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426 Blood Bank > Blood Donation > Flashcards

Blood Donation Flashcards

1
Q

Donor Registration

A
  • Donor’s full name
  • Home/Work address
  • DOB (>= 17)
  • Reason any previous deferrals
  • Date of last donation
  • Gender
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2
Q

Pre-donor screening

A
  • Ensure donor healthy enough to donate

- Ensure donation does not harm a recipient

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3
Q

Process of donor evaluation

A
  • Abbreviated Donor History Questionaire
  • Explanation of donor eligibility
  • Medication list
  • Prospective donors asked to acknowledge in writing that they: have read materials, given a chance to ask questions, provided accurate info
  • Prospective donors can elect to leave (self deferral) at that point
  • Physical exam
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4
Q

Universal Donor History Questionaire

A
  • Developed by AABB in conjunction with FDA
  • Current version 2.0
  • Has 43 questions
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5
Q

Cause of Permanent or Indefinite Deferral

A
  • CJD risk
  • Repeatedly reactive serologic test for: HIV, HBV, HCV, HTLV
  • Viral hepatitis after 11 y/o
  • History of Babesiosis or Chagas
  • History of taking teratogen Tegison
  • Have received: dura mater transplant, Pituitary hormone, Bovine insuline injection
  • Family history of CJD
  • Live in UK > 3 months 1980-1996
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6
Q

Cause 3-year deferral

A
  • Recovered from Malaria

- Immigrants from malaria-endemic area

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7
Q

Cause 1-year deferral

A
  • Needlestick
  • Sex contact with person with HIV or hepatitis
  • Sex contact with person used needles
  • Rape victim
  • Incarcerated > 72 hrs
  • Pay money for sex
  • Blood transfusion
  • Allogeneic transplant of organ/skin/bone
  • Live with person with active hepatitis
  • Tattoo/piercings
  • Travel to malaria-endemic area
  • Syphilis/gonorrhea
  • Non-prophylactic rabies vaccination
  • Travel to Iraq
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8
Q

Other causes for Deferral

A
  • Pregnancy
  • Medication list
  • Heart and Lung Disease
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9
Q

Immunization deferrals

A
  • No deferral for killed, toxoid, or recombinant/synthetics vaccines
  • 4 weeks: Rubella, Varicella
  • 2 weeks: Measles, Mumps, Oral polio, Yellow Fever, Oral Typhoid
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10
Q

Smallpox immunization

A
  • Based on presence/absence of vaccine scab and post vaccine symptoms
  • No: Until scab falls off or 21 days
  • Yes: Until 14 days after symptoms resolve
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11
Q

Medication deferrals

A
  • HepB immunoglobin: 1 year
  • Unlicensed vaccine: 1 year
  • Anti-PLT drugs: aspirin (48hrs), Feldene (48hrs), Clopidogrel (2 wks), Ticlopidine (2 weeks)
  • Warfarin: 7 days
  • Direct thrombin inh & direct Xa inh & heparin derivatives: 2 days
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12
Q

Confidential Unit Exclusion

A
  • Donor can request that unit is collected but discarded wo testing
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13
Q

Physical exam

A
  • General donor appearance
  • Arm inspection
  • Pulse: 50-100/min w/o irregularities
  • Temp: less or equal to 37.5
  • BP: 90-180 systolic & 50-100 diastolic
  • Weight: >= 110 lbs
  • HCT: women (HCT 38%), men (HCT 39%)
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14
Q

Cause of Immune hemolysis

A 
Warm AIHA
Cold agglutination
Paroxysmal Cold Hemoglobinuria
Transfusion Reaction
HDFN
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15
Q

Cause of Non-immune hemolysis

A 
Microangiopathic (DIC, Mechanical Heart Valve)
Paroxysmal Nocturnal Hemoglobinuria
Toxins/Medication
Thermal burns
Infection
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16
Q

Purpose of DAT (Direct Coomb’s test)

A
  • Determine if RBC coated with IgG & complement or
    both
  • Investigation of: HTR, HDFN, AIHA, Drug Induced Anemia
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17
Q

Principles of DAT

A
  • EDTA: anticoagulation blood samples
  • Test freshly washed RBC with AHG containing IgG and anti-C3d
  • AHG activity against: heavy chain (Fc portion of IgG) and complement components
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18
Q

Steps of DAT

A
  • Wash RBC: remove plasma free globulin and complements
  • Polyspecific AHG
  • If positive, monospecific reagent (anti-IgG and anti-complement) - If umbilical cord —> ok to use IgG only
  • -> DAT is not dx of hemolytic anemia. Need to check pt’s history
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19
Q

Warm autoimmune hemolytic Anemia (WAIHA)

A
  • 60-70% Immune hemolytic anemia
  • Against high-frequency antigens on RBC (Rh proteins)
  • Can be secondary to other disease such as: leukamia lymphoma, lupus
  • AutoAb: IgG
  • Elute: panagglutinin pattern in most cases.
20
Q

WAIHA - Lab test

A
  • Polyspecific AHG: Usually positive
  • anti-IgG: Usually positive
  • anti-C3: Can be positive
  • 20% only IgG, 67% both, 13% only C3
21
Q

WAIHA - Treatment

A
  • Steroid, immunosuppressive drugs, splenectomy
  • Supportive blood transfusion if needed
  • Transfusion requires: Antibody ID studies (autoantibody, alloantibody, or both) –> Transfusion accepted in severe case but MUST r/o the presence of alloantibodies
22
Q

WAIHA - Transfusion

A
  • Phenotypically matched unit
  • R/O underlying alloantibodies, using less sensitive methods such as LISS/saline
  • Autoadsorption: treat pt with their own RBC to remove found IgG, modified cells are incubated with pt serums
  • Alloadsorption: if pt has been transfused, severe case, not enough sample –> use RBC antigen negative
23
Q

Cold Agglutinin Disease (CAD)

A
  • 16-30% of immune hemolytic anemia
  • Autoab: mostly IgM, rare IgG and IgGA
  • Cold auto-ab facilitate RBC destruction
  • 2nd disease assc. with mycoplasma pneumonia (anti-I, anti-IH) and infectious mononucleosis (anti-i)
24
Q

CAD - Lab test

A
  • Polyspecific: pos
  • anti-IgG: non-reactive
  • anti-C3: pos
  • May need to maintain at 37C when testing
  • Auto-Ab: anti-I, anti-IH, anti-i, anti-Pr
25
Q

CAD - other helpful tests

A
  • Antibody titer: two-fold dilution –> High titer (usually > 1:64)
  • Thermal amplitude –> Wide thermal amplitude
  • Adsorption (auto & allo) at 4C to r/o underlying alloantibodies
26
Q

CAD - Treatment

A
  • Avoid corticosteroids
  • Keep pt warm
  • Anti-CD20 has 50% response rate
  • Severe case: remove Ab via plasmapheresis
27
Q

Paroxysmal Cold Hemoglobinuria (PCH)

A
  • Rarest form
  • Common in children as 2ndary disease to transient viral infection
  • Was described with syphillis
  • Biphasic IgG auto-ab
28
Q

PCH - Lab test

A
  • Polyspecific: pos
  • anti-IgG: neg - non reactive
  • anti-C3: pos
  • Biphasic
  • Diagnostic with Donath Landsteiner test
  • Usually anti-P specificity
29
Q

PCH - Treatment

A
  • Self-limited
  • Transfusion if needed with warm blood
  • P-neg unit is not needed
30
Q

Donath-Landsteiner Test

A
  • 3 sets of 3 tubes: patient serum, pt serum + normal serum, normal serum
  • Each sets was incubated at different temp: ice, 37C, ice and then 37C
31
Q

Mixed type of Autoimmunue

A

8%
Serology of both WAIHA and CAD
Severe hemolysis
Cold auto-Ab + Warm auto-Ab

32
Q

Drug-Induced Hemolytic Anemia

A
  • 10% immune hemolytic anemia
  • Severity varies and DAT varies
  • Hapten (chemical compound) can bind protein carrier (albumin) to elicit immune response
  • Ab can develop: to haptens, combination hapten-carrier, only carrier
33
Q

Hapten-specific/Drug adsorption

A
  • Ab react with drug-treated cells
  • Penicillin, ampicillin, cephalosporins (pediatric)
  • Variable presentation
  • Diagnostic:
    + prepare RBC with suspected drug
    + Pt’s serum and Eluate reacts with treated RBC but not untreated RBC
34
Q

Neoantigen/Immune Complex Deposition

A
  • Ab react with untreated cells in presence of solutions of drugs
  • Quinine, piperacillin, 2nd and 3rd generation of Cephalosporins
  • Ab against drugs or its metabolites
  • Assc. with severe hemolysis
  • Dx: Incubated pt’s serum + untreated cells + drug solution. Negative control: no drug solution
35
Q

Autoantibody from drugs

A
  • Drug-independent Ab with autoab production
  • Methyldopa, fludarabine
  • Ab against RBC antigens
  • Dx: No required drug. Elute will be panreactive and indistinguishable with WAIHA. Pt serum can be nonreactive (Adsorption required to R/O allo-ab)
36
Q

Nonimmunologic Protein Adsorption

A
  • Drug independent
  • Assc. with cephalothin, cisplatin
  • Hemolysis is rare
  • Drug modifies RBC membrane –> show protein on membrane –> DAT is positive if antiglobulin/antiprotein is used
37
Q

Type of blood donation

A
  • Allogeneic: from s/oelse than self
  • Autologous: unit is donated for self
  • Directed: unit donated for specific person (PLT, granulocyte, rare blood type)
38
Q

The potential risk of autologous donation

A
  • Mixed up with other patients
  • Iron depletion with each time
  • Increased cost
  • Wastage
39
Q

Requirements for autologous donation

A
  • Used for: difficult to match, religion,
  • Less strict
  • Requires: physician order, defer if donor bacteremia, special label, only Medical Director can approve for use for another than donor.
40
Q

Process of WB

A
  • Donor ID confirmed
  • Primary bag, sample bag
  • Vein selected –> Disinfected –> Venipuncture –> Post donation care
  • 1st 30-45mL diverted to pouch. Mix frequently
  • Collection 8-12 min
  • Volume: 450-500 ml, max 50mL for tube. Max volume 10.5mL/kg
41
Q

Anticoagulants and additives used

A
  • Anticoagulant: CPD, CPDA1, CPDA2 for primary bag

- Additives: AS-1 (Adsol), AS-3 (Nutricell), AS-5 (Optisol_ for secondary bag

42
Q

Autologous Standard

A
  • Interval: 72 hrs prior to surgery/use
  • HH: >= 11g/dL or 33%
  • Weight, Age: None
  • Infection screening: not required
  • History of dz of positive test result: Potentially eligible
43
Q

Apheresis Donation

A
  • Automate separation of blood into component
  • Centrifuge: most common, separation based on density.
  • Equipment can collect > 1 product at the same time: RBC, PLT, Plasma, WBC
44
Q

Donor reaction

A
  • Vasovagal: most common, breath into the paper bag. More in young
  • Local injury related to needle: nerve irritation, vessel injury, infection. More in older
  • Apheresis- related: Infiltration (most common), citrate toxicity lead to low Ca,
  • Allergic
  • Major cardiovascular
45
Q

Plateletepheresis Donor requirement

A
  • No aspirin in last 48 hrs
  • No clopidogrel or ticlopidine in last 14 days
  • Pre-procedure PLT count 150,000/L

426 Blood Bank (9 decks)

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