Академический Документы
Профессиональный Документы
Культура Документы
Rarely if ever used anymore Anticoagulant ONLY Transfuse within 48 hours, preferably 8
Anticoagulants
CPD Storage time 21 days CPD-A1 35 days
Temperature 1-6 C
Adenine Volume Dextrose Citrate None
1-6 C
Substrate for ATP synthesis
Slows glycolytic activity 450 +/- 10% Supports ATP generation by glycolytic pathway Prevents coagulation by binding calcium
Additive Solution
Primary bag with satellite bags attached. One bag has additive solution (AS) Unit drawn into CPD anticoagulant
Additive Solution
Remove platelet rich plasma within 72 hours Add additive solution to RBCs, ADSOL, which consists of:
Storage Lesion
Biochemical changes which occur at 1-6C Affects oxygen dissociation curve, increased affinity of hemoglobin for oxygen.
Low 2,3-DPG, increased O2 affinity, less O2 released. pH drops causes 2,3-DPG levels to fall Once transfused RBCs regenerate ATP and 2,3-DPG
Viable cells
pH ATP 2,3-DPG Plasma Na+ Helps release oxygen from hemoglobin (once transfused, ATP & 2,3DPG return to normal)
Storage Lesion
Significant for infants and massive transfusion. Other biochemical changes
Preparation of Components
Collect unit within 15 minutes to prevent activation of coagulation system Draw into closed system primary bag with satellite bags with hermetic seal between. If hermetic seal broken transfuse within 24 hours if stored at 1-4C, 4 hours if stored at 2024C
Preparation of Components
Centrifuge light spin, platelets suspended Remove platelet rich plasma (PRP) Centrifuge PRP heavy spin Remove platelet poor plasma Freeze plasma solid within 8 hours Thaw plasma at 1-4C precipitate forms Centrifuge, express plasma leaving cryoprecipitate. Store both at -18C RBCs CPD 21 days, ADSOL 42 days 1-6C
Preparation of Components
Preparation of Components
Transfusion practice
Transfusion requires doctors prescription All components MUST be administered through a filter Infuse quickly, within 4 hours D (Rh) neg require D neg cellular products ABO identical preferred, ABO compatible OK Universal donor RBCs group O, plasma AB
Blood Components
Cellular
Red blood cell products Platelets Granulocytes
Plasma
FFP Cryoprecipitate
Whole Blood
Clinical indications for use of WB are extremely limited. Used for massive transfusion to correct acute hypovolemia such as in trauma and shock, exchange transfusion. RARELY used today, platelets non-functional, labile coagulation factors gone. Must be ABO identical.
Leukocytes can induce adverse affects during transfusion, primarily febrile, non-hemolytic reactions. Reactions to cytokines produced by leukocytes in transfused units. Other explanations to reactions include: immunization of recipient to transfused HLA or granulocyte antigens, micro aggregates and fragmentation of granulocytes. Historically, indicated only for patients who had 2 or more febrile transfusion reactions, now a commonly ordered, popular component. CMV safe blood, since CMV lives in WBCs. Most blood centers now leukoreduce blood immediately after collection. Bed side filters are available to leukoreduce products during transfusion.
Leukocyte Reduction
Washing removes plasma proteins, platelets, WBCs and micro aggregates which may cause febrile or urticarial reactions. Patient requiring this product is the IgA deficient patient with anti-IgA antibodies. Prepared by using a machine which washes the cells 3 times with saline to remove and WBCs. Two types of labels:
e.
Washed RBCs - do not need to QC for WBCs. Leukocyte Poor WRBCs, QC must be done to guarantee removal of 85% of WBCs. No longer considered effective method for leukoreduction.
Frozen Blood
Blood is frozen to preserve: rare types, for autologous transfusion, stock piling blood for military mobilization and/or civilian natural disasters. Blood is drawn into an anticoagulant preservative.
Expiration
Plasma is removed and glycerol is added. After equilibration unit is centrifuged to remove excess glycerol and frozen. If frozen, 10 years. After deglycerolization, 24 hours. high glycerol -65 C. low glycerol -120 C, liquid nitrogen.
Storage temperature
Platelet Products
Platelets (PLTS), Platelet Concentrate (PC) or Random Donor Platelet Concentrate (RD-PC)
Used to prevent spontaneous bleeding or stop established bleeding in thrombocytopenic patients. Prepared from a single unit of whole blood. Due to storage at RT it is the most likely component to be contaminated with bacteria. Therapeutic dose for adults is 6 to 10 units. Some patients become "refractory" to platelet therapy.
Store at 20-24 C (RT) with constant agitation. D negative patients should be transfused with D negative platelets due to the presence of a small number of RBCs.
Plasma
RBCs
PRP
Platelet concentrate
Platelets (PLTS), Platelet Concentrate (PC) or Random Donor Platelet Concentrate (RD-PC)
One bag from ONE donor Need 6-10 for therapeutic dose
Pooling Platelets
6-10 units transferred into one bag Expiration = 4 hours
Platelets Pheresis, Apheresis Platelet Concentrate, Single Donor Platelet Concentrate (SD-PC)
Used to decrease donor exposure, obtain HLA matched platelets for patients who are refractory to RD-PC or prevent platelet refractoriness from occurring. Prepared by hemapheresis, stored in two connected bags to maintain viability. One pheresed unit is equivalent to 6-8 RD-PC. Store at 20-24 C (RT) with agitation for 5 days, after
combining, 24 hours
D negative patients should be transfused with D negative platelets due to the presence of a small number of RBCs
Apheresis
Apheresis
Platelets Pheresis
One bag (unit) from one donor One unit is a therapeutic dose Volume approximately 250 ccs
Granulocytes
Lymphocyte
Monocyte
Neutrophils
Eosinophils
Basophils
Granulocytes
Primary use is for patients with neutropenia who have gram negative infections documented by culture, but are unresponsive to antibiotics. Therapeutic efficacy and indications for granulocyte transfusions are not well defined. Better antimicrobial agents and use of granulocyte and macrophage colony stimulating factors best for adults, best success with this component has been with babies Daily transfusions are necessary. Prepared by hemapheresis. Expiration time is 24 hours but best to infuse ASAP. Store at 20-24 C.
Plasma Components
Used to replace labile and non-labile coagulation factors in massively bleeding patients OR treat bleeding associated with clotting factor deficiencies when factor concentrate is not available.
Storage temperature
frozen -18 C, preferably -30 C or lower thawed - 1-6 C
Thawed in 30-37C water bath or FDA approved microwave Must have mechanism to detect units which have thawed and refrozen due to improper storage. Must be ABO compatible
Used to treat patients with stable clotting factor deficiencies for which no concentrate is available or for patients undergoing therapeutic plasmapheresis. Prepared by separating the plasma from the RBCs on or before the 5th day after expiration of the whole blood. Once separated can:
Freeze, store at -18 C for 5 years If not frozen, called liquid plasma, store at 1-6 C for up to 5 days after expiration of WB.
Once FFP is one year old can redesignate as Plasma, expiration is 5 years.
Decreases disease transmission for diseases tested for. Doesnt inactivate viruses with non-lipid envelopes: parvo virus B19, hepatitis A, and unrecognized pathogens
Cold insoluble portion of plasma that precipitates when FFP is thawed at 1-6C. Cryoprecipitate contains high levels of Factor VIII and Fibrinogen, used for treatment of hemophiliacs and Von Willebrands when concentrates are not available. Used most commonly for patients with DIC or low fibrinogen levels.
Can be prepared from WB which is then designated as "Whole Blood Cryoprecipitate Removed" or from FFP Plasma is frozen. Plasma is then thawed at 1-6 C, a precipitate forms. Plasma is centrifuged, cryoprecipitate will go to bottom. Remove plasma, freeze within 1 hour of preparation
Plasma cryoprecipitate, reduced (TTP, FII, V, Vii, IX, X, XI) Frozen within 8 hours Thawed FFP
Refrozen with 24 hrs of separation Store at 18C 1 yr 5 day expiration at 1-6C
Storage Temperature
Frozen -18 C or lower Thawed - room temperature
Expiration:
Frozen 1 year Thawed 6 hours Pooled 4 hours
Cellular blood components are irradiated to destroy viable T- lymphocytes which may cause
GVHD is a disease that results when immunocompetent, viable lymphocytes in donor blood engraft in an immunocompromised host, recognize the patient tissues as foreign and produce antibodies against patient tissues, primarily skin, liver and GI tract. The resulting disease has serious consequences including death. GVHD may be chronic or acute
Irradiation inactivates lymphocytes, leaving platelets, RBCs and granulocytes relatively undamaged. Must be labeled "irradiated".
It is required that donor units be inspected periodically during storage and prior to issuing to patient. The following may indicate an unacceptable unit:
Red cell mass looks purple or clots are visible. Zone of hemolysis observed just above RBC mass, look for hemolysis in sprigs, especially those closest to the unit. Plasma or supernatant plasma appears murky, purple, brown or red. A greenish hue need not cause a unit to be rejected. Inspect platelets for aggregates.
Inspect FFP and CRYO for signs of thawing, evidence of cracks in bag, or unusual turbidity in CRYO or FFP (i.e., extreme lipemia).
If bacterial contamination is suspected the unit should be cultured and a gram stain performed. Positive blood cultures usually indicative of:
If one component is contaminated, other components prepared from the same donor unit may be contaminated.
Inadequate donor arm preparation Improper pooling technique Health of donor - bacteremia in donor
WB and RBC
Sturdy well insulated cardboard and/or styrofoam container, wet ice in ziplock bag to cool, temperature must be monitored. Mobile collection units should transport blood ASAP and leave at RT if platelets are to be made. In-house transport place in cooler with wet ice and thermometer, monitor temperature every 30 minutes.
Frozen components
Temperature must be maintained at or below required storage temperature. Use dry ice in well insulated container.
Records
Must be made concurrently with each step of component preparation, being as detailed as possible for clear understanding. Must be legible and indelible. Must include dates of various steps and person responsible.
EXAM 1 ONLINE