VUMC Blood Bank Board Review Garrett S Booth
VUMC Blood Bank Board Review Garrett S. Booth, M. D. , M. S.
PART 1 • Blood Donation-lots of questions on this topic given the numerous regulations that surround blood donors/donations
Whole Blood • What is the standard deferral time period for whole blood donation? • How much can be donated? • Does this impact the donor deferral time period?
• For single unit (500 m. L) whole blood donation the deferral period is 8 weeks. • If someone donates by apheresis, for example, a double red blood cell donation, the deferral is 16 weeks • Yes, RBC and plasma products can be collected at the same time
Cryoprecipitate • Can you collect just cryoprecipitate from a blood donor? • Collection versus manufacture?
• No • Cryo is a manufactured product • Must collect FFP and then freeze. Although to thaw in 1 -6 C refrigerator and isolate the supernatant • Cryo=fibrinogen, Factor XIII, Factor VIII, v. WF, fibronectin
Platelet Donation • What is the maximum total number of times someone can donate apheresis platelets in a 12 month time period? • Can you give out of group platelet products?
• 24 times • The time between donations is 48 hours, but cannot donate more than twice a week
Platelet • What is the minimum dose of an apheresis platelet?
• 3. 0 x 1011 platelets per product
Medication • Which of the following psoriasis medications results in a permanent deferral? Tegison or Soriatane
• Tegison-Permanent deferral • Soriatane-three year deferal
Cohabitation • If you are living with a person with hepatitis C, how long are you deferred for? • What type of virus is hepatitis C? • What other question in the universal donor health questionnaire is designed to identify donors with hepatitis C?
• 1 year • Flavivirus • IV Drug use
Blood Exposure • While working in surgical pathology you cut yourself while dissecting a liver. How long are you deferred for?
• 1 year • Contact with blood is a one year deferral • So is tattoo, needle stick, sex with HIV person, rape victim, jail>72 hours, paying for sex, being transfused, travel to malaria region
• A new mother presents for donation to show her community she is an “active contributor” and is “working to make the world for her new baby a better place”. • Despite her well intentions, how long following delivery is the standard deferral period?
• 6 weeks
WNV deferral time period • What is the deferral time period for WNV in a US blood donor?
• 120 days • This is a weird one, so remember it • WNV is only tested by NAT (MP vs IP depending on seasonality or positivity in your community)
Europe • My sister, Lynde, has lived in the UK for most of her life, if she ever decides to come visit me in Nashville, TN can she donate? Why/why not?
• No, living in UK for more than 5 years is a permanent deferral. • Preventing TA-v. CJD
MMR • An individual moves to the US from a nonmalaria endemic region and begins her vaccination program. She is given the option of getting the MMR shots at once, but opts instead to get her Measles shot only. How long is she deferred for?
• Measles- 2 week deferral • Mumps- 2 week deferral • Rubella- 4 week deferral
Influenza • VUMC recently completed the largest vaccination event for influenza ever. These super eager VUMC employees also wanted to make the world a better place and donate blood. Can you donate whole blood on the same day you get a flu shot?
• Yes • There is no deferral for influenza vaccine • Also no deferral for Hep. A/Hep. B vaccine
Unlicensed Vaccine • A poor college student enrolls in a clinical trial at VUMC for the money. The subject is given an unlicensed vaccine as part of the trial. Six months later a blood drive comes to his dormitory, can he donate?
• No • Unlicensed vaccine is a 12 month deferral
Hepatitis B • A donor presents for whole blood donation, but is unsure about his vaccination history. He knows that because he recently started nursing school that he received “a ton of shots”. What is the serologic pattern for an individual that has received the hepatitis B vaccine? • HBV DNA, HBs. Ag, Anti-HBc, Anti-HBs. Ag
• Vaccinated individual should only have anti. HBs. Ag, unless you tested them immediately following the vaccine itself
Allogeneic Donor demographics • • • What are the minimum weight Temperature Pulse Blood pressure Hemoglobin
• • • Weight >110 pounds Temperature <37. 5 C (99. 5 F) Pulse (50 -100) BP <180/100 Hemoglobin >12. 5 g/d. L HCT >38%
Anticoagulant • What is the anticoagulant used in donated blood products?
• Citrate
Storage Duration of Blood Products Shelf LIfe of Red Blood Cells based on different anticoagulant/preservative solutions Anticoagulant/Preservative Solution: • ACD/CP 2 D: • CPDA-1: • AS: 35 days 42 days 21 days
Autologous Blood Donation • What is the minimum hemoglobin for an autologous blood donor?
• 11 g/d. L (HCT 33%)
Specimen Retention • The pretransfusion sample (EDTA tube) must be kept in the blood bank following transfusion for what time period?
• 7 days
Hepatitis • What type of hepatitis is a recipient most at risk of obtaining through transfusion in the US? • Hepatitis A • Hepatitis B • Hepatitis C • Hepatitis E
• Hepatitis B • Risk of hepatitis B transfusion transmission is 1/300, 000 to 1/400, 000 • Hepatitis C risk is ~1/1. 5 million • Hepatitis E is not tested for, but has been shown to be transmitted in Europe. Yuck.
CMV • Is CMV testing required for all blood donors in the US?
• NO • Leukocyte reduction and serologic testing of donors are considered equivalent in the US blood supply
Residual Leukocytes • What is the requirement to qualify as leukocyte reduced?
• <5. 0 x 106 residual leukocytes
Chagas Disease • What is the screening test for Chagas disease in the US?
• T. cruzi is screened for by EIA
Finasteride • A balding elderly male returns to donate whole blood but appears to have a some new-found hair growth. He is excited to donate today because he is contributing another unit and is going to make the wall of fame for 4 gallon donor! When asked about medications he states he is taking something to help his hair grow back so he can look better for the photo opportunity. The pill box he carries his filled with vitamins and supplements, but there also finasteride pills present. Can he donate? Is there a deferral?
• Finasteride (Proscar, Propecia) is a 30 day deferral.
Other stuff • Calculations – Correct count increments (CCI) – Antigen frequencies • Number of units needed to be screened • Blood donor frequencies – In general need to know some high frequency antigens, typically designated with the superscript “b” and there antithetical counterpart, the low frequency antigen designated with the superscript “a” – Rh. IG dose calculations
Other Stuff • Immunohematology panels – Practice, practice • You should have: emailed practice panels, panels from www. pathquestions. com, and I have other practice books if you want (can make some photo copies). • The ASCP book has some refresher panel information (basics), these should be reviewed. • The Blood Bank Guy website (www. bbguy. org) also has some panels
Other Stuff • AABB Standards (28 th ed. ) has a few nice summary tables in the middle of the book which you can photo copy (the book itself is very small, but very expensive). – Ms. M. Johnson has a copy of this text and if you are nice she may let you make a copy, but do NOT remove from the blood bank and make sure you have her permission first!!!
- Slides: 52