UNIT 6 Flashcards by FRANCHESCA MAUREEN CUISON

Transfusion of young RBCs “neocytes”

neocytopheresis

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Considered an exchange procedure
Predetermined quantity of red cells is removed from the patient and
replaced with homologous blood

erythrocytapheresis

therapeutic plasmapheresis

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Used to treat various complications of Sickle cell disease, such as:

Priapism;
Impending stroke.
Patient with severe parasitic infections from malaria and babesia

erythrocytapheresis

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Most common therapeutic apheresis (TA) procedure.
Removes plasma while returning all cellular components to the
patient

therapeutic plasmapheresis

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Replacement Fluids

NSS
NSA
PPF
FFP

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To remove the offending agent in the plasma causing clinical symptoms in cases of Paraproteinemia (e.g. Multiple Myeloma, Waldenstrom
Macroglobulinemia, etc.), Familial Hypercholesterolemia, etc.
To collect rare red & white cell abs
Beneficial particularly in diseases that involve malfunction of the immune
system (SLE, RA)

therapeutic plasmaapheresis

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Means of producing immunosuppression in conditions like:

RA
SLE
Kidney transplant rejection
Autoimmune diseases
Alloimmune disease

lymphocyte apheresis

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Sedimenting agent used for granulocyte collection.
Causes red cells to form rouleaux thus allowing WBCs to be
harvested more efficiently.

HES HYDROXYETHYL STARCH

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Administered to the donors 12-24 hours before pheresis to
increase the number of circulating granulocytes by pulling them
from the marginal pool.

corticosteroids

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Used to treat patients with leukemia (wbc >100,000/uL) such as Hairy cell
leukemia, AML, Cutaneous T cell lymphoma

LEUKAPHERESIS

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Used to treat patients who have abnormally elevated platelet counts (plt. ct.
>1,000,000/uL) such as in the case of Polycythemia vera and myelogenous
conditions

PLATELETPHERESIS

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OXYGEN CARRYING
COMPONENTS/PRODUCTS

Red cell concentrates
Leukocyte-poor red blood cells
Frozen-thawed red cells

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PLATELET PRODUCTS

PRP AND PC

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PLASMA PRODUCTS

Fresh frozen plasma (FFP)
Frozen plasma (FP)
Cryoprecipitate
Stored plasma

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Blood that is drawn some time before the anticipated transfusion
and stored, usually liquid but occasionally frozen.

Useful for patients with multiple RBC antibodies or antibodies to
high-incidence antigens, as they can store frozen units.
Drawbacks: Expensive and often results in unused units; patients
may still require allogeneic transfusion due to lower pre-surgery
hematocrit levels.

predeposit donation

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Blood is collected during the surgical procedure and usually reinfused immediately.

Collecting shed blood from the surgical site

The blood collected is processed using an
instrument that washes it with saline to
remove tissue debris, free hemoglobin and
plasma that may contain activated
coagulation factors; concentrating the
residual RBCs to a hematocrit of 50-60% and
then reinfusing these cells immediately

The process is repeated throughout the
surgery.

Blood unit generally does not leave the
operating room
Blood units must be labeled properly
Blood units may be stored at 1 to 6 degrees
centigrade for up to 24 hours

intraoperative autologous transfusion

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Takes place in the operating room when 1-3 units of WB are collected and the patient’s volume is replaced with colloid or crystalloid.

The blood is reinfused during the surgical procedure.

Collection of whole blood with the concurrent
infusion of crystalloid or colloid solutions
thus maintaining a normal volume but
decreasing the patient’s hematocrit

Ratio: 3:1 for crystalloids, 1:1 for colloids

The number of units collected is dependent
on the patient’s ability to tolerate the
decrease in hemoglobin and hematocrit.
Limited hemodilution will reduce the
hematocrit to 28% and severe dilution will
reach 21% or less.

immediate preoperative hemodilution

acute normovolemic hemodilution

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An autologous donation
Drainage tube is placed in the surgical site and postoperative
bleeding is salvaged, cleaned and reinfused

It is reinfused, with or without processing via
microaggregate filters to screen out any
debris

The blood is characterized as being dilute,
partially hemolyzed and defibrinated.

Blood is delivered to sterilized
containers and must be
transfused back within 6
hours

Does not yield a large volume
of blood
It carries a risk for febrile
nonhemolytic transfusion
reactions

postoperative salvage

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Donors participating in pheresis program

48 hrs

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Tooth extraction or dental work

3 days

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Vaccination:
● Mumps
● Oral polio (Sabin)
● Rubeola (measles)
●Smallpox
●Yellow fever
● Influenza (live virus)

TWO WEEKS DEFERRAL

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Donors taking Accutane (isotretinoin for acne therapy is also a potent teratogen)
2. Vaccination:
Rubella (German measles)
Varicella zoster (chicken pox)

ONE MONTH (4 weeks deferral)

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Pregnant: Deferred during pregnancy and 6 weeks following a
third-trimester delivery

6 WEEKS

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1st and 2nd trimester abortion or miscarriage need not to be a
cause for deferral.

TRUE

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Whole blood donation

TWO MONTHS 8 weeks 56 days

Close contact to patients with hepatitis 2. Donors who received blood or blood products, an organ or tissue transplant 3. Tattoo, ear, and skin piercing

12 months

Infected with malaria 2. Immigrants or refugees from an area considered endemic for malaria/ residents of an area endemic for malaria.

3 years deferred

Received HBIg bec, it is given for exposure to possible infection and it may delay the onset of symptoms of disease 5. Donors who have had or been treated for syphilis or gonorrhea 6. (+) serologic test for syphilis

12 months

Donors who have traveled to areas considered endemic for malaria (don’t defer a donor who started antimalarial therapy in preparation for travel to areas endemic for malaria)

12 months deferral

Rabies vaccine 9. Sexual contact with any person who has high risk of exposure to HIV

12 months deferred

Babesiosis 12. Receiving growth hormone (Creutzfeldt-Jakob disease) 13. Symptoms of AIDS Related Complex (ARC), HIV/AIDS 14. Donors taking Tegison for psoriasis (potentially teratogenic) 15. Active pulmonary TB

PERMANENT

History of Viral Hepatitis ● (+) HBsAg ● Reactive for Anti-HBc ● Past/present evidence of Hepatitis C infection ● Donor involved in post-transfusion hepatitis

PERMANENT

History of jaundice of unknown cause 3. Past/present abuse of self-injected drugs 4. Cancer 5. Abnormal bleeding tendencies 6. Cardiopulmonary diseases

PERMANENT

Leukemia, Lymphoma 8. High-risk sexual behavior 9. High-risk occupation (e.g. prostitute) 10. Chaga’s disease

PERMANENT

Blood withdrawal, processing and reinfusion are done simultaneously 2 venipuncture sites are necessary dual lumen central venous catheter

CONTINUOUS FLOW CENTRIFUGATION

Blood is processed in batches or cycles

intermittent flow

rotates at a constant speed to separate blood components based on sp gr.

BOWL OR CHAMBER

1. Donor’s name; 2. Donor’s address, phone no.; 3. Sex; 4. Age ; 5. Date of donation; 6. Donor’s consent; 7. Donor’s occupation; 8. Race; 9. Time of last meal.

PERSONAL INFORMATION

Most common anticoagulant used during apheresis

ACD - 21 days

MECHANICAL SEPARATION USING LEUKOREDUCTION FILTERS

First generation filters - 170 um Second generation filters - 20-10 um Third generation filters (3-log filter

MEANS OF LEUKOCYTE REMOVAL

1. CENTRIFUGATION 2. WASHING PROCEDURES USING SALINE OR GLYCEROL 3. MECHANICAL SEPARATION USING LEUKOREDUCTION FILTERS

Whole blood is removed from the body and passed through an apparatus that separates out one or more particular blood constituents. The remainder of the constituent to the individual's circulation.

APHERESIS

Irradiation uses

Cesium-137 or Cobalt-60

Radiating a unit to remove a certain component (not red cells, but

T CELLS

Affects RBC membranes causing ______plasma K, _______ ATP and 2,3- DPG

INCREASE K DCREASE ATP AND 2,3 DPG

used to irradiate blood components to prevent graft-versus-host disease (GVHD).

GAMMA RADIATION

Irradiation QC applied is

2500 rads or CGy or 25 y

BM transplant Direct donation from a blood relative Exchange transfusion IUT Transfusion for immunocompromised patients Low birth weight neonates Immunosuppressed patients undergoing therapy (chemotherapy) Patients with genetic deficiency

IRRADIATED BLOOD

28 days or the normal dating period of the blood, whichever comes first

IRRADIATED

Temporarily expand the blood volume of patients

SYNTHETIC VOLUME EXPANDERS

Examples: NSS Ringer’s lactate Electrolyte Solution Dextran Hydroxyethyl starch (HES)

synthetic vilume expanders

Contents ○ 80-85% Albumin ○ 15-20% Globulin

Plasma protein fraction

Contents 96% Albumin 4% Globulin

NORMAL SERUM ALBUMIN

Plasma volume expansion ○ Surgery ○ Trauma ○ Burns

NORMAL SERUM ALBUMIN

Prophylactic treatment to patients exposed to hepatitis Measles or chickenpox Treatment of congenital hypogammaglobulinemia

immune serum globulin

Hemophilia B ○Problem with factor 9

prothrombin complex

Hemophilia A ○Problem with factor 8

FACTOR 8 CONCENTRATE

Concentrates of plasma proteins that are prepared from pools (many units) of plasma

PLASMA DERIVATIVES

Correct severe neutropenia Fever Unresponsive to antibiotic therapy Myeloid hypoplasia of the bone marrow

GRANULOCYTE CONCENTRATE

Thawed: 20-24°C without continuous agglutination

GRABULOCYTE CONCENTRATION

1 x 10¹⁰ WBCs

GRANULOCYTE CONCENTRATION

consists of Factors 1, 8, 13, and vWF

CRYOPRECIPITATE

quantitative defects

Hypofibrinogenemia and Afibrinogenemia

function defect

Dysfibrinogenemia

Hemophilia A needs high concentration of Factor VIII, so if Factor VIII concentrate or lyophilized is available, use that instead.

TRUE

Hemophilia A Von Willebrand’s disease Fibrinogen deficiency ○ Hypofibrinogenemia ○ Afibrinogenemia ○ Dysfribrinogenemia Factor XIII deficiency

CRYOPRECIPITATE ANTIHEMOPHILIC FACTOR (CRYOPRECIPITATE)

Immediate Effect: ● Increase fibrinogen 5-10mg/dL

CRYOPRECIPITATE ANTIHEMOPHILIC FACTOR (CRYOPRECIPITATE)

CRYOPRECIPITATE ANTIHEMOPHILIC FACTOR (CRYOPRECIPITATE) Frozen: Thawed: Pooled:

FROZEN: 1 YEAR THAWED: 6 hrs POOLED: 4 HRS

Thawed at 1-6C and a precipitate is left behind

CRYOPERCIPITATE

Factor VIII: ≥ 80IU Fibrinogen: ≥ 150mg

TRUE

No fibrinogen, factor 8, 13, vWF

CRYOREDUCED PLASMA / CRYO- POOR PLASMA / CRYO- SUPERNATANT

FFP is thawed and, 2 layers are produced:

SUPERNATANT = CRYOREDUCED PRECIPITATED = CRYOPRECIPITATE

Antihemophilic factors

CRYOREDUCED PLASMA / CRYO- POOR PLASMA / CRYO- SUPERNATANT

Up to 5 days relabel the unit as

“Thawed Plasma Cryoprecipitate Reduced” (AABB)

Factor XIII, VIII, vWF, and fibrinogen deficiency For transfusion/fluid replacement in TTP Decreased levels of cryo components Other coag factors are near normal levels

CRYOREDUCED

Treatment of stable clotting factor deficiencies

SDP

Liquid: _____ beyond whole blood expiration (1-6) Frozen: _______ (-18 or colder )

SDP LIQUID: 5 DAYS FROZEN:5 YEARS

contain all non labile coagulation factors.

FFP AND PF 24

has normal levels of factors V and VIII;

FFP

has reduced factor VIII and protein C.

PF24

Treatment of multiple coagulation factor deficiencies ○Caused by massive blood loss (due to hemodilution), trauma, liver disease, DIC

FFP SINGLE DONOR 380 ml

Treatment of Antithrombin III deficiency, TTP, HUS Have stable factors and higher levels of labile factors

FFP

Frozen: ○1 year (≤-18°C) ○7 years (≤-65°C) Thawed: 24 hours

FFP

Must be made & frozen within ____hours of collection

FFP - 8 hours

If plasma exceeds 8 hours, it must be prepared and labelled as

PF 24

Done when preparation of FFP is delayed.

PF 24

Long exposure of coagulation factors result in the decrease of the labile factors

FACTOR 5 and 8

Have decreased amounts of labile factors: ○ Factors 5 & 8

PF 24

20-24°C with constant agitation ● 4 hours

POOLED PLATELETS

Increase platelet count by 30,000-60,000/μL

PLATELTES SINGLE DONOR

Closed system: 5 days (5-7 days) Open system: 24 hours 3.0 X 10¹¹ platelets in approx. 300 mL of plasma pH ≥ 6.2 Obtained by: apheresis

PLATELETS SINGLE DONOR

Immediate Effect ● Increase coagulation factors: 20-30%

PLATELETS SINGLE DONOR

Thrombocytopenia Patients refractory to random platelets due to platelet antibodies (alloantibodies)

SDP

LIGHT SPIN

PRP RBC

HARD SPIN

PC RESIDUAL PLASMA

Immediate Effect: ● Increase platelet: 5,000-10,000/ul

PLATELETS RANDOM DONOR 50-70 ml

Thrombocytopenia Disseminated Intravascular Coagulation (DIC) Platelet disorders Bleeding disorders Correction of low platelets due to platelet dysfunctions Decreased platelet production/consumption Multiple transfusions Prone to septic shock transfusion reaction Viral infection Chemotherapy patients

PLATELETS (RANDOM DONOR, prepared from whole blood) (50-70ml)

≥ 5.5 X 10¹⁰ platelets in 50-65 mL of plasma pH ≥ 6.2 Obtained by: WB (whole blood) Collection ○ Must not be cooled below 20C as they are labile in low temperatures.

PLATELETS (RANDOM DONOR, prepared from whole blood) (50-70ml)

5 days with continuous agitation (average)

PLATELETS (RANDOM DONOR, prepared from whole blood) (50-70ml)

Increase hematocrit by 3% and increase hemoglobin by 1g/dL ● Deglycerolized RBCs retain 80% or more of original erythrocytes.

DEGLYCEROLIZED / WASHED RBC (OPEN SYSTEM)

80% RBC Recovery <1% glycerol

DEGLYCEROLIZED / WASHED RBC (OPEN SYSTEM)

DEGLYCEROLIZATION

THAWING WASHING

autologous units or if you have rare units. Also known as glycerolized RBC.

FROZEN RBC

Freezing: ≤-65°C SLOW FREEZING Uses regular freezers in the blood bank.

HIGH GLYCEROL 40%

uses liquid nitrogen to freeze quickly FAST FREEZING frozen = -196 C stored = -120 C

LOW GLYCEROL 20%

GLYCEROL WITH DEXTROSE FRUCTOSE AND EDTA frozen = -80C stored = -65

79% agglomeration method

Frozen – 10 years, Given that it is stored in ≤–65°C 1 year (if lower temp. → -18C)

FROZEN RBC

Cryoprotective solution; prevents cell dehydration, formation of ice crystals that may cause hemolysis.

GLYCEROL

cryoprotective agent; shields RBCs to not be affected by extreme temperatures; also to prevent red cells from causing hydration or crystal formation (crystallization) that may lead to death / non-viability of red cells.

GLYCEROL

Immediate Effect: Increase Hct by 3% Increase hemoglobin by 1g/dL Main Use: ● Remove any components not intended for transfusion

WASHED RBC 180ml

Hct: 70-80%

WASHED RBC

HCT= 85%

LEUKOREDUCED

HCT= 80% (65-85%)

PACKED RBC

Anemia with history of febrile reactions Paroxysmal nocturnal hemoglobinuria (PNH) Patients with plasma proteins antibodies to reduced allergic reactions (e.g., IgA-deficient patients)

WASHED RBC

Can be prepared 3 days after expiration date Addition of Rejuvenation solution (PIGPA → Phosphate, Inosine, Glucose, Pyruvate, Adenosine) to regenerate ATP and 2,3-DPG.

REJUVENATED RBC ATP AND 2,3 DPG

Rejuvenated RBCs must be washed before infusion to remove potentially toxic inosine.

TRUE

Immediate Effect of One Unit: Increase Hematocrit by 3% Increase hemoglobin by 1g/dL 1-6°C **Open or closed system Reducing leukocytes in the red cell unit. Presence of leukocyte in packed red cells can cause deterioration and release cytokines = immunologic reaction.

LEUKOPOOR RED BLOOD CELLS / RBC LEUKOREDUCED (250-300ml)

<5 x 10⁶ residual WBC ○ 85% of original red cells retained

LEUKOPOOR RED BLOOD CELLS / RBC LEUKOREDUCED (250-300ml)

Anemia with history of febrile reactions ○ Febrile reactions: increase 1C after receiving blood → exposed to inflammatory cytokines (IL-1,IL-6, TNF-alpha)

LEUKOPOOR RED BLOOD CELLS / RBC LEUKOREDUCED (250-300ml)

Decrease alloimmunization to WBC or HLA antigens or CMV (cytomegalovirus) transmission To reduce HLA alloimmunization and CMV transmission, leukocyte content must be reduced to <5 × 10⁶ Increase RBC mass Minimization of febrile allergic reactions Reduce CMV transmission

LEUKOPOOR RED BLOOD CELLS / RBC LEUKOREDUCED (250-300ml)

The average unit of leukocyte-reduced RBCs contains

less thn. 5 x10 ^6

Active bleeding Hemorrhagic shock Exchange transfusion ○ Indicated when both oxygen-carrying capacity and volume expansion are required.

Done in patients with certain conditions, like HDFN to remove maternal antibodies in the system of fetus. Rapid Blood Loss 25% of blood volume

Whole blood is contraindicated in severe chronic anemia

TRUE

Primary cellular component used in transfusion therapy. Restore oxygen carrying capacity (anemia).

PRBC

To increase RBC mass in patients with symptomatic anemia. No hypovolemia. Seen in chronic infections & conditions.

PACKED RBC

Hct 65%-85% in CPD2 units. Hematocrit should be >80% CPDA-1 units. ○ Since plasma is expelled, Hct is higher.

PRBC

Each unit contains approx. _____ pRBC.

150-250 mL

Plasma removed

200-250 ml

Needed to increase tissue oxygenation (acute and chronic blood loss). ○ i.e., hookworm infection Massive transfusion leading to delusional complication (plasma dilutes the platelet count).

PRBC

Hct approx. 40%/33% ○ Because whole blood contains 35-45% Hct. ○ 33% (lower) because blood is diluted by liquid anticoagulant.

shorter time; much weaker strength of centrifugation rotation.

LIGHT SPIN PRP AND PRBC

longer duration; hard spin of 5000g.

HARD SPIN PPP AND PRBC

PLATELET RICH PLASMA

PC AND FFP

FFP:

CRYOPRECIPITATE AND CRYOREDUCED

Contains mannitol.

AS1 (ADSOL) and AS5 (OPTISOL)

Contains citrate and phosphate.

AS-3 (NUTRICEL)

DECREASED

GLUCOSE ATP PH PLASMA SODIUM 2,3 DPG

INCREASED

LACTATE FREE HGB PLASMA POTASSIUM OXYGEN AFFINITY PLASMA AMMONIUM

Allow prevention of caramelization of citrate-dextrose during heat sterilization

citric acid

Glucose; source of ATP. Provides ATP for blood cell metabolism, either aerobic or anaerobic respiration.

DEXTROSE

Improve survival of red cells by further providing and maximizing ATP production.

ADENINE

Acts as red cell membrane stabilizer. Sometimes include a buffer:

MANNITOL

maintains pH and prevents decrease in pH.

sodium biphosphate

To prevent coagulation. Not given as a single component; always in a combined component

HEPARIN - 2 days

Chelates Calcium. To prevent clotting / coagulation.

CITRATE

Done at the beginning of surgery ○ Temporary replacement of the blood with blood expanders ○Blood will be contained in a sterilized container with an anticoagulant ○ Heparin: 24-48 hour lifespan ○ Storage: 24 hours in ref temp: 1-6 C, ave. 4C)

acute normovolemic hemodilution