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Blood groups (Most common) O > A > B > AB (Least common)
37’C
‡Thawed cryoppt
hrs
Granulocyte 1. Granulocyte dysfunction 20-24’C 24h Contains 1 x 1010
concentrate (CGD) w/o granulocytes
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2. Myeloid hypoplasia agitation
Platelet 1. Thrombocytopenia 20-24’C 5d (20-24’C w/ 1 unit will platelet
concentrate w/ agitation) count by 5,000-
agitation 2d (1-6’C) 10,000/μL
1-6’C
Irradiated blood 1. Prevent GVHD 28 days from Usually RBCs and
component irradiation or orig. platelets are
exp. date whichever irradiated
comes first
Factor VIII 1. For hemophilia A 1-6’C Varies Stored in lyophilized
concentrate form
‡
Factor IX 1. For hemophilia B 1-6’C Varies A.k.a. prothrombin
concentrate complex
‡
Contains factors II,
VII, IX and X
NSA 1. Hypovolemic shock 2-10’C 5 years 96% Albumin
4% Globulin
Blood Component Indication Storage Transport Shelf-life Other Info
PPF 1. Hypovolemic shock 2-10’C 5 years 80-85% Albumin
10-15% Globulin
SDP 5 years SDP: Single donor
plasma
Methods of Freezing RBCs
Concentration Frozen at Stored at Equipment
High glycerol 40% w/v glycerol -80’C -65’C Mechanical freezer
(Slow freezing)
Low glycerol 20% w/v glycerol -196’C -120’C Liquid nitrogen
(Fast freezing)
Agglomeration Glycerol -80’C -65’C Mechanical freezer
Glucose
Fructose
EDTA
Cryoprotective agent Prevents rupture of RBCs during freezing
Ex. Glycerol
Deglycerolization Removal of glycerol
Hypertonic solution followed by an isotonic solution
High glycerol (DG) 12% NaCl -----> 1.6% NaCl -----> 0.9% NaCl
Low glycerol (DG) 45% NaCl in 15% mannitol
Agglomeration (DG) 50% Glucose + 5% Fructose -----> 0.9% NaCl
Cryoprecipitate After thawing = administer w/in 6 hours
After pooling = administer w/in 4 hours
Leukapheresis HES (Hydroxyethylstarch) = Separation bet. WBCs and RBCs
Donor: administered w/ corticosteroids 12-24 hrs before donation
= # of circulating granulocytes
Plateletpheresis Usually takes 1-2 hours
Donor:
= Platelet count: ≥150 x 109/L
= Aspirin-free: 3 days
Single donor platelets (SDP) A.k.a. super packed platelets
From plateletpheresis
For patients who are refractory or unresponsive to RDP
Limit patient exposure to multiple donors
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RDP: Random Donor Platelets SDP: Single Donor Platelets
Preparation From WB: Light spin Heavy spin Plateletpheresis
10
Amount 5.5 x 10 platelets 3.0 x 1011 platelets
Vol. of plasma 50-75mL 300mL
pH ≥ 6.0 (New: 6.2) ≥6.0 (New: 6.2)
Storage 20-24’C w/ agitation 20-24’C w/ agitation
Shelf-life 5 days 5 days
At risk of TA-GVHD Recipient of BM transplant
Patients w/ hematologic or oncologic disease
Patients w/ congenital immunodeficiency
Recipient of blood from 1st degree relative (direct)
Irradiation Radiation source: 25-35 Gy (Gy: Gray | 1Gy = 100 rads)
a. Cesium (Ce)
b. Cobalt (Co)
Infusion IV fluids:
a. NSS = the only fluid allowed to start an IV line prior to transfusion
b. D5W (5% dextrose in H2O) = Not allowed to start (hypotonic hemolysis)
c. Ringer’s lactate =not allowed to start (contains Ca2+ promote coagulation)
Blood warmers 37’C
Temp. >42’C = hemolyzed
Filters 1. Clot screen filter (170μm) = to remove gross clots
2. Leukocyte depletion filter
Speed of infusion 15gtts = 1mL
60gtts = 1min
1min = 4mL
1hr = 240mL
Rate = 240mL/hr
1 unit must be completed w/in 4hrs of blood transfusion
Polyagglutination (Hubener-Thomsen-Fridenrich Phenomenon)
Cryptantigens Hidden Ag’s
Covered w/ NANA (N-acetylneuraminic acid) or sialic acid
When NANA is destroyed (by neuraminidase) Ag’s are exposed
Exposed Ag’s Agglutination = React w/ tetrasaccharide of Thomas & Winzler (T
receptor)
Acquired Microbially-Associated Polyagglutination
T C. perfringens
V. cholerae
S. pneumoniae
All produce neuraminidase
Th E. coli
Proteus sp.
Produce weaker neuraminidase
Tx Bacterial and viral
Unknown mechanism
Tk “CABS”
C. albicans
A. niger
B. fragilis
S. marcescens
All produce endo/exogalactosidase
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Altered precursor substances (Altered: ABH, Le, I, P)
Acquired B phenomenon Bacteria: Deacetylase enzyme
N-acetylgalactosamine --(Deacetylase)--> N-acetyl + galactosamine
Galactosamine = Group B
Remedy: Add acetic anhydride
VA Vienna, Virginia
Microbial fucosidase = fucose = H
Acquired Non-Microbially Associated Polyagglutination
Tn (-) β-3-D-galactosyltransferase enzyme needed for the normal structure of T
receptor (Tetrasaccharide of Thomas and Winzler)
Inherited Polyagglutination
a
Cad Sd
HEMPAS/CDA II Adult i Ag = H Ag, Sialic acid
Others HbM – Hyde Park
NOR = Norfolk, Virginia
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Tn Cad T Tk
Arachis hypogaea - - + +
Salvia sclarea + - - -
Salvia horminum + + - -
Glycine soja + + + -
Autologous Donation
Predeposit AD Before anticipated transfusion
Requirements:
*No age limit
*No strict weight requirement (vol. by 4mL/1 pound below 110)
*Hgb ≥ 11g/dL
*Hct ≥ 33%
*Frequency: every ≥ 3days
Intraoperative AD Collect blood during surgical procedure reinfused immediately
Immediate preoperative Collect blood replace patient volume w/ colloid/crystalloid reinfuse during surgical
hemodilution procedure
Postoperative salvage Drainage tube
Postoperative bleeding salvaged (saved) clean and reinfused
Immediate Immune Transfusion Reactions
FNHTR 1’C in temperature
Cause: anti-leukocyte Ab’s (leukoagglutinins)
Prevention: Leukopoor RBCs
Allergic Cause: Donor plasma w/ foreign proteins
Prevention: Washed RBCs
Anaphylactic Afebrile (no fever)
Signs and symptoms occur only after the infusion of only few mL of blood
IgA deficiency w/ anti-IgA antibody
Prevention: Washed RBCs | IgA-deficient donor (rare)
Anaphylactoid Afebrile
Normal IgA w/ anti-IgA to donor IgA
Prevention: Washed RBCs | IgA-deficient donor (rare)
TRALI (NCPE) Cause: Anti-leukocyte Ab’s (leukoagglutinins)
Signs and symptoms resemble respiratory distress
Prevention: Leukopoor RBCs
Hemolytic Bleeding, hypotension, hemoglobinuria, anuria
Delayed Immune Transfusion Reactions
TA-GVHD Cause: T lymphocyte proliferation
Prevention: Irradiated RBCs
PTP Onset of thrombocytopenia
Cause: anti-platelet Ab’s (HPA-1a negative platelets)
Prevention: Therapy
a. Administration of corticosteroid
b. Exchange transfusion
c. IV immunoglobulins
DHTR 7 days
Immediate Nonimmune Transfusion Reactions
TACO Administration of blood w/o equivalent blood loss
Iatrogenic: physician-caused
At risk:
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a. Young children
b. Elderly patients
c. Patients w/ cardiac disease
Prevention: Therapy
a. Therapeutic phlebotomy
b. IV diuretics
c. O2 therapy
Bacterial contamination Cause: Endotoxin production by psychrophilic/cryophilic bacteria
Y. enterocolitica (most common)
E. coli
P. aeruginosa
Factors:
a. During phlebotomy
b. During preparation/processing
c. During thawing
Prevention:
a. Sterile technique
b. Visual inspection of unit
→ Blood unit = Brown, purple, hemolysis, clot
→ Plasma = Murky (dark brown) purple, red
PCITR Causes:
- Small bore needle
- Warming blood above 50’C
- Freezing blood w/o cryoprotective agent
- Citrate toxicity
Delayed Nonimmune Transfusion Reactions
Iron Overload Patients w/ normovolemic anemia
(Hemosiderosis) Transfusion-dependend patients:
- Aplastic anemia
- Congenital hemolytic anemia
Prevention:
a. Iron-chelating agent = Deferroxamine
b. Neocytes = young RBCs, has longer lifespan
Disease transmission HBV, HCV, HDV, CMV, EBV, HTLV-I and II, HIV, T. pallidum, Plasmodium spp., B.
microti, T. cruzi, T. gondii
Hemolytic Disease of the Newborn
In utero Anemia ( immature RBCs, enlarged spleen & liver = extramedullary hematopoiesis)
Hydrops fetalis = cardiac insufficiency, edema
Neonatal period Unconjugated bilirubin Brain Kernicterus
Treatment 1. Intrauterine transfusion
- In utero
- Corrects anemia
- X-match: Mother’s serum
2. Exchange transfusion
- Neonatal period
- Removes bilirubin & Ab-coated RBCs
- X-match: Mother’s serum (preferred) or infant’s serum
Cross-Matching
Full X-match 2 hours
Can be shortened to 30 mins
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Abbreviated X-match Type/screen + immediate spin
DC/PS = no agglutination/hemolysis
Electronic X-match Patient blood type is determined on 2 occasions
Emergency situation Patient blood type is unknown
Group O (Rh-) pRBCs
(+) Major X-match (-) Alloantibody control
(+) Autoantibody, autocontrol
Ratio of serum to cells Routine = 40:1
Det. weak Ab’s = 133:1
Saline for washing pH 7.2-7.4
Incubation period 30-120 mins (majority: 30 mins)
Enhancement media 1. Albumin
2. PEG
3. LISS (Incubation pd: 5-15 mins)
Lectin Sources
Anti-A1 Dolichos biflorus
Anti-H Ulex europaeus
Anti-M Iberis amara
Iberis umbellate
Iberis semperivens
Maclura aurantiaca
Anti-N Bauhinia variegate
Bauhinia purpura
Bauhinia bonatiana
Bauhinia candicans
Vicia graminea
Anti-B Bandeirae simplicifolia
Quality Control
Annually Mercury thermometers
Quarterly (Every 3 months) Speed timer (centrifuge)
Cell washers (speed, timer)
Blood warmers
Monthly Alarm Activation (refrigeration and freezers)
Temperature (refrigerated centrifuge)
Daily Refrigerators and freezers (continuous monitors)
Platelet incubators (enclosed, monitored chambers)
Daily when in use Transfusion service:
- Heating blocks
- Water baths
Donor facility:
- Donor unit agitators
- Scales
- Balances
- Hemoglobinometer
- Microhematocrit centrifuges
Every 4 hours Platelet incubators (ambient temperature storage)
Other Topics
Apheresis/Hemapheresis Whole blood is withdrawn, a desired component separated, and the remainder of
the tube returned to the donor
Intermittent-flow 1 venipuncture
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centrifugation (IFC) Blood is withdrawn and reinfused through the same needle
Once the desired component is separated, the remaining components are
reinfused to the donor
Continuous-flow 2 venipunctures
centrifugation (CFC) Withdraw, process and return the blood to the individual simultaneously
Antibody screen Collect new specimen every 3 days in a series of transfusion
Donor & recipient samples Keep for 7 days after transfusion (at 1-6’C)
Compatibility testing Series of tests that ensure safety of transfusion to recipient and donor
1. Review of BB records
2. ABO and Rh
3. Ab screen
4. Cross matching
a. Major X-match = DC/PS
b. Minor X-match = PC/DS
DHTRs Occur 3 to 7 days after transfusion
Virus inactivation in plasma Heating in a liquid state w/ LMW stabilizers
products Heating in lyophilized state
UV irradiation
Y. enterocolitica Bacterial contamination of blood
Density Separates neocytes from mature RBCs
Requirements for blood 1. (-) HbS
products to be transfused to 2. <7 days
infants 3. γ-irradiated
4. (-) CMV
Allogeneic donor blood from Repeat ABO and Rh typing
outside sources
w/in 30 mins Time limit when a unit of blood is removed from 2-8’C and returned back to the
refrigerator
Procedure when HTR occurs 1. Stop transfusion
2. Keep IV line open
3. Notify the physician and BB
Specimens for investigation 1. Patient pre-transfusion blood sample
of HTR 2. Patient post-transfusion blood sample
= PT/PTT/DAT
= Pink: Hgb 0.2 g/L or 20 mg/dL
= Red: Hgb >1 g/L or 100 mg/dL
3. Patient post-transfusion urine
= Bilirubin/Urobilinogen
4. Blood bag
= GS/CS
LISS Glycine/glucose + saline
5-15 mins incubation
ZZAP Cysteine-activated papain
Mixture of DTT and papain
True chimerism Presence of 2 cell population
Ex. Twins
Mixed-field agglutination
Artificial chimerism After:
-BM transplantation
-Blood transfusion
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-Exchange transfusion
-Fetomaternal hemorrhage
AB cis genotype Group IV discrepancy
Inheritance of 3 ABO genes (AB/O)
Acquired A antigen 1. Tn activation
2. P. mirabilis
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