently

Answer 44

a. 10 years

Question 45

Packed red blood cells are stored in a refrigerator that does not have constant temperature recording. At what time interval must the temperature be documented? a. Every 6 hours b. Every 12 hours c. Every 4 hours d. Once a day

Answer 45

c. Every 4 hours

Question 46

A lookback was initiated when the blood supplier notified the blood bank supervisor that a unit already shipped was found to be from a donor with hepatitis C virus. How long must the look back investigation be kept on file? a. 10 years b. 5 years c. Indefinitely d. Permanently

Answer 46

a. 10 years

Question 47

How long must records of irradiating cellular components be kept on file in the transfusion service? a. 10 years b. 5 years c. Indefinitely d. Permanently

Answer 47

a. 10 years

Question 48

How long must physician orders for blood components be kept on file? a. 10 years b. 5 years c. Indefinitely d. Permanently

Answer 48

b. 5 years

Question 49

Patient samples and donor red cell segments must be kept for a minimum of: a. 7 days b. 7 days following transfusion c. 5 days d. 5 days following transfusion

Answer 49

b. 7 days following transfusion

Question 50

What is the accepted time interval a patient sample may be used for crossmatching? a. 3 days b. 5 days c. 7 days d. 14 days

Answer 50

a. 3 days

Question 51

A physician has placed an order to raise a patient's FVIII level from 3% to 50%. The patient's hematocrit is 40% and weight is 120 pounds. How many units of factor VIII are needed? a. 1400 b. 1435 c. 1390 d. 1075

Answer 51

d. 1075

Question 52

A physician placed as order to raise the fibrinogen level in a patient from 20 mg/dL to 100 mg/dL. The patient's weight is 70 kg and hematocrit is 47%. Calculate the number of bags of cryoprecipitate that should be transfused. a. 9 b. 5 c. 2 d. 12

Answer 52

a. 9

Question 53

Calculate the equivalent number of random platelets given the following platelet count in apheresis unit 5.1 x 10^11. a. 9 b. 12 c. 5 d. 2

Answer 53

a. 9

Question 54

Indicate is the patient is refractory given the following: pretransfusion platelet count 5000, post transfusion platelet count 12,5000 u/L, BSA 2.0 m2. Unit contained 4 x 10^11 platelets. a. Yes, patient is refractory b. No, patient is not refractory

Answer 54

a. Yes, patient is refractory

Question 55

Using a standard dose of 10-15 mL/kg, the hemoglobin in a neonate may be raised by: a. 2 g/dL b. 5 g/dL c. 7 g/dL d. 10 g/dL

Answer 55

a. 2 g/dL

Question 56

A physician wishes to increase a patient's platelet count from 25,000 TO 100,000/uL. How many units of random donor platelets might achieve this? a. 8 b. 5 c. 2 d. 4

Answer 56

a. 8

Question 57

Using a standard dose of 10-15 mL/kg, the hemoglobin in a neonate may be raised by: a. 2 g/dL b. 5 g/dL c. 7 g/dL d. 10 g/dL

Answer 57

a. 2 g/dL

Question 58

How does AABB define irradiation? a. Exposure of blood components using gamma rays or x rays of 25 Gy to the central portion of irradiation canister or field to prevent the proliferation of T lymphocytes. b. Exposure of blood components using x rays of 25 Gy to the central portion of the irradiation canister or field to prevent the proliferation of lymphocytes. c.Exposure of blood components using gamma rays of 25 Gy to the central portion of the irradiation canister or field to prevent the proliferation of T lymphocytes d. Exposure of blood components using UV light of 25 Gy to the central portion of the irradiation canister or field to prevent the proliferation of B lymphocytes

Answer 58

a. Exposure of blood components using gamma rays or x rays of 25 Gy to the central portion of irradiation canister or field to prevent the proliferation of T lymphocytes.

Question 59

What is the shelf life for a whole blood collection using CPDA-1 and AS-3 preservative solution? a. 35 days b. 42 days c. 21 days d. 56 days

Answer 59

b. 42 days

Question 60

Which of the following is false regarding freezing red blood cells? a. May be frozen up to 6 days post expiration b. Must be frozen within 6 days of collection c. Can be frozen after 6 days of collection using rejuvenation d. Can use low or high glycerol concentrations

Answer 60

a. May be frozen up to 6 days post expiration

Question 61

When would it be appropriate to label a unit of red blood cells as Low Volume? a. 350 mLs was collected into a 450 mL bag b. 450 mLs was collected into a 500 mL bag c. 420 mLs was collected into a 450 mL bag d. 455 mLs was collected into a 500 mL bag.

Answer 61

a. 350 mLs was collected into a 450 mL bag

Question 62

For prestorage pooled cryoprecipitate, which of the following is true? a. Each pool must contain 80 IU antihemophilic factor b. Each pool must contain 200 mg/dL of fibrinogen c. Each pool must contain 150 mg/dL of fibrinogen d. Each pool must contain at least 150 mg/dL of fibrinogen and at least 80 IU of antihemophilic factor times the number of components in the pool.

Answer 62

d. Each pool must contain at least 150 mg/dL of fibrinogen and at least 80 IU of antihemophilic factor times the number of components in the pool.

Question 63

A unit of apheresis granulocytes must contain a minimum of: a. 1 x 10^10 granulocytes in at least 75% of units tested b. 1 x 10^6 granulocytes in at least 75% of units tested c. 1 x 10^5 granulocytes in at least 75% of units tested d. 1 x 10^12 granulocytes in at least 75% of units tested

Answer 63

a. 1 x 10^10 granulocytes in at least 75% of units tested

Question 64

Which of the following applies to quality control of random donor platelets? a. A minimum of 5.5 x 10^10 platelets and pH of >6.2 in at least 75% of units b. A minimum of 3.0 x 10^11 platelets and pH of >6.2 in at least 90% of units c. A minimum of 5.5 x 10^10 platelets and pH of >6.2 in at least 90% of units d. A minimum of 3.0 x 10^11 platelets and pH of >6.2 in at least 75% of units

Answer 64

c. A minimum of 5.5 x 10^10 platelets and pH of >6.2 in at least 90% of units

Question 65

What must the leukocyte count be in a unit of pooled platelets leukocyte reduced? a. <5 x16^6 b. <8.3 x 10^5 c. <3 x 10^11 d. <5.5 x 10^10

Answer 65

a. <5 x16^6

Question 66

FFP prepared from whole blood using CPDA-1 must be frozen within how many hours of collection? a. 6 a. <5 x16^6 c. 12 d. 24

Answer 66

a. <5 x16^6

Question 67

From a managerial standpoint, why might medical directors prefer PF24 over FFP? a. PF24 is cheaper b. PF24 will contain all coagulation factors c. FFP will be devoid of factors V and VII d. PF24 has an expiration date of 48 hours once thawed

Answer 67

a. PF24 is cheaper

Question 68

What is contained in Rejuvesol (PIPA)? a. Phosphate, inositol, pyruvate, adenine b. Phosphate, inositol, phenol, adolase c. Phosphate, imuxitab, phenol, adenine d. Phosphate, imuxitab, pyruvate, adenine

Answer 68

a. Phosphate, inositol, pyruvate, adenine

Question 69

It is acceptable practice to use a sterile connecting device to replace incompatible plasma with normal sterile saline in a platelet unit for select transplant patients. a. True b. False

Answer 69

a. True

Question 70

What is contained in the formula for relative centrifugal force? a. RPM and radius of rotor b. RPM and acceleration time c. RPM and de-acceleration time d. Radius of rotor and number of buckets

Answer 70

a. RPM and radius of rotor

Question 71

In separating red blood cells from plasma in a whole blood unit, which of the following would be used? a. 5000 x g for 5 minutes b. 2000 x g for 5 minutes c. 1000 x g for 5 minutes d. 10000 x g for 5 minutes

Answer 71

a. 5000 x g for 5 minutes

Question 72

What would be the best component for a patient with anti-IgA? a. packed red blood cells b. whole blood c. washed red blood cells d. leukopoor red blood cells

Answer 72

c. washed red blood cells

Question 73

This product might be indicated for a patient with Chronic Granulomatous Disease. a. Granulocytes b. Irradiated RBCs c. Irradiated platelets d. Cryoprecipitate

Answer 73

a. Granulocytes

Question 74

This product might be indicated for a patient with afibrinogenemia. a. Cryoprecipitate b. Apheresis platelets c. Normal serum albumin d. Red blood cells

Answer 74

a. Cryoprecipitate

Question 75

This product might be indicated for a stem cell transplant patient. a. Leukoreduced platelets b. Irradiated red blood cells c. Cryoprecipitate d. Granulocytes

Answer 75

b. Irradiated red blood cells

Question 76

This product might be indicated for a patient with anti-HLA A2 a. HLA matched platelets b. Leukocyte reduced platelets c. CMV negative red cells d. Irradiated granulocytes

Answer 76

a. HLA matched platelets

Question 77

Which product might be useful for a patient with anti-k? a. Frozen red blood cells b. HLA matched platelets c. Leukocyte reduced red blood cells d. Cryo reduced FFP

Answer 77

a. Frozen red blood cells

Question 78

What would be the best product to transfuse for a patient with Factor XIII decifiency? a. Cryoprecipitate b. FFP c. PF24 d. Cryo poor FFP

Answer 78

a. Cryoprecipitate

Question 79

A plasma exchange may be employed for which of the following patient conditions? a. ITP b. TTP c. Iron decifiency anemia d. DIC

Answer 79

b. TTP

Question 80

When preparing cryoprecipitate, FFP is thawed at what temperature? a. 22-24 C b. 1-6 C c. 30-37 C d. None of the above

Answer 80

b. 1-6 C

Question 81

In deglycerolizing a unit of red blood cells, what concentration of sodium chloride is typically used first? a. 12% b. 0.9% c. 6% d. 9%

Answer 81

a. 12%

Question 82

How many units would need to be screen if a patient had anti-K and the physician ordered 4 units of red blood cells? a. 2 b. 5 c. 7 d. 9

Answer 82

b. 5

Question 83

How many units would need to be screened if a patient had anti-E and anti-Fya in their plasma and the physician ordered 4 units of red blood cells? a. 5 b. 20 c. 8 d. 15

Answer 83

b. 20

Question 84

A patient with a warm autoantibody was recently transfused with 4 units of red blood cells. If an R1R2Jk(a+b-) cell was treated with ZZAP what antibodies might be left in absorbed plasma after performing an allogenic absorption? a. Anti-D, C, Jka, Fya, Fyb b. Anti-E,c, Jkb, Fya, M, N c. Anti-E, c, Jkb, Fya, Fyb d. Anti-C, E, Jkb, Fya Fyb

Answer 84

c. Anti-E, c, Jkb, Fya, Fyb

Question 85

What would be the effect in infusing a unit of RBCs with ringers lactate? a. component would clot b. RBCs would swell c. ATP levels would decrease d. Calcium would decrease

Answer 85

a. component would clot

Question 86

All of the following are exceptions to the rule that only isotonic saline can be administered with blood, except: a. ABO compatible plasma b. 5% albumin c. 25% albumin d. Plasma protein fraction

Answer 86

c. 25% albumin

Question 87

Regarding QC, what platelet component does not require documentation of pH being 6.2 or greater? a. apheresis platelets b. random donor leukoreduced c. apheresis platelets leukoreduced d. apheresis platelets leukoreduced with additive solution

Answer 87

d. apheresis platelets leukoreduced with additive solution

Question 88

In the eBDS for platelet bacterial testing a decrease in oxygen from the baseline reading indicates: a. bacteria has not been detected in platelet sample b. bacteria has been detected in platelet sample

Answer 88

b. bacteria has been detected in platelet sample

Question 89

What is the principle of the INTERCEPT blood system for platelets in detecting bacteria before a decision is made to transfuse? a. amotosalen crosslinks nucleic acids of bacteria and enveloped viruses upon activation by illumination b. amotosalen crosslinks nucleic aids of bacteria and enveloped viruses c. bacteria in platelet sample consumes oxygen which can be measured d. bacteria in platelet sample produces oxygen which can be measured

Answer 89

a. amotosalen crosslinks nucleic acids of bacteria and enveloped viruses upon activation by illumination

Question 90

All of the following is true regarding secondary testing of platelets for bacteria except: a. usually conducted late in storage period b. can only be conducted using a culture based bacterial detection device c. intended to detect bacterial contamination not revealed by primary testing d. intended to test a platelet unit which previously tested negative for bacteria on primary testing

Answer 90

b. can only be conducted using a culture based bacterial detection device

Question 91

The FDA recommend testing pre-storage pooled platelets using an FDA cleared culture based bacterial detection device >24 hours after collection of the: a. oldest unit in the pool b. freshest unit in the pool

Answer 91

b. freshest unit in the pool

Question 92

Detection of bacteria in post-storage platelets should be performed using a FDA cleared rapid bacterial detection test within how many hours prior to transfusion on whole blood derived platelets? a. 6 b. 1 c. 8 d. 4

Answer 92

d. 4

Question 93

What should be done if a unit of irradiated RBCs has not been transfused in 24 hours from the time it was irradiated? a. irradiated again b. washed c. frozen d. rejuvenated

Answer 93

d. rejuvenated

Question 94

platelet gel is produced when these substances are added to platelet rich plasma yielding a glue-like substance for surgical applications. a. thrombin and plasma b. calcium and antihemophilic factor c. activated protein c and fibrinogen d. calcium and thrombin

Answer 94

d. calcium and thrombin

Question 95

Regarding shipping of platelets, the maximum time without agitation is: a. 1 hour b. 4 hours c. 8 hours d. 24 hours

Answer 95

d. 24 hours

Question 96

A 2 year old female (weight 12 kg) with hypofibrinogenemia has a baseline fibronogen of 105 mg/dL. How many units of Cryo are needed to raise the fibrinogen to 170 mg/dL? a. 2 b. 5 c. 8 d. 10

Answer 96

a. 2

Question 97

The purpose of irradiating blood product is to: a. Prevent post-transfusion purpura b. Prevent graft vs host disease c. Prevent virus transmission d. Prevent non-cardiogenic pulmonary edema

Answer 97

b. Prevent graft vs host disease Irradiation destroys the functionality of the nucleus, so that the transfused blood is not able to elicit an immune response against the patient.

Question 98

Each unit of cryoprecipitate contains a minimum of: a. 150 Iu of Factor VIII and 80 mg of fibrinogen b. 25 IU of Factor IX and 150 mg of fibrinogen c. 80 IU of Factor VIII and 150 mg of fibrinogen d. 80 IU of Factor VIII and 100 mg of fibrinogen

Answer 98

c. 80 IU of Factor VIII and 150 mg of fibrinogen

Question 99

Liquid plasma may be prepared from a whole blood unit until: a. WB expiration date b. 1 day after expiration c. 3 days after expiration d. 5 days after expiration

Answer 99

d. 5 days after expiration This is an AABB standard for components. See AABB standards 23rd ed reference standard 5.1.8A

Question 100

At what factor level do hemophilia patients experience profuse bleeding after surgery or trauma? a. 0-1% b. 6-30% c. 40-65% d. 2-5%

Answer 100

d. 2-5%

Question 101

How much Fibrinogen is in the average unit of whole blood? a. 25 mg b. 80 mg c. 150 mg d. 1500 mg

Answer 101

c. 150 mg Each unit of whole blood will produce one unit of cryoprecipitate, which typically has 150 mg of fibrinogen.

Question 102

A 70 kg patient with severe hemophilia has a hematocrit of 40% and an inititial factor VIII level of 2 units/dl (0.02 units/ml). How many bags of cryoprecipitate should be given to raise the factor VIII level to 50 units/dl (0.5 units/ml). a. 10 b. 14 c. 18 d. 22

Answer 102

18 bags Calculation as follows: Patient weight (kg) x 70 ml/kg = total blood volume x (1-hct) = plasma volume Plasma Volume x (desired concentration - initial concentration) = # units Favor VIII Therefore, 70 x 70 = 4900 (blood volume) 4900 x (1-.40) = 2940 ml plasma volume 2940 x (0.50-0.0.2) = 1411 units of Factor VIII needed 1411/80 = 17.64 bags, but round up to 18

Question 103

A unit of RBCs in prepared in CP2D with an AS-3 additive. What is the expiration date of the RBCs? a. 24 hours b. 21 days c. 35 days d. 42 days

Answer 103

42 days CP2D units are good for 21 days. If you add the additive solution, then the expiration is extended to 42 days.

Question 104

Which of teh following HIV western blood patterns should be interpreted as positive? a. p24 and gp41 bands are present b. p31, p17, p55 bands are present c. p24, p31, p55 bands are present d. gp 120/160, p31, p55 bands are present

Answer 104

a. p24 and gp41 bands are present Interpretation is as follows for HIV western blot: Negative: No bands present Positive at least two bands from p24, gp41 or gp120/160 Indeterminate: presence of bands, but do not fulfill criteria for positive result

Question 105

A patient has a height of 72 inches an a weight of 175 lbs. His pre-transfusion platelet count is 10,000/uL. He was transfused with 6 units of platelet concentrates. The 1 hour post transfusion platelet count is 50,000/uL. What is the corrected count increment (CCI) for the platelets transfusion? a. 15,758 b. 21,456 c. 24,242 d. 25,525

Answer 105

c. 24,242 BSA (meters squared) = The square root of [height (cm) x Weight (kg)] divided by 3600. Corrected Count Increment (CCI) = [Post transfusion Platelet Count - Pre transfusion Platelet Count]xBSA] divided by the number of platelets transfused. First calculate the BSA 1 inch =2.2 pounds The patient is 175/2.2=79.5 kg (80 kg) BSA in meters squared = the square root of [height (cm) x weight (kg)] divided by 3600 So (183 x 80)/3600 = 4.066(4) The square root of 4=2 So the BSA = 2m(2) represents "squared" Now that we have the BSA we can do the rest of the calculation. The calculation for corrected count increment is: Absolute platelet increment/ul x body surface area (m2) divided by the number of platelets transfused. The absolute platelet increment is the post-transfusion minus the pretransfusion count. The pretransfusion count was 10,000 and the post transfusion count was 50,000. 50,000-10,000 = 40,000 absolute platelet count. So if we put these numbers in our formula we now have: [40,000 x 2] = divided by the number of platelets transfused. To get the number of platelets transfused, we look again at the question. The patient received 6 units of random platelets. The average platelet has 5.5 x 10(10) platelets. We want this number in the exponent of 10(11) so the average value is then 0.55 x 10(11) 6x0.55 = 3.3 x 10(11) platelets transfused Now, our calculation for CCI has all the numbers we need, so we can perform the math. Corrected Count Increment (CCI) = [Post transfusion Platelet Count - Pre transfusion Platelet Count]xBSA] divided by the number of platelets transfused. [40,000x2] divided by 3.3 = 24,242

Question 106

According to AABB standards, what is the correct interpretation of the plateletpheresis quality control results below? Unit# Platelet Count pH 1 3.2 x 10^11 6.2 2 3.0 x 10^11 6.4 3 3.4 x 10^10 6.4 5 3.0 x 10^11 6.4 a. QC passes b. QC fails for platelet count c. QC fails for pH d. QC results are invalid

Answer 106

b. QC fails for platelet count Unit#3 fails for platelet count, and as such, the QC does not have a 90% pass rate for platelet count.

Question 107

A hospital orders 20 units of group O RBCs from the blood supplier. Upon arrival to the hospital transfusion service, the technologist reads the thermometer in the RBC shipping container and it reads 9 C. What is the correct course of action? a. refuse delivery of the RBCs because the temperature is too high. b. accept delivery of the RBCs, but they must be used within 24 hours of arrival time. c. Quarantine the units for 24 hours and observe them for hemolysis. If the visual inspection is acceptable, the units may be released from quarantine and used. d. Accept the units and process as per SOP

Answer 107

d. Accept the units and process as per SOP AABB standards states that whole blood and RBC components may be transported (Shipped) at 1-10 C. Therefore the shipment is acceptable.

Question 108

RBC storage times vary with the anticoagulant/preservative used. Which of the following is properly paired? a. Citrate-phosphate-dextrose (CPD): 35 days b. Additive solution (AS): 47 days c. Citrate-phosphate-dextrose-adenine (CPDA)-1: 21 days d. Citrate-phosphate-dextrose-dextrose (CP2D): 21 days

Answer 108

d. citrate-phosphate-dextrose-dextrose (CP2D): 21 days CP2D is an anticoagulant and preservative used for collection of WB from donors, but it is only licensed for storage for 21 days at 1-6 C. Citrate-phosphate-dextrose (CPD) is also only licensed for 21 day storage. (If you add the preservative solution to this you can extend the life to 42 days). Additive solution (AS) is licensed to extend the expiration to 42 days. Citrate-phosphate-dextrose-adenine (CPDA)-1 has an expiration of 35 days. AABB Standards 30th ed section 5.1.6A is a chart of storage, transport and expiration for various components.

Question 109

Which of the following statements concerning West Nile Virus (WNV) is true? a. Infected humans can transmit the virus to mosquitos, completing the virus's life cycle. b. West Nile Virus testing is performed via NAT for all US blood donors c. The main reservoir for the virus is rodents d. West Nile Virus testing via ELISA is mandated by the FDA

Answer 109

b. West Nile Virus testing is performed via NAT for all US blood donors Since 2003, West Nile Virus testing via NAT has been performed on blood donors "Infected humans can transmit the virus to mosquitos, completing the virus's life cycle" and "The main reservoir for the virus is rodents" are not true statements. Mosquitos feed off infected birds and then bite humans, injecting them with WNV. "West Nile Virus testing via ELISA is mandated by the FDA" is not a true statement because testing is performed via NAT, which is more sensitive.

Question 110

Which of the following statements about transfusion transmitted Trypanosoma Cruzi and testing for T. cruzi is true? a. T. cruzi can be transmitted via transfusion of RBCs Frozen/Deglycerlyzed RBCs and platelets. b. T. cruzi is a retrovirus endemic in North America c. The Center for Biologics Evaluation and Research (CBER) has licensed a T. cruzi NAT for the detection of the parasite d. T. cruzi is not a concern for peripheral blood progenitor cell products as it does not survive freezing in 5% dimethyl sulfoxide (DMSO)

Answer 110

a. T. cruzi can be transmitted via transfusion of RBCs Frozen/Deglycerlyzed RBCs and platelets. Trypanosoma cruzi is a flagellate protozoan that causes Chagas Disease, and the CDC estimated in 2013 that over 300,000 people living in the US are infected with T cruzi. Chagas disease is endemic in Central and South America and it is estimated that population has 8 million infected people. T. cruzi can survive at room temperature, in refrigerated products and even can survive freezing and thawing, so the risk is very real for all blood components and transplants organs and tissues. Current blood donor testing gin the US is via ELISA

Question 111

Fresh frozen plasma that was thawed but not used in 24 hours should be relabeled as______? a. recovered plasma b. source plasma c. thawed plasma d. FFP can retain its labeling if it is refrozen within 24 hours

Answer 111

thawed plasma If not used within 24 hours of thawing, FFP can be relabeled as thawed plasma. The words "fresh frozen" must be removed because the labile clotting factors, V and VIII are no longer at therapeutic, viable levels. Recovered plasms is obtained as a by-product when making cryoprecipitate. Source plasma is a term used by the FDA for those products collected from paid plasma donors. It is not acceptable to re-freeze plasma once it has been thawed.

Question 112

According to federal regulations, requalification (reentry) of a donor is available which of the following test results? a. Positive anti-HIV-1/2 EIA with an indeterminate Western Blot. b. Positive HBsAg that is neutralizable. c. Positive anti-HCV EIA with a negative RIBA. d. Positive HIV-1 p24 antigen that is neutralizable.

Answer 112

c. Positive anti-HCV EIA with a negative RIBA. Only donors who have positive screening tests with negative confirmatory tests are eligible for reinstatement. The HBSag and HIV-P24 are not eligible because their confirmatory tests are POSITIVE. Recall that in a neutralization assay, neutralization is a positive result. Indeterminate western blot for HIV is also not eligible for reinstatement.

Question 113

The :following results are obtained for Hepatitis C Testing: HCV Nucleiv Acid Testing: Reactive Anti-HCV (IgM): Non-reactive Anti-HCV (IgG): Reactive Which answer below is the best interpretation of these results? a. Acute infection b. Infection is resolved c. Chronic infection d. Non-infectious for HCV

Answer 113

c. Chronic infection In a chronic infection, IgG class anti-HCV and HCV viral RNA persist in the donor. In an acute infection, the IgM class anti-HCV would be positive and the IgG class would be negative, signifying a primary immune response. If the infection were resolved, the nucleic acid testing would no longer be positive because there would not still be virus circulating in the patient.

Question 114

All of the following are indications for the use of leukoreduced blood components except: a. To prevent and/or decrease the incidence of alloimmunization to HLA antigens in chronically transfused patients. b. To prevent febrile nonhemolytic transfusion reactions. c. To prevent reactivation of endogenous viral infections such as human immunodeficiency virus (HIV) and cytomegalovirus (CMV) d. To prevent and/or decrease the incidence of alloimmunization to HLA antigens in nonhepatic solid organ transplantation.

Answer 114

c. To prevent reactivation of endogenous viral infections such as human immunodeficiency virus (HIV) and cytomegalovirus (CMV) The question asks which one is NOT true. Leukoreduction is not a prevention against viral disease r their reoccurrance. While leukoreduction removes lymphocytes which carry the CMV virus, this is no guarantee that a previous infection will not reactivate.

Question 115

All of the following are indications for the transfusion of washed RBCs except: a. Paroxysmal nocturnal hemoglobinuria (PNH) b. Maternal red cells required for an infant with hemolytic disease of the fetus and newborn (HDFN) due to a high-incidence antibody. c. A patient with anti-IgG and anti-IgA d. The only unit of blood available for a large volume transfusion of a neonate is a 21 day old, irradiated unit.

Answer 115

a. Paroxysmal nocturnal hemoglobinuria (PNH) The question is asking which one is NOT an indication. For the other three choices, the problem for transfusion is something to do with the solution in which the RBCs is suspended, and not the RBCs themselves. Maternal RBCs will lack the antigen to which the mother has produced the antibody that is causing HDFN. If we can remove any residual plasma from her RBC unit, it could be used for fetal transfusion. A patient you has antibody to either IgG or IgA can be treated with washed cells because any free IgG and/or IgA are removed during the washing process. While it is not an idea situation, in a pinch, we could wash and use the irradiated cell for the infant. The problem with irradiation is that the levels of potassium rise in the solution. Washing the RBC removes the excess potassium and other by products of RBC lesion of storage. In PNH, the offending antibody is in the PATIENT serum, and there is nothing wrong with the donor cells. Therefore, washing the RBCs won't offer any protection against the biphasic antibody in PNH.

Question 116

All of the following changes occur in stored Whole Blood except: a. Plasma lactic acid concentration decreases b. Plasma postassium concentration increases c. Red cell 2,3 DPG decreases d. Plasma hemoglobin increases

Answer 116

Correct: Plasma lactic acid concentration decreases Lactic acid increases in the serum, because there is lactic acid in RBCs. As they change and breakdown during storage, lactic acid is released to the serum. The storage lesion refers to changes in red cells during storage: Glucose in stored blood is consumed Levels of 2,3-diphosphoglycerate (DPG) and ATP decrease Potassium levels increase As a result, there is red cell membrane loss during storage that leads to substantial changes in rheological properties. This loss of red cell integrity results in hemolysis and formation of microparticles that may contribute to complications associated with transfusion.

Question 117

The most common concentration of glycerol used to freeze RBCs is" a. 10% b. 20% c. 40% d. 65%

Answer 117

Correct: 40% In North America, red blood cells (RBCs) are cryopreserved in a clinical setting using high glycerol concentrations (most common: 40% w/v) with slow cooling rates (~1°C/min) prior to storage at 65C or below and maintained for 10 years. btw 40% w/v is equal to 40% glycerol weight per volume. It's certainly a great deal of glycerol, in fact frozen units are processed in large bags to make up for the added volume of glycerol. There is a low glycerol method (20% glycerol weight per volume), but this is less commonly used. If the low glycerol method is used, the freezing must occur at a much faster, controlled rate, typically achieved by using liquid nitrogen (rapid freeze). The low glycerol method is more expensive, difficult to maintain, and RBC destruction can occur more easily due to LESS glycerol protecting the unit. As a side note: Our IRL recently had a patient with anti-diego(b) . Diego b is a high prevalence antigen attached to band3. Anti-Dib has a suggested risk of moderate/delayed hemolytic transfusion reactions, The only compatible unit matching the patients needs was a frozen blood product located in NY. The product matched the needs of the patient but was frozen in 20% glycerol, not 40% :( . Our Irl had to REJECT the import due to the rare molar concentration of 20% glycerol. As mentioned above the 20% includes additional risks but our IRL ultimately rejected the unit because the method of deglycerolization (through washing) did not align with the FDA approved 40% method.

Question 118

The rationale for deglycerolizing frozen RBCs with extensive washing is: a. Glycerol is not approved by the FDA b. Glycerol is toxic to kidneys c. Glycerol can cause hemolysis d. Glycerol can cause thrombocytopenia

Answer 118

Correct: Glycerol can cause hemolysis As the RBCs thaw, the large glycerol molecules can cause the membrane to burst if not washed from the cells. See the SBB Minute - Freezing and Deglycerolization for more information

Question 119

Which of the following choices explains why a unit of blood may form an insoluble jelly-like mass during deglycerolization? a. Inadequate deglycerolization b. Bacterial contamination c. Inadvertent use of hypotonic saline for washing d. Red cells from a donor with sickle cell trait

Answer 119

Correct: Red cells from a donor with sickle cell trait The key phrase here is "jelly-like". Before freezing RBCs they should be screened for sickle cell trait. This is because the freezing process is a low oxygen environment, and RBCs from donors with the sickle cell trait will collapse on themselves in a classic "sickle" pattern. These cells then clump together to give a jelly like appearance to the blood. Inadequate deglycerolyzation and hypotonic saline for washing would most likely result in hemolysis. Bacterial contamination would not likely manifest during the washing process since the unit of RBCs had been frozen. If bacterial contamination were an issue, we would likely see discoloration or hemolysis rather than the cells clumping together in jelly like fashion.

Question 120

The maximum allowable shelf life of platelets without gentle agitation is: a. 4 hours b. 8 hours c. 24 hours d. 36 hours

Answer 120

Correct: 24 hours Gentle agitation at room temperature prolongs the life of platelets to 5 days because it promotes proper gas exchange to keep the platelets viable. Note on this question: The most recent changes in the standards included a change in: maximum time without agitation for platelets from 24 to 30 hours. When I look in the tech manual, the guidance is still 24 hours. (page 154: In-vitro studies have shown minimal platelet damage when they are stored without agitation for up to 24 hours. However, longer periods without agitation can lead to unacceptable pH decline). This question on the quiz does not contain the answer 30. Similar to the SBB exam pick the best answers of those capable of selecting. Know 24-30 range. My current employer is using the 24 rule to error on the side of caution. Here is a blog posting I found referencing the blood bank guy podcast below Change to Maximum Time Without Agitation for Platelets Standard 5.1.8A details the requirements for storage, transportation, and expiration of various blood products. For platelets, the maximum time without agitation is defined in this standard, along with requiring continuous gentle agitation and a temperature range of 20-24C. When platelets are shipped from place to place it is not feasible to keep them on a platelet agitator. Therefore, an allowance is made for the time they can go without agitation. Up until now, this time frame was 24-hours. Over time, it was discovered that shipping delays are a common occurrence and that shipments of platelet products sometimes arrive just an hour or two beyond the 24-hour deadline. When this happens, a team has to be convened to evaluate the platelets and determine whether they are acceptable for use. (Because of the high value and short shelf life of platelet products, to simply discard them out of hand would be a terrible waste of a precious resource.) So, the Standards committee set out to evaluate the 24-hour constraint. They found that a longer time frame without agitation had already been studied. This assessment concluded that platelet quality was maintained for up to 30 hours without agitation, supporting a change to the maximum time without agitation for platelets during transport. Extending the maximum time without agitation from 24 to 30-hours will have a positive impact on the availability of platelet products, especially when inclement weather creates flight delays and cancellations. This means that more of this life-saving blood product will be available to patients. https://www.bbguy.org/pdf/BBGE_046_Pat-Ooley_Transcript.pdf

Question 121

According to AABB Standards, 90% of the units of random-donor platelets prepared from whole blood should contain a minimum of ____ platelets per unit. a. 5.5 x 10^9 b. 5.5 x 10^10 c. 5.5 x 10^11 d. 3 x 10^11 3 x 10^11

Answer 121

Correct: 5.5 x 1010 See AABB Standard 5.7.4.18 in the 29th ed of the Standards. Platelets Pheresis units must have at least 90% of units with 3.0 X 1011 at the end of storage.

Question 122

The minimum acceptable pH of platelet units at the end of the storage period is: a. 5.2 b. 6.2 c. 7.2 d. 8.2

Answer 122

Correct = 6.2 According to AABB standards (see section 5.7.4.18 in the 29th ed) at least 90% of platelets must have a pH of 6.2 or greater at the end of storage. This is true for both whole blood donor platelets as well as platelet pheresis. Both types of platelets have requirements for minimum platelet counts at the end of storage. At least 90% of Whole Blood Platelets must have a platelet count of 5.5 X 1010 Apheresis platelets must have at least 3.0 X 1011

Question 123

Changes with platelet storage include all of the following except: a. Platelet activation b. Changes in shape from discoid to round c. Decreased swirling effect d. Increased expression of glycoprotein Ib and glycoprotein IIb/IIIa

Answer 123

Correct: Increased expression of glycoprotein Ib and glycoprotein IIb/IIIa Like RBCs, platelets undergo lesion of storage which can include: platelet activation loss of swirling change in shape glycoprotein receptors decrease

Question 124

Transfusion of one platelet concentrate unit into a hematologically stable adult of average size with no history of transfusion and/or pregnancy is expected to increase the platelet count by: a. 3,000 to 5,000 /uL b. 3,000 to 12,000 /uL c. 5,000 to 10,000 /uL d. 30,000 to 40,000 /uL

Answer 124

Correct: 5,000 to 10,000 /uL One platelet concentrate is from Whole Blood platelets. A unit of apheresis platelets in the same person would raise the platelet count 20,000-60,000/ul

Question 125

All of the following are advantages associated with apheresis platelets except: a. Source of HLA-matched or crossmatched-compatible platelets b. Prevent transfusion-associated graft-vs-host disease c. Decreased donor exposure and lower incidence of bacterial contamination d. Can minimize the risk of HLA alloimmunization, febrile, nonhemolytic transfusion reactions, and cytomegalovirus infection

Answer 125

Correct: Prevent transfusion-associated graft-vs-host disease The main benefit of transfusing apheresis platelets units is minimizing exposure to donors, which can in turn minimize the risk of allo-immunization. If we need specially typed units like HLA compatible, then it is more beneficial to collect from one donor whose type we know, rather than screening random WB donors. However, platelets pheresis does not reduce or prevent the risk of GVHD. It is still live tissue, which is foreign to the patient, so the units can elicit a GVHD reaction.

Question 126

Thawed fresh frozen plasma should be transfused within: a. 4 hours b. 6 hours c. 12 hours d. 24 hours

Answer 126

Correct: 24 hours In order to call a thawed component "Fresh Frozen" Plasma, it has to be capable of providing labile coagulation factors (V and VIII) at therapeutic levels. This can only occur up to 24 hours from the time of thawing. After the 24 hour mark has passed, the unit can still be transfused up to 5 days, but the labeling must be changed to thawed "Plasma", which is a component that is not indicated to provide high levels of V and VIII. Because we think in terms of transfusing plasma up to 5 days from thawing, we forget sometimes the subtleties in labeling. However, labeling of blood components is governed by the FDA and the Code of Federal Regulations. Failure to follow these strict rules is violation of federal law.

Question 127

Which of the following statements is true? a. To prepare fresh frozen plasma, plasma must be separated from red cells within 24 hours b. If an additive solution is used, the expiration date for RBCs stored at 1-6C is 42 days after phlebotomy c. To prepare cryoprecipitated antihemophiliac factor, FFP is thawed at 20-24C d. The expiration date of RBCs that are frozen and stored at less than or equal to -65C is 5 years

Answer 127

Correct: If an additive solution is used, the expiration date for RBCs stored at 1-6C is 42 days after phlebotomy To prepare Fresh Frozen plasma, the plasma must be separated from the whole blood within the time specified by the manufacturer of the blood collection bag. Most manufacturers are 8 hours. Plasma can be harvested up to 24 hours, but can't be called Fresh Frozen plasma unless it is prepared in such a time frame as to assure the labile coagulation factors (V and VIII) are maintained at therapeutic levels. After that time, the component may be called "Plasma, harvested within 24 hours of phlebotomy". To the FDA, which regulates labeling of blood products, there is a tremendous difference between "Fresh Frozen Plasma" and "Plasma" Frozen RBCs prepared in a high glycerol method can be stored at -65C or below for 10 years Cryoprecipitate is prepared from plasma that is thawed slowly at 1-6C. It must be thawed at a low temperature in order to make sure that the cryoprecipitate does not re-dissolve into the plasma, so that the excess plasma can be removed prior to re-freezing.

Question 128

According to AABB standards, each bag of Cryoprecipitate AHF must contain a minimum of how many International Units (IUs) of Factor VIII? a. 70 b. 80 c. 100 d. 150

Answer 128

Correct = 80 CRYO must be prepared by a method known to produce units of CRYO that have at least 80 IU of Factor VIII and 150mg of Fibrinogen

Question 129

Cryoprecipitate contains all the following except: a. Factor VIII b. von Willebrand factor c. Fibrinogen d. Factor VII

Answer 129

Correct: Factor VII Cryo does not contain Factor VII

Question 130

Allogeneic transplantation with major ABO-mismatched marrow can be expected to result in delayed engraftment of which of the following: a. Lymphocytes b. Granulocytes c. Platelets d. Red cells

Answer 130

Correct: Red Blood Cells The other cells are not dependent on ABO compatibility in terms of transplantation

Question 131

A group B recipient receives a group A allogeneic HPC transplant. Which of the following would describe the best choices for transfusion support during the transplant? a. Group O red cells and AB plasma/platelets b. Group O red cells and A plasma/platelets c. Group B red cells and AB plasma/platelets d. Group A red cells and AB plasma/platelets

Answer 131

Correct: Group O red cells and AB plasma/platelets Because there is already an ABO mismatch, transfusion support should be lacking in antigens and antibodies that will further exacerbate the mismatch. Group O cells lack A and B antigens, and so will not react with the antibodies in the patient's serum. Group AB plasma lacks all ABO antibodies, so it will not react with either the patient RBCs or the engrafted RBCs

Question 132

Select the QC test below which is not commonly performed to evaluate the quality of a hematopoietic progenitor cell graft at time of collection or infusion a. CD34+ cell enumeration b. Colony-forming assays c. Mononuclear cell count d. Cell viability

Answer 132

Correct: Colony-forming assays Colony-forming assays are NOT useful in evaluating HPC during collection Per the Tech Manual 20th ed. page 753 "Commonly performed QC tests for HPCs include TNC count ad differential, cell viability, CD34+ cell count and viability, sterility testing, and for allogeneic products, T-cell content. CFU assays are performed in some centers; however, these are not uniformly validated for standard clinical practice or release criteria."

Question 133

Complications that occur during Peripheral Bone Progenitor Cell (PBPC) apheresis include all of the following except: a. Syncopal reactions b. Hypomagnesemia c. Hypocalcemia d. Hyperkalemia e. Citrate toxicity

Answer 133

Correct: Hyperkalemia

Question 134

Therapeutic plasma exchange requires that a replacement fluid be used to replace the volume of plasma removed. For which of the following disorders is Fresh Frozen Plasma indicated as a replacement fluid? a. Myasthenia gravis b. Acute inflammatory demyelinating polyneuropathy c. Thrombotic thrombocytopenic purpura d. Refsum's syndrome e All of the above

Answer 134

Correct: Thrombotic Thrombocytopenia Purpura For the conditions listed, TTP is most likely to be associated with bleeding. The replacement fluid should be something that will lack the offending antibody and yet provide additional coagulation factors to help control bleeding. The other conditions are better served with plasma substitutes as replacement fluids.

Question 135

Which of the following statements about therapeutic erythrocytopheresis (red cell exchange) is false? a. It can be used to treat hyperparasitemia due to Babesia or Plasmodium b. It is indicated for the treatment of priapism in sickle cell disease c. It is indicated for the treatment of painful crises in sickle cell disease d. It is indicated for the treatment of acute chest syndrome in sickle cell disease

Answer 135

Correct: It is indicated for the treatment of painful crises in sickle cell disease It is NOT indicated for the treatment of painful crises in sickle cell disease Red Cell Exchanges are indicated in all of the following: Treat hyperparasitemia due to Babesia or Plasmodium Treatment of priapism and acute chest syndrome in sickle cell disease Erythrocytapheresis also gives the advantage of controlling iron accumulation in patients with SCD who undergo long-term transfusion, as well as the ability to achieve adequate Hb and HbS concentrations without exceeding the normal concentration.

Question 136

An inpatient with rare anti-Tca has a colostomy reversal surgery scheduled next month. The patient has agreed to donate autologously. The care team is pleased to inform the patient that their hospital staff is capable of collecting and processing the unit on site! If a hospital has the means to collect blood units and is not transporting the unit to another facility for processing, which test(s) of the answers provide below are required? a. ABO/Rh b. ABO/Rh, Antibody Screen c. ABO/Rh, Antibody Screen, Viral Markers d. ABO/Rh, Antibody Screen, Viral Markers, WNV, Syphilis

Answer 136

Correct: ABO/Rh If a hospital has the means to collect blood units and is not transporting the unit to another facility for processing, only an ABO/Rh are required. AABB Standards 5.12 Serologic Confirmation of Donor Blood ABO/Rh (including autologous units) Before transfusion, the ABO group of each unit of Whole Blood, Red Blood Cell and Granulocyte component and the Rh type of such units labeled as Rh negative shall be confirmed by a serologic test from an integrally attached segment. Confirmatory testing for weak D is not required. 5.14.4 Pretransfusion Testing for Autologous Transfusion Pretransfusion testing for autologous transfusion shall include ABO group and Rh type on the patient sample. 5.8.6 Tests Intended to Prevent Disease Transmission by Autologous Donations Autologous blood or components that will be transfused outside the collection facility shall be tested for HBV DNA, HBsAg, anti-HBc, anti-HCV, HCV RNA, anti-HIV-1/2, HIV-1 RNA, anti-HTLV-I/II, WNV RNA, Zika Virus RNA, and syphilis by a serologic test. Donations collected in states specified by FDA guidance shall undergo nucleic acid testing for Babesia.* These tests shall be performed before shipping on at least the first unit collected during each 30-day period.* Each donor shall be tested at least once for antibodies to T. cruzi. Standard 4.3.2.1 applies. If the patients autologous unit will be used outside of the collection facility (e.g. collected at a local blood center than shipped to the hospital), the unit must be tested for ABO/Rh, Antibody, Viral Markers, WNV, and Syphilis. Viral Markers required: HBV-DNA, HBsAg, anti-HBc HCV-RNA, anti-HCV HIV 1-RNA, anti-HIV 1/2 anti-HTLV I/II anti-T.cruzi (Once per lifetime) Testing required only once every 30 days.

Question 137

Which of the following anticoagulants and preservatives is added to a unit of blood to stabilize the RBC membrane? a. Dextrose b. Adenine c. Citrate d. Mannitol e. Sodium Biphosphate

Answer 137

Correct: Mannitol Dextrose: Supports ATP generation by Glycolytic pathway Adenine: Substrate for RBC ATP synthesis Citrate: anticoagulant, chelates calcium Sodium Biphosphate: buffers pH

Question 138

A unit of blood containing CP2D anticoagulant has an outdate of how many days? a. 21 b. 35 c. 42 d. 5

Answer 138

a. 21

Question 139

Red cells prepared without an additive solution should be prepared by a method known to result in a final hematocrit less than or equal to: a. 90% b. 50% c. 65% d. 80%

Answer 139

Correct: 80% A standard red cell prepared with anticoagulant and additive solution should have a hematocrit of approximately 65% If NO additive solution was added, the final hematocrit should be 65-80%

Question 140

Hydroxyethyl starch (HES) is often used as a sedimenting agent when a donor is undergoing what procedure? a. Plasmapheresis b. Plateletpheresis c. Leukapheresis d. RBC Apheresis

Answer 140

Correct: Leukapheresis Leukapheresis is the only effective method for collecting leukocytes, specifically granulocytes. Sedimenting agents, such as HES, help collect the required amount of granulocytes for therapeutic effectiveness (> 1x1011). Other, less common, meds that can be used: Corticosteroids (prednisone, dexamethasone) - work by pulling granulocytes into circulation and increasing the amount available for harvesting. Growth Factors - Newest agent being used, produce 4-8 times the volume of cells in each collection compared to other methods (Harmening 7th Edition, Page 297)

Question 141

Which of the following is NOT required for a leukapheresis (granulocyte) donation? a. ABO/Rh b. HLA Type c. Crossmatch with recipient if RBC contamination is greater than 2 mL d. All of the above are required

Answer 141

Correct: All of the above are required

Question 142

Which of the following would be a cause for deferral for a male donor? a. 99.3F Temperature b. 38% Hematocrit c. Had a blood transfusion 3 years ago in the United States d. Visited Southeast Asia for two week in 2019

Answer 142

Correct: 37% Hematocrit Temperature: Donor must be less than or equal to 37.5C or 99.5F Hematocrit: Male donor hematocrit must be greater than or equal to 39% for males (38% is acceptable for women) Blood Transfusion: 12 month deferral for anyone who has received a blood transfusion due to risk of exposure. Blood transfusions in UK or France since 1980 are an indefinite deferral Travel: A visit to Southeast Asia results in a 12 month deferral due to malaria risk. 3 year deferral after departure is in place for anyone that lived 5+ consecutive years in a malaria endemic area