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Rejuvenation to Quality Assurance

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Last updated: November 11, 2025
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Rejuvenation/ Freezing/ Deglycerolization
Rejuvenation solutions are used to restore or regenerate ___ and ___
ATP and 2,3-DPG
Rejuvenation is used primarily to salvage __________________ (1) that are outdated or used with specific anticoagulant preservative solution up to ____ past outdate.
O and rare RBC units
Rejuvenation is used primarily to salvage __________________ that are outdated or used with specific anticoagulant preservative solution up to ____ (2) past outdate.
3 days
Stored RBCs regain the ability to synthesize 2,3-DPG after transfusion, but levels necessary for optimal hemoglobinoxygen delivery are not reached immediately. Approximately ___________ are required to restore normal levels of 2,3-DPG after transfusion.
24 hours
volume of rejuvenating solution, temperature, time
50 ml; 37C, 1 hour
only FDA approved rejuvenation solution
Rejuvesol
Rejuvenated RBCs may be prepared up to ______ when stored in CPD, CPDA-1, and AS-1 storage solutions.
3 days after expiration
Mnemonics of the component of rejuvenation solution
PIGPA
Rejuvenated RBCs must be washed before infusion to remove the _____ (which may be toxic) and transfused within 24 hours or frozen for long-term storage.
Inosine
RBC freezing is primarily used for
autologous units and rare blood types
Frozen RBC shelf life
10 years
It involves the addition of a cryoprotective agent to RBCs that are
less than 6 days old
RBC freezing commonly uses ______ as a freezing agent
glycerol
Small molecules enter the cells and prevents cell dehydration as the ice forms
Penetrating agent
Large molecules; does not enter the cells; forms a shell around the cells, thereby preventing loss of water
Non-penetrating agent
Rapid, more controlled freezing; 20% w/v final concentration
Low glycerol method
Slow, uncontrolled freezing; 40% w/v final concentration
High glycerol method
more commonly used RBC freezing method
High glycerol method
Removal of glycerol from a unit of red blood cells after thawing has been performed; it is required to return the cells to a ________
normal osmolality
A blood unit is exposed to decreasing osmolarity, from _________________________________
hypertonic to isotonic
For deglycerolization, how long does the thawing process take? And in what range of temperature in the water bath should you immerse that unit?
45 minutes; 30-37C
In deglycerolization with high glycerol, at what concentration should you wash the RBCs? Enumerate the steps.
12 NaCl; 1.6% NaCl; 0.9% NaCl with 0.2% dextrose
In deglycerolization, what should be omitted in the case of patient diagnosed with sickle cell trait as their RBCs would hemolyze upon solution in hypertonic solution?
1.6% NaCl
In deglycerolization with low glycerol, at what concentration should you wash the RBCs? Enumerate the steps.
45% NaCl with 15% mannitol; 0.9% NaCl
Shelf-life of deglycerolized unit
24 hours
Temperature in which deglycerolized units should be stored at
1-6C
Deglycerolized blood product should ensure ___ RBC mass recovery
80%
Glycerol must be removed to a level of ______ residual.
<1%
 
 
Blood substitute and components
synthetic hydrocarbon structures in which all hydrogen atoms have been replaced with fluorine
perfluorocarbons
Spin conditions: Red blood cells + plasma
5,000 g x 5 minutes
Spin conditions: Red blood cells + platelet-rich plasma
2,000 g x 3 minutes
Spin conditions: Harvesting platelets or cryoprecipitate from plasma
5,000 g x 7 minutes
Component collected: 5000g for 5 minutes
packed red blood cells and platelet concentrate
Component collected: 5000g for 7 minutes
packed red blood cells and cell-free plasma
Component collected: 2000g for 3 minutes
platelet-rich plasma
2,000 g x 3 minutes. what is this called?
light/soft spin
5,000 g x 5 minutes and 7 minutes. what is this called?
heavy/hard spin
Whole blood is collected in a ratio of ___ of anticoagulant preservative for every 100 mL of whole blood targeted for collection
14 mL
450 mL (±10%) of whole blood. how many mL of anticoagulant?
63 mL
500 mL (±10%) of whole blood. how many mL of anticoagulant?
70 mL
If additive solutions (AS) are employed, as much of the plasma is removed as possible, and the AS must be added to the RBC component within 3 days of collection, resulting in a finished product with a hematocrit of ___
55-65%
If an additive solution is not used, the volume of plasma removed is targeted such that the finished RBC product has a hematocrit of ___
65-80%
RBC components typically have a final red cell volume of _____ mL (1) or _____ of hemoglobin suspended in the residual plasma and/or additive solution
160-275 mL
RBC components typically have a final red cell volume of _____ mL or _____ g (2) of hemoglobin suspended in the residual plasma and/or additive solution
50-80 g
red blood cells collected by apheresis must contain a mean of at least __ (1) of hemoglobin or ____ of RBC volume
60 g
red blood cells collected by apheresis must contain a mean of at least __ of hemoglobin or ____ (2) of RBC volume
180 mL
Whole blood used to prepare platelet concentrates must be drawn by a single nontraumatic venipuncture, and the concentrate must be prepared within ____ of collection.
8 hours
platelets derived from whole blood are typically called ________
random-donor platelet
platelet product obtained from an apheresis donation is referred to as _______ because each component contains one adult dose from a single donor.
single-donor platelet
Whole blood to be used for RDP preparation must be process within ____ after collection (general)
6-8 hours
Whole blood, with CPDA1 as the anticoagulant, to be used for RDP preparation must be process within ____ after collection
8 hours
Whole blood, with CPD as the anticoagulant, to be used for RDP preparation must be process within ____ after collection
8 hours
Whole blood, with ACD as the anticoagulant, to be used for RDP preparation must be process within ____ after collection
6 hours
Whole blood, with CP2D as the anticoagulant, to be used for RDP preparation must be process within ____ after collection
8 hours
Whole blood to be used for RDP preparation must be maintained at ___
20-24 C
Platelets are stored at ____ with constant agitation
20-24 C
Prevent platelet aggregation and promote gas exchange
agitation
Transfusion of platelet concentrates is indicated for neonates whose counts fall below _______ and who are experiencing bleeding
50,000 /mL
Two platelet additive solutions, _____ and _______, have been approved for use in the United States.
Intersol; Isoplate
Minimum no. of platelets in RDPs
5.5 x 10^10
Minimum no. of platelets in RDPs
3 x 10^11
Plasma volume in RDP
40-70 mL
Plasma volume in SDP
300 mL
Increase of platelet count in RDP
5,000-10,000 /uL
Increase of platelet count in SDP
30,000-60,000 /uL
Platelet percent component retention should be at least ______
85%
Platelet product pH should be ___________
greater than or equal to 6.2
Shelf life: platelet at room temp with agitation
5 days
Shelf life: platelet stored at 1-6C
2 days
Shelf life: frozen platelet
2 years
Shelf life: pooled; in an open system; washed platelets
4 hours
Platelets are collected by apheresis, the cryopreservative _____ (1) is added, and the platelets are frozen at ____ (2). The frozen platelets can be stored for up to _________ (3). Prior to transfusion, the platelets are thawed and centrifuged to remove the DMSO.
DMSO; -80C; 2 years
Cryoprecipitate and cryo-poor plasma units are prepared from ____
Fresh frozen plasma
For cryoprecipitate and cryo-poor plasma, how long does the thawing process of FFP take when using a refrigerator? And in what range of temperature in the water bath should you immerse that unit?
14-16 hours; 1-6 C
For cryoprecipitate and cryo-poor plasma, how long does the thawing process of FFP take when using a circulating cryoprecipitate thaw bath? And in what range of temperature in the water bath should you immerse that unit?
2-4 hours; 4 C
Endpoint of thawing FFP to produce CPP is when plasma becomes
slushy
An adult dose of cryoprecipitate is considered ___
10 units of FFP
Both cryoprecipitate and CPP are stored at ___ or below for up to ___ from the whole blood collection date.
-18 C; 1 year
Cryoprecipitate should be thawed before issuing. Cryoprecipitate should be thawed quickly at _____ and stored at room temperature (22° to 24°C) until transfused.
30-37 C
Prestorage pooled cryoprecipitate and single units of cryoprecipitate must be transfused within ______ after thawing
6 hours
Cryoprecipitate pooled in the transfusion service laboratory using an open system must be transfused within ____
4 hours
Cryoprecipitate is indicated in the treatment of ______ deficiency, as a source of fibrinogen for hypofibrinogenemia, and as a secondary line of treatment for classic hemophilia (hemophilia A) and von Willebrand’s disease
Factor XIII
Fibrin glue is composed of
cryoprecipitate and topical thrombin
Cryoprecipitate contains at least ______ of AHF activity and at least ___ of fibrinogen.
80 units and 150 mg
Component of cryoprecipitate
AHF; fibrinogen; VwF; Factor XIII; Fibronectin
CPP is also thawed at 30° to 37°C, but it is stored at refrigerated temperatures and transfused within ____ unless relabeled as thawed plasma, cryoprecipitate reduced.
24 hours
CPP contains
albumin, 25791011, ADAMTS13
CPP is deficient in
1813, vWF, cryoglobulin, fibronectin
If the plasma unit has been prepared within 6 hours after collection (if ACD is used) or within 8 hours after collection (if CP2D, CPD, or CPDA1 is used). What is this component? abbreviation only
FFP
If the plasma unit has been prepared within 8-24 hours after collection. What is this component? abbreviation only
PF24
Frozen plasma is stored at ___ or colder for 1 year or at _____ or below for 7 years
-18 C; -65 C
Plasma from whole blood donations may also remain in a liquid state, stored at 1° to 6°C, and be labeled as ________. It expires ______ after the whole blood shelf life from which it was collected.
liquid plasma; 5 days
FFP is initially stored _________, but once frozen, should be shifted to _______ position
horizontally; vertically
FFP must be thawed before transfusion. Unit must be placed inside a plastic bag to prevent contamination. Both PF24 and FFP are thawed at temperatures between ______ or in an FDA-approved microwave device.
30-37 C
Once thawing is complete, the product may be stored at _____ for up to _____
1-6 C; 24 hours
If not transfused within the initial 24-hour period the thawed plasma may be stored for up to_____, but the product label must be changed to “______________” because it can not maintain therapeutic levels of the labile clotting Factor V and Factor VIII.
5 days; thawed plasma
The volume of a unit of FFP or PF24 from apheresis may be as much as ______.
800 mL
A single unit of FFP or PF24, from whole blood collection, should contain ____ (200-375ml 7th edition of Harmening) of plasma, approximately ____ (300mg 7th ed of Harmening) of fibrinogen per 100 mL, and 1 unit of activity per mL of each of the stable clotting factors. FFP also contains the same level (1 unit/mL) of factors V and VIII.
150-250 mL; 400 mg
Whole blood can be modified by having ___ of plasma removed in the preparation of platelets, or ____ of plasma removed in the prepration of cryoprecipitate.
50 mL; 10-15 mL
Irradiation of cellular blood components (red blood cells, platelets, and granulocytes) is indicated to prevent the development of ___________ (abbreviation)
TA-GVHD
Irradiation is performed to inactivate the ____________, which can cause graft-vs-host disease.
lymphocytes (T)
Both the FDA and AABB recommend a minimum dose of ____ of _____ to the central portion of the blood unit, with no less than _____ delivered to any part of the blood unit
gamma irradiation; 25 gy; 15 gy
Irradiation may be achieved by using either a radioactive source (________________) or x-ray
Cesium 137 or cobalt
To confirm a product was irradiated, a________________ is affixed to the component before it is placed into the metal canister of the irradiator. Darkening of the film confirms irradiation requirements.
radiochromic film label
The expiration date of irradiated RBCs is __________ from the time of irradiation or the original outdate, whichever is sooner.
25 days
What is not impacted by irradiation?
platelets and granulocytes
Process of removal of white blood cells (WBCs) from blood or blood components prior to transfusion
Leukoreduction
leukoreduced blood components were to contain ______ residual white blood cells per each whole blood, red blood cells, or apheresis platelet
<5 x 10^6
each platelets derived from whole blood should contain _____ residual WBCs
<8 x10^5
at least ___ of the original component must be recovered after leukoreduction.
85%
Leukoreduction performed shortly after collection, usually within
3 days
Causes of febrile transfusion reactions
White blood cells and biological response modifiers
Impetus for prestorage leukoreduction
biological response modifier
Can prevent febrile trasfusion reactions caused by WBCs but not the BRMs
post-storage leukoreduction
specialized hemocytometer which is designed to count WBCs at exceptionally low levels
Nagoette chamber
Washed RBCs are stored at ________ for up to ____ hours.
1-6 C; 24 hours
Washed platelets are stored at _______ and must be transfused within ____ hours.
20-24 C; 4 hours
Extracellular potassium levels increase over time in stored RBC units, which have been documented to contain as high as 60 mEq/L potassium after ______
32 days
Irradiated RBCs have been documented to have extracellular potassium levels as high as _____ as soon as 2 days after irradiation.
31 mEq/L
are often transfused during the neonatal period or in infants younger than 4 months of age due to their small blood volume.
aliquot
Transfusions for neonates are typically dosed at 10 to 15 mL/kg, therefore requiring only small volumes of blood products (_________) per dose.
10-25 mL
Red blood cell aliquots maintain the outdate of the original RBC component.
closed system
RBC aliquot must be transfused within 24 hours.
open system
Aliquot cannot be returned if ____ have passed
30 minutes
Tests Performed on Donor’s Blood
Most commonly employed method for detection of hepatitis infection
ELISA
What are to be detected when testing for hepatitis infection?
HBsAg and anti-HBc
Hepatitis C was initially referred to as
Non-A, Non-B hepatitis
Screening tests for HCV include (2)
EIA and ChLIA
Surrogate tests used to screen for HCV are (2)
ALT and anti-HCV
Confirmatory tests for HCV are (2)
RIBA and HCV RNA
What presence should be detected when screening for HIV?
HIV-1/2
If HIV screening test is positive, how many times should you repeat the test?
duplicate
Screening test for HIV include (3)
EIA, ChLIA, NAT
Confirmatory test for HIV include (2)
Western blot and IFA
How many bands in Western blot confirm the presence of HIV
2 out of 3
Bands in the western blot include
p24, gp41, gp120/160
Spirochetes cannot thrive in blood stored for ____ days at ____
3-4 days; 1-6 C
Component capable of transmitting spirochete infections
platelet
Screening tests for syphilis (2)
RPR and VDRL
Both screening tests are based on antibody directed toward ____ particles
cardiolipin
Confirmatory test for syphilis
FTA-ABS
_____ detects parasitic lactate dehydrogenase (p-LDH) produced by variable malaria parasite
OptiMal assay
____ detects for HRP-2 (Histidine-rich protein-2) produced by Plasmodium falciparum
MalaQuick Standby Malaria Test
Transfusion Therapy
To restore blood volume and oxygen-carryimng capacity; Symptomatic anemia with large-volume deficit
Whole blood
Restore/Increases oxygen carrying capacity, Symptomatic anemia; red blood cell exchange transfusion
Packed RBC
To removes plasma proteins; IgA deficiency with anaphylactoid/ anaphylactic reaction; Severe allergic reactions, rare donors, symptomatic anemia; red blood cell exchange transfusion
Washed RBC
Storage of rare blood and autologous units
Frozen RBC
Symptomatic anemia; Febrile reactions due to leukocyte antibodies; Reduction of CMV transmission and HLA Alloimmunization; TRALI
Leukoreduced RBC
Sickle cell anemia, thalassemia
Neocyte-enriched RBC
Inactivate T lymphocyte; patients who are receiving a bone marrow or stem cell transplant and fetuses undergoing an intrauterine transfusion. Also indicated for recipients of components collected from a blood relative or HLA-matched donors (prevention of GVHD)
Irradiated blood component
Bleeding due to quantitative or qaulitative platelet defect
RDP
Bleeding due to quantitative or qaulitative platelet defect; generally indicated for patients who are unresponsive to random platelets due to HLA alloimmunization or to limit the platelet exposure from multiple donors; Prevention of bleeding from marrow hypoplasia
SDP
Neutropenia with infection unresponsive to appropriate antibiotics
Granulocytes
Correct multiple coagulation factor deficiency occurring in patients with liver failure, DIC, vitamin K deficiency, warfarin overdose, or massive transfusion TTP Replace isolated factor deficiencies when specific component is not available Reverse effects of warfarin anticoagulant drug
FFP
Hypofibrinogenemia; Factor XIII deficiency (Second line therapy for von Willebrand’s disease,hemophilia A, and uremic bleeding); DIC
Cryoprecipitate
Prevent or control bleeding in hemophilia A patients.
Factor VIII concentrate
Prevent or control bleeding in patients with hemophilia B or with specific factor deficiencies
Factor IX concentrate
used for patients with congenital hypogammaglobulinemia and for patients exposed to diseases such as hepatitis A or measles.
immune globulin
To increase blood volume while maintaining colliodal oncotic pressure
Albumin
 
 
Pre-transfusion Testing
Pretransfusion testing begins and ends with the proper _______ of the patient sample
Identification and collection
A major cause of transfusion-associated fatalities is _____ resulting in incorrect ABO groupings and transfusion of ABO incompatible blood. Clerical error is the greatest threat to safe transfusion therapy. The most common cause of error is misidentification of the recipient
clerical error
When should be the final clerical check?
Patient bedside
Pretransfusion specimens, labels, and testing requests must contain at least _____ unique identifiers.
2
Either __________________ are acceptable for pretransfusion testing. Anticoagulated specimens are often preferred due to ease of handling. Red blood cells from an anticoagulated sample are ideal for preparing a uniform cell suspension for testing. Clotted red blood cells may require additional washing steps to minimize interference in test interpretations. In addition, serum may contain small fibrin clots that can be difficult to distinguish from true agglutination.
anticoagulated or clotted specimens
About ___ of blood is usually sufficient for all testing procedures if there are no known serologic problems.
10 mL
A ___ saline suspension of RBCs is used for most serologic testing procedures
2-5%
Pretransfusion specimens and donor unit segments are typically stored at _____ and must be retained in the event that additional testing is warranted.
2-8 C
According to AABB Standards, a pretransfusion specimen for testing and red cell transfusion is valid for ____Hours. After ____ hours, a new sample must be drawn.
72 hours
The patient sample and a segment from the donor unit must be retained post-transfusion for at least ____.
7 days
determining the recipient’s ABO group and Rh type, screening for any unexpected antibodies, and crossmatching the donor unit with the recipient’s plasma.
crossmatching tests
extreme emergencies, when there is no time to obtain and test a pretransfusion sample, group __ can be used
O Rh-negative
Is the transfusing facility required to confirm the ABO grouping on all units and the Rh typing on all Rh-negative units upon receipt from the supplier?
Yes
ABO grouping, Rh typing, and screening for unexpected antibodies must be performed within____ prior to the scheduled transfusion.
3 days
An Rh control is indicated when spontaneous agglutination of red blood cells is suspected, such as in patients typing as _______.
AB Rh-positive
Can we give a different blood group of platelet to patient?
No
In what conditions can be a Rh-negative patient receive Rh-positive blood?
male and post-menopausal women with no preformed anti-D
Is compatibility testing required for the transfusion of platelets, thawed plasma, and cryoprecipitate?
No
final step of pretransfusion compatibility testing
crossmatching
The type and screen, coupled with an immediate spin crossmatch, is referred to as ________
abbreviated crossmatch
Patient RBC + Patient serum; What is this called?
Autocontrol
What does the enzyme potentiator cleave?
sialic acid
Provides an excess of cations that neutralize the repulsive force between red cells, producing nonspecific aggregation and antibody- mediated lattice work formation. What potentiator is this?
polybrene or protamine
This crossmatching eliminates the need for a serologic crossmatch, which reduces sample volume requirements and testing time. What is this?
Computer crossmatch
For emergent transfusions, if patient blood type is unknown, what can be required to transfuse?
O
For emergent transfusion, Rh-negative red blood cell units are preferred but may be limited to________ in order to conserve inventory.
women of childbearing age
For emergent transfusions, issuing ________ to traumatically injured patients where ABO grouping is unknown is becoming widespread practice
group A thawed plasma
To be considered as massive transfusion, how many blood units is transfused in less than 24 hours?
8-10
To be considered as massive transfusion, how many blood units is transfused in within 1 hour?
4-5
The American College of Surgeons recommends transfusion of red blood cells, thawed plasma, and platelets in a ratio of ____ for effective blood component resuscitation.
1:1:1
For neonatal transfusions, what blood type is selected?
O Rh-negative
For neonatal transfusions, can you perform antibody screening and any required for compatibility to the specimen of mother?
Yes
Intrauterine transfusions (IUT) are indicated in severe cases of _____
fetal anemia
For IUT, what blood type is selected?
O Rh-negative
General Blood Transfusion Practices
What vital signs are monitored periodically during the transfusion to detect signs of transfusion reaction? alphabetically
blood pressure, pulse, respiration, temperature
Blood components are infused slowly for the first 10 to 15 minutes (approximately ________) while the patient is observed closely for signs of a transfusion reaction.
2 mL for the 1st 15 minutes
It is desirable to complete a red cell transfusion within ____
2 hours
Platelet or plasma transfusion within _____
30-60 minutes
Any transfusion must be completed within ____ of initiation.
4 hours
About 200ml blood /hr Infusion must be completed within 4 hours
speed of infusion
Blood warmer should have automatic temperature control with an alarm that will sound if the blood is warmed over ____
42C
Blood warmer such as water bath is set at _____
37C
Should be used as intravenous solutions to dilute blood components
Isotonic saline or 5% albumin
Solution that causes shocking of RBCs
Ringers solution
 
 
Reissue of Unit
Blood can be reissued after returning from the ward if the following conditions are met: - The closure must not have been entered in anyway - The blood must have been kept between 1-10oC on a continuous basis - The pilot tube or sealed segment of the donor tube must still be attached to the container - The blood should not be away from the blood bank for more than ____ - Records must be available that verify all inspections criteria.
30 minutes
 
 
Transfusion Reactions
A transfusion reaction with signs or symptoms presenting during or within 24 hours of transfusion is defined as a ___________________
Acute transfusion reaction
A transfusion reaction with signs or symptoms presenting after 24 hours of transfusion is defined as _____________
Delayed transfusion reaction
Cause: Incompatible blood transfused (commonly ABO) (abbreviation)
AHTR
What is the cause of FNHTR?
anti-leukocyte antibody
In FNHTR, what do the WBCs release when the antibodies attack them?
endogenous pyrogens
Endogenous pyrogen is also known as
cytokines
What cytokines are common?
16TNFa8
Among AHTR and FNHTR, which one results to hypotension?
AHTR
In AHTR, what symptom was highlighted in the trans?
flank pain
How much is the rise of temperature in FNHTR?
1C
Cause of ALTR
response of recipient antibody to allergen in donor’s blood component
Characteristic symptom of ALTR
Hives and wheals
Anaphylactic Transfusion Reaction is attributed to the condition of the patient
IgA deficiency
For ANTR to occur, what is the requirement?
Sensitization from transfusion or pregnancy
Level of IgA to be considered absolute IgA deficiency?
<0.05 mg/dL
ALA, Anti-HLA class 1, ANA
TRALI
What has ALA, Anti-HLA class 1, and ANA?
plasma of donor
Cause of TACO
iatrogenic
level of BP in TACO
elevated
A post-transfusion to pretransfusion BNP ratio of ____, with a post-transfusion level equal or greater than 100 picograms per milliliter as a cutoff point, provides a sensitivity of 81% and a specificity of 89% for diagnosis of TACO.
1.5
Cause of bacterial contamination transfusion-associated sepsis
psychrophilic bacteria
Level of rise in the temperature in sepsis
2C
leading cause of transfusion-associated fatalities
TRALI
According to CDC, it is the Most common cause of death by bacterial contaminated blood components
Yersinia enterocolitica
second most common cause of transfusion related deaths reported to the FDA
TACO
Second most common isolate found of RBC units
Pseudomonas spp.
Common isolate of human skin, was the most common bacterial contaminants in RBC
Propionibacterium spp.
Most frequently recovered from donated blood and contamination of platelet
Bacillus cereus, Staphylococcus epidermidis
Causes of TRAEDMTAPANHDT
period
EKG abnormality in citrate toxicity
prolonged QT interval
EKG abnormality in potassium toxicity
prolongedPR interval
Cause: Incompatible blood transfusion especially KIDD BGS (most common)
DHTR
Cause: delayed immune transfusion reaction due to an immunologic attack by viable donor lymphocytes (T cells) contained in the transfused blood component against the transfusion recipient.
TA-GVHD
Cause: Anti-platelet antibodies / anti-HPA1 (human platelet antigen1) antibodies
PTP
When does a patient with PTP normally go back to normal?
within 2 weeks
PTP occurs ___ after transfusion
5-10 days
Cause: Iron overload is a delayed, nonimmune complication of transfusion, presenting with multiorgan (i.e., liver, heart, endocrine organs) damage secondary to excessive iron accumulation
Hemosiderosis
unit of red blood cells contains approximately ___ mg of iron.
250 mg
After ____ red cell transfusions, excess iron is present in the liver, heart, and endocrine organs
10-15
 
 
Transfusion Transmitted Diseases
first retrovirus to be associated with a human disease.
HTLV-1
fifth disease
Human Parvovirus B19
fifth disease mild rash on the face is described as
slapped cheek
most frequently transmitted virus from mother to fetus.
CMV
HTLV is associated to
ATLL
cell in which EBV replicates
B
Alphabetically, who has resistance to malaria?
Duffy negative blood, G6PD deficiency, sickle cell anemnia
HDFN
is considered as the most severe cause of HDFN.
Rh
Currently the most common cause of HDFN
ABO
Of the non–Rh system antibodies, _____ is considered the most clinically significant in its ability to cause HDFN.
Kell
Which order of child affected by HDFN due to Rh?
2nd
As little as ________ of fetal RBCs can immunize the mother
1 mL
Which order of child affected by HDFN due to ABO?
1st
_____________ and _____________________ in the infant are characteristic of ABO HDFN, but not of Rh HDFN
Microspherocytes and increased RBC fragility
Destruction of fetal RBCs leading to ______ is extremely rare
severe anemia
RhIg shelf-life
2 years
RhIG is a concentrate of ________ prepared from pools of human plasma.
IgG anti-D
Mechanism of RhIg
Period
The first dose is provided at ____________ (antepartum) since the majority of allosensitization appears to occur after this time.
28 weeks gestation
A second dose is given after delivery of Rh-D positive infant (it is recommended to give RhIG within______ after delivery)
3 days
Can you still give RhIg even if 72 hours has already elapsed?
Yes
A full dose of __________ RhIG provides protection for up to ____ of D-positive red cells (approximately ____ of fetal whole blood).
300 ug; 15 mL; 30 mL
Minidose of _________ RhIg is sufficient for abortion, amniocentesis and ectopic rupture up to 12 weeks gestation.
30 ug
Qualitative screening test for FMH that detects fetal D+ red cells in maternal Rh negative blood
Rosette test
Rosette test may be _____________ if the mother is weak-D positive and may be ____________ if the baby is weak-D positive
false positive; false negative
The rosette screen will be positive if there is a FMH of _________
10 mL or more
The number of fetal cells (which take up the stain) are counted per total number of RBCs examined (which is usually ____), then multiplied by 100 (so that we can express it in percent).
2,000
A __________________________- should be performed to quantitate the FMH
Kleihauer-Betke or flow cytometry
Based on the principle that _______ (found in baby’s RBCs) are resistant to acid elution (that means, they’re not removed by acid), whereas adult hemoglobin (found in mother’s RBCs) are eluted (or removed) by acid
Hemoglobin F
Fetal cells remain intact because of high concentrations of Hgb F and would appear __________ after staining
deep pink
Hemoglobin A is eluted from the maternal cells; and thus the maternal cells would appear as _____________.
pale ghost cell
% fetal cells formula
no. of RBCs with fetal F/total RBCs examined x 100
FMH formula
% fetal cells/100 x MBV
In getting the maternal blood volume, if mother’s weight is given multiply by ______ (constant; average blood volume per kg of body weight)
70 mL/kg
In getting the maternal blood volume, if mother maternal blood volume and/or mothers weight is not given, use the average maternal volume of ______
5,000
FMH formula shortcut
% fetal cells x 50
No. of Rhogam vials formula; constant and whole blood bleeding
FMH/30
In determining the no. of Rhogam vials, what number should you use as the denominator if fetomaternal bleed is purely RBCs?
15
Round the calculated dose up if _____ 0.5 following decimal point or down if _____ 0.5
greater than or equal to; <
Add ______ of RhIG to calculated dose to provide a safety margin
1 vial
The goal of intrauterine transfusion is to maintain fetal hemoglobin above ______
10 g/dL
_____ is performed as an initial treatment for hyperbilirubinemia in infants.
Phototherapy
Exposure of newborns to fluorescent blue light in the __________ range can successfully treat physiologic jaundice and mild cases of HDFN, particularly ABO HDFN.
420-475 nm
Exposure of newborns to fluorescent blue light in the __________ range can successfully treat physiologic jaundice and mild cases of HDFN, particularly ABO HDFN. (Harmening version)
460-490 nm
Cases of hyperbilirubinemia that fail to respond to phototherapy require ____
exchange transfusion
________ is the use of whole blood or equivalent to replace the neonate’s circulating blood and simultaneously remove maternal antibodies and bilirubin (unconjugated).
exchange transfusiom
Exchange transfusions are used primarily to remove high levels of _________________ and thus prevent kernicterus.
unconjugated bilirubin
After a two-volume exchange transfusion, approximately ___ of the red blood cells have been replaced and ___ of the bilirubin has been removed
90%; 50%
The relative concentration of all antibodies capable of crossing the placenta and causing HDFN is determined by antibody titration. For the recommended method, ___ is considered the critical titer.
16
The most important serologic test for diagnosing HDFN in the Newborn or infant’s sample is the _____ with anti-IgG reagent. A positive test result indicates that the antibody is coating the infant’s RBCs; however, the strength of the reaction does not correlate well with the severity of the HDFN
DAT
Using high-resolution ultrasound with color Doppler enhancement of blood flow, the umbilical vein is,visualized at the level of the cord insertion into the placenta. A spinal needle is inserted into the umbilical vein, and a sample of the fetal blood is obtained The fetal blood sample can then be tested for hemoglobin, hematocrit, bilirubin, blood type, direct,antiglobulin test (DAT), and antigen phenotype and genotype.
Cordocentesis or PUBS
The measurement of the fetal middle cerebral artery peak systolic velocity (MCA-PSV) with color _____ ultrasonography can reliably predict anemia in the fetus.
Doppler
Readings of MCA-PSV are typically done every____ to track the degree of fetal anemia; those that are greater than 1.5 multiples of the mean (MoM) are sensitive enough to predict significant fetal anemia in which intervention may be needed
2 weeks
The product most often transfused during the neonatal period or in infants younger than 4 months of age. It has a shelf life of 24hrs and should be stored at 1 to 6 C
Aliquoted red cell
The anticoagulant of aliquoted red cell most often used for neonatal transfusions is ___
CPDA-1
Aliquoted red cell is shelf life and temperature
24 hours; 1-6C
 
 
Quality Assurance in Blood Bank
Blood banks are inspected
yearly
All antisera should be stored at _____ when not in use
2-6C
Timing of the centrifuge and serofuges must be checked periodically with a ____.
stopwatch
Speed of centrifuge must be checked with a _______ at least every 6 months
tachometer
Heating blocks, Water Baths, Donor unit agitators, Scales, Balances, Hemoglobinometer, Microhematocrit centrifuges, Refrigerator and Freezers (continuous monitoring)
Daily when in use
Water baths and heat blocks are maintained at ___
37C
Alarm activation (freezers and refrigerators), centrifuge temperature (refrigerated)
Monthly
Blood warmers, Cell washers (speed, timer), Centrifuge speed timer
Quarterly
Mercury thermometers
Annually
Platelet incubators (enclosed, monitored chambers)
Every 4 hours
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