Blood bank--blood sources and pretx testing

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What is needed for donor hx for homologous (allogenic) blood donation?

1. Full name
2. Home/work address
3. Date of birth/age
4. Date of last donation
5. Reasons for previous deferral

How long do you defer someone with viral hepatitis after 11th bday?

Permanent

How long do you defer someone with high risk AIDS behavior?

Permanent

How long do you defer someone with + serology for HBc, HIV, HCV, or HTLV?

permanent

How long do you defer someone who receives money for sex?

permanent

How long do you defer someone with IVDU?

permanent

How long do you defer someone with babesiosis or chagas?

permanent

How long do you defer someone with leukemia/lymphoma?

permanent

How long do you defer someone who received clotting fx (hemophiliac)?

permanent

How long do you defer someone with dura mater graft?

permanent

How long do you defer someone who had bovine insulin?

permanent

How long do you defer someone with GH from human pre-1985?

permanent

How long do you defer someone male who had sex with men after 1977?

permanent

How long do you defer someone with tegison use?

permanent

How long do you defer someone with non-hematologic malig?

indefinitely until 5y dz free

How long do you defer someone with BCC or SCC?

no deferral

How long do you defer someone with hx of malaria?

3yr

How long do you defer someone who lived (5 consecutive yrs) in endemic malaria area?

3yr

How long do you defer someone with soriataine (acitretin)?

3yr

How long do you defer someone with needle stick or blood contact?

1yr

How long do you defer someone who was a rape victim?

1yr

How long do you defer someone who paid for sex?

1yr

How long do you defer someone who had sex with someone who was IVDU?

1yr

How long do you defer someone who had gonorrhea or syphillis?

1yr

How long do you defer someone who was incarcerated >72hr

1yr

How long do you defer someone with tattoos?

1yr

How long do you defer someone with travel to malaria endemic area?

1yr

How long do you defer someone with travel to Iraq?

1yr

How long do you defer someone with HbIg?

1yr

How long do you defer someone with non prophylactic rabies vaccination?

1yr

How long do you defer someone who had sex with someone who had HIV or hepatitis?

1yr

How long do you defer someone who lives with a person with active hepatitis?

1yr

How long do you defer someone who received allogenic tissue (organ/skin/bone)?

1yr

How long do you defer someone with allogenic blood tx/non-hemophiliac clotting fx?

1yr

How long do you defer a pregnant woman?

through 6 weeks post partum (except if baby needs blood)

How long do you defer someone with non-routine dental work?

72hrs

How long do you defer someone who lives in certain countries in Africa where there is HIV O?

permanent

How long do you defer someone with CJD risk (Europe>3mo from 1980-now, family hx CJD or vCJD)

permanent

How long do you defer someone with measles vaccine?

2 weeks

How long do you defer someone with mumps vaccine?

2 weeks

How long do you defer someone with oral polio vaccine?

2 weeks

How long do you defer someone with oral typhoid vaccine?

2 weeks

How long do you defer someone with yellow fever vaccine?

2 weeks

How long do you defer someone with rubella vaccine?

4 weeks (MMR is 4 week deferral)

How long do you defer someone with varicella vaccine?

4 weeks

How long do you defer someone with killed, toxoid or recombinant vaccines?

no deferral
(only defer with live attenuate vaccines)

How long do you defer someone with smallpox vaccination without complications?

after scab falls off or 21 days, whichever longer

How long do you defer someone with smallpox vaccination with complications?

14 days AFTER sxs resolve.

What are the 5 teratogens deferred for blood donation?

Etretinate (Tegison)
Acitretin (Soriatane)
Duasteride (Avodart)
Finasteride (Proscar, Propecia)
Isoretinoin (Accutane)

How long do you defer someone with tegison (etretinate)?

permanent

How long do you defer someone with soriatane (acitretin)?

3yr

How long do you defer someone with avodart (duasteride)?

6 months

How long do you defer someone with finasteride (proscar, propecia)?

30 days

How long do you defer someone with isoretinoin (accutane)?

30 days

How long do you defer someone with WNV?

28 days from sxs onset OR
14 days after sxs resolve (whichever later)

What are the donor screening physical criteria?

1. gen appearance
2. arm check--both arms for IVDU and venous access
3. physical requirements

What is the wt requirement for blood donation?

>= 110lb (50kg)

What is the temp req for blood donation?

<= 99.5F (37.5C)

What is the BP req for blood donation?

<= 180/100

What is the pulse req for blood donation?

50-100 bpm (unless atheletes, then less)

What is the hb/hct req for blood donation?

>= 12.5 g/dL or 38%

What is the amt of blood drawn during donation?

450 +/- 45 mL OR 500 +/- 50 mL

What is the max amt of blood that can be drawn during donation?

10.5 mL/kg

What is the term that describes the process of sep blood into different components all at one time?

Apheresis

What is the most common method of apheresis?

Centrifugation, sep based on density

What is the method of apheresis used for ITP and LDL removal in familial hyperchol?

Adsorption (blood passed through column of material that attracts desired substance)

What are the 3 methods of apheresis?

centrifugation
adsorption
membrane filtration

What are the 4 targets of apheresis?

plt
plasma
WBC
RBC

What is the most common reason for apheresis?

plt
from donation and ET

What is plasma pheresis used for?

donation
TTP
Waldenstroms/myeloma
Myasthenia gravis/ Guillian-Barre
Familial hypercholesterolemia
Goodpasture's synd

What is WBC pheresis used for?

donation
blast crisis

What is RBC pheresis used for?

donation
Sickle cell complications

What products can you collect during one pheresis?

2 RBCs
1 RBC, 1 plasma
1 RBC, 1 plt
1 RBC, 1 plt, 1 plasma

What is the hb/hct for plt donation?

>= 12.5g/dL and 38%

What are the donation intervals for plt donation?

48h between donations
no more than 2 donations/week
no more than 24 donations/yr
at least 8 wk between whole blood donation or if lost>100mL blood

What is the aspirin interval in plt donation?

no aspirin/aspirin-like meds in past 36 hrs

What is the plt count if less than 4 weeks between donations?

>= 150,000/microL

What is the max plasma loss allowed during plt donation?

no more than 600mL (700mL if >175 lb)

What is the requirement for plasma donation if you are occasional donor (donate less freq than q 4wk)?

same as whole blood (8 weeks)

What is the requirements for serial plasma donation?

Total prot and SPEP q 4 months
no more than 2 donations/week
no more than 24 donations/yr
<25 ml of red cell loss/week

What is the donation interval for double RBC donors?

16 weeks

What is the citrate effect during apheresis?

citrate anticoag binds free Ca:
-perioral tingling
- tetany and arrhythmias uncommon
- give oral Ca (TUMS)
-slow rate of infusion

What is the hypersensitivity rxn in apheresis of WBC?

Hetastarch, causes rouleaux for better sep, can get anaphylaxis

What is the donation interval for allogenic blood?

8 weeks

What is the donation interval for autologous blood?

72 hrs

What is the hb/hct req for allogeneic blood donation?

>= 12.5g/dL or 38%

What is the hb/hct req for autologous blood donation?

>= 11g/dL or 33%

What is the age req for allogeneic blood donor?

>17yr

What is the age req for autologous donor?

none

What is the weight req for allogeneic donors?

>= 110lb (50kg)

What is the wt req for autologus donors?

none

Is infectious dz scrn required in autologous or allogeneic blood donor?

allogenic
only need in autologous donor if blood being shipped out

Do you accept autologous or allogeneic blood from a donor with a hx of dz or + test for dz?

Never accept in allogeneic donation
May accept in autologous donation

Who do you notifiy if autologous blood tests + for dz?

Physician AND patient

What is the highest risk of contamination in autologous blood donation?

Bacteria

What is the primary goal of isovolemic (normovolemic) hemodilution?

reduce blood vol before surgery

How much blood can you remove in isovolemic hemodilution prior to surgery?

up to 1 L

For every 1 mL of blood removed during normovol (isovol) hemodilution what do you replace it with?

3 mL or saline (or crystalloid)

When putting blood back into body from normovol(isovol) dilution what is the order?

Last blood out is first blood in

What are the 4 criteria for isovol hemodilution?

>10% chance need transfusion
Hb at least 12.5 g/dL
no serious med conds
no infxn or bacteremia

what is the shelf life of isovol/normovol hemodilution?

8h in OR
24h in blood bank

What are the possible probs with intraop blood salvage (cell saver)?

1. air embolus
2. hemolysis due to excessive suction
3. coag fx activation

What is the shelf life for intra op blood salvage?

4h OR
24h in blood bank

What is post op blood salvage?

blood from JP drains, etc reinfused, nasty!

What is the shelf life of post op blood salvage?

6h RT (OR)

What is the #1 cause of fatal HTR?

clerical errors--ID is CRITICAL!!!

What types of tubes for serum and plasma do you get for testing blood?

red top (serum)
lavender top (plasma)-preferred for nontube tests

How often do you need a new pt speciment if the pt has been tx or preg in last 3 months?

every 3 days (day collected is day 0, then next day is 1, 2, midnight day 3 (really 4th day), expired)

How long do you hold pt blood sample in lab after tx?

7 days

What tests do you do for a type and hold?

ABO/Rh
hold sample not blood pdcts

What tests do you do for a type and screen?

Records check
ABO (forward and reverse)
Rh
Ab scrn

What do you do a records check for?

see if any hx of tx complications or prev Ab, compare, but don't use in place of, current sample

Do you do the weak D test in a pt if D-?

no EXCEPT in preg patients do the weak D test (IAT)

What is the purpose of the Ab screen on blood testing?

Find unexpected Ab

What ABO type of cells are used for Ab scrn?

Group O only

What are the cells used in Ab Scrn?

Cell I: R1R1
Cell II:R2R2
Cell III:rr

What type of testing is req for the Ab scrn?

Only IAT (not IS or 37C), if IAT is + go on to Ab ID

What tests are performed for Type and Cross?

Same as type and screen:
Records check
ABO
Rh
Ab scrn
AND CROSSMATCH

What is a major crossmatch?

1.Recipient SERUM + donor RBCs (need to make sure RBC viable)
2. final ABO check
3. don't need to do IAT if Ab scrn -
4. REQUIRED if >= 2mL RBC in pdct (PRBC, contam plt, GCF)

What is a minor crossmatch?

recipient RBC+donor SERUM
not required

What are the reasons for a +Ab in a + major crossmatch?

1. alloAb
2. autoAb
3. reagent Ab
4. rouleaux or other false +

What are the reasons for a + major crossmatch when the Ab is -?

1. ABO incompat
2. Ab or Ag low incidence
3. + DAT in donor

How do make a T&S into a T&C?

just ABO check (if Ab scrn-) then
immed spin (IS) crossmatch OR computer crossmatch

What is the MSBOS?

maximum surgical blood ordering schedule
gives surgeons and blood bankers idea of how many RBC units to Xmatch for given procedure

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