Blood Transfusion and Red Blood Cells
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What is the main indication for the use of whole blood or packed RBCs?

  • For patients with sickle cell anemia
  • For patients who have lost at least 25% of their blood volume (correct)
  • For patients with hemoglobin levels below 10 g/dL and/or hematocrit levels below 30%
  • For oncology patients undergoing chemotherapy or radiation therapy

    • What is the shelf life of packed RBCs in a close system when stored in ACD or CPD?

  • 14 days
  • 35 days
  • 24 hours
  • 21 days (correct)

    • What is the purpose of leukocyte-reduced RBCs?

  • To improve platelet count in thrombocytopenic patients
  • To reduce the risk of HLA alloimmunization
  • To increase RBC mass in patients with severe anemia
  • To increase RBC mass in patients with severe and/or recurrent febrile transfusion reactions due to leukocyte antibodies (correct)

    • How are leukocyte-reduced RBCs prepared?

    <p>By filtration or apheresis</p> Signup and view all the answers

    What is the correct count increment for platelets in a 75-kg recipient?

    <p>30,000-60,000/μL</p> Signup and view all the answers

    What is the shelf life of a plateletpheresis unit or single donor platelet?

    <p>5 days with constant agitation</p> Signup and view all the answers

    What is the purpose of leukocyte-reduced platelets?

    <p>To reduce the risk of HLA alloimmunization in thrombocytopenic patients</p> Signup and view all the answers

    How are packed RBCs prepared?

    <p>By removing 80% of plasma from whole blood</p> Signup and view all the answers

    What is the minimum percentage of original RBCs that must be retained in leukocyte-reduced RBCs?

    <p>85%</p> Signup and view all the answers

    What is the purpose of whole blood transfusions?

    <p>To provide blood volume expansion and RBC mass in acute blood loss</p> Signup and view all the answers

    What is the primary indication for using granulocytes in patients?

    <p>To treat patients with severe neutropenia with infection non-responsive to antibiotic therapy</p> Signup and view all the answers

    What is added to the donor's blood before donating granulocytes?

    <p>Corticosteroid</p> Signup and view all the answers

    How are granulocytes typically stored?

    <p>Not applicable, as they are not stored</p> Signup and view all the answers

    What is the main indication for using fresh frozen plasma?

    <p>Bleeding patients who require factors II, V, VII, IX, and X</p> Signup and view all the answers

    How is fresh frozen plasma typically thawed?

    <p>In a waterbath at 30-37°C for 30-45 minutes</p> Signup and view all the answers

    What is the recommended storage condition for thawed plasma?

    <p>At 4°C for up to 5 days if factor VIII is not needed</p> Signup and view all the answers

    What is the approximate volume of a single unit of granulocytes?

    <p>20-50 mL of RBCs, platelets, and granulocytes</p> Signup and view all the answers

    What is the primary role of hydroxyethyl starch (HES) in granulocyte collection?

    <p>As a sedimenting agent</p> Signup and view all the answers

    What is the primary purpose of leukoreduction filters in blood transfusions?

    <p>To remove 99.9% of WBC from RBC and platelet products</p> Signup and view all the answers

    What is the minimum dose of irradiation required for whole blood, RBC, granulocytes, and platelets?

    <p>2500 cGy</p> Signup and view all the answers

    Which of the following is a characteristic of an open system in blood storage?

    <p>The seal on the unit is broken to attach an external transfer bag</p> Signup and view all the answers

    What is the purpose of apheresis in blood donation?

    <p>To collect specific blood components from a donor</p> Signup and view all the answers

    What type of transfusion therapy involves the use of blood components to treat a disease in a patient?

    <p>Hemotherapy</p> Signup and view all the answers

    What is the primary purpose of washing RBCs?

    <p>To reduce the risk of transfusion-related complications</p> Signup and view all the answers

    What is the minimum total protein required in a donor for plasmapheresis?

    <p>Not specified in the content</p> Signup and view all the answers

    What is the primary purpose of recombinant DNA technology in medicine?

    <p>To produce new genetic combinations for medical applications</p> Signup and view all the answers

    What is the primary purpose of examining pretransfusion clotted blood specimens, an EDTA anticoagulated post-transfusion blood specimen, and the blood bag?

    <p>To identify the presence of antibodies</p> Signup and view all the answers

    Which of the following is NOT a test performed for transfusion-transmitted diseases?

    <p>Influenza</p> Signup and view all the answers

    What should be performed if an antibody is suspected in a patient?

    <p>Perform an RBC panel</p> Signup and view all the answers

    What is the purpose of a Gram's stain on the blood in the bag?

    <p>To detect bacterial contamination</p> Signup and view all the answers

    Why is it essential to keep the IV line open with crystalloid?

    <p>To prepare for immediate treatment of hypotension</p> Signup and view all the answers

    What is the significance of performing a DAT (direct antiglobulin test) on an EDTA anticoagulated post-transfusion blood specimen?

    <p>To diagnose hemolytic disease</p> Signup and view all the answers

    What is the purpose of repeating the ABO/Rh typing, antibody screen, and crossmatch?

    <p>To ensure compatibility of the blood</p> Signup and view all the answers

    What is the purpose of measuring hemoglobin and/or hematocrit at frequent intervals?

    <p>To monitor for hemolysis</p> Signup and view all the answers

    What is the primary cause of hemolytic reactions?

    <p>Recipient's immune system reacting to antigens on donated RBCs</p> Signup and view all the answers

    What is the primary symptom of post-transfusion purpura?

    <p>Profound self-limiting thrombocytopenia</p> Signup and view all the answers

    What is the primary cause of delayed transfusion reactions?

    <p>Recipient's immune system reacting to antigens on donated RBCs</p> Signup and view all the answers

    What is the primary purpose of leukoreduction filters in blood transfusions?

    <p>To remove leukocytes from donated blood</p> Signup and view all the answers

    What is the primary indication for irradiating blood components?

    <p>To prevent graft-versus-host disease</p> Signup and view all the answers

    What is the primary purpose of washing RBCs?

    <p>To remove plasma from donated blood</p> Signup and view all the answers

    What is the primary cause of transfusion-associated graft-versus-host disease?

    <p>Immunocompetent lymphocytes in donated blood reacting to recipient's tissues</p> Signup and view all the answers

    What is the primary purpose of apheresis in blood donation?

    <p>To collect platelets from donors</p> Signup and view all the answers

    What is the primary purpose of leukoreduction in blood transfusions?

    <p>To reduce the risk of febrile non-hemolytic transfusion reactions</p> Signup and view all the answers

    What is the primary purpose of storing blood components at 1°-6°C?

    <p>To prevent bacterial growth</p> Signup and view all the answers

    What is the primary mechanism of acute hemolytic transfusion reaction?

    <p>Antibody to leukocyte antigens</p> Signup and view all the answers

    Which of the following is a characteristic of febrile non-hemolytic transfusion reaction?

    <p>Increase in temperature of 1'C or more</p> Signup and view all the answers

    What is the mechanism of anaphylaxis in transfusion reactions?

    <p>Reaction between anti-IgA and IgA in transfused products</p> Signup and view all the answers

    What is the primary mechanism of delayed hemolytic transfusion reaction?

    <p>Anamnestic antibody to red cell antigens</p> Signup and view all the answers

    Which of the following is a characteristic of transfusion-associated graft-vs-host disease?

    <p>Engraftment of transfused functional lymphocytes</p> Signup and view all the answers

    Which of the following bacteria is associated with transfusion-associated sepsis?

    <p>Escherichia species</p> Signup and view all the answers

    What is the primary mechanism of transfusion-related acute lung injury?

    <p>Antibody to leukocytes or complement activation</p> Signup and view all the answers

    Which of the following is a characteristic of allergy or urticaria in transfusion reactions?

    <p>Antibody to plasma proteins</p> Signup and view all the answers

    Study Notes

    Red Blood Cells

    • Main indication for use: Patient hemoglobin is < 8g/dL and/or hematocrit is < 25%
    • 1 unit of Whole Blood or Packed RBC can increase hemoglobin by 1g/dL and hematocrit by 3-5%
    • Whole blood provides blood volume expansion and RBC mass in acute blood loss; for actively bleeding patients who have lost at least 25% of their blood volume, or patients requiring exchange transfusions

    Storage and Transport

    • Whole blood: ACD and CPD = 21 days, CPDA-1 = 35 days
    • When whole blood is not available, reconstitute whole blood by mixing RBCs with thawed AB type plasma from a different donor

    Packed RBCs

    • Indication: Increase RBC mass in symptomatic, normovolemic patients, including oncology patients undergoing chemotherapy or radiation therapy, trauma patients, dialysis patients, premature infants, and patients with sickle cell anemia
    • Preparation: 80% of plasma removed from whole blood, hematocrit: 65-80% (not exceeding 80%)
    • Storage and Transport: Open system: 24 hours, Close system: ACD and CPD = 21 days, CPDA-1 = 35 days

    Leukocyte-Reduced RBCs

    • Indication: Increase RBC mass in patients with severe and/or recurrent febrile transfusion reactions due to leukocyte antibodies
    • Preparation: Filtration (within 24 hours from time of collection) or apheresis; saline washing
    • Must retain 85% of original RBCs; 1 unit contains ≥ 6.2 x 10^10 RBCs
    • Should not be used if visible aggregates present; may contain residual RBCs
    • Usually pooled

    Platelets

    Guidelines for the Effectiveness of Platelet Transfusion

    • Corrected Count Increment for Platelets: Good increment: ≥ 7,500, Refractoriness: < 5,000
    • Percent Recovery: 66% at 1 hour, 48% at 24 hours

    Plateletpheresis Unit or Single Donor Platelet (SDP)

    • Indication: For thrombocytopenic patients alloimmunized to HLA or platelet antigen (donor should be HLA matched)
    • Preparation: Apheresis
    • Storage: 5 days with constant agitation
    • 1 unit contains ≥ 3.5 x 10^11 platelets, equivalent to 4-6 units of random donor platelets

    Leukocyte-Reduced Platelets

    • Indication: Same as Single Donor Platelet (SDP) or Plateletpheresis unit
    • Preparation: Filtration or apheresis processing
    • Storage: Open system: 5 days with agitation, Apheresis: 5 days with agitation

    Granulocyte

    • Main indication for use: Patients with absolute granulocyte count of < 500
    • Indication: Patients with granulocyte dysfunction or myeloid hypoplasia who are unresponsive to antibiotics; severe neutropenia with infection non-responsive to antibiotic therapy
    • Limited to septic infants
    • Preparation: Apheresis; uses hydroxyethyl starch (HES) as sedimenting agent
    • 1 unit contains ≥ 1 x 10^10 granulocytes, platelets, and 20-50 mL of RBCs

    Plasma and Derivatives

    • Main indication for use: PT is < 15 seconds, aPTT is < 1.5 times normal, fibrinogen is < 100 mg/dL

    Fresh Frozen Plasma

    • Indication: Bleeding patients who require factors II, V, VII, IX, and X
    • Replace isolated factor deficiencies when specific component is not available
    • Reverse effects of Warfarin (Coumadin; Panwarfin; Sofarin) anticoagulant drug
    • Treatment of thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome
    • Patients with liver disease to prevent or correct bleeding
    • Antithrombin III deficiencies; disseminated intravascular coagulation when fibrinogen is < 100 mg/dL
    • Preparation: Thawed plasma from FFP, thaw in water bath at 30°-37°C for 30-45 minutes
    • Transfuse immediately, store at 1°-6°C for up to 24 hours or store at 4°C for up to 5 days if factor VIII is not needed

    Leukoreduction and Washing

    • Leukoreduction filters: used to remove 99.9% of WBC from RBC and platelet products
    • Leukoreduced RBC: filters can reduce number of leukocytes in a bag while being transfused
    • Leukoreduced Random Donor Platelet (RDP): filters can reduce number of leukocytes in a bag while being transfused
    • Washing: RBC and platelets can be washed to remove plasma and reduce allergic reactions

    Apheresis

    • Blood is drawn from a donor or a patient and separated into components; one or more of the components is retained, and the remaining constituents are recombined and returned to the individual
    • Types: Erythrocytapheresis, Plateletpheresis or thrombocytapheresis, Leukapheresis, Plasmapheresis
    • Total protein of donor must not be less than 12 g/dL

    Irradiation

    • Using X-rays or gamma rays to inactivate WBCs and prevent graft-versus-host disease
    • For whole blood, RBC, granulocytes, and platelets
    • Irradiate up to 28 days of collection and stored for another 28 days
    • Minimum dose: 2,500 cGy at the center of the unit, 1,500 cGy at other parts of the unit

    Recombinant DNA Technology

    • A process of recombining two DNA fragments from different species and inserting such recombinant molecule into a host organism in order to produce new genetic combinations that are of value in medicine, science, and industry

    Transfusion Reactions and Complications

    • IV line must be kept open with crystalloid in case immediate treatment is necessary to overcome hypotension.
    • Attending physician and blood bank must be notified as soon as possible in case of a reaction.

    Workup

    • Clerical check of compatibility tag on blood bag, blood bag label, and patient identification for discrepancies.
    • Examination of pre-transfusion clotted blood specimen, EDTA anticoagulated post-transfusion blood specimen, and blood bag.
    • Perform Gram's stain on blood in the bag and culture if necessary to determine bacterial contamination.

    Transfusion-Transmitted Diseases

    • Infectious diseases that can be transmitted through blood transfusion:
      • HIV
      • HCV
      • HBV
      • HTLV
      • Syphilis
      • Cytomegalovirus
      • Trypanosoma cruzi
      • West Nile Virus

    Transfusion Reactions

    • Immediate effects:
      • Hemolytic reactions:
        • Fever, chills, flushing, nausea, dyspnea, chest pain, flank pain, hypotension, shock, hemoglobinemia, hemoglobinuria, DIC, renal failure.
        • Treatment: avoid human error, use well-written procedure manuals, and use highly trained clinical and laboratory staff.
      • Febrile non-hemolytic transfusion reaction (FNHTR):
        • Chills, fever, and urticaria.
        • Treatment: premedicate with antipyretics, administer antipyretics, and transfuse leukocyte-reduced products.
      • Anaphylactic reactions:
        • Flushing of the skin, abrupt hypertension followed by hypotension, substernal pain, dyspnea, nausea, abdominal cramps, emesis, diarrhea.
        • Treatment: give immediate treatment with epinephrine, IV corticosteroids, and O2 therapy.
      • Transfusion-related acute lung injury (TRALI):
        • Chills, fever, nonproductive cough, dyspnea, cyanosis, bilateral pulmonary edema, severe hypoxemia, hypotension.
        • Treatment: use proper donor selection, give respiratory support, steroids, and diuretics.
    • Non-immunologic effects:
      • Iron overload or transfusion-associated hemosiderosis:
        • Multiple transfusions.
      • Hepatitis:
        • NANB, occasionally.
      • Acquired immune deficiency syndrome:
        • Host response to agent in donor blood.
      • Protozoan infection:
        • Malaria parasites.

    Delayed Transfusion Reactions

    • Hemolytic reactions:
      • Fever, decreased hemoglobin, mild jaundice.
      • Treatment: give antigen-negative blood for subsequent transfusions.
    • Post-transfusion purpura:
      • Profound self-limiting thrombocytopenia, generalized purpura.
      • Treatment: use corticosteroids, therapeutic plasma exchange, and high-dose intravenous immunoglobulins.
    • Transfusion-associated graft-versus-host disease:
      • ACUTE: fever, diffuse skin rash, diarrhea, infection, abnormal liver function, pancytopenia, usually fatal.
      • CHRONIC: fever, scleroderma-like disease, Sicca syndrome, interstitial pneumonitis, malabsorption.
      • Treatment: irradiate all blood components containing lymphocytes with a dose of 25 Gy before transfusion to susceptible individuals.
    • Transfusion-induced hemosiderosis:
      • Muscle weakness, weight loss, mild jaundice, fatigue, cardiac arrhythmias, mild diabetes, growth retardation in children.
      • Treatment: administer deferroxamine, and super or hypertransfusion of neocytes.

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    Description

    This quiz covers the main indications for using red blood cells, the effects of transfusions, and the storage and transportation of blood products.

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