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Questions and Answers
What is the minimum weight requirement for a whole blood donation of 400ml?
What is the minimum weight requirement for a whole blood donation of 400ml?
Which blood product is derived from plasma?
Which blood product is derived from plasma?
What is the minimum acceptable hemoglobin level for a male blood donor?
What is the minimum acceptable hemoglobin level for a male blood donor?
Why are multiparous female donors screened for HLA and/or HNA antibodies?
Why are multiparous female donors screened for HLA and/or HNA antibodies?
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Which of the following criteria would disqualify an individual from donating blood?
Which of the following criteria would disqualify an individual from donating blood?
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What is the primary purpose of a whole blood unit in transfusion medicine?
What is the primary purpose of a whole blood unit in transfusion medicine?
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What should be the maximum time to start a transfusion after blood has been removed from refrigeration?
What should be the maximum time to start a transfusion after blood has been removed from refrigeration?
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Which of the following is a contraindication for administering a whole blood unit?
Which of the following is a contraindication for administering a whole blood unit?
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How much does 1 ml/kg of packed red cells increase the hematocrit in pediatric patients?
How much does 1 ml/kg of packed red cells increase the hematocrit in pediatric patients?
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To which group of patients is platelet concentrate primarily indicated?
To which group of patients is platelet concentrate primarily indicated?
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Which vital component is absent in whole blood units?
Which vital component is absent in whole blood units?
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During the storage of whole blood at +2°C to +6°C, what change occurs?
During the storage of whole blood at +2°C to +6°C, what change occurs?
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What is the minimum platelet count required in one unit of platelet concentrates?
What is the minimum platelet count required in one unit of platelet concentrates?
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Flashcards
Blood Products
Blood Products
Components derived from blood, used in transfusions, including red cells, platelets, and plasma.
Donor Age Criteria
Donor Age Criteria
WHO guidelines state donors must be between 18 to 65 years old.
Weight Requirement
Weight Requirement
Donors must weigh at least 45 kg to donate 350 ml, or 50 kg for 450 ml.
Hemoglobin Level
Hemoglobin Level
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Transfusion Reaction Classification
Transfusion Reaction Classification
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Whole blood unit
Whole blood unit
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Infection risk screening
Infection risk screening
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Storage conditions
Storage conditions
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Indications for red cell transfusion
Indications for red cell transfusion
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Contraindications for whole blood
Contraindications for whole blood
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Packed red cells
Packed red cells
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Platelet concentrates
Platelet concentrates
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Transfusion timing
Transfusion timing
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Study Notes
Blood Transfusion
- Learning Objectives (ILOs): Distinguish blood products, describe indications for blood products, and classify transfusion reactions.
Blood Products
- Red Cell Concentrate: Plasma derivative; includes albumin, coagulation factors, and immunoglobulins
- Plasma: Plasma derivative; includes albumin, coagulation factors, and immunoglobulins
- Platelet Concentrates:
- Cryoprecipitate:
Blood Donation Selection Criteria
- Age/Weight: Donors aged 18-65; weight at least 45kg to donate 350ml of whole blood, or 50kg for 450ml.
- Gender: Female donors can generally donate, deferment for pregnant/lactating females. Male donors are often prioritized for concentrates.
- Health/Hb: No malnutrition, debilitating conditions, or mental status issues; haemoglobin level of 12g/dL for women and 13g/dL for men.
Whole Blood Unit
- Volume: 450 ml whole blood donation (510 ml total volume).
- Composition: 450 ml donor blood, 63 ml anticoagulant-preservative solution, haemoglobin ~12 g/ml, haematocrit 35%-45%, no functional platelets, and no labile coagulation factors (V&VIII).
Infection Risk
- Screening: Routine screening for transfusion-transmissible infections including HIV, hepatitis B & C, other hepatitis viruses, syphilis, malaria, and Chagas disease.
- Storage: Stored between +2°C and +6°C. Changes in composition can occur from red cell metabolism during storage. Transfusion should begin within 30 minutes of removal from the refrigerator.
Indications
- Red Cell Replacement: Acute blood loss with hypovolemia; exchange transfusion; red cell transfusions when concentrates are unavailable.
- Volume Overload Risk: Patients with chronic anaemia and/or incipient cardiac failure are contraindicated.
- Administration Requirements: ABO and RhD compatibility with the recipient; no medications added to blood units; complete transfusion within 4 hours.
Red Cell Concentrate (Packed Red Cells)
- Volume: 150-200ml of red cells without plasma.
- Haemoglobin: ~20g/100ml.
- Haematocrit: 55%-75%.
- Clinical Effect: Every 1 ml/kg of packed cells increases hematocrit by at least 1% in pediatric patients, and 1 unit increases Hb by at least 1 gm %.
Indications (Packed Red Cells)
- Anaemia: Replacement of red blood cells in anaemic patients with a hemoglobin level less than 9.0 gm/dl; in thalassemic patients.
- Acute Blood Loss: Use with crystalloid or colloid solution in acute blood loss when hemoglobin is less than 13 gm/dl and other conditions are present. Other indicated conditions include:-severe pulmonary disease; cyanotic heart disease; heart failure;
- Sickle Cell Disease: Treatment to suppress hemoglobin production in sickle cell disease patients with further specified conditions. -documented cerebrovascular accident -documented acute chest syndrome -documented splenic and/or hepatic sequestration -documented recurrent priapism
Platelet Concentrates
- Unit Volume: 50-60ml of plasma.
- Platelets/unit: at least 55 x 10⁹ platelets.
- Red blood cells/unit: less than 1.2 x 10⁹ red cells.
- Leucocytes/unit: less than 0.12 x 10⁹ leucocytes.
- Pooled unit: Platelets prepared from 4-6 donor units and at least 240 x 10⁹ platelets.
- Single-donor unit: Platelets prepared from one donation; 150-500 x 10⁹ platelets.
- Clinical effect per unit: 1 unit (10 kg body weight) will cause an increment of 50,000 platelets in 10-60 min.
Indications (Platelets)
- Low platelet count: Platelet count equal to or less than 10,000/µl and less than 20,000µl if feverish, 50,000/µl and scheduled for minor procedure within 12 hours or active bleeding; less than 100,000/µl in case of major procedure. Requires a documented qualitative platelet dysfunction if active bleeding.
Plasma
- Source: Plasma separated from whole blood donation, collected within 6 hours of donation; rapidly frozen to -25°C or below for 1 year storage.
- Volume: 200-300 ml.
- Composition: Contains normal plasma levels of stable clotting factors, albumin, and immunoglobulins; Factor VIII level is at least 70% of normal fresh plasma.
- Dosage: Initial dose is 15ml/kg.
- Administration: Thawed at 30°C-37°C in blood bank. Higher temperatures can destroy clotting factors and proteins.
Indications (Cryoprecipitate)
- Multiple Factor Deficiencies: Replacement of multiple coagulation factor deficiencies (e.g., liver disease, warfarin overdose).
- Specific Factor Deficiencies: Documented coagulation factor deficiency (Factors II, V, VII, IX, X, or XI) when appropriate factor concentrate is unavailable.
- Disseminated Intravascular Coagulation (DIC): Replacement for DIC.
Cryoprecipitate Preparation
- Source: Prepared from a single unit of FFP after thawing at 4°C; harvesting by centrifugation.
- Composition: Contains 100-120 IU of factor VIII, 100-250 mg fibrinogen, and von Willebrand factor and factor XIII.
- Compatibility: Preferably ABO/Rh compatible but not always required.
Indications (Cryoprecipitate)
- Von Willebrand's disease: In case factor VIII replacement concentrates are unavailable, it is used for Von Willebrand’s disease types II and III, and hemophilia A.
- Hypofibrinogenemia: For Hypofibrinogenemia (serum fibrinogen < 100mg/dl).
- Dysfibrinogenemia: Used in transfusion-induced hypofibrinogenemia with active microvascular bleeding and in DIC-induced hypo/dysfibrinogenemia with active microvascular bleeding.
Leucocyte-Depleted Red Cells
- Preparation: Red cell suspensions/concentrates with less than 5 x 10⁶ white cells per pack; prepared by filtration through a leucocyte-depleting filter.
- CMV Transmission Risk Reduction: Leucocyte depletion reduces CMV transmission risk.
- Indications: Minimize white cell immunisation in patients receiving repeated transfusions; reduce risk of CMV transmission; use in patients with prior febrile reactions to red cell transfusions.
Irradiation of Blood Components
- Dose: Minimum dose of 25 Gy. No single area receiving more than 50 Gy (1B).
- Indications for Irradiation: First-second degree relatives; severe T lymphocyte immunodeficiency; Hodgkin's lymphoma recipients; allogenic/autologous stem cell transplant patients. (specific timeframes are detailed in the text)
- Red Cells: Irradiated at any time up to 14 days after collection; should be transfused within 24 hours.
- Platelets: Irradiated at any stage during storage and can be stored for normal shelf life).
Transfusion Reactions
- Classification: Immediate (immunologic and non-immunologic) or delayed (immunologic and non-immunologic).
- Immediate Reactions -Immunologic: Hemolytic (e.g., Hemolytic transfusion reactions), Non-hemolytic febrile (NHFTR), Allergic (TRALI). -Non-immunologic: Bacterial contamination, Circulatory overload.
- Delayed Reactions -Immunologic: Hemolytic (delayed hemolytic transfusion reactions), GVHD -Non-immunologic: Iron overload, Infections, Diseases.
Acute Hemolytic Transfusion Reactions
- Symptoms: Sudden onset of fever, chills; loin pain; hypotension; dyspnoea; haemoglobinuria/haemoglobinaemia; DIC; and acute renal failure.
- Diagnosis: Clinical findings and serological incompatibility.
- Management: Supportive care.
Delayed Hemolytic Transfusion Reactions
- Symptoms (Timing): 24 hours-28 days after transfusion; dark urine or jaundice (45-50%); Fever; chest, abdominal, or back pain
- Diagnosis: Fall or failure of haemoglobin; rise in indirect bilirubin; and positive direct antiglobulin (Coombs') test.
- Management: Additional transfusions to maintain desired Hb. Red blood cell exchange for management of DHTR in SCD patients (sickle cell disease), methylprednisolone, prospective extended red cell antigen matching.
Febrile Non-Hemolytic Reactions
- Symptoms: Temperature rise of 1°C or higher accompanied by transient hypertension, chills, rigors, and discomfort.
- Diagnosis: Diagnosis of exclusion.
- Management: Antipyretic drugs (e.g., paracetamol); pethidine (2).
Septic Transfusion Reactions
- Symptoms: Occurring during or within 4 hours of transfusion; lack of improvement; and presence of additional clinical signs; or bacterial culture from patient or indwelling lines before antibiotics.
- Broad-spectrum Antibiotics: ß-lactams and aminoglycosides; specifically anti-Pseudomonas coverage
- Management Donor screening; proper skin disinfection; and surveillance of platelet units.
Allergic/Anaphylactic Reactions
- Mild/Moderate Symptoms: Rash, pruritus, urticaria, localized angioedema. Severe reaction with bronchospasm, respiratory distress, and hypotension
- Diagnosis: Clinical findings.
- Management: Mild/moderate reactions: H1 antihistamine administration (1A). Severe reactions: prompt IM epinephrine administration. Other 2nd line drugs include, H1 antihistamine ( 1C), bronchodilators ( 1C), and glucocorticoid intravenous administration (1C).
- Minimize Plasma: minimize content of the plasma in the unit.
Transfusion-Related Acute Lung Injury (TRALI)
- Symptoms: Occurring within 6 hours (up to 72 hours post-transfusion) with dyspnea, tachypnea, hypoxemia; and possibly rigors, tachycardia, fever, hypothermia, and hypotension or hypertension. Chest X-ray shows bilateral interstitial infiltrates.
- Management: Supportive care; supplemental oxygen as needed; application of restrictive tidal volume ventilation and restrictive fluid strategy.
- Donor selection: Male donors only for plasma; screening female apheresis platelet donors for HLA/HNA antibodies; and retesting after pregnancies.
Transfusion-associated Circulatory Overload
- Symptoms: New onset or exacerbation of three or more of: respiratory distress; elevated central venous pressure; left heart failure; positive fluid balance; pulmonary edema.
- Management: Stop transfusion; administer supplemental oxygen; administer diuretics.
- At-risk patients: Transfusion slowly over 3-4 hours; use smallest possible quantity of blood.
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Description
Test your knowledge on blood donation criteria, transfusion medicine, and the associated parameters for donors. This quiz covers essential aspects such as weight requirements, hemoglobin levels, and platelet concentrations necessary for safe blood donation and transfusion practices.
