Immunology Exam 2 Chapter 15

1. Leukocyte-reduced filters can do all of the follow- D. Prevent TA-GVHD ing except: A. reduce the risk of CMV infection B. Prevent or reduce the risk of HLA alloimmunization C. Prevent febrile, nonhemolytic transfusion reactions D. Prevent TA-GVHD 2. Albumin should not be given for A. Burns B. Shock C. Nutrition D. Plasmapheresis C. Nutrition 3. Of the following, which blood type is selected when a pateint cannot wait for ABO-matched RBCs? A. A B. B C. O D. AB C. O 4. Which patient does not need an irradiated compo- C. Adult receiving an RBC transfunent? sion A. Bone marrow transplant recipient B. Neonate weighing less than 1,200 g C. Adult receiving an RBC transfusion D. Adult receiving an RBC transfusion from a blood relative 5. A. Within 4 hours 1 / 12 RBC transfusions should be given A. Within 4 hours B. with lactated Ringer's solution C. With dextrose and water D. With cryoprecipitate 6. Which type of transplantation requires all cellular A. Bone marrow blood components to be irradiated? A. Bone marrow B. Heart C. Liver D. Kidney 7. Characteristics of deglycerolized RBCs include the A. Inexpensive following except: A. Inexpensive B. 24-hour expiration date after thawing C. Used for rare antigen-type donor blood D. Used for IgA-deficient recipient with history of severe reaction 8. Select the appropriate product for a bone marrow B. Irradiated RBCs transplant patient with anemia? A. RBCs B. Irradiated RBCs C. Leukoreduced RBCs D. Washed RBCs 9. Which blood product should be selected for vita- D. Plasma min K deficiency? A. Cryoprecipitate B. Factor VIII 2 / 12 C. Factor IX D. Plasma 10. Which fluid should be used to dilute RBCs? A. 0.9% saline B. 5% dextrose and water C. Immune globulin D. Lactated Ringers solution A. 0.9% saline 11. What are the benefits of component separation? When whole blood is split into its different parts (RBCs, plasma, platelets, etc), it can be use to help at least 3 people instead of just one. Additionally, someone with a particular condition may not need those other components (or those others may even be detrimental given certain conditions) 12. What is a storage lesion? The biochemical and morphologic changes that occur when blood is stored at 1-6C, which affects red cell viability and function. 13. What results during prolonged blood storage? Storage lesion. Plasma, plasma K+, and hemoglobin INCREASE Number of viable cells, plasma pH, Na+, and RBC ATP + 2,3 DPG DECREASE 3 / 12 14. What is in the anticoagulant CPD? How long is its Citrate-phosphate-dextrose. storage limit? 21 day limit 15. What is in the anticoagulant CP2D? What is its storage limit? Citrate-phosphate-2-dextrose. 21 day limit 16. What is in the anticoagulant CPDA-1? What is its storage limit? Citrate-phosphate-dextrose-adenine 35 day limit 17. What is in the anticoagulant AS-1 (adsol) and AS-5 Dextrose. adenine, mannitol, and (nutricel)? What are their storage limit? saline 42 day limit 18. What is in the AS-3 (Optisol) anticoagulant? What Dextrose, adenine, saline, and is its storage limit? citrate. 42 day limit 19. What is in the AS-7 (SLOX) anticoagulant? What is Dextrose, adenine, mannitol, its storage limit? saline, citrate, and sodium bicarbdonate 42 day limit 20. What are the steps in blood component prepara- 1. Whole blood with satellite bags tion? attached is centrifuged at a light spin, pushing the platelet-rich plasma (PRP) into one satellite bag. The RBCs remain in the original bag, and the tube between the plasma and red cells is heat-sealed and cut. 2. The bag containing PRP is centrifuged at heavy spin, causing 4 / 12 platelets to sediment to the bottom of the bag and allow for the removal of 50-70ml of plasma (some plasma must remain to maintain pH 6.2 or higher). Bag with platelets can rest up to an hour before having to be sotred with gentle agitation at 20-24C for up to 5 days 3. Removed plasma can be placed into additional bag and can either be frozen to make fresh frozen plasma or frozen and thawed to make cryoprecipitated anthemophilic factor 21. What are the blood components? 1. Whole blood 2. RBCs 3. Leukocyte-reduced RBCs 4. Washed RBCs and frosen/deglycerolized RBCs 5. Platelets and plateletpheresis 6. Granulocyte pheresis 7. Plasma 8. Cryoprecipitate 9. Factor VII 10. Factor IX 11. Antithrombin 12. Albumin 13. Immune globulin 22. 5 / 12 When would you want to transfuse someone with When the person has lost both whole blood? RBC mass and plasma volume. So, in the case of rapidly bleeding patients *You would NOT give a person with severe chronic anemia because those patients compensate the loss of RBCs with increased plasma. Giving these patients whole blood with further increase the plasma, leading to kidney failure and edema. 23. When would you want to transfuse someone with When the patient requires inRBCs? creased oxygen-carrying capacity. These pateints typically have pulse rates greater than 100 beats per minute, respiration rates greater than 30 breaths per minute, and may experience dizziness, weakness, chest pain, and iffucisulty thinking. Leukemia or aplastic anemia patients (decreased bone marrow), hemolytic anemia patients (decreased RBC survival), or patients experiencing surgical or traumatic bleeding. 24. How does the human body compensate for ane- Increase plasma volume, heart mia (lack of RBCs)? What signs would you look for rate (>100b/m), respiratory rate in a patient who should be transfused with RBCs? (>30b/m), and oxygen extraction 6 / 12 from RBCs (dizziness, weakness, chest pain, and difficulty thinking) 25. T/F T Patients with iron deficiency anemia or pernicious *These patients should be well anemia should not be transfused with RBCs compensated for the anemia 26. What is the anticipiated increases associated with Hemoglobin 1g/dl transfusing a person with RBCs? Hct 3% 27. When should leukocyte-reduced RBCs be used? To prevent febrile nonhemolytic transfusion reactions, to prevent or delay the deveopment of HLA antibodies, and to reduce the risk of CMV transmission (since leukocytes can cause those problems) *Decrease febrile nonhemolytic transfusion reactions, decrease alloimmunizatin to white blood cell antigens, decrease transmission of cytomegalovirus) 28. By how much should the leukocyte content of leukocyte-reduced RBC be ? Leukocyte content in donor RBCs should be reduced to LESS than 5x10^6 by use of leukocyte reduction filters. 29. When should washed and frozen/deglycerolized When patients have anaphylactic RBCs be transfused? transfusion reactions to ordinary units of RBCs. *The washing process removes 7 / 12 plasma proteins, the cause of most allergic reactions. *Freezing RBCs allows the long-term storage of rare blood donor units, autologous units, and units for special purposes, such as intrauterine transfusion. 30. When should a patient be transfused with platelets? Thrombocytopenia with bleeding or invasic procedure Chemotherapy for malignancy (decreased production, less than 5,000 - 10,ooo/ul) Disseminated intravascular coagulation (increased destruction, less than 50,000/ul) Massive transfusion (platelet dilution, less than 50,000 to 100,000/uL) 31. If a person has platelet count under 5,000 - 10,000 Yes uL, should you give them a platelet transfusion? 32. What quality control requirement is required for Bacterial testing for each platelet transfusion of platelets? product. 33. Plateletpheresis components are prepared from 5.5x10^10 platelets one donor and must contain a minimum of *a pool of 5 units, will contain ________ platelets roughly 3x10^11 platelets 34. Anticipated increase in platelet count in a person 5,000 to 10,000/uL transfused with plateletpheresis would be what? 8 / 12 35. What signs would you look for to conclude that the Fever, neutrophil count less than patient requires a granulocyte transfusion? 500/uL, septicemia or bacterial infection unresponsive to antibiotics, reversible bone marrow hypoplasia, and a reasonable chance for survival 36. What quality control requirement is required when attempting granulocyte transfusion? Crossmatch, and the patient being monitorred for resolution of symptoms and clinical evidence of efficacy. 37. When should you transfuse someone with plas- Use in treatment of single or mulma? What are you looking for? What are you treat- tiple coagulation deficiencies, viing? tamin K deficiency or Warfarin overdose, liver disease or failure, to treat DIC. 38. Why is a plasma transfusion good for treating sin- Because both plasma and plasma gle or multiple coagulation deficiencies? 24 contain all coagulation factors. 39. T/F Congenital coagulation factor deficiencies are rarely treated with plasma T *Dose requirement for surgical procedures and serious bleeding can cause pulmonary edema as a result of volume overload. 40. What is a coagulation factor unit? The activity in 1 mL of pooled normal plasma. So 100% activity is 1 unit/mL or 100units/dL. About 30% activity of each of the coagulation factors is required for adequate hemostasis. Thus, less 9 / 12 than half of the plasma volume, or about 4-6 plasma units, is required to correct a coagulopathy such as in liver disease, or DIC. 41. Should plasma be ABO compatible? Should they be Rh compatible? They should be ABO, but do NOT have to be Rh compatible. 42. When should cryoprecipitate be transfused? When patient requires fibrinogen replacement. Liver faillure, DIC, or massive transfusion, and in rare patient swith congenital fibrinogen deficiency. 43. What are the AABB requirements for fibrinogen content? At least 150 mg of fibrinogen be in each unit, and 80 units of Factor VIII/unit 44. What are the quality control levels of fibrinogen Usually over 250mg required in cryoprecipitate to be used for transfu- *Though the AABB states that sion? there must be at least 150 mg 45. To what patients should factor VIII be given? To pateints with hemophilia A or with Factor VIII deficiency. *And to patients with von Willebrand's Disorder if the Factor VIII product is labeled as containing vWF 46. Who should be given Factor IX? Patients with hemophilia B, patients with Factor VII or X deficiency (rare), and selected patients 10 / 12 with Factor VIII inhibitors, or for reversal of Warfarin overdose. 47. What would you give a person with a tendency for Protein C thrombosis? *This inactivates factors V and VIII, thus preventing thrombus formation. Can be used for patients with DIC and sepsis 48. When would you want to give some one recombi- Wen the patient has a wide varinant human activated factor VII (rFVIIa)? ety of bleeding disorders 49. When would you give someone albumin? When they need fluid replacement. So in situations where the patient has plasmapheresis or burns. 50. If a person has hypogammaglobulinemia or has Immune globulin been exposed to Hepatiis A or measles, what *Also comes in Rh immune could you give them? globulin (RhIG) form to protect RH-neg female who is pregnant or who delivers an Rh-pos infant. 51. When would you give a person cryoprecipitate? If they have fibrinogen deficiency or factor XIII deficiency 52. Under which of the following would you transfuse E. All of the above someone with RBCs A. Decreased oxygen-carrying capacity B. Acute loss of more than 20% blood volume C. Hemoglobin less than 7g/dL D. Hematocrit less than 21% E. All of the above 11 / 12 53. You would transfuse someone with RBCs if they had Acute loss of more than _____% blood volume Hemoglobin LESS than ___ g/dL Hematocrit LESS than ____% Acute loss of more than 20% blood volume Hemoglobin less than 7g/dL Hematocrit less than 21% 54. What are the labeling requirements common to all ISBT 128 labeling; blood components? 1. Donor identification number (14 characters containing info relating to the country, center of origin, year of collection, a sequential number, and a check character). 2. ABO/Rh Blood groups 3. Produce code 4. Expiration date (and time) 5. Unique identifier to the unit 6. Component labels 7. Donor classified as either autologous or volunteer 12 / 12