Lecture 12

Question 1

how much is 1 unit of blood

Answer 1

1 pint= 450 mL or 1/10th of blood volume

4.6 units of blood are required per patient

Question 2

Blood to be transfused is mixed with

Answer 2

with 63 ml Citrate Phosphate Dextrose (CPD) anticoagulant or Acid Citrate Dextrose (ACD)

Question 3

Blood Donor Requirements

Answer 3

o Personal identification information
o at least 17 years of age
o every 56 days for males and every 84 days for females since last donation
o 72 hrs since dental surgery, extraction or root canal
o 6 months since tattooing , ear or body piercing
o < 6mths in malaria area- after one year upon returning to Canada
o > 6 months in malaria area- 3 years upon returning to Canada
o Donor must be in good health
o Weight 50 k
o Full recovery from cold , flu or sore throat
o Cannot donate if had malaria
o Some cancer- After 5 years treatment cancer free ( These include breast, prostate, colon, thyroid and uterine cancer)
o Skin cancer – after treatment
o Homosexual males- I year waiting period
o Male Hgb= 130 g/L – quick test with CUSulf ..sinks too much hemo
o Female Hgb = 125g/L

Question 4

Ineligible to Donate

Answer 4

• Creutzfeldt jakob disease
Mad cow
• Zika Virus
o People who have taken money or drugs for sex, since 1977 cannot give blood.
o Intravenous use of illegal street drugs
• Disease-e.g. Lupus
• Diabetes ( treated with insulin )
• Chronic Fatigue Syndrome (xenotropic murine leukemia virus-related virus (XMRV).
• Trans individual -Donated Blood is tested for

Question 5

Donated Blood is tested for

Answer 5

 ABO and Rh group, - HOSIPITAL ( Canadian blood services does the rest)
 Red cell antibody screening
 Syphilis, Hepatitis B (viral DNA) and C( HVC)
 Human immunodeficiency virus - HIV 1 and HIV 2,
 Viral RNA- HIV 1 and HCV
 Human T-Cell lymphotropic viruses HTLV I and II
 West Nile Virus ( when increased risk is present)
 Cytomegalovirus ( CMV) antibody and IgA

Question 6

EXTRACTION

Answer 6

Blood is centrifuged
The red blood cells and plasma are both extracted, leaving the buffy coat layer

Pooled buffy coat is then centrifuged a second time, and the platelet rich plasma is extracted through a leukoreduction filter to produce a pooled platelet concentrate.

Question 7

leukoreduction

Answer 7

a filtration process whereby white blood cells are removed. White blood cells often carry viruses and bacteria.

Question 8

 Whole Blood shelf life

Answer 8

35 days at 1-6ºC

Red blood cells can be used to help accident victims, surgical patients and people with anemia

Question 9

 Packed Red Blood Cells shelf life

Answer 9

Shelf life: 42 days at 1-6ºC (not all cells are brand new , so keep for half the days so the patient gets almost new cells if they live for 120 days. You cant give a patient blood cells that are 110 days old.
Frozen< -18°C: 10 years

Question 10

plateletpheresis

Answer 10

Donation of platelets
The platelets are collected and the rest of the blood is returned to the donor through the same needle

Up to 5 times more platelets can be recovered for a donor
Takes about 75-100 mins
Can donate every 2 weeks
Shelf life: 5 days at 20-24C(RT) with agitation
Platelets can be used to treat leukemia, cancer and thrombocytopenic patients

Question 11

Albumin donation

Answer 11

for volume replacement

Question 12

Cryoprecipitate donation

Answer 12

AHF) concentrate of factor VIII, factor XIII, von Willebrand factor and fibrinogen; used for hemophilia A and fibrinogen replacement
Frozen up to one year : stored < -18°C or thawed: stored 20-24C

Question 13

Factor VIII Concentrate donation

Answer 13

for hemophilia A

Question 14

Factor IX Concentrate donation

Answer 14

for hemophilia B

Question 15

Immunoglobulins donation

Answer 15

for immunodeficiency or exposure to infectious diseases such as hepatitis

Question 16

Plasmapheresis

Answer 16

Blood from donor is collected, centrifuged and the cells are returned to donor through the same needle.
Only plasma is collected
Yields double the volume of a unit of blood
Products: plasma, platelet concentrate, WBCs (to harvest stem cells)
• Donation monthly up to weekly
Fresh frozen plasma: 1 year stored at < -18°C
Thawed plasma < 24 hours stored at 1 to 6C
Plasma is effective in treating patients suffering from burns or shock
Plasma serves as a source of plasma proteins for patients who are deficient in or have defective plasma proteins
Given to patients who require replacement of multiple plasma coagulation factors.

Question 17

Hematopoietic Progenitor Cells (HPC), Cord Blood

Answer 17

• HPC, Cord Blood contains hematopoietic progenitor cells collected from the umbilical cord and placenta immediately after delivery of a baby
• The cryopreserved HPC, Cord Blood product in the Canadian Blood Services’ Cord Blood Bank (CBB) is stored in liquid nitrogen at -196°C and does not have an expiry date

Question 18

The HPC, Cord Blood is tested for the following

Answer 18

• ABO group
• Rh type
• Abnormal Hemoglobin
• HLA typing
• Microbial culture testing

Question 19

The HPC, Cord Blood may be used to treat:

Answer 19

• Malignant hematological and non-malignant diseases
(e.g. leukemia, lymphoma, multiple myeloma, hemoglobinopathies, inherited metabolic disorders)
• Post chemotherapy for cancer treatment).

Question 20

Blood Bank Component Quality Assurance

Answer 20

Note: All blood received from Canadian Blood Service are visually inspected for deterioration
•	bacterial contamination 
•	discolouration - hemolysis
•	Fibrin and clot
•	Lipemia
•	Icterus

Monitor and record refrigerator and freezer temperatures; refrigerators have continuous monitors and alarm systems.

Question 21

Blood Collection Principle

Answer 21

5–10 ml of the patient’s blood
should be collected into a pink top or red top tube in order to ensure that plasma or serum, is available for carrying out the compatibility test.

Question 22

Cross-match

Answer 22

The testing of the patient’s serum against the donor red cells and the donor serum against the patient’s red cells, before transfusion.
it is important that blood of the correct ABO group is used.
must be ABO and Rh compatibility

Question 23

Patient Identification

Answer 23

blood sample should be clearly labelled with the patient’s full name, hospital unique ID number, ward and signed by the person taking the blood. Sent blood sample immediately to the laboratory, together with a completed blood request form.
The signature of the person taking the blood sample must be on the label and requisition. Samples are rejected if there are no signatures.

Question 24

INPATIENT

Answer 24

1. Print and take computer bar code blood labels to the patient’s bedside
2. Check computer blood labels with patient’s armband.
3. Ask the patient to spell their name and state their DOB to compare with computer blood label and requisition form when possible.

Question 25

OUTPATIENT

Answer 25

4. Ask the patient to spell their name and state their DOB to verify with blood computer label, requisition form and Health Card. MANDATORY 5. Draw blood samples 6. Label blood samples at the patient’s bedside (inpatient). 7. Label at the patients phlebotomy chair (outpatient) 8. Date and sign the BTL requisition / label(full name)

Question 26

Manual Specimen Labels

Answer 26

```  Patient first and last name  Patient age  Unique ID number  Specimen date.  Collection time.  Phlebotomist full name and initial  The specimen number. ```

Question 27

Patient’s requisition.

Answer 27

 First and Last name  Unique identification number  The required blood component or blood product and dosage  Date and time of intended transfusion if available  Special requirements, if applicable  Patient’s location  Name of the ordering physician  Patient’s date of birth  Diagnosis and reason for transfusion/infusion  Priority  Transfusion history and Pregnancy history  Signature of the doctor requesting the transfusion

Question 28

Retention

Answer 28

• Healthcare employee signatures, initials and computer identification are retained for ten years or according to established SOP

Question 29

Blood Component Labeling Standard- ISBT

Answer 29

An international standard for the transfer of information associated with tissue transplantation, cellular therapy and blood transfusion , bar coding

Question 30

The unit label must include:

Answer 30

* 13 Digit ISBT 128 Donation Number provides unique identification of blood products world wide for a 100 year period * 13 Digit Donation Number – Facility identification code (global) – Year indicator (won’t repeat for 100 years) * Product code and Component Description: name of the whole blood or component. Other information * Blood group code * ABO/ Rh Blood Group * Expiration date and time * Special Testing e.g. antibodies present * Collection date and time

Question 31

Transfusion of Blood Components

Answer 31

For patients who are: • undergoing major surgery • undergoing organ or bone marrow transplants • being treated for trauma, cancer or other medical problems

Question 32

Patient’s vital signs are monitored and documented;

Answer 32

 before the transfusion begins  within the first 15 minutes of starting the transfusion  every hour during the transfusion  30 minutes after completion of the transfusion.

Question 33

Symptoms of transfusion reaction

Answer 33

 fever, chills, shakes, hives or itching  difficulty breathing, backache, pain  can lead to death

Question 34

Febrile reactions

Answer 34

Febrile reactions lead to headache followed by a sudden chill, shiveringand a rise in body temperature. These reactions are rarely severe and respond rapidly to medical treatment.

Question 35

Allergic reactions

Answer 35

called anaphylactic reactions are comparatively rare. In such cases, the patient can suffer urticaria of the skin, moderate bronchial spasm and possible laryngeal edema

Question 36

Haemolytic reactions

Answer 36

most severe of the three types of transfusion reaction and are initiated by: antibody in the patient’s serum reacting with itscorresponding antigen on the donor red cells antibody in the donor plasma reacting with its corresponding antigen on the patient’s red cells. Haemolytic transfusion reactions can occur either intravascularly or extravascularly.

Question 37

Intravascular reactions

Answer 37

cause haemolysis of the red cells within the circulatory system, with subsequent jaundice and haemoglobinaemia mainly by antibodies of the IgM type, the most dangerous of these being the specific anti-A and anti- B of the ABO system

Question 38

Extravascular reactions

Answer 38

caused by IgG antibodies which bring about destruction of the red cells via the macrophages. This sometimes results in a sudden drop in the patient’s haemoglobinlevel, often up to 10 days after the transfusion

Question 39

WHEN A TRANSFUSION REACTION OCCUR- THE TRANSFUSION MUST BE ABORTED

Answer 39

 The transfusion is stopped  The physician is notified.  Patient’s vital signs are rechecked and documented.  The Blood Transfusion Laboratory is notified  Transfusion reaction signs and symptoms are documented on the patient  The volume transfused is documented  Transfusion bag is returned to the lab

Question 40

Post Transfusion blood samples should include:

Answer 40

* An immediate post-transfusion clotted and nonclotted blood sample from the patient red cell and plasma residues from the transfused donor blood * The first specimen of the patient’s urine following the reaction. * The patient’s pre-transfusion sample should already be in the laboratory

Question 41

laryngeal oedema

Answer 41

Swelling of the larynx creating difficulty in breathing

Question 42

haemoglobinaemia:

Answer 42

Free haemoglobin in the bloodstream (plasma).